Maria Arti, Mukherjee Ritika, Upadhyay Swati, Pratima Kumari, Bandyopadhyay Tapas, Gupta Rachita, Dubey Bhawna, Sharma Abhinav, Mall Pranaya Kumar, Sahoo Manaswinee, Pathak Keshav Kumar, Pawar Priyanka, Mohapatra Archisman
Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Generating Research Insights for Development (GRID) Council, Executive Office, Noida, Uttar Pradesh, India.
Front Nutr. 2022 Dec 8;9:1052340. doi: 10.3389/fnut.2022.1052340. eCollection 2022.
The COVID-19 pandemic disrupted newborn care and breastfeeding practices across most healthcare facilities. We undertook this study to explore the barriers and enablers for newborn care and breastfeeding practices in hospitals in Delhi, India for recently delivered mother (RDM)-newborn dyads during the first wave of the COVID-19 pandemic (2020) and inductively design a "pathway of impaction" for informing mitigatory initiatives during the current and future pandemics, at least in the initial months.
We used an exploratory descriptive design (qualitative research method) and collected information from seven leading public health facilities in Delhi, India. We conducted separate interviews with the head and senior faculty from the Departments of Pediatrics/Neonatology ( = 12) and Obstetrics ( = 7), resident doctors ( = 14), nurses (labor room/maternity ward; = 13), and RDMs ( = 45) across three profiles: (a) COVID-19-negative RDM with healthy newborn ( = 18), (b) COVID-19-positive RDM with healthy newborn ( = 19), and (c) COVID-19 positive RDM with sick newborn needing intensive care ( = 8) along with their care-giving family members ( = 39). We analyzed the data using grounded theory as the method and phenomenology as the philosophy of our research.
Anxiety among clients and providers, evolving evidence and advisories, separation of the COVID-positive RDM from her newborn at birth, providers' tendency to minimize contact duration and frequency with COVID-positive mothers, compromised counseling on breastfeeding, logistic difficulties in expression and transportation of COVID-positive mother's milk to her baby in the nursery, COVID restrictions, staff shortage and unavailable family support in wards and nursery, and inadequate infrastructure were identified as major barriers. Keeping the RDM-newborn together, harmonization of standard operating procedures between professional associations and within and between departments, strategic mobilization of resources, optimization of human resources, strengthening client-provider interaction, risk triaging, leveraging technology, and leadership-in-crisis-situations were notable enablers.
The separation of the RDM and newborn led to a cascade of disruptions to newborn care and breastfeeding practices in the study institutions. Separating the newborn from the mother should be avoided during public health emergencies unless there is robust evidence favoring the same; routine institutional practices should be family centered.
新冠疫情扰乱了大多数医疗机构的新生儿护理和母乳喂养实践。我们开展这项研究，旨在探索印度德里各医院中，在新冠疫情第一波（2020年）期间，近期分娩的母亲（RDM）与新生儿这一母婴二元组的新生儿护理和母乳喂养实践的障碍与促进因素，并归纳设计出一条“影响路径”，以便为当前及未来疫情期间（至少在最初几个月）的缓解措施提供信息。
我们采用探索性描述性设计（定性研究方法），从印度德里的七家主要公共卫生机构收集信息。我们分别对儿科/新生儿科（n = 12）和产科（n = 7）的负责人及资深教员、住院医生（n = 14）、护士（产房/产科病房；n = 13）以及RDM（n = 45）进行了访谈，涉及三种情况：（a）新冠病毒检测呈阴性且新生儿健康的RDM（n = 18），（b）新冠病毒检测呈阳性且新生儿健康的RDM（n = 19），以及（c）新冠病毒检测呈阳性且新生儿患病需要重症监护的RDM（n = 8）及其照顾家庭成员（n = 39）。我们以扎根理论为方法、现象学为研究哲学对数据进行了分析。
客户和医护人员的焦虑、不断变化的证据和建议、新冠病毒检测呈阳性的RDM在分娩时与新生儿分离、医护人员尽量缩短与新冠病毒检测呈阳性母亲的接触时长和频率的倾向、母乳喂养咨询不足、将新冠病毒检测呈阳性母亲的母乳挤出并运送到育婴室给其婴儿存在后勤困难、新冠疫情限制措施、病房和育婴室人员短缺以及家庭支持缺失，以及基础设施不足，被确定为主要障碍。让RDM与新生儿在一起、专业协会之间以及部门内部和部门之间的标准操作程序协调一致、资源的战略调动、人力资源的优化、加强客户与医护人员的互动、风险分级、利用技术以及危机情况下的领导力，是显著的促进因素。
在研究机构中，RDM与新生儿的分离导致了新生儿护理和母乳喂养实践的一系列中断。在突发公共卫生事件期间，除非有充分证据支持，否则应避免将新生儿与母亲分离；常规的机构做法应以家庭为中心。
