At the beginning of the SARS-CoV-2 pandemic, Vermont Oxford Network, in partnership with the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine, developed an audit to assess the impact of the pandemic on hospital care for pregnant women, infants, and families.

Hospitals were recruited via email to complete the audit in April, May, June, September, and December 2020, and March 2021. Any hospital caring for newborn infants was eligible to participate regardless of membership in VON. Each hospital chose one day to conduct the audit using an online tool.

Hospitals could complete Part 1 and 2, or just Part 2.

• Part 1 identified the census of infants admitted within 28 days of birth, confirmed infant cases, and suspected infant cases on the day of the audit in: mother-infant rooms; level I, II, III, or IV neonatal units; and special units created for the care of infants with COVID-19. Confirmed cases involved infants with a positive test result for SARS-CoV-2. Suspected cases involved infants with signs of COVID-19 or who were exposed to a person with confirmed or suspected COVID-19.
• Part 2 addressed significant impacts to the quality of care for infants and families in the form of shortages of equipment, testing, or personnel and policies governing family and staff access.

An online tool provided by the Institutional Review Board of the University of Vermont was used to determine that this audit was not research.

Over the six time periods, we received 1,031 completed audits (Figure 1) from 28 countries and 47 states or territories.

Part 1

Respondents reported 109 confirmed and 883 suspected cases over the six audit time points (Table 1). At every audited time point, the median number of confirmed or suspected cases was zero. The maximum number of confirmed or suspected cases across the newborn care locations ranged from a high of 40 to a low of 7.

Part 2

In April 2020, 53% of respondents reported a shortage of equipment or personnel that significantly impacted newborn care (Figure 2). That figure decreased to 34% by June but was 44% in March 2021 when nearly 15% of respondents reported test shortages (Figure 3) and 22% reported nursing shortages (Figure 4).  Over the year, most respondents reported that the pandemic caused minor disruptions in care (Figure 5).

In May, we added a question on whether policies separating mothers from infants or restrictions on family visitation significantly impacted the quality of care for infants and families.  At that time, 42% responded yes; in March 2021, 36% responded yes.

In December, we added questions about visitation and vaccinations. At that time, 18% of respondents limited visitation to family members who tested negative or were vaccinated while 2% had the same limitations on staff. In March 2021, 13% of respondents limited visitation to family members who tested negative or were vaccinated while 7% had the same limitations on staff. In December, 12% of respondents reported that their units would require staff members to be vaccinated, while 22% did not know and 66% reported no. In March, 19% of respondents reported that their units would require staff members to be vaccinated, while 5% did not know and 75% reported no.

While the audits showed that confirmed and suspected cases of SARS-CoV-2 among infants were very low, the pandemic did effect hospitals’ ability to provide quality care for infants and their families. Throughout the pandemic, hospitals reported demands for testing, PPE, and nursing. Hospitals also reported disruptions to families, with policies separating mothers from infants or restrictions on family visitation. Rather than welcoming families as partners in care, family presence was prohibited or sharply limited, which was a drastic deviation from the core concepts of patient- and family-centered care. Future studies from this audit will report on the comments and family stories reported by participants.

We thank the hospitals that participated in the Vermont Oxford Network / Section on Neonatal-Perinatal Medicine SARS-CoV-2 audit.

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