{"id":49291,"date":"2020-12-23T19:26:01","date_gmt":"2020-12-23T18:26:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49291"},"modified":"2020-12-23T19:26:01","modified_gmt":"2020-12-23T18:26:01","slug":"behind-closed-doors-lessons-from-elite-sport-could-help-parents-locked-out-of-neonatal-units","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/23\/behind-closed-doors-lessons-from-elite-sport-could-help-parents-locked-out-of-neonatal-units\/","title":{"rendered":"Behind closed doors: lessons from elite sport could help parents locked out of neonatal units\u00a0"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Thousands of elite athletes are once again participating in close-contact sport every week, and even throughout the recent &#8220;Lockdown 2.0<\/span><span style=\"font-weight: 400\">,&#8221; and <\/span><span style=\"font-weight: 400\">despite the ongoing covid-19 pandemic restrictions. Athletes have special concessions allowing them to contravene social distancing when considered essential for their sport to be played. The restart was facilitated by official guidance documents \u201c<\/span><i><span style=\"font-weight: 400\">Return to Domestic Competition \u2013 No Spectators\u201d <\/span><\/i><span style=\"font-weight: 400\">and <\/span><i><span style=\"font-weight: 400\">\u201cBehind Closed Doors\u201d<\/span><\/i><span style=\"font-weight: 400\">, their titles reflecting<\/span> <span style=\"font-weight: 400\">spectator bans. [<\/span><span style=\"font-weight: 400\">1,2]<\/span><\/p>\n<p><span style=\"font-weight: 400\">Within UK men\u2019s and women\u2019s senior football alone, eight international and 214 domestic teams are training and competing regularly, mixing in different locations up and down the country, and around the globe. Not to mention support staff, each match sees up to 28 players battling in close-contact sport, and teams embracing in close-celebration. [<\/span><span style=\"font-weight: 400\">3]<\/span><\/p>\n<p><span style=\"font-weight: 400\">Parents of babies in neonatal intensive care units (NICUs) receive no such special mitigations to enable them to be with their infants during hospitalisation. Consequently, many infants also receive their care behind closed doors, their parents shut out. Yet Bliss charity, the British Association of Perinatal Medicine (BAPM), and the Royal College of Paediatrics and Child Health (RCPCH) affirm that parents are <\/span><i><span style=\"font-weight: 400\">partners<\/span><\/i><span style=\"font-weight: 400\"> in the care of their infants and not just visitors. [<\/span><span style=\"font-weight: 400\">4,5]<\/span><span style=\"font-weight: 400\"> And all who care for babies know that optimal outcomes can only be achieved with direct parental involvement. [<\/span><span style=\"font-weight: 400\">6]<\/span><span style=\"font-weight: 400\"> The guidance from BAPM and RCPCH specifies that parental presence should be facilitated around the clock. [<\/span><span style=\"font-weight: 400\">4]<\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite these recommendations, visitation restrictions on NICUs persist as hospitals try to reduce footfall and maintain social distancing for the protection of all. Yet the severe restrictions have not only limited the duration of parental visits, but have prevented both parents visiting their sick and sometimes dying infants together. [<\/span><span style=\"font-weight: 400\">7]<\/span><\/p>\n<p><span style=\"font-weight: 400\">We recently surveyed 224 parents\/guardians of babies cared for in six tertiary-level NICUs (four UK, two US). [<\/span><span style=\"font-weight: 400\">7]<\/span><span style=\"font-weight: 400\"> Parental visiting was restricted in all units in response to the SARS-CoV-2 pandemic. Nearly two-thirds of parents perceived their NICU\u2019s visitation policies as being too restrictive. Findings of adverse impacts on ability to visit, care for, bond with, and breastfeed their infants were as expected as they were concerning. Furthermore, the more severe the visiting restrictions, the worse the perceived impact upon parents.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Bliss charity issued a press release recently which identified similar problems: of 242 parents surveyed 14% were unable to see their baby at all due to covid-19 restrictions and an additional 39% faced compulsory limits on visit duration. Blanket enforcement of austere hospital visiting restrictions on NICU parents was considered a major contributing issue to significant adverse impacts on their bonding, stress and mental health. [<\/span><span style=\"font-weight: 400\">8]<\/span><span style=\"font-weight: 400\"> This survey attracted major media attention but with no discernible change in governmental policy. [<\/span><span style=\"font-weight: 400\">9,10,11]<\/span><\/p>\n<p><span style=\"font-weight: 400\">Why can\u2019t the same mechanisms that enabled the restart and continuation of elite sports be applied to the UK\u2019s 189 neonatal units? Doing so could mitigate the additional dire impact of the pandemic upon NICU parents and families. Regulations which allow athletes to tussle together in a &#8220;covid-secure&#8221; fashion, can surely be adopted and enhanced to allow both parents to be with their hospitalised neonates in an unrestricted fashion.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Many of the specific measures that the Government introduced to allow sport to continue can be translated or adapted into practice on NICUs; indeed many similar mitigations are already in place. [<\/span><span style=\"font-weight: 400\">1,2,12,13]<\/span><span style=\"font-weight: 400\"> A national NHS framework for COVID-secure parental visiting could be practically copied from elite sport\u2019s guidance, but\u2014crucially\u2014adequate funding and political will is also essential for successful implementation of any such framework.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">More controversial measures from the guidance would likely include a \u2018code of conduct\u2019 to be signed by parents, which would mandate adherence to government advice on hygiene, mask wearing, and social distancing at all times, as well as more stringent screening measures for parents and staff\u2014such as temperature checks on arrival and consideration of regular SARS-CoV-2 surveillance swabs.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Is it really feasible to swab NICU staff and parents regularly? Within the current football season the Premier League has completed ~1,600 tests every 5 days, and detected ~7 positive tests per round. [<\/span><span style=\"font-weight: 400\">14]<\/span><span style=\"font-weight: 400\"> Similarly, the Women\u2019s Super League and Championship has completed ~900 tests per week, with mean 5.3 positive results per week in the past month. [<\/span><span style=\"font-weight: 400\">15]<\/span><span style=\"font-weight: 400\"> If the Premier League can achieve 80 tests per club every 5 days, then so could the UK\u2019s 13 neonatal networks introduce regular testing programmes in all neonatal units. While feasible, local transmission rates will impact pre- and post-test probabilities, so regional evidence-based decisions would be needed on asymptomatic screening swabs. [<\/span><span style=\"font-weight: 400\">16,17]<\/span><\/p>\n<p><span style=\"font-weight: 400\">If elite sport can achieve full return to domestic and international competition\u2014where lives are not at stake, then our goal must be full return to unrestricted parental visiting in NICUs\u2014where matters of life and death are a daily concern.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Behind closed doors, elite sports may continue despite empty stadiums; but in the NICU precious lives and moments may pass forever without parents present. With the unique emotional, physical and psychological challenges parents face, we must remind ourselves that parents are key players, not mere spectators.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Paul Cawley, (@PaulCawleyUK) Neonatologist, London<\/span><\/p>\n<p><span style=\"font-weight: 400\">Paul Clarke, (@drpaulclarke) Consultant Neonatologist and Honorary Professor of the University of East Anglia, Norwich<\/span><\/p>\n<p><b>Conflict of interest:<\/b><span style=\"font-weight: 400\"> None declared<\/span><\/p>\n<p><b>References:<\/b><\/p>\n<ol>\n<li><span style=\"font-weight: 400\"> UK Government, Department for Digital, Culture, Media &amp; Sport. Elite sport &#8211; return to domestic competition guidance. Last accessed 05\/12\/2020 at: <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-guidance-on-phased-return-of-sport-and-recreation\/elite-sport-return-to-domestic-competition-guidance\"><span style=\"font-weight: 400\">https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-guidance-on-phased-return-of-sport-and-recreation\/elite-sport-return-to-domestic-competition-guidance<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Premier League. Season 2019\/20 Restart Guide \u2013 Behind Closed Doors. Version 01. Last accessed 05\/12\/2020 at: <\/span><a href=\"https:\/\/resources.premierleague.com\/premierleague\/document\/2020\/06\/16\/aa4f9f51-f97b-4582-907b-29fabbe74f69\/Premier-League-2019-20-Restart-Guide.pdf\"><span style=\"font-weight: 400\">https:\/\/resources.premierleague.com\/premierleague\/document\/2020\/06\/16\/aa4f9f51-f97b-4582-907b-29fabbe74f69\/Premier-League-2019-20-Restart-Guide.pdf<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Scotland National Team @ScotlandNT Oh, yes sir\u2026 #NoScotlandNoParty [Twitter]. Nov 12, 2020. Last accessed 5\/11\/2020 at: https:\/\/twitter.com\/ScotlandNT\/status\/1327023447332057088?s=20<\/span><\/li>\n<li><span style=\"font-weight: 400\"> Royal College of Paediatrics &amp; Child Health, &amp; British Association of Perinatal Medicine. COVID-19: Frequently asked questions within neonatal services. November 2020. Last accessed 05\/12\/2020 at: <\/span><a href=\"https:\/\/www.rcpch.ac.uk\/resources\/bapm-covid-19-frequently-asked-questions-within-neonatal-services#managing-parents-and-visitors-to-the-neonatal-unit-and-or-transitional-care-unit-tcu\"><span style=\"font-weight: 400\">https:\/\/www.rcpch.ac.uk\/resources\/bapm-covid-19-frequently-asked-questions-within-neonatal-services#managing-parents-and-visitors-to-the-neonatal-unit-and-or-transitional-care-unit-tcu<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Bliss Statement: COVID-19 and parental involvement on neonatal units. Updated 6 July 2020. Last accessed 05\/12\/2020 at: <\/span><a href=\"https:\/\/s3.eu-west-2.amazonaws.com\/files.bliss.org.uk\/images\/Bliss-Statement_Version-4.pdf?mtime=20200706153313&amp;focal=none\"><span style=\"font-weight: 400\">https:\/\/s3.eu-west-2.amazonaws.com\/files.bliss.org.uk\/images\/Bliss-Statement_Version-4.pdf?mtime=20200706153313&amp;focal=none<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> O&#8217;Brien K, Robson K, Bracht M, et al. Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health 2018;2:245\u201354. doi:10.1016\/S2352-4642(18)30039-7. Accessible at: <\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30169298\"><span style=\"font-weight: 400\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30169298<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Muniraman H, Ali M, Cawley P, et al. Parental perceptions of the impact of neonatal unit visitation policies during COVID-19 pandemic. BMJ Paediatrics Open. 2020;4:e000899. doi: 10.1136\/bmjpo-2020-000899. Accessible at: <\/span><a href=\"https:\/\/bmjpaedsopen.bmj.com\/content\/4\/1\/e000899\"><span style=\"font-weight: 400\">https:\/\/bmjpaedsopen.bmj.com\/content\/4\/1\/e000899<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Bliss. COVID-19 Press release November 2020. Obtained by personal correspondence<\/span><\/li>\n<li><span style=\"font-weight: 400\"> Macfarlane J. New parents are barred from being by their sick babies&#8217; sides on hospital wards because of strict coronavirus rules. MailOnline. 08\/11\/2020. Last accessed 5\/12\/2020 at: <\/span><a href=\"https:\/\/www.dailymail.co.uk\/news\/article-8925515\/New-parents-barred-sick-babies-sides-hospital-wards-coronavirus-rules.html?utm_content=buffer0e802&amp;utm_medium=social&amp;utm_source=twitter.com&amp;utm_campaign=buffer\"><span style=\"font-weight: 400\">https:\/\/www.dailymail.co.uk\/news\/article-8925515\/New-parents-barred-sick-babies-sides-hospital-wards-coronavirus-rules.html?utm_content=buffer0e802&amp;utm_medium=social&amp;utm_source=twitter.com&amp;utm_campaign=buffer<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Johnson S. Mothers needlessly separated from babies under UK hospital Covid rules. The Guardian. 16\/11\/2020. Last accessed 5\/12\/2020 at: https:\/\/www.theguardian.com\/society\/2020\/nov\/16\/mothers-needlessly-separated-babies-hospital-covid-rules?CMP=Share_AndroidApp_Other&amp;utm_content=buffer30900&amp;utm_medium=social&amp;utm_source=twitter.com&amp;utm_campaign=buffer<\/span><\/li>\n<li><span style=\"font-weight: 400\"> Zindulka K. COVID-1984: Parents blocked from seeing sick newborns by UK\u2019s socialised healthcare system. Breitbart. 09\/11\/2020. Last accessed 5\/12\/2020 at: https:\/\/www.breitbart.com\/europe\/2020\/11\/09\/covid-1984-parents-blocked-seeing-sick-newborns-uk-socialised-healthcare-system\/#<\/span><\/li>\n<li><span style=\"font-weight: 400\"> UK Government, Department for Digital, Culture, Media &amp; Sport. Guidance &#8211; Elite sport return to training guidance: Stage One. Last accessed 05\/12\/2020 at: <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-guidance-on-phased-return-of-sport-and-recreation\/elite-sport-return-to-training-guidance-step-one--2#guidance-for-sports-clubs-and-support-service-providers\"><span style=\"font-weight: 400\">https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-guidance-on-phased-return-of-sport-and-recreation\/elite-sport-return-to-training-guidance-step-one&#8211;2#guidance-for-sports-clubs-and-support-service-providers<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> UK Government, Department for Digital, Culture, Media &amp; Sport. Guidance &#8211; Elite sport return to training guidance: Stage Two. Last accessed 05\/12\/2020 at: <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-guidance-on-phased-return-of-sport-and-recreation\/elite-sport-return-to-training-guidance-stage-two\"><span style=\"font-weight: 400\">https:\/\/www.gov.uk\/government\/publications\/coronavirus-covid-19-guidance-on-phased-return-of-sport-and-recreation\/elite-sport-return-to-training-guidance-stage-two<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Premier League. Latest statement on results of COVID-19 tests. 30\/11\/2020. Last accessed 05\/12\/2020 at: <\/span><a href=\"https:\/\/www.premierleague.com\/news\/1814863\"><span style=\"font-weight: 400\">https:\/\/www.premierleague.com\/news\/1814863<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> The Football Association. Latest Barclays FA WSL &amp; Women\u2019s Championship COVID-19 Testing Results. 01\/12\/2020. Last accessed 05\/12\/2020 at: <\/span><a href=\"https:\/\/www.thefa.com\/news\/2020\/jul\/14\/barclays-fa-womens-super-league-and-championship-covid-19-testing\"><span style=\"font-weight: 400\">https:\/\/www.thefa.com\/news\/2020\/jul\/14\/barclays-fa-womens-super-league-and-championship-covid-19-testing<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Watson J, Whiting P, Brush J. Interpreting a covid-19 test result. BMJ 2020; 369 :m1808 Accessible at: <\/span><a href=\"https:\/\/www.bmj.com\/content\/bmj\/369\/bmj.m1808.full.pdf\"><span style=\"font-weight: 400\">https:\/\/www.bmj.com\/content\/bmj\/369\/bmj.m1808.full.pdf<\/span><\/a><\/li>\n<li><span style=\"font-weight: 400\"> Raffle A. Screening the healthy population for covid-19 is of unknown value, but is being introduced nationwide. The BMJ Opinion. 09\/11\/2020. Last accessed 5\/12\/2020 at: https:\/\/blogs.bmj.com\/bmj\/2020\/11\/09\/screening-the-healthy-population-for-covid-19-is-of-unknown-value-but-is-being-introduced-nationwide\/<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Thousands of elite athletes are once again participating in close-contact sport every week, and even throughout the recent &#8220;Lockdown 2.0,&#8221; and despite the ongoing covid-19 pandemic restrictions. Athletes have special [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/23\/behind-closed-doors-lessons-from-elite-sport-could-help-parents-locked-out-of-neonatal-units\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":49293,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-49291","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Behind closed doors: lessons from elite sport could help parents locked out of neonatal units\u00a0 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/23\/behind-closed-doors-lessons-from-elite-sport-could-help-parents-locked-out-of-neonatal-units\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Behind closed doors: lessons from elite sport could help parents locked out of neonatal units\u00a0 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Thousands of elite athletes are once again participating in close-contact sport every week, and even throughout the recent &#8220;Lockdown 2.0,&#8221; and despite the ongoing covid-19 pandemic restrictions. 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