On the occasion of International Prematurity Awareness Month, the "Forum for Prematurity" publishes the Prematurity Situation Report, which this year focuses on the consequences of the Corona crisis on the quality of care for premature infants in Israel and the challenges it poses to preemies in hospitals and to the parents of premature infants.
Knesset member Michal Shir, Likud:
"In this challenging year, I am happy to lead Prematurity Day in the Knesset and to encourage them to promote the issue of premature births and improve the health and quality of life of premature babies and their families. There is no doubt that the corona virus also has consequences for the care of premature babies, so I will work to provide a proper and optimal response to the special needs of premature babies in Israel, and especially at this time.'
Dr. Shmuel Tsangan, Chairman of the Israeli Association for Neonatology and member of the board of the forum:
"Since the appearance of the corona virus in Israel, over 700 newborns have been born to mothers who were infected with the corona virus. Fortunately, all the newborns were without symptoms of the corona disease. This is because it was found that the virus does not pass from the mother to the fetus through the placenta. On the other hand, there were many cases where the babies were separated from their mothers immediately after birth for an extended period of time. Also, a large part of these newborns did not receive breast milk, even though the corona virus is not found in the breast milk of mothers confirmed for corona. Following the corona, restrictions were also imposed on the presence of parents in premature babies with their babies, a phenomenon that caused a reduction in the duration of skin-to-skin contact For the skin with premature babies, which is essential for their proper development."
He further adds: "We call on the Ministry of Health to invest in the establishment of preemies with separate rooms for prematures, as recommended in the Western world, and in the establishment of wards that allow the mother and newborn to stay together (housing wards) in order to reduce the damage caused by the separation of parents from their babies. On this occasion, we welcome the establishment of a milk bank- The first mother in Israel and call on the Ministry of Health to complete the procedure for allocating the budget required to purchase breast milk from the bank and thereby prevent its closure."
black rummy, CEO of the Lehab Association (for premature infants in Israel):
"The corona crisis has greatly intensified the mental distress and anxiety of the parents of premature babies. In recent times, the association has witnessed an increase in 50% and more requests for help and mental support in regards to the effects of the corona crisis on the presence of parents in premature babies, separation between the mothers and premature babies for a prolonged period, and an inadequate response to the mothers' needs and premature infants during this period, both on the issue of breast milk and on the issue of skin-to-skin contact, which are critical to the survival of premature infants. The association adapts the answer according to the request, with the support of the association's volunteers, mothers of premature infants themselves or mothers of premature infants from the health professions, works to make emotional support and treatments accessible, through a degree intern project Second in social work, subsidizing support groups through Zoom, finding discounted therapists for applicants and connecting to treatments in the community."
Rumi adds: "The association appeals to the Ministry of Health with the demand to invest in infrastructures that will enable a significant reduction in the consequences of the corona virus on the mental and emotional state of the parents and premature infants, and to the health insurance funds to allow continued accompaniment by social and psychological workers for premature infants, in order to produce a continuum of treatment until there is a significant benefit in the condition of the mothers or until appropriate treatment in the community In addition, the decrease in the rates of newborns fed with breast milk during the Corona period, together with the lack of continuous regulation of the operation of the breast milk bank, results in a real risk to the lives of premature babies who need breast milk to survive, and severe distress among mothers of premature babies whose medical conditions require continued feeding with breast milk even at home and find the themselves in existential anxiety in view of the threats to the continuous operation of the milk bank".
The main findings of the report:
- Infection and morbidity of newborns and premature infants with the corona virus in Israel - During the 8 months March-October 2020, there were about 700 births to verified mothers out of a total of about 120,000 births, which is about half the percentage of all births. The range of verified births ranges from 2% of all births in medical centers in the 'red' cities to 0.2% of all births in the 'green' cities. So far, no proven cases of infection of newborns through the placenta from the mother have been reported (similar to the data collected in the world), But isolated cases of newborns being infected with Covid 19 several days after birth have been reported. The disease was manifested by mild symptoms of fever, sleepiness and lack of appetite that passed within a few days. According to the data so far, the corona virus is not found in breast milk, therefore there is no contraindication to giving breast milk from a mother infected with the virus.
- Decrease in the rates of newborns fed with breast milk during the Corona period– Due to the anxiety of the corona and the lack of infrastructure in the first wave of morbidity, most of the newborns were separated from the mothers who were suspected or confirmed and as a result, the babies did not receive nourishment in breast milk, even though the virus does not pass through breast milk. Over time, infrastructures were built that allowed the mother to stay with the baby, but they are insufficient in most medical centers And although there is an increase in the rate of newborns to verified mothers receiving breast milk, still, a rate This is significantly lower (less than 50%) compared to the national rate of newborns receiving breast milk as part of their hospitalization after birth (over 70%). The required solution is to improve infrastructure and allocate designated rooms for verified births that will allow the mother and newborn to stay together, under the supervision and guidance of the medical staff, in the mother and newborn wards.
- Fear of a decrease in vaccination of premature infants for the RSV virus during the winter period - For premature babies, the RSV virus is more dangerous than the corona virus. Premature babies are exposed to morbidity from the virus (also known as the 'premature virus') which can cause severe respiratory morbidity to the point of hospitalization and ventilation in intensive care units and even death. Therefore, premature babies in Israel born under 35 weeks receive a vaccine (Sabil) in the winter season in their first year of life. The vaccinations are given at the centers determined by the health insurance funds at fixed times. Now, in the routine of the corona, the health funds must prepare and present a program that locates babies and/or their parents who are in isolation and takes care of their vaccination (through home visits under protected conditions or proactive coordination of an alternative date for the vaccination).
- Exposure and attachment of staff members in the obstetrics system to confirmed births: In the last 2 waves of the corona, midwives and members of the medical staff were exposed and infected from confirmed asymptomatic midwives, who were hospitalized in the mother and newborn wards. The required solution is to improve the infrastructure in the wards to allow the mother and the newborn, including a permanent attendant, to stay in one room and together for the entire hospitalization period and thus reduce the risk of exposing the medical staff, the mothers and their babies to confirmed non-symptomatic births.
- Reducing the presence of parents in preemies: For their proper development, premature babies need several hours a day of skin-to-skin contact with their parents (the 'kangaroo' method). Due to the spread of the corona virus and with an emphasis on the morbidity in the 'red' cities, the entry of parents to premature babies was significantly limited and as a result, premature babies did not receive the supportive care required from the parents. This separation hurt the premature babies and also caused anxiety and frustration among the parents. The proposed solution, for the short term, is to allow the entry of parents who are not sick while making sure they wear masks and keep their distance. Unfortunately, there is a lot of overcrowding in most preemies in Israel and therefore the proposed solution is not satisfactory. Therefore, the implementation of the requirement of the Israeli Association for Neonatal and Premature Medicine for the protection and construction of preemies in accordance with the accepted standards with single rooms for the preemies and their parents in the format of the preemies existing in the Western world must be accelerated.
- An increase in the rate of early discharges from the neonatal wards -Due to the refusal of a significant part of the confirmed mothers to be hospitalized in the corona wards, they sign a refusal of hospitalization and are released with the baby before the minimum period of 36 hours stipulated in the procedures of the Ministry of Health. The early discharge exposes the babies to poor monitoring and treatment of neonatal jaundice and to the risk of dehydration due to the lack of monitoring and treatment required to establish the economy in the newborn. Also, these newborns are discharged home without performing the essential screening tests to rule out severe hereditary diseases, deafness and heart defects. In the months of the first wave (March and April), there were more than 20 times more cases of early discharges of newborns compared to the previous months. The proposed solution is to assign designated and safe rooms for the care of the confirmed mother and her newborn within the obstetric system and not in the corona wards.
- Increase in mental distress of parents – The corona intensified the anxieties of parents of premature babies, and the number of requests for support and emotional assistance increased by at least 50% and even more. Situations in which a mother confirmed to have corona has to be separated from her baby for the duration of the recovery, are a huge trauma and this has effects on the survival of the premature baby and the emotional state of the mother.
We noticed that mothers who were separated from their babies tend to have greater emotional difficulty not only during the preterm period, where there is a wide treatment team that includes social and psychological workers, but also during the transition from preterm to home. Beyond the solutions mentioned above, in terms of infrastructure and at the operative level, we offer a solution to the emotional state of the mothers for the purpose of entitlement to a therapeutic sequence even after release from prematurity, using form 17, in order to identify situations in which there is emotional difficulty, depression and anxiety, and to support them for a period of time until the situation improves or Until the transition to continued treatment in the community, so that they will not be left alone with the hardship and difficulty.
- Breast milk bank- The Prematurity Forum welcomes the opening of the first breast milk bank in Israel in August of this year under the supervision of the Ministry of Health and the management of MDA located in Jerusalem. The issue of milk pricing is still under negotiation between the Ministry of Health and MDA and as a result, some premature babies are not yet entitled to receive milk donations - If. The forum demands from all parties to stop using premature babies in Israel as 'hostages' for the purpose of promoting the negotiations.
The union's request to include the donation of breast milk through a breast milk bank into the technological health basket, was rejected by the Ministry of Health. The forum wishes to speed up the negotiations and find sources to finance the donation of breast milk through a breast milk bank. Breast milk nutrition prevents morbidity with prolonged hospitalization and even death of dozens of premature infants per year from necrotizing intestinal disease (NEC). It should be noted that breast milk is mainly intended for premature babies, but it is also given in special compassionate cases, to mature newborns.
- Development of an up-to-date database that will reflect in real time data related to the treatment of premature babies - Dealing with the corona virus has led the Ministry of Health to develop a dashboard to receive real-time data that will enable professionals and policy makers to make decisions/interventions based on reliable and up-to-date data. Currently, the system for collecting data on the morbidity and treatment of premature babies is partial and slow and does not allow obtaining an up-to-date and complete picture of the situation in order to carry out an intervention Based, informed and necessary to improve the treatment of premature infants in Israel. The proposed solution is to upgrade the database of the perinatal system (maternity and premature infants) similar to existing in several countries in the world for the purpose of forming projects to improve the quality of care for premature infants in Israel. The Israeli Association of Neonatology formulated a plan including an estimated budget for the development of the control panel.
- Improving the availability of a senior doctor to treat premature infants : The insufficient set of neonatologists in Israel (there are actually about 120 doctors out of 180 doctors required), does not allow for 24/7 coverage by a senior doctor Inside the hospitals. The senior doctors are called from their home as on-call (they must arrive within half an hour according to the procedure), but sometimes, they arrive after the premature or at-risk newborn has already been born. Premature and unstable newborns require the immediate availability of a senior physician (similar to a senior obstetrician who is present 24/7 at the hospital). The proposed solution is to encourage, through an incentive, senior doctors to perform the on-call from the hospital (and not from home) through an incentive that will double the value of their on-call. The Israeli union developed a model that budgets the incentive at about NIS 6 million per year. The rush of doctors on call to attend the hospital will reduce the mortality and morbidity of premature infants, with an emphasis on premature infants with a birth weight of less than 1 kg. In these premature infants, the mortality and severe morbidity rates are, still, more than 2 times compared to developed countries.