Impact of COVID-19 Pandemic on the Health of Preterm Infants in Iran

Document Type : Short Communication


Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Department of Neonatology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran


Background: Coronavirus disease 2019 (COVID-19) directly increases the risk of preterm delivery. Furthermore, the COVID-19 pandemic may indirectly affect the health status of preterm infants. In the present study, several views have been mentioned regarding the negative effects of this viral disease on postnatal health that require much consideration.
Methods: A related brief study was conducted in 2020. Previously published works have revealed several adverse effects of the COVID-19 pandemic on the health of preterm neonates.
Results: Literature review has demonstrated that several policies have been implemented to protect newborns from the risk of infection in the neonatal intensive care units (NICU). Some of these policies are isolation of COVID-19 positive mothers, mother-infant separation, interruption in skin-to-skin contact and breastfeeding, restrictions associated with the presence of parents in the NICUs. Moreover, postponement of follow-up consultations and deficiency in healthcare services are other critical issues.
Conclusion: Urgent measures seem to be implemented to protect preterm neonates and their parents from severe consequences. Some beneficial recommendations are providing adequate professional human resources in the NICUs, improving virtual communication for involving parents in NICU admissions and postnatal follow-up appointments, promoting exclusive breastfeeding for subjects without any contraindications, reminding vaccination schedule by calling or texting, reducing the family financial instability by governmental support, and improving mother-infant bonding with hand and respiratory hygienes.


  1. Browne PC, Linfert JB, Perez-Jorge E. Successful treatment of preterm labor in association with acute COVID-19 infection. Am J Perinatol. 2020; 37(8):866-8.
  2. Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020; 2(2):100107.
  3. Erdei C, Liu CH. The downstream effects of COVID-19: a call for supporting family wellbeing in the NICU. J Perinatol. 2020; 40(9):1283-5.
  4. Chiu SH, Anderson GC. Effect of early skin-to-skin contact on mother–preterm infant interaction through 18 months: a randomized controlled trial. Int J Nurs Stud. 2009; 46(9):1168-80.
  5. Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry. 2014; 75(1):56-64.
  6. Butruille L, Blouin A, De Jonckheere J, Mur S, Margez T, Rakza T, et al. Impact of skin-to-skin contact on the autonomic nervous system in the preterm infant and his mother. Infant Behav Dev. 2017; 49:83-6.
  7. Angelhoff C, Blomqvist YT, Helmer CS, Olsson E, Shorey S, Frostell A, et al. Effect of skin-to-skin contact on parents’ sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomized controlled trial. BMJ Open. 2018; 8(7):e021606.
  8. Boscia C. Skin-to-skin care and COVID-19. Pediatrics. 2020; 146(2):e20201836.
  9. Davanzo R, Merewood A, Manzoni P. Skin-to-Skin contact at birth in the COVID-19 era: in need of help! Am J Perinatol. 2020; 37(S2): S1-4.
  10. Stuebe A. Should infants be separated from mothers with COVID-19? First, do no harm. Breastfeed Med. 2020; 15(5):351-2.
  11. Cavicchiolo ME, Lolli E, Trevisanuto D, Baraldi E. Managing a tertiary‐level NICU in the time of COVID‐19: Lessons learned from a high‐risk zone. Pediatr Pulmonol. 2020; 55(6):1308-10.
  12. Salvatore CM, Han JY, Acker KP, Tiwari P, Jin J, Brandler M, et al. Neonatal management and outcomes during the COVID-19 pandemic: an observational cohort study. Lancet Child Adolesc Health. 2020; 10(4):721-7.
  13. Green J, Petty J, Bromley P, Walker K, Jones L. COVID 19 in babies: knowledge for neonatal care. J Neonat Nurs. 2020; 26(5):239-46.
  14. Bry A, Wigert H. Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study. BMC Psychol. 2019; 7(1):76.
  15. Mahoney AD, White RD, Velasquez A, Barrett TS, Clark RH, Ahmad KA. Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. J Perinatol. 2020; 40(Suppl 1):36-46.
  16. Davanzo R, Moro G, Sandri F, Agosti M, Moretti
    C, Mosca F. Breastfeeding and coronavirus disease‐2019: Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr. 2020; 16(3):e13010.
  17. Easterlin MC, De Beritto T, Yeh AM, Wertheimer FB, Ramanathan R. Extremely preterm infant born to a mother with severe COVID-19 pneumonia. J Investig Med High Impact Case Rep. 2020; 8:2324709
  18. Chandrasekharan P, Vento M, Trevisanuto D, Partridge E, Underwood MA, Wiedeman J, et al. Neonatal resuscitation and post resuscitation care of infants born to mothers with suspected or confirmed SARS-CoV-2 infection. Am J Perinatol. 2020; 37(8):813-24.
  19. Tran HT, Nguyen PTK, Huynh LT, Le CHM, Giang HTN, Nguyen PTT, et al. Appropriate care for neonates born to mothers with COVID‐19 disease. Acta Paediatr. 2020; 109(9):1713-6.
  20. Dinleyici EC, Borrow R, Safadi MAP, van Damme P, Munoz FM. Vaccines and routine immunization strategies during the COVID-19 pandemic. Hum Vaccin Immunother. 2021; 17(2):400-7.
  21. Ali I. Impact of COVID-19 on vaccination programs: adverse or positive? Hum Vaccin Immunother. 2020; 16(11):2594-2600.
  22. Santoli JM, Lindley MC, DeSilva MB, Kharbanda EO, Daley MF, Galloway L, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration - the United States, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(19):591-3.
  23. Albayrak B, Dathe AK, Cordier L, Felderhoff-Müser U, Hüning B. Clinical experience on video consultation in preterm follow-up care in times of the COVID-19 pandemic. Pediatr Res. 2020; 22:9.
  24. Taleghani NT, Fallahi M, Soltanttooyeh Z, Shamshiri AR, Radfar M. Post-discharge follow-up of preterm infants at high-risk neonatal follow-up clinic of a maternity hospital. J Comprehens Pediatr. 2019; 11(1):e93379.
  25. Fierson WM. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018; 142(6):e20183061.
  26. Beam AL, Fried I, Palmer N, Agniel D, Brat G, Fox K, et al. Estimates of healthcare spending for preterm and low-birthweight infants in a commercially insured population: 2008-2016. J Perinatol. 2020; 40(7):1091-9.
  27. Alizadeh A, Khankeh HR, Barati M, Ahmadi Y, Hadian A, Azizi M. Psychological distress among Iranian health-care providers exposed to coronavirus disease 2019 (COVID-19): a qualitative study. BMC Psychiatry. 2020; 20(1):494.
  28. Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020; 8(6):e790-8.