64 Consensus Practice Recommendations Regarding Parental Presence in Canadian NICUs to Inform Ongoing and Post Pandemic Policies

Abstract Introduction/Background In March 2020, parental presence restriction policies were introduced in Canadian NICUs as institutions aimed to prevent COVID-19 transmission during the emerging global pandemic. However, parental presence in NICUs is necessary for maximizing parent and infant health outcomes, and there continues to be significant variation in parental restriction across Canadian NICUs. Objectives To identify the impact of parental restriction policies in Canadian NICUs on parents, infants, and healthcare providers and co-create practice recommendations for ongoing pandemic management and post-pandemic policies. Design/Methods A national survey was conducted to assess the impact of Canadian NICU restriction policies. Recommendations were developed through Delphi and Values and Preferences research methods. For the first Delphi survey, participants rated 50 items of importance from the national survey on a scale from 1 (very low importance) to 5 (very high). On the second Delphi survey, participants ranked the top 20 items from highest relative to lowest importance. A literature review was conducted for the top 10 items, and evidence of known benefits and harms was presented to the panel of decision-makers during the Values and Preferences consensus meetings. Participants voted on the inclusion of each item as a national recommendation and discussed additional caveats. A vote of 80% or more was deemed a consensus. Results Parents (n=426) and healthcare providers (n=205) completed a national survey, from which a list of reported impacts was derived. After two separate Delphi rounds (n=39, and n=20), a series of 10 recommendations with the highest rated importance were identified. A representative panel of decision-makers (n=20), including parents of NICU infants, NICU healthcare providers and managers, and infectious disease and public health policy-makers, took part in a Values and Preferences task. Items of importance included 7 strong recommendations (parents as essential caregivers, providing skin-to-skin contact, direct or mothers’ own expressed milk feeding, attending medical rounds, mental health and psychosocial services access, food and drink access, and inclusion of parent partners in pandemic response planning) and 6 conditional recommendations (providing hands-on care tasks, touch, two parents present at the same time, use of communication devices, and in-person access to medical rounds and mental health and psychosocial services). Consensus was reached on all items in favour of inclusion in national recommendations for Canadian NICUs. Conclusion These recommendations will guide ongoing and future pandemic management and policies with respect to parental presence and involvement in their infants’ care.