Effects of Contact Restrictions During the COVID-19 Pandemic on Newborns and Their Parents
Condition: Mother-Child Interaction
MeSH terms: COVID-19
Study type: Observational

Summary: 
      In the study, the researchers aim to investigate the impact of contact restrictions during
      the pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory
      syndrome coronavirus 2 (SARS-CoV-2) on newborns and their parents. At the onset of this
      COVID-19 pandemic, contact restrictions in Germany were introduced on March 16th, 2020. These
      included, among others, the ban on visits to hospitals. This also applied to visits by
      fathers of newborn children. In many hospitals, fathers were allowed to accompany the mother
      in the delivery room for birth, but had to leave the hospital before the mother was being
      transferred to the ward. Fathers were not allowed to visit their wives and newborns until
      discharge several days later.

      The hypothesis of this study is that these contact restrictions have an influence on
      mother-infant interaction as well as on the psychological well-being of the parents.
      Furthermore, the investigators postulate that these restrictions additionally have a
      long-term effect on neonatal stress signaling pathways. For this purpose, children are
      studied, who were born during the period of strict contact restrictions from March, 16th to
      April, 30th, 2020. The children will be assessed at about six months of age.
    

Detailed description: 
      Due to the COVID-19 pandemic in spring 2020, the German government decided to impose strict
      contact restrictions to prevent an exponential increase in SARS-CoV-2-positive individuals.
      These included visiting regulations in hospitals from March 16th, 2020. These also applied to
      obstetrics departments in Cologne until April 30th, 2020. At the Obstetrics University
      Hospital Cologne as well as at the Protestant Hospital Cologne-Weyertal, fathers were allowed
      to be present in the delivery room for the birth of their newborns, but had to leave the
      hospital again before the mothers were being transferred to the obstetrics ward. The fathers
      could not see their newborn again until they were discharged a few days later. The
      consequences of these contact restrictions on the newborns and their parents have been little
      studied.

      In a few hospitals, there were exceptions currently to the strict contact restrictions. These
      included the Hospital of the Augustinian Sisters in Cologne, where no visitation bans were
      imposed on fathers in the obstetrics department. With general precautions fathers were still
      allowed to accompany their newborns and mothers in the obstetric ward. The study of the
      newborns of this hospital enables the researchers to see whether the parents were
      nevertheless affected by the general changes in the living situation during a pandemic.

      The phenomenon of "neonatal programming", which establishes the connection between formative
      influences in the neonatal period (e.g. pain or stress by separation of mothers) and
      disorders in later life (attention deficits, lack of concentration, learning difficulties)
      has received increasing attention in recent years. In particular, the search for molecular
      mechanisms that cause such programming has been the focus of scientific projects. In a
      delivery-room skin-to-skin study (deisy) conducted by this research group preterm infants
      were randomized to skin-to-skin contact or visual contact with their mothers. Significant
      differences were found in both mother-infant interaction at six months of age and the
      expression of candidate genes of stress signaling pathway.

      An important regulatory mechanism for influencing the activity of certain genes in the long
      term is the methylation of their promoter region. This epigenetic regulatory mechanism plays
      an important role, so that the modulation of DNA methylation by events in the neonatal period
      could be responsible for a permanent determination of a certain infant phenotype. This
      methylation in candidate genes in the stress signaling pathway is currently investigated by
      the research team in healthy mature neonates born before the onset of the pandemic, and
      results are pending.

      The aim of the present study is to investigate the impact of contact restrictions during the
      coronavirus pandemic on newborns and their parents.

      Normally in healthy mother-infant-dyads without separation during the first postpartal hours,
      the mother has the best conditions to develop a high level of sensitivity. Sensitive maternal
      behavior favors the formation of optimal mother-infant interaction and is relevant for infant
      neurocognitive development. Due to the stressful situation caused by the separation of the
      father for several days, the psychological well-being of the parents as well as the optimal
      mother-child interaction could be negatively affected.
    

Intervention name(s): no intervention
Intervention type(s): Other
Intervention description(s): There will be no intervention.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study population consits of healthy mature newborns who were born during the time of
        strict contact restrictions from March, 16th to April, 30th, 2020. The recruitment will
        take place in three obstetric hospitals in Cologne (University Hospital of Cologne,
        Krankenhaus der Augustinnerinnen, evangelisches Krankenhaus Köln-Weyertal).
      
Biospecimen description: 
      2 buccal swabs with mucosal epithelial cells for RNA and DNA extraction
    
Keywords: stress response; neurodevelopment; newborn; SARS-CoV-2