Üsküdar Üniversitesi hosted Prof. Dr. Güler Cimete, Head of the Midwifery Department at Üsküdar Üniversitesi, as a guest for the program "Impact of COVID-19 on Babies and Children in Light of Current Information," organized as part of Midwifery Week. Cimete stated that childbirth is a stressful event; during the pandemic, pregnant women experienced increased stress, citing the risk of hospital-acquired infection and restrictions on relatives supporting the mother during and after childbirth as significant factors. Cimete also added that studies found an increase in symptoms of stress, anxiety, and depression in women who gave birth after the Covid-19 pandemic, and that mothers with Covid-19 did not differ from non-Covid mothers in terms of preterm birth or the death of their babies before or after birth.
Benefit of vaccination or being Covid positive during pregnancy for the baby
Cimete stated that information on the quantity and effects of antibodies passed to the baby from vaccinated mothers and mothers who contracted the disease during pregnancy is limited, saying, “There are studies showing that antibodies are transferred via the placenta to babies of mothers who were Covid-19 positive during pregnancy and mothers who received the Covid-19 vaccine. However, antibody transfer is limited, and more research is needed on this topic.”
Does breast milk transmit the disease to the baby, or does it protect against it?
Cimete, mentioning that the risk of transmission through breast milk is very low, emphasized that the virus was detected in the milk of very few Covid-19 positive mothers, referring to the studies of some researchers on this matter. Cimete stated; “Chambers and colleagues detected SARS-CoV-2 RNA (indicating the presence of the virus in milk) in only one of 64 milk samples taken from 18 infected women. However, the fact that this mother's baby did not get infected despite breastfeeding suggested that breast milk has a protective effect rather than transmitting the disease to the baby. Furthermore, in this study, 13 mothers breastfed their babies, and subsequent PCR tests were positive for 4 babies. This indicates that the transmission occurred from the mother to the baby later, rather than through breast milk.”
Cimete also added; “The detection of IgG and IgA antibodies against COVID-19 in the milk of breastfeeding mothers who tested positive for COVID-19 or had a positive history in the past also suggests that breast milk provides protection against the virus.”
“Protective measures should be explained to the family”
Cimete, repeatedly emphasizing the importance of breastfeeding, continued her speech as follows:
“The World Health Organization has also been recommending since the beginning of the pandemic that, in cases where the mother or baby is Covid positive, protective measures should be explained to the mother and family, ensuring that these measures are strictly applied, and supporting them to breastfeed their babies. Healthcare personnel should 'weigh the benefits of skin-to-skin breastfeeding between mother and baby against the Covid risk and support the side that outweighs the other.' Healthcare personnel should also keep in mind that 'the risk of Covid in babies is low and the course of the disease is generally favorable, whereas preventing early skin-to-skin contact and breastfeeding can lead to many negative consequences for both mother and baby (such as increased susceptibility of the baby to infections, shortening of the breastfeeding duration due to late initiation, weakening of bonding with the baby, increased risk of neglect-abuse, elevated stress levels in parents, and decreased parental self-efficacy).”
“Transmission does not vary by birth method”
Cimete stated that transmission does not differ based on the birth method; "After the pandemic, there has been a significant increase in cesarean births, and it is recommended to avoid unnecessary cesareans without strong evidence. Normal vaginal births require the mother and healthcare personnel to be in the same environment for a longer period. Therefore, healthcare personnel must take serious protective measures and reduce the risk of transmission both from the mother to themselves and from healthcare personnel to the mother. Mutual transmission risk should not be a justification for performing a cesarean section. Furthermore, it may be appropriate for Covid-19 suspected or positive mothers and babies to receive initial care in separate rooms. The Turkish Neonatology Association recommends that mothers and babies should not be brought together in the operating room or delivery room. However, by ensuring the mother takes protective measures, early contact and breastfeeding with her baby after birth should be provided.”
"No specific treatment for newborns"
Cimete, discussing the symptoms observed in Covid-19 positive babies; “Symptoms such as respiratory distress, fever, lethargy, vomiting, leukocytosis, leukopenia, thrombocytopenia, high creatinine, tachycardia, hypoxemia, cough, tachypnea, and less frequently, feeding difficulties, retractions, rales, nasal congestion and runny nose, and liver function disorders are observed in babies. Some of these findings were also observed in a study conducted in Turkey. It is recommended to monitor babies born to Covid-19 positive mothers for poor sucking and changes in skin color. There is no specific treatment for newborns. Symptomatic, supportive treatment is applied. Late hypoxia can develop 10-15 days after discharge home. We need to warn mothers who have given birth, especially those who are Covid positive, to contact healthcare personnel immediately if they notice any changes in their babies.”
“Traumatic stress paves the way for breastfeeding failure and bonding problems”
Cimete stated that pregnant women were more stressed during the pandemic; "An increase in stress, anxiety, and depression symptoms has been observed in women who gave birth after the Covid-19 pandemic. Childbirth is a stressful event. Stress also increased in pregnant women during Covid-19. Hospitals being allocated for Covid-19 positive patients made hospitals a frightening place. Hospital visitor policies changed, and women were isolated during labor and delivery. Traumatic stress paves the way for breastfeeding failure and bonding problems. Women who gave birth before the pandemic and those who gave birth after the pandemic were critically examined (with 637 mothers in each group). When looking at the post-pandemic group; acute stress during birth was high, as were birth-related Post-Traumatic Stress Disorder, breastfeeding problems, early bonding problems, and general bonding problems."
Why does it affect children less?
Evaluating the impact and care of COVID-19 on children, Lecturer Günay Arslan, a Pediatric Health and Diseases Nurse from Üsküdar Üniversitesi Faculty of Health Sciences, stated; “Although Covid-19 generally affects all age groups, it is seen less frequently in children compared to adults. The reasons for children being less affected can be explained by their less frequent travel, protection by their parents, more immature ACE-2 receptors compared to adults, having fewer chronic diseases, and more frequent common colds.”
Disease encountered in 2021 studies and associated with Covid-19
Arslan stated, “Although studies say it affects children less, new publications have identified multisystem inflammatory syndrome (MIS-C) seen in children as being associated with Covid-19 (SARS-CoV-2).” Arslan added; “Patients with MIS-C frequently present to the hospital with high fever, gastrointestinal symptoms, and shock. A large proportion of these patients have cardiac involvement, including ventricular dysfunction, coronary artery dilation or aneurysm, and arrhythmias.”
“Children may be more affected than adults”
Referring to the results of studies on this topic, Arslan stated; “Research shows that not being able to go to school and spending long periods at home negatively affect children's activity and mental health. It also reports deterioration of nutritional functions and that girls staying at home pose a risk in terms of neglect and abuse. (Sperrotto et al 2021, Girona- Alarkon et al 2021, Remppis et al 2021, Lee et al 2020, Wang et al 2020, Nunes et al 2020, Borman et al 2020, UNICEF 2021).”
How should masks be used in children?
Arslan, pointing out that the American Academy of Pediatrics (AAP) does not recommend face mask use for children under 3 years of age; “Weak motor skills and coordination in children in these groups can make it difficult to remove the mask and may cause choking. I can recommend the use of face shields for children under this age. In this regard, the World Health Organization (WHO) and UNICEF recommend that children up to 5 years old should not wear masks, those between 6 and 11 years old should use them for short periods considering the risk-benefit, and from 12 years old onwards, they should use them like adults. However, special circumstances and situations (disability, previous serious illness, school sports, etc.) should also be taken into account.”
How to ensure children wear masks?
Arslan, stating that it is understandable for children to be afraid of wearing masks initially, offered the following recommendations to facilitate mask use in children:
“Look in the mirror with a face mask on and talk about it. We can wear a mask designed with their favorite character or animals. We can choose masks in more fun designs, pictures, and colors. We can show children pictures of other children wearing masks. We can practice wearing face masks at home to help children get used to it.”
How should mask use be explained to children?
Arslan stated that questions from children under 3 years old should be answered in a language they understand; “If they ask why people wear face masks, explain that sometimes people need to wear them to stay healthy. For children over 3 years old, try to focus on germs. Explain that germs are special to your body. Some germs are good and some are bad. Bad ones can make you sick. Since we can't always tell which are good or bad, face masks help keep these germs away from your body.”
Finally, Arslan said; “Although COVID-19 is less common in children than in adults and they are biologically less affected, when we look at all dimensions through holistic care; we can say that they are equally or more affected in social, physiological, psychological, and spiritual aspects, and we need to provide care for all these dimensions within the framework of nursing care.”