TABLE 1.

Characteristics of included studies

First author	Region	Study design	Period	Population of interest	Exposure/intervention due to COVID	Outcomes measured in			Outcome (quantitative)	Outcome (qualitative)
						Parents	Infants	HCP
Bainter 18	USA	Informal survey	Unknown	19 family partners, 28 clinicians	Respondents were asked to reflect on the degree to which their centres were inclusive of families in several roles: at the bedside in the care of their babies, as members of quality improvement teams, and as participants in decision‐making processes, both prior to and during the COVID‐19 outbreak.	Y	‐	Y	‐	Recent restrictions on in‐person participation at the bedside and reinstated ‘visiting hours’ have been the most abrupt culture change due to COVID‐19, overriding family preferences and peer support among other aspects of family‐centred care. Family Partners and clinicians surveyed felt that a major concern was the lack of meaningful, consistent communication with families, in relation to baby care, as well as in relation to policy changes in the COVID‐19 environment. Other chief concerns expressed in the survey were the restriction of family access to the NICU and participation in daily care, and decreased overall family support. Both Family Partners and clinicians shared a concern about the lack of family representation in policy and decision‐making processes.
Brown 20	UK	Cross‐sectional survey	for 4 weeks during May–June 2020	1219 mothers, babies aged 0–12 months with breastfeeding at least once during COVID‐19. 724 gave birth during pandemic and 103 mothers had babies in NICU during pandemic	Overall, 7.8% stated they were not supported to have skin‐to‐skin, 4.6% were not encouraged to breastfeed as soon as possible after birth, 24.6% were not given information on expressing milk, and 21.2% stated they received no breastfeeding support in hospitals. Participants who had a baby in neonatal intensive care unit (NICU) were asked whether they could visit their baby.	Y	Y	‐	The most common reason for BF cessation was insufficient professional support followed by physical issues such as difficulties with latch, exhaustion, insufficient milk and pain. Of the 103 mothers who had a baby in NICU, 19.4% (n = 20) were told they could not visit their baby in NICU. Not being able to visit their baby in NICU was associated with no longer breastfeeding (χ 2 = 44.645, p = 0.000). At the time of survey completion, 80.0% who were told they could not visit their baby were no longer breastfeeding compared with 9.6% of those who could.	‐
Cavicchiolo 22	Italy (Veneto, red zone)	Cohort surveillance study	21 February–21 April 2020	114 parents and 112 HCPs, (total of 6726 triage procedures) with 65 infants, 1 unit	To avoid overcrowding, parental visits were restricted to 1 h/day, and only one parent per baby at scheduled times. All parents were asked to wear masks, gloves and disposable clothing. All close contacts, such as kangaroo mother care and holding the baby, were suspended. A video calling service was activated for parents in quarantine who could not visit their children. Written educational material was given to HCPs and parents to help prevent viral transmission. (a) parental triage on arrival at the neonatal ward; (b) universal testing with nasopharyngeal swabs and blood testing for SARS‐ CoV‐2 IgM and IgG antibodies; (c) use of continuous personal protective equipment at the NICU by parents and staff	Y	Y	Y	75 admitted newborns, none were tested positive. 2 Parents asked for psychological support. No other psychological outcomes were measured. 2.2% tested positive (3 healthcare providers and 2 parents)	‐
Darcy Mahoney 17	Globally	Cross‐sectional survey of units	April 21 to 30, 2020	277 units	Hospital and NICU entry policies began to change in January 2020 with a rapid increase in hospitals adopting policy changes throughout March, the majority prior to the issuance of CDC guidance. Overall, 184 (66%) NICUs reported that their new policies during the COVID‐19 pandemic were broadly more restrictive than the customary policies implemented during the winter influenza/respiratory syncytial virus season.	‐	‐	Y	Single‐family room design NICUs best preserved 24/7 parental presence after the emergence of COVID‐19 (single‐family room 65%, hybrid‐design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support. NICU policies preserving 24/7 parental presence decreased (83–53%, p < 0.001) and of preserving full parental participation in rounds fell (71–32%, p < 0.001).	‐
Fan 21	China	Qualitative, interview study	Unknown	14 parents (8 fathers, 6 mothers), 12/14 preterm infants, mean birthweight: 2312 g, 1 unit	NA No data on before practices	Y	‐	‐	‐	5 themes were present for psychological needs of parents: urgent demand for timely up‐to‐date information of the children's condition, need for psychological and emotional support, reducing the inconvenience caused by the epidemic outbreak, demand for protective information after discharge, demand for financial support.
Muniraman 19	UK and USA	Cross‐sectional survey of parents	1 May 2020–21 August 2020	Parents of infants in the NICU (7 tertiary NICUs) 153 mothers, 58 fathers and 5 grandparents. 1 sibling and 1 guardian. 66% preterm infants 45% length stay <1 week	Access limited to a single visitor with no restrictions on duration was the most frequently reported policy; 140/217 (63%). Visitation policies were perceived as being restrictive by 62% (138/219) of the respondents with 37% (80/216) reporting being able to visit less often than desired	Y	‐	‐	41% (78/191) reporting being unable to bond enough and 27% (51/191) reporting not being able to participate in their baby's daily care. Mild to severe impact on breastfeeding was reported by 36% (75/209) of respondents. Stricter policies had a higher impact on families and were significantly associated with a lack of bonding time, inability to participate in care and an adverse impact on breast feeding.	“I will remember this for the rest of my life. I will also remember the kindness of the staff but at 18 h old I was told my baby might die and I had to beg to see him because I had already had my 2 h. How is that ok???” Felt like my baby was not mine and I was asking permission from the nurses. Also has made me feel resentful towards [my] husband as all the emotional burden of a child in NICU fell upon myself; The visiting times force a choice between cuddles and learning how to tube feed etc. Consequently this has left me feeling like I don't take good care of my baby. Not acceptable for a postnatal women. I would imagine PND [postnatal depression] will be very high in this epidemic. I have found the visiting restrictions very tough and would love for nothing more than myself and my partner to be able to see our child together. It has been an extremely tough few weeks emotionally and I wish we could support each other in NICU together and be prepared for discharge.
Semaan 16	Global	Cross‐sectional + thematic analysis with surveys	24 March and 10 April 2020	714 maternal and newborn HCPs; Most were obstetricians/gynaecologists or midwives (38% and 35%, respectively)	Facility‐level responses to COVID‐19 were more common in high‐income countries compared to low‐/middle‐income countries.	‐	‐	Y	90% of respondents reported higher levels of stress Stress levels somewhat higher in 52% and substantially higher in 38% Most were knowledgeable about hospital COVID‐guidelines but up to 80% had some areas of concern or lack of clarity.	Respondents perceived the lack of COVID‐19 symptom screening and testing as threats to staff and patient safety. There were additional concerns that PPE disrupts clear communication with patients; Respondents were concerned over uncertain impacts of reduced contacts on the quality of care. Three respondents from India noted that infant vaccination schedules were disrupted or postponed. HCPs feared that changes in standards of care would lead to poor health outcomes among women and newborns and subsequently to the loss of achieved progress.
				Total: 364 Infants 442 Parents (66 fathers) 854 Healthcare professionals 19 Family partners 5 Grandparents 1 Siblings 1 Guardians 286 Units

Abbreviations: COVID, coronavirus disease; GA, gestational age; HCP, healthcare professional; NA, not available; NICU, neonatal intensive care unit; PPE, personal protective equipment; UK, United Kingdom; USA, United States of America; Y, Yes.

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