Hospitals May Ban Visits to Newborns Due to Swine Flu

The H1N1 virus has some hospitals considering limitations on visits to newborns.

September 22, 2009, 1:05 PM

Sept. 23, 2009— -- When a new baby is born, it often prompts images of gathering -- families coming together around the new mother and child, with friends joining in. But fears of infection may draw an end to that tradition, as hospitals weigh the decision whether to allow children to be near newborns and pregnant women at all.

With a potential outbreak of swine flu on the horizon, many hospitals are becoming more cautious when it comes to protecting newborn babies and their mothers -- fears that have prompted a complete ban of children from areas of one hospital where newborns and their mothers are cared for -- and that have caused more intense deliberations about the issue in other facilities.

"For pregnant women, there is a much higher risk associated with H1N1, and they wanted to err on the side of safety for pregnant women," said Mike Green, the chief executive officer of Concord Hospital in New Hampshire, which imposed the outright ban.

"You could argue that this is a preponderance of caution, but that's OK," he said. "Obviously, this was a reluctant decision on our part, but something the clinicians felt was important that we tried to provide the safest environment possible."

Immediate family of a new baby -- including spouses, grandparents and siblings of the baby -- over 18, are still welcome to visit. The hospital plans to review the policy on a monthly basis.

While an outright ban on healthy child visitors does not appear to be the norm yet, hospitals have indicated that it is a step they would consider over time.

"As an obstetrician, while I recognize the importance of the 'family' event and being family friendly, the most important concern I have is the health of the pregnant woman and later, her newborn," said Dr. Ashlesha Dayal, a maternal-fetal medicine specialist at Montefiore Medical Center in New York City. "A restriction on visitors, during the hospitalization, to me, seems like a small inconvenience, in comparison to having a pregnant woman or newborn baby become seriously ill or worse because a 'chance' was taken."

"We have not made more restrictions in our birth center areas. However, we're evaluating the situation on a daily basis," said Leslie Heying, a spokeswoman for St. Luke's Hospital in Sioux City, Iowa. She says in their neonatal intensive care unit (NICU) " we are restricting visitors who are 14 years-old or younger."

She added that children are not yet restricted from seeing healthier newborns at the hospital.

She also noted that everyone is screened for influenza.

"If somebody is exhibiting signs and symptoms of the flu, we ask that they stay out of the NICU area and they can come back 24 hours later [for rescreening]," said Heying.

Such screening instead of a full ban is the policy at some hospitals, and the full ban may be seen as an overreaction.

"Though these limitations may appear by face value to be of merit, the indiscriminate ban is rather uncalled for at this time of swine flu," said Dr. Salih Yasin, director of obstetrics at Jackson Memorial Hospital in Miami.

Yasin said a better approach would be to monitor patients who visit to see if any appear to have symptoms, and then test those particular patients before allowing them to see the new baby and mother.

A Time-Tested Practice

While restricting access to new mothers may strike some as novel, such controls have been put in place before.

"When my first son was born in 1969, they banned visitors except for immediate family because of the Asian flu epidemic," said Dr. Michelle Warren, medical director of the Center for Menopause, Hormonal Disorders, and Women's Health at New York Presbyterian Hospital.

And while the restrictions may not be popular, some are in place at hospitals even when influenza is not perceived to be as great a threat.

"Throughout the year, no matter if it's flu season or any time of the year, we do have some restrictions in our NICU and our birth center area," said Heying.

Those restrictions include monitoring visitors for illness and making everyone wash their hands.

"Obviously, we're always trying to protect our babies," said Heying. "Everyone would be required to wash their hands before they entered the [NICU]."

Many hospitals also restrict who can enter the NICU, because of the premature and other vulnerable newborns there, restrictions which can include children under 18.

Expected Reaction

At issue with some is how new mothers and their families will react to a ban of child visitors.

Green said that at Concord Hospital, reaction has been varied, with some mothers understanding and many upset.

"It's mixed; obviously it's not something under ideal circumstances we'd like to do," he said. "Many mothers today have a birth plan, and that birth plan has roles for the siblings of the newborn, and so the policy does interfere."

ABC News asked a number of physicians what they would expect the reaction to be, and got similarly mixed answers.

"I am certain that many families will react negatively to this prohibition, especially if there is no such recommendation by the CDC or other national or professional organization," said Dr. Manuel Porto, professor and chairman of the department of obstetrics and gynecology at the University of California-Irvine.

Other doctors were more optimistic.

"If they understand the reasons, I think they will be glad for the concern about safety," said Dr. Jerome Yankowitz, an obstetrician at the University of Iowa.

"The H1N1 flu is hitting us hard in the southeastern U.S.A. I think people would understand," said Dr. Kevin Ault, an associate professor of gynecology and obstetrics, at the Emory School of Medicine in Atlanta.

He also recommended vaccinations for the mother and people who will be around the baby, since children that young cannot receive the vaccine.

Dr. Jeff Ecker, an obstetrician who deals with high-risk deliveries at Massachusetts General Hospital, said such drastic steps are meaningless if the family does not follow through with them afterward, keeping the new baby away from sick visitors.

"Banning visitors absent symptoms seems both unnecessary and unpopular," he said. "Most babies room in with mothers and will soon be exposed to their family and visitors when they leave the hospital for home. Whether at home or in the hospital, the important issue is to avoid those most likely to be infectious as defined by symptoms."

Green noted that there has been one unexpected result for some new mothers that the hospital had not counted on.

"Since we've instituted the policy, mothers have reported to us that [they're] getting more rest," he said. "So that's an interesting unintended consequence."

Alessandra Sozio contributed to this report.

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