Sibling visits and viral infection in the neonatal intensive care unit
and Kahoru Fukuoka
Division of Infectious Diseases, Department of Pediatrics,
Division of Neonatology,
Department of Nursing,
Division of Microbiology, Department of Laboratory and
Department of Pharmacy, Tokyo
Metropolitan Children’s Medical Center, Fuchu, Tokyo, Japan
Abstract Background: Sibling visits to the neonatal intensive care unit (NICU) are a part of family-centered care, which is
now being increasingly endorsed as a positive development in patient care. Sibling visits, however, pose a risk of
viral infection, and hence many NICU in Japan impose strict limits on the practice. The aim of this study was there-
fore to assess whether sibling visits to the NICU are related to an increase in the nosocomial viral infection rate.
Methods: This retrospective study was conducted between April 2012 and March 2017 at Tokyo Metropolitan Chil-
dren’s Medical Center in Japan. Sibling visits were implemented after screening for symptoms of viral illness.
Symptomatic patients in the NICU were tested for common viruses on rapid antigen test and polymerase chain reac-
tion. The number of sibling visits and the rate of nosocomial viral infections were examined on Spearman’s correla-
Results: The total number of sibling visits and rate of nosocomial viral infection in the NICU was 102 and 0.068
per 1,000 patient-days during the study period, respectively. The number of enterovirus, respiratory syncytial virus,
human metapneumovirus, inﬂuenza virus A, and Herpes simplex virus infections was 3, 2, 1, 1, 1, and 1, respec-
tively. No infections were identiﬁed after sibling visits. The number of sibling visits and the rate of nosocomial
viral infections were not correlated (correlation coefﬁcient, À0.1; P = 0.873).
Conclusion: Sibling visits to the NICU did not result in an increase in the nosocomial viral infection rate.
Key words family-centered care, neonatal intensive care unit, nosocomial infection, sibling visitation, viral infection.
Visits by children to the neonatal intensive care unit (NICU)
are generally restricted in Japan due to concern about viral
infections, which may cause serious consequences in hospital-
In 2002, the proportion of NICU that allowed
visits by parents and by patients’ siblings was only 58.3% (67/
115) and 2.6% (3/115) in Japan, respectively.
In a recent
2012 survey, sibling visitation was allowed in 43.9% (47/107)
of tertiary hospitals in Japan.
Another survey in 2012 noted
that 90.2% of parents were allowed to meet their infant
without any restrictions; visits by siblings, in contrast, were
restricted in 80.4% of NICU in Japan.
The form of sibling
visits varies widely, from viewing a patient through a window
outside the NICU; visiting the patient in the palliative stage;
and allowing only older siblings to enter the NICU; to
allowing entry after screening for infection regardless of age.
Nosocomial viral infections that are occasionally reported
in the NICU are usually caused by respiratory syncytial virus
(RSV), rotavirus, enterovirus, and human rhinovirus.
ally, sibling visits are not related to an increase in nosocomial
viral infections in the NICU.
One study in Boston,
however, reported that nosocomial RSV infection increased
due to visits by siblings during the RSV season, and that
restricting visits by siblings <13 years of age resulted in a
reduction in RSV infection in the NICU.
the ﬁndings was limited because the restrictions were consid-
ered only for periods when the incidence of nosocomial RSV
infection was high.
Challenges exist in diagnosing viral infection in Japan. The
majority of viral diagnoses rely on the rapid antigen test,
which is a less sensitive and speciﬁc method. Although several
Government-approved rapid antigen tests are currently avail-
able in Japan, most molecular tests are not reimbursable under
the national health insurance system, making the cost of such
tests prohibitively high in most cases.
Despite these challenges, sibling visitation is a part of
family-centered care that is being increasingly endorsed in
The Tokyo metropolitan government
released a bill of rights for children in need of medical care,
one article of which included the right of the patient to remain
with family members through hospitalization.
policy, however, banned any visits to the NICU by children
except when a patient was in end-of-life care. In 2012, the
policy on sibling visits to the NICU was changed so that fami-
lies may now freely visit after undergoing adequate screening
for infections. In addition to rapid antigen test, polymerase
Correspondence: Yuho Horikoshi, MD, Tokyo Metropolitan Chil-
dren’s Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-
8561, Japan. Email: firstname.lastname@example.org
Received 3 August 2017; revised 14 September 2017; accepted
30 November 2017.
© 2017 Japan Pediatric Society
Pediatrics International (2018) 60, 153–156 doi: 10.1111/ped.13470