Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has urged the development and
implementation of guidelines and protocols on diagnosis, management, infection control
strategies, and discharge planning. However, very little is currently known about
neonatal COVID-19 and severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2)
infections. Thus, many questions arise with regard to respiratory care after birth,
necessary protection to health care workers (HCW) in the delivery room and neonatal
intensive care unit (NICU), and safety of bag and mask ventilation, noninvasive respiratory
support, deep suctioning, endotracheal intubation, and mechanical ventilation. Indeed,
these questions have created tremendous confusion amongst neonatal HCW. In this manuscript,
we comprehensively reviewed the current evidence regarding COVID-19 perinatal transmission,
respiratory outcomes of neonates born to mothers with COVID-19 and infants with documented
SARS-CoV-2 infection, and the evidence for using different respiratory support modalities
and aerosol-generating procedures in this specific population. The results demonstrated
that to date, neonatal COVID-19 infection is uncommon, generally acquired postnatally,
and associated with favorable respiratory outcomes. The reason why infants display
a milder spectrum of disease remains unclear. Nonetheless, the risk of severe or critical
illness in young patients exists. Currently, the recommended respiratory approach
for infants with suspected or confirmed infection is not evidence based but should
include all routinely used types of support, with the addition of viral filters, proper
personal protective equipment, and placement of infants in isolation rooms, ideally
with negative pressure. As information is changing rapidly, clinicians should frequently
watch out for updates on the subject.
Key Points
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Novel coronavirus disease 2019 (COVID-19) pandemic urged development of guidelines.
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Neonatal COVID-19 disease is uncommon.
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Respiratory outcomes in neonates seems favorable.
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Current neonatal respiratory care should continue.
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Clinicians should watch frequently for updates.
Keywords
neonatal respiratory care - neonatal COVID-19 - aerosol-generating procedures
