Literature Spotlight: Covid-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach

Literature Spotlight: Covid-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach

New evidence is emerging daily in the fight against COVID-19, however, neonatal COVID-19 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain largely unstudied. In a newly published article, “Covid-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach,” in the American Journal of Perinatology, authors Dr. Wissam Shalish, MD; Dr. Satyanarayana Lakshminrusimha, MD; Dr. Paolo Manzoni, MD; Dr. Martin Keszler, MD; and Dr. Guilherme M Sant’Anna, MD, PhD, FRCPC, provide a comprehensive review of the current evidence on neonatal COVID-19. The authors examine the topics of “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.”
Here are some key takeaways from the article:

Perinatal Transmission

The authors found no convincing case for vertical transmission with a caesarean section delivery route.  Additionally, with the few documented cases where infants born to mothers with positive SARS-CoV-2 infection had positive or equivocal tests, the postnatal course was generally favourable. 

Respiratory Outcomes of Infants under 1 year with SARS-CoV-2 Infection 

The exact physiology behind why infants generally experience a milder form of COVID-19 compared to adults is the subject of ongoing research.  What’s clear is that infants overall, and especially neonates experience mild or no symptoms. Further clouding the picture, is that only a small portion of patients included in the literature have actually confirmed positive SARS-CoV-2 tests, raising the possibility that many of the suspected cases may have been caused by viral pathogens other than SARS-CoV-2. 

Respiratory Support Modalities & Aerosol-Generating Procedures

Of primary importance in caring for neonates with suspected or confirmed SARS-CoV-2 is that healthcare workers should have access to and utilize adequate personal protection equipment (PPE) including:

  •  long-sleeved gown
  • single-use gloves
  • eye protection
  • N95 mask or the equivalent

Evidence-based care should begin in the delivery room with minimal personal and use of proper PPE. When manual bag mask ventilation is required, some NICUs have begun to utilize bacterial/viral filters, although as the authors discuss adequate studies have yet to be conducted.  Additionally, using these filters in neonates < 1000g is potentially dangerous as they create 10-40 mL of dead space raising risk for iatrogenic hypercapnia and subsequent intraventricular hemorrhage.

The article goes on to address the topics of suctioning, CPAP, NIPPV, Mechanical Ventilation, and more! In the flood of COVID-19 information, this article provides a comprehensive review of the evidence regarding neonatal COVID-19.

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