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

[et_pb_section fb_built=”1″ _builder_version=”3.21.1″][et_pb_row custom_padding=”21.5781px|0px|0|0px|false|false” _builder_version=”3.21.1″][et_pb_column type=”4_4″ _builder_version=”3.21.1″][et_pb_text _builder_version=”3.21.1″]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.”[/et_pb_text][et_pb_text _builder_version=”3.21.1″]Here are some key takeaways from the article:[/et_pb_text][et_pb_text _builder_version=”3.21.1″]

Perinatal Transmission

[/et_pb_text][et_pb_text _builder_version=”3.21.1″ text_font=”||||||||” custom_margin=”18px||”]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. [/et_pb_text][et_pb_text _builder_version=”3.21.1″]

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

[/et_pb_text][et_pb_text _builder_version=”3.21.1″]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. [/et_pb_text][et_pb_text _builder_version=”3.21.1″]

Respiratory Support Modalities & Aerosol-Generating Procedures

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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
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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.

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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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