Download PDF
Am J Perinatol 2020; 37(08): 780-791
DOI: 10.1055/s-0040-1710522
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

COVID-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach

Wissam Shalish
1   Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
,
Satyanarayana Lakshminrusimha
2   Department of Pediatrics, UC Davis, Sacramento, California
,
Paolo Manzoni
3   Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
,
Martin Keszler
4   Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island
,
Guilherme M. Sant'Anna
1   Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
› Author Affiliations Funding None.
Further Information

Publication History

17 April 2020

17 April 2020

Publication Date:
02 May 2020 (online)

Also available at
   Permissions and Reprints

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

  • Novel coronavirus disease 2019 (COVID-19) pandemic urged development of guidelines.

  • Neonatal COVID-19 disease is uncommon.

  • Respiratory outcomes in neonates seems favorable.

  • Current neonatal respiratory care should continue.

  • Clinicians should watch frequently for updates.

Keywords

neonatal respiratory care - neonatal COVID-19 - aerosol-generating procedures

Authors' Contributions

W.S. and G.M.S. conceptualized and designed the review, drafted the initial manuscript, and reviewed and revised the manuscript. P.M. and M.K. reviewed the extracted data and analyses of the cases and reviewed and revised the final manuscript including all tables and figures. S.L. conceptualized and designed all figures, participated on several drafts of the manuscript, and reviewed and revised the final manuscript, including all tables. All authors critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


 

  • References

  • 1 Breslin N, Baptiste C, Gyamfi-Bannerman C. , et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020 (e-pub ahead of print) doi: 10.1016/j.ajogmf.2020.100118
    PubMedGoogle Scholar
  • 2 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
    CrossrefPubMedGoogle Scholar
  • 3 Chen S, Huang B, Luo DJ. , et al. [Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases] (in Chinese). Zhonghua Bing Li Xue Za Zhi 2020; 49 (00) E005
    PubMedGoogle Scholar
  • 4 Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol 2020 (e-pub ahead of print) Doi: 10.1002/jmv.25789
    PubMedGoogle Scholar
  • 5 Chen Y, Peng H, Wang L. , et al. Infants born to mothers with a new coronavirus (COVID-19). Front Pediatr 2020; 8 (104) 104
    CrossrefPubMedGoogle Scholar
  • 6 Fan C, Lei D, Fang C. , et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry?. Clin Infect Dis 2020; ciaa226 (e-pub ahead of print). Doi: 10.1093/cid/ciaa226
    CrossrefPubMedGoogle Scholar
  • 7 Gidlöf S, Savchenko J, Brune T, Josefsson H. COVID-19 in pregnancy with comorbidities: More liberal testing strategy is needed. Acta Obstet Gynecol Scand 2020 (e-pub ahead of print). Doi: 10.1111/aogs.13862
    PubMedGoogle Scholar
  • 8 Iqbal SN, Overcash R, Mokhtari N. , et al. An uncomplicated delivery in a patient with COVID-19 in the United States. N Engl J Med 2020; 382 (16) e34 (e-pub ahead of print) Doi: 10.1056/NEJMc2007605
    CrossrefPubMedGoogle Scholar
  • 9 SINInforma 2020: [Management of the newborn with suspected or confirmed SARS-CoV-2 infection]. Available at: https://www.sin-neonatologia.it/pdf/SIN_INFORMA_n78_speciale_covid19.pdf . Accessed April 6, 2020
    PubMed
  • 10 Khan S, Jun L. , Nawsherwan, et al. Association of COVID-19 infection with pregnancy outcomes in healthcare workers and general women. Clin Microbiol Infect 2020 ;S1198-743X(20)30180-4 (e-pub ahead of print). Doi: 10.1016/j.cmi.2020.03.034
    PubMedGoogle Scholar
  • 11 Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency caesarean section on severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) confirmed patient. Korean J Anesthesiol 2020 (e-pub ahead of print). Doi: 10.4097/kja.20116
    PubMedGoogle Scholar
  • 12 Li N, Han L, Peng M. , et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis 2020; ciaa352 (e-pub ahead of print). Doi: 10.1093/cid/ciaa352
    CrossrefPubMedGoogle Scholar
  • 13 Li Y, Zhao R, Zheng S. , et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis 2020; 26 (06) 1335-1336
    CrossrefPubMedGoogle Scholar
  • 14 Liu D, Li L, Wu X. , et al. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis. Am J Roentgenol 2020; 1-6 (e-pub ahead of print). Doi: 10.2214/AJR.20.23072
    PubMedGoogle Scholar
  • 15 Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J Infect 2020; 80 (05) e7-e13
    CrossrefPubMedGoogle Scholar
  • 16 Liu W, Wang Q, Zhang Q. , et al. Coronavirus disease 2019 (COVID-19) during pregnancy: a case series. Preprints 2020; 2020020373
    PubMedGoogle Scholar
  • 17 Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020 ;S0163-4453(20)30109-2 (e-pub ahead of print). Doi: 10.1016/j.jinf.2020.02.028
    PubMedGoogle Scholar
  • 18 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020; ciaa200 (e-pub ahead of print). Doi: 10.1093/cid/ciaa200
    PubMedGoogle Scholar
  • 19 Wu X, Sun R, Chen J, Xie Y, Zhang S, Wang X. Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. Int J Gynaecol Obstet 2020 (e-pub ahead of print). Doi: 10.1002/ijgo.13165
    PubMedGoogle Scholar
  • 20 Yu N, Li W, Kang Q. , et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis 2020 ;S1473-3099(20)30176-6 (e-pub ahead of print). Doi: 10.1016/S1473-3099(20)30176-6
    PubMedGoogle Scholar
  • 21 Zambrano LI, Fuentes-Barahona IC, Bejarano-Torres DA. , et al. A pregnant woman with COVID-19 in Central America. Travel Med Infect Dis 2020; 101639 (e-pub ahead of print). Doi:10.1016/j.tmaid.2020.101639
    CrossrefPubMedGoogle Scholar
  • 22 Zeng H, Xu C, Fan J. , et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020 (e-pub ahead of print). Doi: 10.1001/jama.2020.4861
    PubMedGoogle Scholar
  • 23 Zeng L, Xia S, Yuan W. , et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020 (e-pub ahead of print). Doi: 10.1001/jamapediatrics.2020.0878
    PubMedGoogle Scholar
  • 24 Zhang L, Jiang Y, Wei M. , et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province] (in Chinese). Zhonghua Fu Chan Ke Za Zhi 2020; 55 (00) E009
    PubMedGoogle Scholar
  • 25 Zhu H, Wang L, Fang C. , et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9 (01) 51-60
    CrossrefPubMedGoogle Scholar
  • 26 Dong L, Tian J, He S. , et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020 (e-pub ahead of print). Doi: 10.1001/jama.2020.4621
    PubMedGoogle Scholar
  • 27 Wang S, Guo L, Chen L. , et al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis 2020; ciaa225 (e-pub ahead of print). Doi: 10.1093/cid/ciaa225
    PubMedGoogle Scholar
  • 28 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero? More definite evidence is needed. JAMA 2020 (e-pub ahead of print). Doi: 10.1001/jama.2020.4868
    PubMedGoogle Scholar
  • 29 Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020 (e-pub ahead of print). Doi: 10.1001/jama.2020.2648
    PubMedGoogle Scholar
  • 30 Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA 2020 (e-pub ahead of print). Doi: 10.1001/jama.2020.4344
    PubMedGoogle Scholar
  • 31 CDC COVID-19 Response Team. Coronavirus disease in children – United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (14) 422-426
    CrossrefPubMedGoogle Scholar
  • 32 Cai J, Xu J, Lin D. , et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2020; ciaa198 (e-pub ahead of print). Doi: 10.1093/cid/ciaa198
    CrossrefPubMedGoogle Scholar
  • 33 Canarutto D, Priolo A, Russo G, Pitea M, Vigone MC, Barera G. COVID-19 infection in a paucisymptomatic infant: Raising the index of suspicion in epidemic settings. Pediatr Pulmonol 2020 (e-pub ahead of print). Doi: 10.1002/ppul.24754
    PubMedGoogle Scholar
  • 34 Cui Y, Tian M, Huang D. , et al. A 55-day-old female infant infected with COVID 19: presenting with pneumonia, liver injury, and heart damage. J Infect Dis 2020; jiaa113 (e-pub ahead of print). Doi: 10.1093/infdis/jiaa113
    PubMedGoogle Scholar
  • 35 Dong Y, Mo X, Hu Y. , et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020 (e-pub ahead of print). Doi: 10.1542/peds.2020-0702
    PubMedGoogle Scholar
  • 36 Kam KQ, Yung CF, Cui L. , et al. A well infant with Coronavirus Disease 2019 (COVID-19) with high viral load. Clin Infect Dis 2020; ciaa201 (e-pub ahead of print). Doi: 10.1093/cid/ciaa201
    PubMedGoogle Scholar
  • 37 Aghdam MK, Jafari N, Eftekhari K. Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect Dis (Lond) 2020; 427-429 (e-pub ahead of print). Doi: 10.1080/23744235.2020.1747634
    PubMedGoogle Scholar
  • 38 Le HT, Nguyen LV, Tran DM. , et al. The first infant case of COVID-19 acquired from a secondary transmission in Vietnam. Lancet Child Adolesc Health 2020 ;S2352-4642(20)30091-2 (e-pub ahead of print). Doi: 10.1016/S2352-4642(20)30091-2
    PubMedGoogle Scholar
  • 39 Li W, Cui H, Li K, Fang Y, Li S. Chest computed tomography in children with COVID-19 respiratory infection. Pediatr Radiol 2020 (e-pub ahead of print). Doi: 10.1007/s00247-020-04656-7
    PubMedGoogle Scholar
  • 40 Lu X, Zhang L, Du H. , et al. SARS-CoV-2 Infection in Children. N Eng J Med 2020 (e-pub ahead of print). Doi: 10.1056/NEJMc2005073
    PubMedGoogle Scholar
  • 41 Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020 ;S1473-3099(20)30198-5 (e-pub ahead of print). Doi: 10.1016/S1473-3099(20)30198-5
    PubMedGoogle Scholar
  • 42 Su L, Ma X, Yu H. , et al. The different clinical characteristics of corona virus disease cases between children and their families in China - the character of children with COVID-19. Emerg Microbes Infect 2020; 9 (01) 707-713
    Google Scholar
  • 43 Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang Z-J. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA 2020; 323 (14) 1313-1314 (e-pub ahead of print). Doi: 10.1001/jama.2020.2131
    CrossrefPubMedGoogle Scholar
  • 44 Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol 2020; 55 (05) 1169-1174
    CrossrefPubMedGoogle Scholar
  • 45 Zeng LK, Tao XW, Yuan WH, Wang J, Liu X, Liu ZS. [First case of neonate infected with novel coronavirus pneumonia in China] (in Chinese). Zhonghua Er Ke Za Zhi 2020; 58 (00) E009
    PubMedGoogle Scholar
  • 46 Zhang YH, Lin DJ, Xiao MF. , et al. [2019-novel coronavirus infection in a three-month-old baby] (in Chinese). Zhonghua Er Ke Za Zhi 2020; 58 (00) E006
    PubMedGoogle Scholar
  • 47 Molloy EJ, Bearer CF. COVID-19 in children and altered inflammatory responses. Pediatr Res 2020 (e-pub ahead of print). Doi: 10.1038/s41390-020-0881-y
    PubMedGoogle Scholar
  • 48 Auriti C, Tzialla C, Giuffrè M, Manzoni P. What do we know about SARS-CoV-2 infection in neonates and infants? The Neonatal Infectious Diseases Collaborative Group of the Italian Society of Neonatology. SIN Informa Magazine of the Italian Society of Neonatology 2020, April issue (e-pub ahead of print). Availabe at: https://www.sin-neonatologia.it/ . Accessed April 27, 2020
    PubMedGoogle Scholar
  • 49 De Luca D, van Kaam AH, Tingay DG. , et al. The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity. Lancet Respir Med 2017; 5 (08) 657-666
    CrossrefPubMedGoogle Scholar
  • 50 American Academy of Pediatrics & American Heart Association; Weiner GM, Zaichkin J. , eds. Textbook of Neonatal Resuscitation (NRP) 7th ed. Itasca, IL: American Academy of Pediatrics; 2016
    Google Scholar
  • 51 Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. Protecting healthcare workers from SARS-CoV-2 infection: practical indications. Eur Respir Rev 2020; 29 (155) 200068
    CrossrefPubMedGoogle Scholar
  • 52 Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Available at: https://apps.who.int/iris/bitstream/handle/10665/112656/9789241507134_eng.pdf . Accessed April 21, 2020
    PubMedGoogle Scholar
  • 53 Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7 (04) e35797
    Google Scholar
  • 54 Thompson KA, Pappachan JV, Bennett AM. , et al; EASE Study Consortium. Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic--the risk of aerosol generation during medical procedures. PLoS One 2013; 8 (02) e56278
    CrossrefPubMedGoogle Scholar
  • 55 Chan MTV, Chow BK, Lo T. , et al. Exhaled air dispersion during bag-mask ventilation and sputum suctioning - Implications for infection control. Sci Rep 2018; 8 (01) 198
    CrossrefPubMedGoogle Scholar
  • 56 Chan MT, Chow BK, Chu L, Hui DS. Mask ventilation and dispersion of exhaled air. Am J Respir Crit Care Med 2013; 187 (07) e12-e14
    CrossrefPubMedGoogle Scholar
  • 57 Hui DS, Hall SD, Chan MTV. , et al. Noninvasive positive-pressure ventilation: An experimental model to assess air and particle dispersion. Chest 2006; 130 (03) 730-740
    CrossrefPubMedGoogle Scholar
  • 58 Hui DS. Non-invasive Mechanical Ventilation: Models to Assess Air and Particle Dispersion. In: Esquinas AM. , ed. Non-invasive Ventilation in High-Risk Infections and Mass Casualty Events. 1st ed. Vienna, Austria: Springer; 2014: 7-16
    Google Scholar
  • 59 Simonds AK, Hanak A, Chatwin M. , et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess 2010; 14 (46) 131-172
    PubMedGoogle Scholar
  • 60 Hui DS, Chow BK, Ng SS. , et al. Exhaled air dispersion distances during noninvasive ventilation via different Respironics face masks. Chest 2009; 136 (04) 998-1005
    CrossrefPubMedGoogle Scholar
  • 61 Hui DS, Chow BK, Chu L. , et al. Exhaled air dispersion and removal is influenced by isolation room size and ventilation settings during oxygen delivery via nasal cannula. Respirology 2011; 16 (06) 1005-1013
    CrossrefPubMedGoogle Scholar