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

Wissam Shalish, Satyanarayana Lakshminrusimha, Paolo Manzoni, Martin Keszler, Guilherme M. Sant'anna

Research output: Contribution to journalReview articlepeer-review

41 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)780-791
Number of pages12
JournalAmerican journal of perinatology
Issue number8
StatePublished - Jun 1 2020


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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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