Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada.
Department of Pediatrics, UC Davis, Sacramento, California.
Am J Perinatol. 2020 Jun;37(8):780-791. doi: 10.1055/s-0040-1710522. Epub 2020 May 2.
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..
新型冠状病毒病 2019（COVID-19）大流行促使人们制定并实施了有关诊断、管理、感染控制策略和出院计划的指南和方案。然而，目前对于新生儿 COVID-19 和严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）感染知之甚少。因此，关于出生后的呼吸护理、产房和新生儿重症监护病房（NICU）中卫生保健工作者（HCW）的必要保护以及气囊面罩通气、无创呼吸支持、深吸痰、气管插管和机械通气的安全性等方面存在许多问题。实际上，这些问题给新生儿 HCW 带来了巨大的困惑。在本文中，我们全面回顾了有关 COVID-19 围产期传播、COVID-19 母亲所生新生儿和确诊 SARS-CoV-2 感染婴儿的呼吸结局以及在该特定人群中使用不同呼吸支持方式和产生气溶胶程序的证据。结果表明，迄今为止，新生儿 COVID-19 感染并不常见，通常是在出生后获得的，并且与良好的呼吸结局相关。婴儿表现出较轻疾病谱的原因尚不清楚。尽管如此，年轻患者发生严重或危急疾病的风险仍然存在。目前，对于疑似或确诊感染的婴儿，建议的呼吸方法不是基于证据，但应包括所有常规使用的支持类型，并添加病毒过滤器、适当的个人防护设备，并将婴儿安置在隔离室中，理想情况下为负压室。由于信息变化迅速，临床医生应经常关注有关该主题的最新信息。要点：·新型冠状病毒病 2019（COVID-19）大流行促使人们制定并实施了指南。·新生儿 COVID-19 疾病并不常见。·新生儿的呼吸结局似乎良好。·当前的新生儿呼吸护理应继续。·临床医生应经常关注最新信息。
