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)


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.

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.