Last Updated: 11 June 2020, 3:44PM (NZDT)
This information resource has been compiled to assist healthcare professionals with the management of neonates, infants, and children with suspected or confirmed COVID-19. This information is not intended to replace the recommendations or requirements of your local hospital policies.
This resource refers to the World Health Organization (WHO) guidelines.1 Please use the link within this resource to ensure you are accessing the WHO’s most up-to-date advice.
The epidemiological and clinical patterns of COVID-19 remain unclear, particularly among neonates, infants and children.
In most pediatric cases, there is no evidence to suggest therapy decisions should be changed. Care should be driven by the patient’s underlying physiological and clinical presentation in conjunction with current evidence-based respiratory-management strategies.
Patients requiring respiratory support due to COVID-19 illness will have a high viral load, and they pose a potential infection risk to healthcare professionals and other patients. All patients with confirmed or suspected COVID-19 illness must be managed with appropriate isolation and personal protective equipment (PPE) precautions. Refer to your hospital policy or the WHO guidelines.
The WHO define endotracheal intubation as an aerosol-generating procedure, and is therefore subject to additional airborne precautions.1 In addition, due to the uncertainty around the potential for aerosolization, nasal high flow (NHF) and noninvasive ventilation (NIV), including bubble CPAP, should be used with airborne precautions. The magnitude of risk posed by noninvasive therapies needs to be evaluated against the risk posed by loud talking (crying),9 coughing and known ‘high risk’ aerosol-generating procedures such as intubation.10 However, a cautious approach to all potentially infectious patients receiving respiratory support is recommended, irrespective of modality, until further safety evaluation can be completed.
The WHO guidelines suggest commencing oxygen therapy with nasal cannula or prongs is the preferred oxygen therapy-delivery method for young children as they may be better tolerated, and NHF may be considered in select patients with hypoxemic respiratory failure. All patients treated with NHF should be closely monitored for clinical deterioration.1
For institutions considering reducing the flow rates delivered via NHF during this pandemic, please be aware that this may negatively impact therapy effectiveness, and currently there is no evidence to suggest this mitigates risks to healthcare personnel. Appropriate isolation and airborne PPE precautions are still recommended (irrespective of flow rate) and, once in place, we suggest following evidence-based flow rates to maximize therapy effectiveness.
For data on aerosol dispersion, please visit Nasal High Flow Therapy COVID-19 Information.
Fisher & Paykel (F&P) Healthcare Nasal High Flow pediatric products#
The WHO guidelines note that in situations where mechanical ventilation might not be available, bubble nasal CPAP may be used for patients with severe hypoxemia and may be more readily available.1
For institutions where bubble CPAP is the current standard of care for newborn infants requiring respiratory support (for non-COVID-19 reasons), there are currently no recommendations to change clinical practice for the majority of neonatal patients.
With any bubble CPAP delivery system there are two main places where gases and potential aerosols are likely to leak: between the patient and the mask/prongs (patient leak), and where the air exits from the bubble CPAP generator (intentional leak).
F&P Healthcare Infant CPAP products#
Although neonatal and infant resuscitation should be considered an aerosol-generating procedure, the European Respiratory Council have stated that there is no current evidence suggesting infection of the respiratory tract at birth or subsequent viral spread generated through devices or resuscitation procedures.13 The Resuscitation Council UK notes that there are no reported cases of healthcare professionals contracting COVID-19 from a newborn baby through resuscitation procedures.14 Given this evidence, alongside the likelihood of mask leak and the negative therapeutic effects that adding filters to the circuits is likely to have, the risks of using filters during infant resuscitation may be greater than the benefit that they could provide.
F&P Healthcare Infant Resuscitation products#
When invasive ventilation is needed, delivering heated and humidified gas is widely recommended and practiced during invasive respiratory support.15
F&P Healthcare Infant Invasive Ventilation humidified circuits#
COVID‑19 patients, who are critically ill with severe respiratory disease, need high levels of humidity to assist with secretion management and mucus plugging.16 Heated humidification promotes efficient ventilation and gas exchange,17 and preserves optimal mucociliary function.18
For information about heated humidification for healthcare professionals managing COVID-19 patients, please visit Heated Humidification for Healthcare Professionals Managing COVID-19 Patients.
For further information on our pediatric product range, including specification sheets, instructions for use, and instructional videos, please visit our Infant Respiratory Care support page.
For further information on our F&P heated humidifiers and flow generators, please visit:
# Always refer to the user instructions supplied with the product for full setup instructions, warnings, cautions and contraindications. If a device setup is off-label, the user recognizes that it is not the approved setup of the device and that the responsibility for doing so is their own.
Delivering respiratory support for spontaneously breathing patients
Full face masks designed for comfort and care
Providing Optimal Humidity for intubated patients
Establish effective spontaneous breathing or assist ventilation of the lungs
Respiratory support that replaces spontaneous breathing
Noninvasive respiratory support that provides a continuous distending pressure
Noninvasive respiratory support that delivers high flows of blended air and oxygen
Designed to work in harmony with the way patients naturally breathe while they sleep
F&P SleepStyle - designed to strike the balance between comfort and effective treatment
Nasal High Flow and Humidification for patients at home and in long term care
Home respiratory therapies that deliver humidification via a mask or tracheotomy tube to support and complement the airway’s natural-defense mechanisms
A flow range of 2 to 60 L/min allows for use across the care continuum - from the most acute hospital environment to the home
With Optiflow you can independently titrate flow and FiO2 according to your patient's needs
F&P Evora™ incorporates CapFit headgear that has been designed to be put on like a cap
The adaptable, reliable and robust humidification system. Use with Evaqua™ 2 circuit technology to minimize condensate
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