Considerations for the management of pediatrics with suspected or confirmed COVID‑19

COVID‑19 INFORMATION & RESOURCES

Last Updated: Thursday 16 April 2020, 4:12PM (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 the neonatal population, several studies have found no evidence of vertical transmission from mothers suffering from COVID-19 to their newborns.2-4
  • In a study of 2,143 pediatric patients with confirmed or suspected COVID-19,5 it was found that:
    • 94% of pediatric patients were diagnosed as asymptomatic, mild, or moderate.
    • 5.9% of pediatric patients were diagnosed as severe or critical, compared with 18.5% of adult patients. There was one reported death of a 14-year-old patient in this study.

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.

Respiratory management of pediatrics in the context of COVID-19


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 suggests that, 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.
 

Nasal high flow

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.

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.
 

Bubble CPAP

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 in resource-limited settings.

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.


Heated humidification

For information about heated humidification for healthcare professionals managing COVID-19 patients, please visit Heated Humidification for Healthcare Professionals Managing COVID-19 Patients.

 

Other useful resources and guidelines

Quick reference for Fisher & Paykel Healthcare pediatric products in the context of COVID-19#


F&P Healthcare Nasal High Flow pediatric products
  • Optiflow™ Junior, Optiflow Junior 2, and Optiflow Junior 2+ nasal high flow interfaces, F&P high flow circuits, and associated accessories are intended for single-patient use only.

F&P Healthcare Infant CPAP products
  • The F&P Bubble CPAP generator, F&P FlexiTrunk™ nasal interface, F&P Infant CPAP circuits, and all associated accessories are intended for single-patient use only.
     
  • The placement of a filter on the expiratory limb of the bubble CPAP system is not advised. F&P Healthcare recommends extreme caution when using filters in unapproved or improvised ways. Resistance to flow, filter efficacy in different conditions, instrumental dead space, flow dynamics through the system, and the potential for gas-trapping are just some of the important safety factors healthcare professionals should consider.  

F&P Healthcare Infant Resuscitation products
  • The F&P Neopuff™ is intended for multiple-patient use. Neopuff is a positive-pressure device which provides unidirectional gas flow. Gas exits the system through the positive end expiratory pressure (PEEP) valve. This prevents any of the patient’s exposed fluids from going back into the device, which reduces the risk of contamination between patients. Please refer to the product technical manual for instructions for cleaning Neopuff between use on patients.
     
  • F&P Infant Resuscitation circuits and masks are intended for single-patient use only.
     
  • The placement of a filter between the T-piece and resuscitation mask is not advised. F&P Healthcare recommends extreme caution when using filters in unapproved or improvised ways. Resistance to flow, filter efficacy in different conditions, instrumental dead space, flow dynamics through the system, and the potential for gas-trapping are just some of the important safety factors healthcare professionals should consider.

F&P Healthcare Infant Invasive Ventilation products
  • F&P Infant Invasive circuits are intended for single-patient use only.
     
  • For questions related to use of inspiratory/expiratory filters with invasive ventilation circuits, please visit Efficiency of Filters and F&P Evaqua™ 2.


Further resources

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.