COVID-19 and The Surgical Neonate

ABSTRACT

COVID-19 pandemic in 2020-2021 affected millions of people including children. Though uncommon, there are few reports of COVID in neonates also. COVID is primarily managed by pediatricians;however, they are involved when providing anesthesia to these neonates for surgery. The role of anesthetists, besides during surgery, has proven to be vital in COVID pandemic for their expertise in airway and ventilatory management, also putting them to the highest risk of exposure. Various testing methods are available, and TrueNAT and RTPCR have emerged as most reliable. Most neonates remain asymptomatic or have mild symptoms;however, RTPCR testing should be done in all at least 72 h of preoperative. Utmost care should be taken during the preoperative evaluation, and in the perioperative period, goal is to prevent transmission of COVID to noninfected HCW involved in the perioperative period, to other newborns and neonates, and also to avoid increasing the severity of the diseases in the positive neonates, while keeping in mind the vulnerability of these babies in combination with their surgical disease and the changing neonatal physiology. COVID care protocols should be followed at all times. Anesthetic considerations remain the same as described in other chapters in the book, in newborns and neonates, both term and preterm. All OT personnel need to don the PPE, which can be problematic especially for the anesthetist, as it restricts the normal unhindered movements, use of stethoscope for chest auscultation for heart rate, respiration, and ETT positioning. Hence, one needs to be very meticulous in IV line and ET placement and their securing to prevent accidental dislodging during positioning and under the drapes. All disposable and non-disposable equipment used for the covid positive baby, should be adequately treated or discarded, as the case may be, after each surgery. Only emergency surgery should be undertaken in COVID-positive neonates to prevent high postoperative morbidity and mortality. There is not much data available in neonates, and most guidelines have been introduced for children and adolescents. Neonatal care has emerged from the experience of the anesthesiologist and from extrapolation of the available pediatric guidelines. Here, we will be discussing COVID in neonates and anesthetic management in COVID-positive neonates undergoing surgery. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.