Clinical practices related to liberation from mechanical ventilation in Latin American pediatric intensive care units: survey of the Sociedad Latino-Americana de Cuidados Intensivos Pediátricos Mechanical Ventilation Liberation Group.

OBJECTIVE: To address the current practice of liberating patients from invasive mechanical ventilation in pediatric intensive care units, with a focus on the use of standardized protocols, criteria, parameters, and indications for noninvasive respiratory support postextubation. METHODS: Electronic research was carried out from November 2021 to May 2022 in Ibero-American pediatric intensive care units. Physicians and respiratory therapists participated, with a single representative for each pediatric intensive care unit included. There were no interventions. RESULTS: The response rate was 48.9% (138/282), representing 10 Ibero-American countries. Written invasive mechanical ventilation liberation protocols were available in only 34.1% (47/138) of the pediatric intensive care units, and their use was associated with the presence of respiratory therapists (OR 3.85; 95%CI 1.79 - 8.33; p = 0.0008). The most common method of liberation involved a gradual reduction in ventilatory support plus a spontaneous breathing trial (47.1%). The mean spontaneous breathing trial duration was 60 - 120 minutes in 64.8% of the responses. The presence of a respiratory therapist in the pediatric intensive care unit was the only variable associated with the use of a spontaneous breathing trial as the primary method of liberation from invasive mechanical ventilation (OR 5.1; 95%CI 2.1 - 12.5). Noninvasive respiratory support protocols were not frequently used postextubation (40.4%). Nearly half of the respondents (43.5%) reported a preference for using bilevel positive airway pressure as the mode of noninvasive ventilation postextubation. CONCLUSION: A high proportion of Ibero-American pediatric intensive care units lack liberation protocols. Our study highlights substantial variability in extubation readiness practices, underscoring the need for standardization in this process. However, the presence of a respiratory therapist was associated with increased adherence to guidelines.

Structured respiratory physiotherapy protocol for resolution of atelectasis in pediatric intensive care.

Children are at higher risk of atelectasis due to their anatomical and physiological particularities. Several physiotherapy techniques are used to treat atelectasis, but only four studies cite methods in pediatric patients undergoing Invasive Mechanical Ventilation (IMV). The objective of this study was to evaluate the Structured Respiratory Physiotherapy Protocol (SRPP) for airway clearance and lung reexpansion for infants on IMV with atelectasis. This is a prospective study including 30 infants (mean ± standard deviation age 8.9 ± 8.0 months; weight 7.5 ± 3.0 kg; BMI 15.8 ± 1.6 kg/cm2 and IMV duration 7.7 ± 4.3 days). The sample was randomized into a Control Group (CG), which received routine physiotherapy, and an Intervention Group (IG), submitted to SRPP (postural drainage, mechanical thoracic vibration, manual hyperinflation, stretching of the accessory respiratory muscles, and functional positioning). Both groups were evaluated before and after physiotherapy for respiratory effort using the Wood Downes Score (WD) and pulmonary aeration using lung ultrasonography (Lung Ultrasound Score ‒ LUS). The outcome of the intervention was evaluated by the magnitude of the effect by the Hedges' g test [(small (0.2 < Hedges' g < 0.5), moderate (0.5 < Hedges' g < 0.8) and large (Hedges' g > 0.8) effects]. There were large within-group effects on the reduction of WD in the CG after intervention in both the CG (Hedges' g = -1.53) and IG (Hedges' g = -2.2). There was a moderate effect on LUS reduction in the CG (Hedges' g = -0.64) and a large effect on IG (Hedges' g = -1.88). This study has shown that the SRPP appears to be safe and may be effective in improving airway clearance and lung reexpansion in children on IMV with atelectasis.

Assessment of newborn neuropsychomotor development born with exposure to SARS-CoV-2 in the perinatal period using the Bayley III scale at 6 months of age.

OBJECTIVE: This study aimed to evaluate the Neuropsychomotor Development (NPMD) of newborns exposed to SARS-CoV-2 in the perinatal period using the Bayley III scale at 6 months of age. METHODS: Childcare appointments were scheduled for the included newborns in the study. During the 6-month consultation, the Screening Test for Bayley III Scale and, based on it, children were classified as "low risk", "moderate risk" or "high risk" in the domains: of cognitive, receptive language, expressive language, fine motor, and gross motor. Those classified as "moderate risk"; or "high risk" received guidance about NPMD stimuli and were instructed to maintain follow-up. RESULTS: Only 13 (37.1 %) of the newborns were classified as low risk in receptive language and 18 (51.4 %) in gross motor skills, with the domains most affected. Prematurity was a risk for cognitive incompetence (moderate risk/high-risk classification) (coefficient: 1.89, Odds Ratio = 6.7, 95 % CI 1.3‒35, p = 0.02). Lower birth weight that 2.500g had a similar effect on cognitive incompetence (coefficient: 1.9, Odds Ratio = 6.2, 95 % CI 1.2‒32.2, p = 0.02). Exclusive breastfeeding at hospital discharge (n = 8) was protective for incompetence (high risk/moderate risk) in the language domain (coefficient -2.14, OR = 0.12, 95 % CI 0.02‒0.71, p = 0.02). CONCLUSIONS: The children included in the study must be monitored and their development monitored in order to clarify whether there is a relationship between the delay in NPMD and perinatal exposure to COVID-19, as delays were observed in these preliminary results.

Performance and labor conditions of physiotherapists in Brazilian intensive care units during the COVID-19 pandemic. What did we learn?

OBJECTIVE: To describe the role of physiotherapists in assisting patients suspected to have or diagnosed with COVID-19 hospitalized in intensive care units in Brazil regarding technical training, working time, care practice, labor conditions and remuneration. METHODS: An analytical cross-sectional survey was carried out through an electronic questionnaire distributed to physiotherapists who worked in the care of patients with COVID-19 in Brazilian intensive care units. RESULTS: A total of 657 questionnaires were completed by physiotherapists from the five regions of the country, with 85.3% working in adult, 5.4% in neonatal, 5.3% in pediatric and 3.8% in mixed intensive care units (pediatric and neonatal). In intensive care units with a physiotherapists available 24 hours/day, physiotherapists worked more frequently (90.6%) in the assembly, titration, and monitoring of noninvasive ventilation (p = 0.001). Most intensive care units with 12-hour/day physiotherapists (25.8%) did not apply any protocol compared to intensive care units with 18-hour/day physiotherapy (9.9%) versus 24 hours/day (10.2%) (p = 0.032). Most of the respondents (51.0%) received remuneration 2 or 3 times the minimum wage, and only 25.1% received an additional payment for working with patients suspected to have or diagnosed with COVID-19; 85.7% of them did not experience a lack of personal protective equipment. CONCLUSION: Intensive care units with 24-hour/day physiotherapists had higher percentages of protocols and noninvasive ventilation for patients with COVID-19. The use of specific resources varied between the types of intensive care units and hospitals and in relation to the physiotherapists' labor conditions. This study showed that most professionals had little experience in intensive care and low wages.

Effect of manual hyperinflation with versus without positive end-expiratory pressure on dynamic compliance in pediatric patients following congenital heart surgery: A randomized controlled trial.

BACKGROUND: We aimed to compare the effect of manual hyperinflation with versus without positive end-expiratory pressure (PEEP) on dynamic compliance of the respiratory system in pediatric patients undergoing congenital heart surgery; to assess the safety of the technique in this population. METHODS: This was a randomized controlled trial conducted at the pediatric intensive care unit (PICU) of a tertiary-care hospital. Patients admitted to the PICU following cardiac surgery and receiving postoperative mechanical ventilation were randomized to the experimental or control group. Patients in the experimental group (n = 14) underwent manual hyperinflation with a PEEP valve set at 5 cm H2O, once daily, during the first 48 hours after surgery. Patients allocated to the control group (n = 16) underwent manual hyperinflation without PEEP, at the same time points. Lung mechanics was assessed before (T0) and 5 minutes (T5) after manual hyperinflation. The primary endpoint was dynamic compliance. Secondary outcomes included oxygen saturation index, duration of mechanical ventilation, length of stay, 28-day mortality and safety. RESULTS: Demographic and clinical characteristics were comparable in both groups. There was no significant difference in dynamic compliance between times in each group (Day 1: (mean) 0.78 vs 0.81 and 0.70 vs 0.77; Day 2: 0.85 vs 0.78 and 0.67 vs 0.68 mL/kg/cm H2O, in experimental and control groups, respectively; P > .05). Mean deltas of dynamic compliance were not significantly different between groups. The proportion of patients extubated <72 hours after surgery was similar in experimental and control groups (43% vs 50%, respectively; P = .73). Oxygen saturation index, length of stay, and 28-day mortality were not significantly different between groups. None of the patients had hemodynamic instability. CONCLUSIONS: Manual hyperinflation was safe and well tolerated in pediatric patients following surgery for congenital heart disease. No significant change in dynamic compliance of the respiratory system or in oxygenation was observed with the use of manual hyperinflation with or without PEEP in this population.

Performance and labor conditions of physiotherapists in Brazilian intensive care units during the COVID-19 pandemic. What did we learn? / Desempenho e condições de trabalho dos fisioterapeutas nas unidades de terapia intensiva brasileiras durante a pandemia da COVID-19. O que aprendemos?

ABSTRACT Objective: To describe the role of physiotherapists in assisting patients suspected to have or diagnosed with COVID-19 hospitalized in intensive care units in Brazil regarding technical training, working time, care practice, labor conditions and remuneration. Methods: An analytical cross-sectional survey was carried out through an electronic questionnaire distributed to physiotherapists who worked in the care of patients with COVID-19 in Brazilian intensive care units. Results: A total of 657 questionnaires were completed by physiotherapists from the five regions of the country, with 85.3% working in adult, 5.4% in neonatal, 5.3% in pediatric and 3.8% in mixed intensive care units (pediatric and neonatal). In intensive care units with a physiotherapists available 24 hours/day, physiotherapists worked more frequently (90.6%) in the assembly, titration, and monitoring of noninvasive ventilation (p = 0.001). Most intensive care units with 12-hour/day physiotherapists (25.8%) did not apply any protocol compared to intensive care units with 18-hour/day physiotherapy (9.9%) versus 24 hours/day (10.2%) (p = 0.032). Most of the respondents (51.0%) received remuneration 2 or 3 times the minimum wage, and only 25.1% received an additional payment for working with patients suspected to have or diagnosed with COVID-19; 85.7% of them did not experience a lack of personal protective equipment. Conclusion: Intensive care units with 24-hour/day physiotherapists had higher percentages of protocols and noninvasive ventilation for patients with COVID-19. The use of specific resources varied between the types of intensive care units and hospitals and in relation to the physiotherapists' labor conditions. This study showed that most professionals had little experience in intensive care and low wages.

RESUMO Objetivo: Descrever o papel dos fisioterapeutas na assistência a pacientes com suspeita ou diagnóstico da COVID-19 internados em unidades de terapia intensiva no Brasil em relação a: formação técnica, tempo de trabalho, prática assistencial, condições de trabalho e remuneração. Métodos: Foi realizado um inquérito transversal analítico com questionário eletrônico distribuído aos fisioterapeutas que atuavam no atendimento de pacientes com COVID-19 em unidades de terapia intensiva brasileiras. Resultados: Foram preenchidos 657 questionários por fisioterapeutas das cinco regiões do país, sendo que 85,3% trabalhavam em unidades de terapia intensiva adulto, 5,4% em neonatal, 5,3% em pediátrica e 3,8% em unidades de terapia intensiva mista (pediátrica e neonatal). Nas unidades de terapia intensiva com um fisioterapeuta disponível 24 horas por dia, os fisioterapeutas trabalharam com mais frequência (90,6%) na montagem, titulação e monitoramento da ventilação não invasiva (p = 0,001). A maioria das UTIs com fisioterapia 12 horas por dia (25,8%) não aplicou nenhum protocolo comparativamente às unidades de terapia intensiva com fisioterapia 18 horas por dia (9,9%) e às de 24 horas por dia (10,2%) (p = 0,032). A maioria dos entrevistados (51,0%) recebia remuneração de duas a três vezes o salário mínimo, e apenas 25,1% recebiam pagamento adicional por trabalhar com pacientes com suspeita ou diagnóstico da COVID-19; 85,7% deles não enfrentaram falta de Equipamentos de Proteção Individual. Conclusão: As unidades de terapia intensiva com fisioterapeutas 24 horas por dia apresentaram maiores porcentagens de protocolos e ventilação não invasiva para pacientes com COVID-19. A utilização de recursos específicos variou entre os tipos de unidades de terapia intensiva e hospitais e em relação às condições de trabalho dos fisioterapeutas. Este estudo mostrou que a maioria dos profissionais tinha pouca experiência em terapia intensiva e baixa remuneração.

Electrical impedance tomography clues to detect pulmonary thrombosis in a teenager with COVID-19.

We report a case of pulmonary thrombosis in a teenager during a hypercoagulable state associated with COVID-19 (coronavirus disease 2019) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). A condition rare in children and adolescents, pulmonary thrombosis underdiagnosis likely increases morbidity and mortality. A pulmonary thrombosis diagnosis requires a high level of suspicion and relies on the combination of clinical presentation, D-dimer elevation, and computed tomography (CT) pulmonary angiography or ventilation/perfusion scans, imaging techniques that are difficult to perform. Electrical impedance tomography (EIT) has gained attention, as it provides real-time ventilation distribution analysis. In addition, lung pulsatility images can be obtained through this technique using electrocardiogram gating to filter out ventilation. In this case report, the reduced EIT pulsatility corresponded to the perfusion defect found on the CT scan, information that was obtained at the bedside without radiation or contrast exposure.

Motor development of infants (6-12 months) with low birth weight.

OBJECTIVE: The aim of this study was to describe the motor development (MD) and growth of infants born with low birth weight (LBW) versus adequate birth weight (ABW) by using the Alberta Infant Motor Scale (AIMS). METHODS: The cross-sectional study including LBW infants (aged 6-12 months) followed at an outpatient clinic from a University Hospital in Brazil and a group of infants of the same age with ABW. The variables were recorded as maternal, birth, and infant conditions. The infants were assessed for MD using the AIMS. RESULTS: In total, 98 infants (38 LBW versus 60 ABW) were evaluated and no statistically significant differences were found in demographic characteristics and in the AIMS results. The AIMS results of the total sample were suspicious or abnormal MD in 44 (45%) of total infants. Higher frequency of suspected or abnormal motor behavior was found in the age group between 9 and 12 (54.6%) months. CONCLUSIONS: A frequency of 45% of suspected or abnormal behavior was observed in the evaluated infants, with a higher frequency of occurrence in those aged 9-12 months (54.6%).

First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit. / Primeira recomendação brasileira de fisioterapia para estimulação sensório-motora de recém-nascidos e lactentes em unidade de terapia intensiva.

OBJECTIVE: To present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit. METHODS: We employed a mixed methods design with a systematic review of the literature and recommendations based on scientific evidence and the opinions of physiotherapists with neonatal expertise. The research included studies published between 2010 and 2018 in the MEDLINE® and Cochrane databases that included newborns (preterm and term) and infants (between 28 days and 6 months of age) hospitalized in the intensive care unit and submitted to sensory motor stimulation methods. The studies found were classified according to the GRADE score by five physiotherapists in different regions of Brazil and presented at eight Scientific Congresses held to discuss the clinical practice guidelines. RESULTS: We included 89 articles to construct the clinical practice guidelines. Auditory, gustatory and skin-to-skin stimulation stand out for enhancing vital signs, and tactile-kinesthetic massage and multisensory stimulation stand out for improving weight or sucking. CONCLUSION: Although all modalities have good ratings for pain or stress control, it is recommended that sensory motor stimulation procedures be tailored to the infant's specific needs and that interventions and be carried out by expert professionals.

OBJETIVO: Apresentar as diretrizes de estimulação sensório-motora para recém-nascidos e lactentes em unidade de terapia intensiva. MÉTODOS: Trata-se de um método de delineamento misto com revisão sistemática da literatura e recomendações com base na evidência científica e opiniões de fisioterapeutas especialistas em fisioterapia neonatal de estudos publicados entre 2010 e 2018 nas bases de dados MEDLINE® e Cochrane, que incluiu recém-nascidos (pré-termo e a termo) e lactentes (entre 28 dias e 6 meses de idade) admitidos à unidade de terapia intensiva e submetidos a métodos de estimulação sensório-motora. Os estudos encontrados foram classificados segundo o escore GRADE por cinco fisioterapeutas em diferentes regiões do país e apresentados em oito congressos científicos para discussão das diretrizes de práticas clínicas. RESULTADOS: Foram incluídos 89 artigos para construir as diretrizes de práticas clínicas. Estimulação auditiva, gustatória e contato pele a pele se destacaram por melhorar os sinais vitais, e a massagem terapêutica, assim como a estimulação multimodal tátil-cinestésica por melhorar o peso ou a sucção. CONCLUSÃO: Embora todas a modalidades tenham boas avaliações para controle da dor ou do estresse, é recomendado que os procedimentos de estimulação sensório-motora sejam adaptados às necessidades específicas da criança, e as intervenções sejam realizadas por profissionais experientes.

Primeira recomendação brasileira de fisioterapia para estimulação sensório-motora de recém-nascidos e lactentes em unidade de terapia intensiva / First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit

RESUMO Objetivo: Apresentar as diretrizes de estimulação sensório-motora para recém-nascidos e lactentes em unidade de terapia intensiva., Métodos: Trata-se de um método de delineamento misto com revisão sistemática da literatura e recomendações com base na evidência científica e opiniões de fisioterapeutas especialistas em fisioterapia neonatal de estudos publicados entre 2010 e 2018 nas bases de dados MEDLINE® e Cochrane, que incluiu recém-nascidos (pré-termo e a termo) e lactentes (entre 28 dias e 6 meses de idade) admitidos à unidade de terapia intensiva e submetidos a métodos de estimulação sensório-motora. Os estudos encontrados foram classificados segundo o escore GRADE por cinco fisioterapeutas em diferentes regiões do país e apresentados em oito congressos científicos para discussão das diretrizes de práticas clínicas., Resultados: Foram incluídos 89 artigos para construir as diretrizes de práticas clínicas. Estimulação auditiva, gustatória e contato pele a pele se destacaram por melhorar os sinais vitais, e a massagem terapêutica, assim como a estimulação multimodal tátil-cinestésica por melhorar o peso ou a sucção., Conclusão: Embora todas a modalidades tenham boas avaliações para controle da dor ou do estresse, é recomendado que os procedimentos de estimulação sensório-motora sejam adaptados às necessidades específicas da criança, e as intervenções sejam realizadas por profissionais experientes.

Abstract Objective: To present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit. Methods: We employed a mixed methods design with a systematic review of the literature and recommendations based on scientific evidence and the opinions of physiotherapists with neonatal expertise. The research included studies published between 2010 and 2018 in the MEDLINE® and Cochrane databases that included newborns (preterm and term) and infants (between 28 days and 6 months of age) hospitalized in the intensive care unit and submitted to sensory motor stimulation methods. The studies found were classified according to the GRADE score by five physiotherapists in different regions of Brazil and presented at eight Scientific Congresses held to discuss the clinical practice guidelines. Results: We included 89 articles to construct the clinical practice guidelines. Auditory, gustatory and skin-to-skin stimulation stand out for enhancing vital signs, and tactile-kinesthetic massage and multisensory stimulation stand out for improving weight or sucking. Conclusion: Although all modalities have good ratings for pain or stress control, it is recommended that sensory motor stimulation procedures be tailored to the infant's specific needs and that interventions and be carried out by expert professionals.

Update on the diagnosis and management of COVID-19 in pediatric patients.

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a pandemic in March 2020, affecting millions of people worldwide. However, COVID-19 in pediatric patients represents 1-5% of all cases, and the risk for developing severe disease and critical illness is much lower in children with COVID-19 than in adults. Multisystem inflammatory syndrome in children (MIS-C), a possible complication of COVID-19, has been described as a hyperinflammatory condition with multiorgan involvement similar to that in Kawasaki disease or toxic shock syndrome in children with evidence of SARS-CoV-2 infection. This review presents an update on the diagnostic methods for COVID-19, including reverse-transcriptase polymerase chain reaction (RT-PCR) tests, serology tests, and imaging, and summarizes the current recommendations for the management of the disease. Particular emphasis is placed on respiratory support, which includes noninvasive ventilation and invasive mechanical ventilation strategies according to lung compliance and pattern of lung injury. Pharmacological treatment, including pathogen-targeted drugs and host-directed therapies, has been addressed. The diagnostic criteria and management of MIS-C are also summarized.

COVID-19 and Liver Damage: Narrative Review and Proposed Clinical Protocol for Critically ill Pediatric Patients.

SARS-CoV-2 shares nearly 80% of its' genomic sequence with SARS-CoV and MERS-CoV, both viruses known to cause respiratory symptoms and liver impairment. The emergence of pediatric cases of multisystem inflammatory syndrome related to the SARS-CoV-2 infection (PIM-TS) has raised concerns over the issue of hepatic damage and liver enzyme elevation in the critically ill pediatric population with COVID-19. Some retrospective cohorts and case series have shown various degrees of ALT/AST elevation in SARS-CoV-2 infections. A limited number of liver histopathological studies are available that show focal hepatic periportal necrosis. This liver damage was associated with higher levels of inflammatory markers, C-reactive protein (CRP), and pro-calcitonin. Proposed pathophysiological mechanisms include an uncontrolled exacerbated inflammatory response, drug-induced liver injury, direct viral infection and damage to cholangiocytes, hypoxic-ischemic lesions, and micro-thrombosis in the liver. Based on the physiopathological characteristics described, our group proposes a clinical protocol for the surveillance, evaluation, management, and follow-up of critically ill pediatric COVID-19 patients with liver damage.

Frequency and characterization of the use of cuffed tracheal tubes in neonatal and pediatric intensive care units in Brazil. / Frequência e caracterização da utilização de cânulas traqueais com balonete em unidades de terapia intensiva neonatais e pediátricas do Brasil.

OBJECTIVE: To identify the neonatal, pediatric and mixed (neonatal and pediatric) intensive care units in Brazil that use cuffed tracheal tubes in clinical practice and to describe the characteristics related to the use of protocols and monitoring. METHODS: To identify the intensive care units in Brazil, the Ministry of Health's National Registry of Health Facilities was accessed, and information was collected on 693 registered intensive care units. This was an analytical cross-sectional survey conducted through electronic questionnaires sent to 298 neonatal, pediatric and mixed intensive care units in Brazil. RESULTS: This study analyzed 146 questionnaires (49.3% from neonatal intensive care units, 35.6% from pediatric intensive care units and 15.1% from mixed pediatric intensive care units). Most of the participating units (78/146) used cuffed tracheal tubes, with a predominance of use in pediatric intensive care units (52/78). Most of the units that used cuffed tracheal tubes applied a cuff pressure monitoring protocol (45/78). The use of cuff monitoring protocols was observed in intensive care units with a physical therapy service exclusive to the unit (38/61) and in those with a physical therapist present 24 hours/day (25/45). The most frequent cause of extubation failure related to the use of cuffed tracheal tubes in pediatric intensive care units was upper airway obstruction. CONCLUSION: In this survey, the use of cuffed tracheal tubes and the application of a cuff pressure monitoring protocol was predominant in pediatric intensive care units. The use of a monitoring protocol was more common in intensive care units that had a physical therapist who was exclusive to the unit and was present 24 hours/day.

Beyond ventilatory support: challenges in general practice and in the treatment of critically Ill children and adolescents with SARS-CoV-2 infection.

Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.

Expert recommendations for the care of newborns of mothers with COVID-19.

This article presents expert recommendations for assisting newborn children of mothers with suspected or diagnosed coronavirus disease 2019 (COVID-19). The consensus was developed by five experts with an average of 20 years of experience in neonatal intensive care working at a reference university hospital in Brazil for the care of pregnant women and newborns with suspected or confirmed COVID-19. Despite the lack of scientific evidence regarding the potential for viral transmission to their fetus in pregnant mothers diagnosed with or suspected of COVID-19, it is important to elaborate the lines of care by specialists from hospitals caring for suspected and confirmed COVID-19 cases to guide multidisciplinary teams and families diagnosed with the disease or involved in the care of pregnant women and newborns in this context. Multidisciplinary teams must be attentive to the signs and symptoms of COVID-19 so that decision-making is oriented and assertive for the management of the mother and newborn in both the hospital setting and at hospital discharge.