The novel coronavirus disease 2019 has raised several questions about how to limit the spread of highly transmissible respiratory viruses. While guidelines and recommendations exist for adult patients, these cannot be extrapolated to infants and neonates, as neonatal respiratory support presents specific issues (e.g., high apparatus dead space compared to neonatal airways, high bias flows, humidified gases, etc.) that make the transmission of respiratory pathogen control particularly challenging. Three recent papers address the issues of pathogen transmission, aerosol-generating procedures, and infection control before, during, and after neonatal resuscitation1,2 and during different respiratory support modes in the neonatal intensive care unit.3 This document provides more detailed indications on how to use bacterial–viral filters to reduce the spread of respiratory pathogens from neonatal patients with acute respiratory infections receiving respiratory support, with a focus on the protection of the environment and healthcare workers.

Bacterial–viral air filters are medical devices used in respiratory ventilators or breathing circuits to protect patients, equipment, and/or the environment from viruses and bacteria. They may be either electrostatic or mechanical, based on their working principle: electrostatic filters use an induced electrostatic charge to capture particles, while mechanical filters use a pleated porous membrane. Mechanical filters can reach higher filtration efficiency than electrostatic filters, but they impose higher airflow resistance. Air filters are classified upon their efficiency: efficiency particulate air (EPA), high-efficiency particulate air (HEPA), and ultra-low penetration air filters retain a minimum of 99.95%, 99.97%, and 99.999% of 0.3 µm particles, respectively. Heat moisture and exchangers (HMEs) retain heat and humidity from exhaled air and return them to the patient during the following inspiration. HMEs also provide a filtration function that can be either electrostatic or mechanical, and they can be classified as either EPA or HEPA based on their filtration efficiency. HMEs are passive humidifiers and, as such, they should be placed at the inlet of the airway interface. HMEs must not be used with humidified gasses because the humidity retained by the hygroscopic membrane may increase airflow resistance.4

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