Germinal matrix intraventricular hemorrhage (IVH) remains a severe and common complication in preterm infants. A neonatal care bundle (NCB) was implemented as an in-house guideline at a tertiary neonatal intensive care unit to reduce the incidence of IVH in preterm infants. The NCB was applied either to preterm infants <1250 g birth weight or <30 weeks gestational age or both, and standardized patient positioning, nursing care, and medical procedures within the first week of life. A retrospective cohort study was performed to investigate the effect of the NCB and other known risk factors on the occurrence and severity of IVH. Data from 229 preterm infants were analyzed. The rate of IVH was 26.2% before and 27.1% after implementing the NCB. The NCB was associated neither with reducing the overall rate of IVH (odds ratio (OR) 1.02; 95% confidence interval (CI) 0.57–1.84; p = 0.94) nor with severe IVH (OR 1.0; 95% CI 0.67–1.55; p = 0.92). After adjustment for group differences and other influencing factors, amnion infection syndrome and early intubation were associated with an increased risk for IVH. An NCB focusing on patient positioning, nursing care, and medical interventions had no impact on IVH in preterm infants. Known risk factors for IVH were confirmed.

Purpose: Given reduced immunity levels for seasonally occurring respiratory infections and the experience of an unusually early, severe wave of RSV infections during 2021, a preexisting clinician-led reporting system (CLRS) was updated to prospectively monitor the anticipated high burden of respiratory infections (ARI) in German pediatric hospitals during fall/winter 2022–2023. Methods: From September 13, 2022 through March 31, 2023, children hospitalized with ARI as a primary diagnosis were monitored via a national CLRS established by the German Society for Pediatric Infectious Diseases (DGPI). Once a week, the CLRS collected overall number of new hospital admissions, ARI-related admissions according to pathogen (SARS-CoV-2, RSV, influenza, and other), plus number of patients admitted to ICU with ARI as a primary diagnosis. Results: With a high participation among children's hospitals across Germany (22.8%), 76 centers submitted 1,053 survey reports. ARI-related hospital admissions showed a steep rise starting in late September 2022 and reached their highpoint in early December 2022 (50.1% of all admissions). In parallel, the average number of newly admitted patients (aNA) with RSV (3.6) peaked, as did those with influenza (2.1) one week later. The average highpoint of ARI patients on ICU (aICU) (2.9) was reached shortly thereafter. Again, RSV (1.6) und influenza (1.2) were predominant pathogens. Conclusion: In fall/winter 2022–2023, German hospitals reported a sharp increase in patients with ARIs. While RSV and influenza represented the greatest proportion of ARI, SARS-CoV-2 played a less significant role. Systematic, dynamic collection of ARI data is critical for assessing real burdens on the health care system.

Purpose: During fall 2021, children’s hospitals in Germany faced a surge in RSV-related hospitalizations, whereas during fall/winter 2022–2023, RSV and influenza infections both led to increased inpatient admissions. Our study prospectively assessed severe acute respiratory infections, their causative pathogens, and the resulting disease burden on German children's hospitals for the fall/winter 2023–2024 season. Methods: From October 3, 2023 through April 16, 2024, children hospitalized with ARI as a primary diagnosis were monitored via a national survey established by the German Society for Pediatric Infectious Diseases (DGPI). Weekly data was collected on total hospital admissions, ARI-related admissions by pathogen (SARS-CoV-2, RSV, influenza, other), ICU admissions with ARI as a primary diagnosis, and respiratory support. Results: Overall, 23% of German children's hospitals (77/334 centers) submitted 1234 survey reports. ARI-related hospital admissions surged starting in November 2023 and peaked in late December 2023 (53.4% of all admissions), in parallel with a peak in the average number of newly-admitted patients (aNA) with RSV (2.5 aNA). In comparison to the 2022/2023 season, fewer newborns and infants were admitted for ARI (4.7%, p < 0.001/1.9%, p = 0.05) and fewer required ICU treatment (5.3%, p = 0.02/5.6%, p = 0.001 respectively). In 74.9% of ICU patients, ventilation support was required—9.1% less than in the previous season. Conclusion: The clinical burden on pediatric hospitals and ICUs is strongly influenced by the changing, annually circulating pathogens and affected age group. Therefore, a continuous, systematic, dynamic collection of ARI data is critical for assessing the ARI-related morbidity and the associated burden on health care systems.

Frühgeburtenrate in 6 Perinatalzentren in Baden-Württemberg – Potential zur Reduktion der Frühgeborenenzahl Sehr geehrte Herren Rossi, Heller und Maier,vielen Dank für Ihren Leserbrief bezüglich unserer Arbeit Trotter et al. 1, gerne gehen wir auf die einzelnen Punkte ein.

Während der Schwangerschaft produziert die Plazenta steigende Mengen an Östradiol (E₂) und Progesteron (P), denen auch der Fetus ausgesetzt ist. Nach der Geburt kommt es zu einem rapiden Konzentrationsabfall beider Steroide bei Mutter und Kind. Welche Auswirkungen dieser relative Mangel an E₂ und P für Frühgeborene hat, ist nicht bekannt. Es gibt Hinweise dafür, dass beide Hormone für die Entwicklung bedeutend sind.