Background: Many children and adolescents are surrounded by smartphones, tablets, and computers and know how to search the internet for almost any information. However, very few of them know how to select proper information from reliable sources. This can become a problem when health issues are concerned, where it is vital to identify incorrect or misleading information. The competence to critically evaluate digital information on health issues is of increasing importance for adolescents.Objective: The aim of this study was to assess how children and adolescents rate their internet-based health literacy and how their actual literacy differs from their ratings. In addition, there was a question on how their search performance is related to their self-efficacy. To evaluate these questions, a criteria-based analysis of the quality of the websites they visited was performed. Finally, the possibility to increase their internet-based health literacy in a 3-day workshop was explored.Methods: A workshop with a focus on health literacy was attended by 14 children and adolescents in an Austrian secondary school. After prior assessments (Culture Fair Intelligence Test, revised German version; Reading Speed and Reading Comprehension Test for Grades 6 to 12, German; electronic health literacy scale [eHEALS]; and General Self-Efficacy Scale, Reversed Version, German), the students were asked to perform an internet-based search on a health-related issue. Browser histories and screenshots of all internet searches were gathered, clustered, and analyzed. After the workshop, the health literacy of the students was assessed again by using the eHEALS.Results: The 14 students opened a total of 85 homepages, but only eight of these homepages were rated as good or fair by two experts (independent rating) based on specific criteria. The analysis showed that the students judged their own internet-based health literacy much higher than the actual value, and students who had rated themselves better did not visit websites of high quality. Internet-based health literacy correlated significantly with the self-efficacy of the students (rs=0.794, P=.002).Conclusions: Our study showed that it is possible to draw the attention of students to critical aspects of internet search and to slightly improve their search competence in a workshop. Targeted improvement of health literacy is urgently required, and students need special instruction for this purpose. Further investigations in this area with larger sets of data, which could be feasible with the help of a computer program, are urgently needed.

Cerebral monitoring during immediate fetal-to-neonatal transition is of increasing interest. The cerebral fractional tissue oxygen extraction (cFTOE) is a useful parameter to gain insight in the balance between tissue oxygen delivery and consumption during this complex process. The aim of this study was to review the literature on cFTOE during the first 15 min immediately after birth. A systematic qualitative literature research was last performed on 23 November 2023 of PubMed and EMBASE with the following search terms: neonate, infant, newborn, transition, after birth, delivery room, NIRS, near-infrared spectroscopy, spectroscopy, cFTOE, cerebral fractional tissue oxygenation extraction, cerebral oxygenation, and fractional oxygen extraction. Additional published reports were identified through a manual search of references in retrieved articles and in review articles. The methodological quality of the included studies was assessed by predefined quality criteria. Only human studies with data of cFTOE in the first 15 min after birth were included. Accordingly, exclusion criteria were defined as no measurement of cFTOE or no measurement within the first 15 min after birth. Across all studies, a total of 3566 infants (2423 term, 1143 preterm infants) were analysed. Twenty-five studies were identified describing cFTOE within the first 15 min after birth. Four studies established reference ranges for cFTOE and another four studies focused on the effect of pre-/perinatal circumstances on cFTOE in the first 15 min after birth. Six studies investigated the course of cFTOE after transition in infants without complications. Eleven studies analysed different potentially influencing parameters on cFTOE during transition. Conclusion: This systematic review provides a comprehensive insight on cFTOE during uncomplicated transition as well as the influence of perinatal circumstances, respiratory, haemodynamic, neurological, and laboratory parameters in preterm and term infants. What is Known: • The NIRS-measured cerebral fractional tissue oxygen extraction (cFTOE) is a useful parameter to estimate the balance between oxygen delivery and consumption. • During normal transition, the cFTOE decreases in the first minutes after birth and then remains at a stable plateau. What is New: • The cFTOE is a promising parameter that gives additional information on cerebral oxygenation and perfusion in preterm and term infants. • Several hemodynamic, metabolic, respiratory, and perinatal factors are identified, influencing the oxygen extraction of the newborn's brain after birth.

Introduction: Carbon dioxide (pCO₂) induces changes in the tone of cerebral vessels. The aim of the present study was to evaluate the impact of pCO₂ on cerebral regional tissue oxygen saturation (crSO₂), cerebral fractional tissue oxygen extraction (cFTOE), and cerebral tissue oxygen extraction (cTOE), measured with near-infrared spectroscopy (NIRS), in preterm and term infants 15 min after birth. Methods: Post hoc analyses of secondary outcome parameters of prospective observational studies were performed. Stable preterm and term infants with cerebral NIRS monitoring (INVOS 5100C) until minute 15 after birth and a blood gas analysis, performed between minutes 14–18 after birth, were included. Heart rate (HR) and arterial oxygen saturation (SpO₂) were recorded. pCO₂ was correlated with crSO₂, cFTOE, cTOE, SpO₂, HR, and partial pressure of oxygen (pO₂). Results: Eleven preterm infants with a median (IQR) gestational age of 34.8 (32.7–36.1) weeks were analyzed. Mean ± SD pCO₂ was 53.5 ± 4.2 mm Hg. At minute 15 after birth, crSO₂ was 82.6 (74.3–91.3)%, cFTOE 0.15 ± 0.09, cTOE 14.6 ± 8.4%, SpO₂ 97.4 ± 2.1%, and HR 152 (136–167) bpm. pCO₂ correlated negatively with crSO₂ (p = 0.012) and positively with cFTOE (p = 0.035) and cTOE (p = 0.037). Eighty-four term infants with a gestational age of 39.0 (38.5–38.9) weeks were analyzed. pCO₂ was 53.5 ± 6.3 mm Hg. At minute 15 after birth, crSO₂ was 84.4 (80.8–85.1)%, cFTOE 0.14 ± 0.08, cTOE 13.6 ± 7.9%, SpO₂ 96.5 ± 2.6%, and HR 155 (153–163) bpm. pCO₂ did only negatively correlate with pO₂ (p = 0.034) in term infants. Conclusion: In preterm infants, higher pCO₂ was associated with lower crSO₂ and higher cFTOE/cTOE. In term infants, no associations were observed. The present findings suggest that the vasodilatative effect of pCO₂ is less pronounced in preterm infants during immediate postnatal transition.

Aim: To investigate cerebral blood volume (CBV) in preterm neonates using time‐resolved near‐infrared spectroscopy.Methods: In this prospective observational study, time‐resolved near‐infrared spectroscopy measurements of CBV using tNIRS‐1 were performed in 70 preterm neonates. For measurements, a sensor was placed for a duration of 1 min, followed by four further reapplications of the sensor, overall five measurements.Results: In this study, 70 preterm neonates with a mean ± SD gestational age of 33.4 ± 1.7 weeks and a birthweight of 1931 ± 398 g were included with a postnatal age of 4.7 ± 2.0 days. Altogether, 2383 CBV values were obtained with an overall mean of 1.85 ± 0.30 mL/100 g brain. A total of 95% of the measured CBV values varied in a range from −0.31 to 0.33 from the overall individual mean. Taking the deviation of the mean of each single application for each patient, this range reduced from −0.07 to 0.07. The precision of the measurement defined as within‐variation in CBV was 0.24 mL/100 g brain.Conclusion: The overall mean CBV in stable preterm neonates was 1.85 ± 0.30 mL/100 g brain. The within‐variation in CBV was 0.24 mL/100 g brain. Based on the precision obtained by our data, CBV of 1.85 ± 0.30 mL/100 g brain may be assumed as normal value for this cohort.

Severe desaturation or bradycardia often occur during neonatal endotracheal intubation. Using continuous gas flow through the endotracheal tube might reduce the incidence of these events. We hypothesized that continuous gas flow through the endotracheal tube during nasotracheal intubation compared to standard nasotracheal intubation will reduce the number of intubation attempts in newborn infants. In a randomized controlled pilot study, neonates were either intubated with continuous gas flow through the endotracheal tube during intubation (intervention group) or no gas flow during intubation (control group). Recruitment was stopped early due to financial and organizational issues. A total of 16 infants and 39 intubation attempts were analyzed. The median (interquartile range) number of intubation attempts and number of abandoned intubations due to desaturation and/or bradycardia were 1 (1–2) and 4 (2–5), (p = 0.056) and n = 3 versus n = 20, (p = 0.060) in the intervention group and control group, respectively. Continuous gas flow through the endotracheal tube during intubation seems to be favorable and there are no major unexpected adverse consequences of attempting this methodology.

Preterm infants exhibit dynamic hematological profiles during the first postnatal days, necessitating robust reference intervals for clinical interpretation. The aim of this study is to establish comprehensive reference intervals for complete blood counts in preterm neonates during the first five postnatal days, stratified by gestational age and postnatal age. Data from preterm neonates (23 + 0–34 + 0 weeks gestation) admitted to the neonatal intensive care unit Graz (2008–2023) were analyzed. Percentiles (2.5th, 10th, 50th, 90th, 97.5th) were generated for the following hematological parameters included in the full/complete and differential blood count (FBC, CBC): leukocytes, thrombocytes, hemoglobin, hematocrit, neutrophilic granulocytes, and lymphocytes. Stringent exclusion criteria minimized confounding factors. Comparisons were made between appropriate-for-gestational age (AGA) and small-for-gestational age (SGA) neonates. A total of 3128 eligible preterm neonates with a median (minimum; maximum) gestational age of 32.1 (23.1; 34.0) weeks and a birth weight of 1700 (297; 3210) grams were included for analysis. Reference intervals were established for each parameter across gestational ages and postnatal days. Significant differences were observed between AGA and SGA neonates, particularly for leukocytes, thrombocytes, and neutrophilic granulocyte with lower values in SGA infants. Hemoglobin concentration and hematocrit were largely similar between groups, with some exceptions at specific gestational ages. Conclusion : This study provides reference intervals for hematological parameters in preterm neonates, enabling improved clinical interpretation and identification of deviations. The large sample size and strict exclusion criteria enhance the validity of these reference intervals. The observed differences between AGA and SGA neonates warrant further investigation to understand the clinical implications of fetal growth restriction on neonatal hemato-/lymphopoiesis. What is Known: • Existing neonatal hematologic reference intervals often lack stratification by gestational age and fetal growth .• This limits their utility in preterm and small-for-gestational-age infants, who have unique hematologic profiles due to distinct developmental trajectories and potential perinatal complications . What is New: • This study establishes hematologic reference intervals stratified by gestational age and postnatal age specifically for preterm neonates .• It further highlights key differences between appropriate-for-gestational age and small-for-gestational age infants, improving the diagnostic accuracy for this vulnerable population .