Background: For preterm infants, human milk (HM) has to be fortified to cover their enhanced nutritional requirements and establish adequate growth. Most HM fortifiers are based on bovine protein sources (BMF). An HM fortifier based on human protein sources (HMF) has become available in the last few years. The aim of this study is to investigate the impact of an HMF versus BMF on growth in extremely low birth weight (ELBW, <1000 g) infants. Methods: This was a retrospective, controlled, multicenter cohort study in infants with a birthweight below 1000 g. The HMF group received an exclusive HM diet up to 32+0 weeks of gestation and was changed to BMF afterwards. The BMF group received HM+BMF from fortifier introduction up to 37+0 weeks. Results: 192 extremely low birth weight (ELBW)-infants were included (HMF n = 96, BMF n = 96) in the study. After the introduction of fortification, growth velocity up to 32+0 weeks was significantly lower in the HMF group (16.5 g/kg/day) in comparison to the BMF group (18.9 g/kg/day, p = 0.009) whereas all other growth parameters did not differ from birth up to 37+0 weeks. Necrotizing enterocolitis (NEC) incidence was 10% in the HMF and 8% in the BMF group. Conclusion: Results from this study do not support the superiority of HFM over BMF in ELBW infants.

Ziel: Die diagnostische Genauigkeit der pränatalen Ultraschalluntersuchung (US) bei der Feststellung zentralnervöser Anomalien wurde untersucht mit dem Ziel, festlegen zu können, in welchen Fällen die US-Untersuchung verlässlich genug ist, um als Grundlage für die Entscheidung über eine medizinisch indizierte Interruptio zu dienen, ohne die Magnetresonanztomographie (MRT) heranziehen zu müssen. Ausführung: Retrospektive Analyse des Entwicklungsverlaufs von 69 Feten, bei denen mittels pränatalem Ultraschall in einer Universitätsklinik Anomalien des ZNS festgestellt wurden. Untersuchungsort: Allgemeines Krankenhaus Wien, Universität Wien, Österreich. Methode: Die pränatale sonographische Diagnose wurde bei Lebendgeborenen verifiziert durch postpartalen US, MRT oder Computertomographie (CT), bei abortierten Feten durch die Autopsie. Ergebnisse: Eine Interruptio wurde durchgeführt bei 40 Feten wegen Anencephalus (n = 4), Exencephalus (n = 6), dorsaler Dysrhaphie (n = 6), Encephalocele (n = 3), ausgeprägtem Hydrocephalus (n = 11), Holoprosencephalus (n = 4), Dandy-Walker-Zyste (n = 5) und einem komplexen Syndrom. Alle diese Diagnosen wurden durch die Autopsie bestätigt. Bei 29 Lebendgeborenen waren Hydrocephalus, Meningomyelocele und Microcephalus jeweils pränatal korrekt diagnostiziert worden. Vier Chiari-Missbildungen waren übersehen worden. Eine Agenesie des Corpus callosum war in vier von vierzehn Fällen unbemerkt geblieben, während sie in fünf Fällen fälschlich diagnostiziert wurde. Zu häufigen Fehldiagnosen führten Fälle von Dandy-Walker-Zyste und großer Cisterna magna. Zusammenfassung: Die transabdominale fetale Sonographie zog keine unnötigen Eingriffe nach sich. Fehler bei der Feststellung von Anomalien der Fossa posterior und des mittleren Telencephalon sowie die ätiologische Klärung eines Hydrocephalus erfordern bei ausgewählten Fällen eine zusätzliche MRT-Untersuchung des fetalen ZNS. Objective: The accuracy of fetal ultrasound (US) in diagnosing central nervous system (CNS) malformations was assessed with the aim to define in which cases US is reliable enough to assist in decisions on medical indication for abortions without resorting to magnetic resonance imaging (MRI). Design: Retrospective analysis of the course of 69 fetuses with anomalies of the CNS detected on prenatal US in a university hospital. Setting: General Hospital of Vienna, University of Vienna, Austria. Method: Prenatal US diagnosis was verified by postpartal US, MRI or computed tomography (CT) in the live births, and by autopsy of the fetus in cases of pregnancy termination. Results: Abortion was induced in 40 fetuses for anencephaly (n = 4), exencephaly (n = 6), dorsal dysraphism (n = 6), encephalocele (n = 3), pronounced hydrocephaly (n = 11), holoprosencephaly (n = 4), Dandy Walker cyst (n = 5), and 1 complex syndrome - all confirmed on autopsy. In 29 live births, hydrocephaly, meningomyelocele, and microcephaly had always been correctly identified prenatally. Four Chiari malformations had been missed. Agenesis of the corpus callosum had remained unnoticed in 4 out of 14 cases and been erroneously reported in 5. Diagnostic errors were frequent for Dandy-Walker cyst and great cerebellomedullary cistern. Conclusion: Transabdominal fetal US did not lead to unjustified interventions. Inaccuracy in diagnosing abnormalities of the posterior fossa and the median telencephalon as well as aetiological clarification of hydrocephalus require additional MRI of the fetal CNS in patients selected accordingly.

Objective: In continuous positive airway pressure (CPAP) devices, pressure can be generated by two different mechanisms: either via an expiratory valve or by one or more jets. Valved CPAP devices are referred to as constant‐flow devices, and jet devices are called variable‐flow devices. Constant‐flow CPAP devices are said to reduce the imposed work of breathing due to lower breath‐dependent pressure fluctuations. The present study investigates the performance of various constant‐ and variable‐flow CPAP devices in relation to breath‐dependent pressure fluctuations.Design: Experimental study comparing the pressure fluctuations incurred by seven neonatal CPAP devices attached to an active neonatal lung model.Methodology: Spontaneous breathing was simulated using a tidal volume of 6 ml at pressure levels of 5, 7, and 9 mbar. The main outcomes were respiratory pressure fluctuations, tidal volume, and end‐expiratory pressure.Results: All CPAP devices tested showed respiratory pressure fluctuations, varying from 0.631 to 3.466 mbar. The generated tidal volume correlated significantly with the pressure fluctuations (r = −0.947; p = 0.001) and varied between 5.550 and 6.316 ml. CPAP devices with jets showed no advantage over CPAP devices with expiratory valves. End‐expiratory pressure in the nose deviated from the set pressure between −1.305 and 0.644 mbar and varied depending on whether the pressure was measured in the device or in the tube extending to the nose.Conclusion: During standard spontaneous breathing, breath‐dependent pressure fluctuations in constant‐ and variable‐flow devices are comparable. Pressure measurements taken in the tubing system can lead to a considerable deviation of the applied pressure.

Background: In respiratory distress syndrome, many neonatology centers worldwide perform minimal invasive surfactant application in premature infants, using small-diameter catheters for endotracheal intubation and surfactant administration. Methods: In this single-center, open-label, randomized-controlled trial, preterm infants requiring surfactant administration after birth, using a standardized minimal invasive protocol, were randomized to two different modes of endotracheal catheterization: Flexible charrière-4 feeding tube inserted using Magill forceps (group 1) and semi-rigid catheter (group 2). Primary outcome was duration of laryngoscopy. Secondary outcomes were complication rate (intraventricular hemorrhage, soft-tissue damage in first week of life) and vital parameters during laryngoscopy. Between 2019 and 2020, 31 infants were included in the study. Prior to in-vivo testing, laryngoscopy durations were studied on a neonatal airway mannequin in students, nurses and doctors. Results: Mean gestational age and birth weight were 27 + 6/7 weeks and 1009 g; and 28 + 0/7 weeks and 1127 g for group 1 and 2, respectively. Length of laryngoscopy was similar in both groups (61.1 s and 64.9 s) overall (p.77) and adjusted for weight (p.70) or gestational age (p.95). Laryngoscopy failed seven times in group 1 (43.8%) and four times (26.7%) in group 2 (p.46). Longer laryngoscopy was associated with lower oxygen saturation with lowest levels occurring after failed laryngoscopy attempts. Secondary outcomes were similar in both groups. In vitro data on 40 students, 40 nurses and 12 neonatologists showed significant faster laryngoscopy in students and nurses group 2 (p < .0001) unlike in neonatologists (p.13). Conclusion: This study showed no difference in laryngoscopy duration in endotracheal catheterization when comparing semi-rigid and flexible catheters for minimal invasive surfactant application in preterm infants. In accordance with preliminary data and in contrast to published in-vitro trials, experienced neonatologists were able to perform endotracheal catheterization using both semi-rigid and flexible catheters at similar rates and ease, in vitro and in vivo. Trial registration: ClinicalTrials.gov. NCT05024435 Registered 27 August 2021—Retrospectively registered.

Because of its simplicity, pulse oximetry plays a ubiquitous role in neonatology. Its measurements are based on the absorption of light by hemoglobin. Ambient light can affect these values, therefore algorithms are designed to compensate for constant ambient light. Modern light-emitting diodes often flicker at a very high frequency. Such flickering ambient light can lead to significant measurement errors in saturation. To present a novel way in which light-emitting diodes influence the function of pulse oximeters and to demonstrate mathematically that a stroboscopic effect may well be responsible for this disturbance. Using publicly available data, a mathematical model of a pulse oximeter with a calibration curve and a proprietary measurement algorithm was created. This was used to simulate saturation measurements in flickering ambient light. To do this, photopletysmograms for red and infrared light at 98% oxygen saturation were mathematically superimposed on the light emission from an examination lamp used in the intensive care unit. From these results, presumable saturation measurements from a pulse oximeter were extrapolated. The light-emitting diodes in the examination lamp flicker at 207 Hz. The pulsating light from the light-emitting diodes causes superimposition of the photoplethysmogram due to the stroboscopic effect. With increasing brightness, the saturation dropped to 85% and the pulse rate to 108 bpm. The pulsed light of light-emitting diodes can distort pulse oximetry measurements. The stroboscopic effect leads to low saturation values, which can lead to the risk of blindness in premature infants due to excessive oxygenation.