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Zusammenfassung Hintergrund und Ziel der Studie Der Transport von Früh und Neugeborenen mit respiratorischem Versagen ist mit einem hohen Transportrisiko assoziiert und stellt höchste Anforderungen an medizinisches Personal und technische Ausrüstung. Eine kontinuierliche Überprüfung der Qualität ist daher unumgänglich. Ziel dieser monozentrischen retrospektiven Analyse ist es, die Mortalität transportierter Neugeborener mit respiratorischem Versagen mithilfe eines Outcomescores, Transport Risk index of Physiologic Stability, Version II, (TRIPS-II-Score) und im Vergleich zu bereits publizierter Literatur zu analysieren. Methodik Es wurden 79 Intensivtransporte von Früh- und Neugeborenen mit hochgradigem respiratorischem Versagen retrospektiv analysiert. Zur Einschätzung des Transportrisikos und der Transportqualität wurde der TRIPS-II-Score erhoben und mit der Literatur verglichen. Ergebnisse Insgesamt wurden 77 Patienten luft- (n = 56, 73 %) oder bodengebunden (n = 21, 27 %) transportiert. Zwei Patienten verstarben vor dem Transport. Kein Patient verstarb während des Transports. Alle Patienten mussten invasiv beatmet werden, davon 22 (29 %) mit Hochfrequenzoszillation (HFOV) und 55 (71 %) erhielten inhalatives Stickoxid (iNO). Der mittlere Oxygenierungsindex (OI) betrug 33 [4-100, min.-max.] Insgesamt mussten 24 Patienten (31 %) nach Aufnahme einer ECMO-Therapie unterzogen werden. Insgesamt verstarben 20 (26 %) Neugeborene, 7 davon in der ECMO-Therapie-Gruppe. Schlussfolgerung Transporte von Neugeborenen mit schwerem Lungenversagen können durch den Einsatz eines spezialisierten Teams mit Sonderequipment meist komplikationslos durchgeführt werden. Die scheinbar sehr hohe Mortalität ist mit Daten der internationalen Literatur vergleichbar.

Zusammenfassung Hintergrund In der Leitlinie zur Prophylaxe der frühen Form (Early Onset Sepsis, EOS) der Neugeborenensepsis durch Streptokokken der Gruppe B (GBS) wird ein GBS Screening aller Schwangeren empfohlen. Dieses ist jedoch nicht Bestandteil der Mutterschaftsrichtlinien. Studienziel war die Überprüfung des zeitlichen Verlaufs der Infektionsrate im Zusammenhang mit dem GBS Screening. Methodik Krankenversicherungsdaten der Jahre 2005 bis 2017 von 313 385 BARMER versicherten Mutter-Kind Paaren wurden analysiert. Über die ICD-10 P36.0 wurde die jährliche Häufigkeit von GBS Infektionen bei Neugeborenen ermittelt. Als Surrogat für das GBS Screening wurde die ICD-10 B95.1 verwendet, welche bekannte positive mütterliche GBS Besiedelung beschreibt. Durch logistische Regressionsmodelle wurden die zeitliche Veränderungen des Erkrankungsrisikos von EOS bei Neugeborenen untersucht. Pearson-Korrelationskoeffizient wurde zur Bewertung des Zusammenhangs zwischen der zeitlichen Veränderung der Häufigkeit an EOS und dem Surrogatmarker für GBS Besiedelung verwendet. Ergebnisse Das Erkrankungsrisiko der EOS bei Neugeborenen hat jährlich um 9,3% abgenommen, gesamt über die Beobachtungsjahre um 72,0%, während für die Spätform LOS (Late Onset Sepsis) keine statistisch signifikante Veränderung beobachtet wurde. Diese Abnahme konnte nicht durch zeitliche Veränderungen bei Kaiserschnitten, Risikofaktoren oder Frühgeburten erklärt werden. Eine gleichzeitige Erhöhung des Anteils der Mütter mit bekanntem positivem GBS Status um den Faktor 3,5 korrelierte invers (r=− 0,75; p=0,002) mit der Inzidenz von EOS. Schlussfolgerung Die starke Abnahme der EOS in Deutschland bei unveränderter Inzidenz von LOS könnte durch eine zunehmende Umsetzung des Schwangerenscreenings erklärt werden.

Introduction: Data on valid incidence estimates of perinatal arterial ischemic stroke (PAIS) are scarce. This analysis aims to determine incidence of PAIS in term- and preterm-born infants and to investigate clinical differences related to prematurity. Methods: This surveillance study (2015–2017) in all German paediatric hospital estimated incidences for MRI-confirmed PAIS in term and preterm infants. To correct for under-reporting, we performed capture-recapture-calculations (CRC) in the most populous federal state and extrapolated nationwide. Differences in clinical presentation in term- and preterm-born infants were assessed. Results: 126 term- and 19 preterm-born infants with PAIS were reported. CRC corrected incidence of PAIS was 22 (95% confidence interval [CI] 17, 27) per 100,000 live births. Stratified by prematurity, the incidence was 32 (95% CI 15, 49) per 100,000 in preterm-born infants and 21 (95% CI 16, 26) per 100,000 term-born infants (significant difference p = 0.001). In symptomatic cases only (n = 120 term born, n = 12 preterm born), incidences did not differ. Risk factor patterns were similar, but number of risk factors in preterm babies was elevated (mean 3.8 vs. 2.9; p = 0.01) and median age at diagnosis was increased (5 vs. 3 days; p = 0.04). Clinical seizures were observed in 88% (106/120) of symptomatic term infants compared to 33% (4/12) in preterm-born infants (p < 0.0001). Conclusion: PAIS incidence rates in Germany, extrapolated from estimates for completeness of reporting in the largest federal state, were within the range of other population-based studies. As a novel finding, we detected symptomatic PAIS in preterm-born infants to be as common as in term-born infants although their symptoms were often unspecific.

Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press. Aim: To describe the incidence of term and preterm neonatal cerebral sinovenous thrombosis (CSVT) and identify perinatal risk factors. Method: This was a national capture-recapture calculation-corrected surveillance and nested case–control study. Infants born preterm and at term with magnetic resonance imaging-confirmed neonatal CSVT were identified by surveillance in all paediatric hospitals in Germany (2015–2017). Incidence was corrected for underreporting using a capture-recapture method in one federal state and then extrapolated nationwide. We reviewed PubMed for comparisons with previously reported incidence estimators. We used a population-based perinatal database for quality assurance to select four controls per case and applied univariate and multivariable regression for risk factor analysis. Results: Fifty-one newborn infants (34 males, 17 females; 14 born preterm) with neonatal CSVT were reported in the 3-year period. The incidence of term and preterm neonatal CSVT was 6.6 (95% confidence interval [CI] 4.4–8.7) per 100000 live births. Median age at time of confirmation of the diagnosis was 9.95 days (range 0–39d). In the univariate analysis, male sex, preterm birth, hypoxia and related indicators (umbilical artery pH

Introduction: Incidence, risk factors, clinical presentation, onset of symptoms, and age at diagnosis differ between neonatal arterial ischaemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT). A more accurate and earlier discrimination of these two entities can be of eminent importance. Methods: Active surveillance for AIS and CSVT was performed in 345 German paediatric hospitals. Only MRI confirmed cases were included in our analysis. Patients with AIS were compared to CSVT cases with regard to age at diagnosis, pattern of clinical symptoms, and case characteristics. Results: Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The frequency of reported AIS cases was 2.8 [95% CI 2.1; 3.9] times higher compared to reported CSVT cases. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; p = 0.02) and to have signs of perinatal acidosis (30.2% CSVT vs. 13.5% AIS; p = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (p < 0.0001). Age at onset of symptoms and at time of diagnosis were shifted to older ages in CSVT (p < 0.0001). Discussion/Conclusion: In the neonatal period, AIS is about three times more common than CSVT. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal complications are more important for CSVT than for AIS.

In the German guidelines for prophylaxis of group B streptococcal (GBS) early onset sepsis in neonates (EOS), GBS screening of all pregnant women has been recommended, but is not yet included in the Maternity Directives. Aim of the study was to identify temporal trends in incidence of EOS and their association to GBS Screening.The analysis based on health insurance data of the statutory health insurance provider Barmer from 2005 to 2017 of 313,385 mother-child pairs. Annual frequency of GBS infections in newborns was determined by ICD-10 P36.0. The frequency of maternal GBS colonization was indicated by ICD-10 B95.1, which was used as surrogate for GBS screening. Temporal trends of the risk of EOS in neonates were assessed in logistic regression models. Pearson's correlation coefficient of EOS incidence and the surrogate marker for maternal GBS colonization was calculated.The risk of EOS in neonates caused by GBS has decreased annually by 9.3%, resulting in an overall decrease in the observation period of 72.0%. There was no statistical significant change in the risk for LOS (Late Onset Sepsis). The decrease of EOS could not be explained by temporal changes in Caesarian section, risk factors or preterm delivery. The 3.5 fold increase in the proportion of mothers with documented positive GBS colonization in the same period correlated inversely with the incidence of EOS (r=- 0.75; p=0.002).The decrease of EOS in neonates caused by GBS in Germany and the unchanged risk of LOS in neonates may be explained by the increasing application of the GBS Screening in pregnant women.In der Leitlinie zur Prophylaxe der frühen Form (Early Onset Sepsis, EOS) der Neugeborenensepsis durch Streptokokken der Gruppe B (GBS) wird ein GBS Screening aller Schwangeren empfohlen. Dieses ist jedoch nicht Bestandteil der Mutterschaftsrichtlinien. Studienziel war die Überprüfung des zeitlichen Verlaufs der Infektionsrate im Zusammenhang mit dem GBS Screening.Krankenversicherungsdaten der Jahre 2005 bis 2017 von 313 385 BARMER versicherten Mutter-Kind Paaren wurden analysiert. Über die ICD-10 P36.0 wurde die jährliche Häufigkeit von GBS Infektionen bei Neugeborenen ermittelt. Als Surrogat für das GBS Screening wurde die ICD-10 B95.1 verwendet, welche bekannte positive mütterliche GBS Besiedelung beschreibt. Durch logistische Regressionsmodelle wurden die zeitliche Veränderungen des Erkrankungsrisikos von EOS bei Neugeborenen untersucht. Pearson-Korrelationskoeffizient wurde zur Bewertung des Zusammenhangs zwischen der zeitlichen Veränderung der Häufigkeit an EOS und dem Surrogatmarker für GBS Besiedelung verwendet.Das Erkrankungsrisiko der EOS bei Neugeborenen hat jährlich um 9,3% abgenommen, gesamt über die Beobachtungsjahre um 72,0%, während für die Spätform LOS (Late Onset Sepsis) keine statistisch signifikante Veränderung beobachtet wurde. Diese Abnahme konnte nicht durch zeitliche Veränderungen bei Kaiserschnitten, Risikofaktoren oder Frühgeburten erklärt werden. Eine gleichzeitige Erhöhung des Anteils der Mütter mit bekanntem positivem GBS Status um den Faktor 3,5 korrelierte invers (r=− 0,75; p=0,002) mit der Inzidenz von EOS.Die starke Abnahme der EOS in Deutschland bei unveränderter Inzidenz von LOS könnte durch eine zunehmende Umsetzung des Schwangerenscreenings erklärt werden.

Background: We aimed to determine nationwide incidence for perinatal arterial ischemic stroke (PAIS) in term and preterm born newborns and to investigate differences in clinical presentation related to gestational age. Methods: This three-year nationwide surveillance study (2015–2017) estimated incidences for MRI confirmed PAIS diagnosed within the first 28 days of life in term and preterm infants. To correct for underreporting we performed capture-recapture-calculations in one federal state and extrapolated nationwide. Differences in clinical presentation in term and preterm born infants were assessed. Findings: 145 infants were reported of whom 19 were born prematurely. CRC corrected incidence for PAIS was 22·0 per 100,000 live births and 31·9 per 100,000 in preterm born infants (p=0·001). 13 (9%) MRI confirmed PAIS cases were classified as asymptomatic. In symptomatic cases, the incidence estimates did not differ between preterm and term born infants. No differences in risk factors were identified but number of risk factors in premature babies was elevated (mean 3·8 versus 2·9; p=0·01). Median age at diagnosis was increased in preterm born infants (7·9 days versus 3·6 days; p=0·04). Clinical seizures were observed in 88% of term born infants with symptoms compared to 33% in premature infants (p

After neonatal lung failure and especially after ECMO therapy long-term morbidities are common. The follow-up of these seriously ill neonates is an indispensable quality criterion for an ECMO centre and beyond that follow-up data are important for counselling parents. Yet, ECMO-centres often cover a large service area and follow-up is difficult due to long travel distances for parents. In this study, we therefor evaluated the applicability of questionnaires sent out to parents.We performed a follow-up examination and development screening for long-term morbidities in a cohort of former newborns with severe lung failure (n=31/41) using a questionnaire. In addition, doctor's letters and telephone interviews were evaluated by a systematic, partly computer-assisted approach RESULTS: Questionnaires were sent out to 28 families of the 31 surviving children. Of those, 23 were returned (82% response). Four children had conspicuous questionnaire results, i. e. they were below the 90In this study specific questionnaires were used for the first time in children with severe neonatal lung failure allowing the detection of abnormal development. This pilot trial shows that application of structured questionnaires seems feasible and should be further evaluated in a large cohort, controlled by established developmental tests.Nach neonatalem Lungenversagen und insbesondere nach einer ECMO-Therapie können verschiedenste Langzeitmorbiditäten auftreten. Das Follow-up dieser schwer kranken Neugeborenen ist als Qualitätskriterium für ein ECMO-Zentrum unverzichtbar und sie besitzt einen hohen Stellenwert in der Beratung von Eltern. Da ECMO-Zentren ein großes Einzugsgebiet haben, ist eine feste Anbindung der Patienten an das Zentrum oft schwierig.Nachsorgeuntersuchung und Entwicklungsscreening einer Kohorte (n=41) ehemaliger Neugeborener und Säuglinge mit schweren Lungenversagen auf Langzeitmorbiditäten durch eine Fragebogenerhebung sowie eine systematische, z.T. computergestützte Recherche mittels Arztbriefen und Telefonbefragung.An 28 von 31 Familien überlebender Kinder konnten Fragebögen versendet werden. 23 Fragebögen wurden zurückgesandt, einer Rücklaufquote von 82% entsprechend. Vier Kinder hatten auffällige Fragebogenergebnisse, d. h. sie lagen unter der 90ten Perzentile der altersentsprechenden Werte und besaßen damit ein Risiko für eine Entwicklungsauffälligkeit. Davon waren 3 Kinder im Alter von 2 Jahren und waren im Rahmen ihres Lungenversagens konventionell behandelt worden. Ein Kind im Alter von 6 Jahren hatte eine ECMO-Therapie erhalten.Die von uns erstmals an Kindern mit einem schweren neonatalen Lungenversagen eingesetzten Fragebögen können der Detektion einer Entwicklungsauffälligkeit dienen. In der klinischen Praxis sind sie als Entwicklungsscreening einsetzbar und auch für wissenschaftlichen Fragestellungen anwendbar.

Background Knowledge about the clinical spectrum of lung disease caused by variations in the ATP binding cassette subfamily A member 3 (ABCA3) gene is limited. Here we describe genotype-phenotype correlations in a European cohort. Methods We retrospectively analysed baseline and outcome characteristics of 40 patients with two disease-causing ABCA3 mutations collected between 2001 and 2015. Results Of 22 homozygous (15 male) and 18 compound heterozygous patients (3 male), 37 presented with neonatal respiratory distress syndrome as term babies. At follow-up, two major phenotypes are documented: patients with (1) early lethal mutations subdivided into (1a) dying within the first 6 months or (1b) before the age of 5 years, and (2) patients with prolonged survival into childhood, adolescence or adulthood. Patients with null/null mutations predicting complete ABCA3 deficiency died within the 1st weeks to months of life, while those with null/other or other/other mutations had a more variable presentation and outcome. Treatment with exogenous surfactant, systemic steroids, hydroxychloroquine and whole lung lavages had apparent but many times transient effects in individual subjects. Conclusions Overall long-term (>5 years) survival of subjects with two disease-causing ABCA3 mutations was

Aim: To identify maternal, obstetric, and neonatal risk factors related to perinatal arterial ischaemic stroke (PAIS) diagnosed within 28days after birth and to understand the underlying pathophysiology. Method: For case and control ascertainment, we used active surveillance in 345 paediatric hospitals and a population-based perinatal database for quality assurance of hospital care. We analysed complete cases of PAIS using logistic regression. Multivariate analysis was guided by a directed acyclic graph. Results: After exclusion of records with missing data, we analysed 134 individuals with PAIS and 576 comparison individuals. In univariate analysis, male sex, preterm birth (

Background Neonatal arterial ischemic stroke (NAIS) accounts for substantial long term sequelae in children. The potential effectiveness of neuroprotective therapies needs to be evaluated in appropriate studies with sufficient power. Objective To identify annual number of NAIS cases in Germany potentially eligible for randomized interventional trials. Methods Active surveillance for NAIS in 345 pediatric hospitals with questionnaire based validation of reported cases. Results Incidence of NAIS (7.1/100000 births) was in the range of other population-based studies. To design future clinical trials with anticoagulative or regenerative therapies, it is of major importance to distinguish between cases with or without relevant perinatal pathology. Children without underlying disease or premature birth accounted for 56% of all reported NAIS cases (primary NAIS). In 69% of the primary cases clinical seizures were observed. Although 31% showed other, less pathognomonic symptoms, NAIS was diagnosed. Mean time span between onset of symptoms and diagnosis was 2.9 days. The sensitivity of the initial ultrasound performed in all cases was 69%. Conclusions NAIS is a rare but not negligible morbidity in newborns. Asymptomatic children account for 56% of NAIS in all neonates. In these, not only seizures but also other unexplained symptoms should trigger diagnostic work-up with cUS and cMRI. Negative initial ultrasound results do not exclude NAIS.

In previous cases, we have observed occasional hypoglycaemic episodes in preterm infants after initial intensive care. In this prospective study, we determined the frequency and severity of abnormal tissue glucose (TG) in clinically stable preterm infants on full enteral nutrition.Preterm infants born at1000 g (n=23; G1) and birth weight 1000-1500 g (n=18; G2) were studied at a postmenstrual age of 32±2 weeks (G1) and 33±2 weeks (G2). Infants were fed two or three hourly, according to a standard bolus-nutrition protocol, and continuous subcutaneous glucose measurements were performed for 72 h. Normal glucose values were assumed at ≥2.5 mmol/L (45 mg/dL) and ≤8.3 mmol/L (150 mg/dL). Frequency, severity and duration of glucose values beyond normal values were determined.We observed asymptomatic low TG values in 39% of infants in G1 and in 44% in G2. High TG values were detected in 83% in G1 and 61% in G2. Infants in G1 experienced prolonged and more severe low TG episodes, and also more frequent and severe high TG episodes. In G1 and G2, 87% and 67% of the infants, respectively, showed glucose fluctuations characterised by rapid glucose increase followed by a rapid glucose drop after feeds. In more mature infants, glucose fluctuations were less pronounced and less dependent on enteral feeds.Clinically stable well-developing preterm infants beyond their initial period of intensive care show interstitial glucose instabilities exceeding values as low as 2.5 mmol/L and as high as 8.3 mmol/L. This novel observation may play an important role for the susceptibility of these high-risk infants for the development of the metabolic syndrome.German trial registration number DRKS00004590.

To determine the occurrence of hypoglycemic episodes in very low birth weight preterm infants under total enteral nutrition and identify potential risk factors.In this single centre cohort study, we analyzed the patients' charts of preterm infants with a gestational age32 weeks (n = 98). Infants were analyzed in two groups (group 1: birth weight1000 g, n = 54; group 2: birth weight 1000-1499 g, n = 44). A total of 3640 pre-feeding blood glucose measurements were screened. Risk factors for the development of hypoglycemia were identified by linear and multiple logistic regression analyses.In group 1, 44% (24 of 54) of infants experienced at least one asymptomatic episode of blood glucose45 mg/dl (2.5 mmol/l) as compared with 23% (10 of 44) in group 2. Regression analysis identified low gestational age and high carbohydrate intake as potential risk factors for the development of hypoglycemia.Our results indicate that numerous preterm infants experience hypoglycemic episodes once on total enteral nutrition, especially those who are1000 g at birth and those with a higher carbohydrate intake. Further studies evaluating a possible impact of these common although asymptomatic episodes on later development could help to better define thresholds that should be considered as "hypoglycemia" in this population.

Knowledge about the clinical spectrum of lung disease caused by variations in the ATP binding cassette subfamily A member 3 (ABCA3) gene is limited. Here we describe genotype-phenotype correlations in a European cohort.We retrospectively analysed baseline and outcome characteristics of 40 patients with two disease-causing ABCA3 mutations collected between 2001 and 2015.Of 22 homozygous (15 male) and 18 compound heterozygous patients (3 male), 37 presented with neonatal respiratory distress syndrome as term babies. At follow-up, two major phenotypes are documented: patients with (1) early lethal mutations subdivided into (1a) dying within the first 6 months or (1b) before the age of 5 years, and (2) patients with prolonged survival into childhood, adolescence or adulthood. Patients with null/null mutations predicting complete ABCA3 deficiency died within the 1st weeks to months of life, while those with null/other or other/other mutations had a more variable presentation and outcome. Treatment with exogenous surfactant, systemic steroids, hydroxychloroquine and whole lung lavages had apparent but many times transient effects in individual subjects.Overall long-term (5 years) survival of subjects with two disease-causing ABCA3 mutations was20%. Response to therapies needs to be ascertained in randomised controlled trials.

Background: Acinar dysplasia and alveolar capillary dysplasia are rare interstitial lung diseases, belonging to the diffuse developmental disorders of the lungs. About 10% of the cases are familiar, 40% carry a FOXF1-mutation. Usually disease starts on the first days of life with severe hypoxia, and is mostly lethal during the newborn period. Aims: Investigate the clinical, histological and genetic spectrum of this orphan disease and differentiate subtypes Methods: All patients categorized as diffuse developmental disorder in the kids lung register were searched. Diagnosis was made by lung biopsy or autopsy. Between October 2004 and October 2014 11 children were observed and analysed retrospectively. Results: All children had a need for oxygen during the neonatal time. 7 children developed severe hypoxemia and pulmonary hypertension at the latest 48 hours after initial good adaptation. An infant with an omphalocele and one preterm-infant needed oxygen immediately after birth. In one infant symptoms started not until day 12 of life, he showed complete remission at the age of 29 days. Outcome was lethal in 8 children at an average age of 44 days. In 4 patients FOXF1 gene was analysed and two heterozygote deletions were detected. Conclusion: Diffuse developmental disorders of the lungs represent a rare but important differential diagnosis in children with hypoxemia and pulmonary hypertension. Fatality was associated with histologic pattern, i.e. presence of misalignment of the pulmonary veins. Screen for disease causing mutations in the FOXF1-gene, particular in infants with associated malformations, may reduce the number of lung biopsies necessary for diagnosis.

Background We previously observed hypoglycaemic episodes in preterm infants after achieving full enteral feeds and during a stable postnatal period. The purpose of this study was to prospectively determine subcutaneous glucose levels in this population. Methods Preterm infants Results 81.3% of the infants in A and 44.4% in B showed relevant glucose fluctuations during monitoring. Hypoglycaemic episodes occurred in 37.5% in group A, compared to 22.2% in group B. In group A 7% of infants showed glucose values below 1.7mmol/L. We also observed hyperglycaemic episodes (>8.3mmol/L) after feeds (A: 57%, B:17%), followed by rapid drops in both cohorts. Cumulatively, all hypo- and hyperglycaemic episodes lasted >60 min (16%), 35–60 min (21%), 10–30min (60%) and Conclusion Otherwise stable, well developing former very low birth weight preterm infants are at risk for glucose instability, generally considered as unfavourable. It remains unclear whether this instability is likely to influence long-term outcome and whether continuous feeds are preventive.

Background Neonatal extracorporal membrane oxygenation (ECMO) for pulmonary failure is characterised by small cannulas and low flow rates. Novel rotary pumps with diagonal blood flow and a reduced priming volume are now available. Bench studies in different in-vitro models and the short-term use for cardio-pulmonary bypass in paediatric patients are encouraging. However, little data exist on the effect of these devices on hemolysis in the defined group of neonates with respiratory failure. Design We prospectively studied circuit settings, plasma-free haemoglobin (fHb), lactatdehydrogenase and coagulation activation in neonates receiving veno-arterial ECMO due to respiratory failure with a novel diagonal pump system. Results Eight newborns (3280 g [2700; 4380, Median; Range]) received veno-arterial ECMO through 8–10Fr venous and 8Fr arterial cannulas appropriate for neck vessels. All infants were maintained on a centrifugal pump system for 4.3d (2; 7.3). Median flow rate and venous cannula pressure were 259 ml/min (215; 314), and -9 cm H2O (-50; -1) respectively. The median revolutions per minute of the pump were 4774 (4008; 6801). Mild hemolysis was detected within 24 h in all patients [median fHb 12.1 mg/dl (7.0; 70.9)] with a further increase after 48 hrs. Two patients (25%) developed disseminated intravascular coagulation and persistent moderate hemolysis. Conclusion Our in vivo data support previous in vitro studies by demonstrating that the use of a centrifugal pump on small venous and arterial cannula appears to be safe and effective for neonatal ECMO. Yet, ECMO for more than 48 hrs holds the risk for an increased hemolysis and disseminated intravascular coagulation.