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SARS-CoV-2 infection during pregnancy can adversely affect maternal and neonatal health, although risks vary depending on the variant of concern (VOC). Omicron, although highly infectious, causes fewer maternal and neonatal complications than earlier VOC, so vaccination may be considered unnecessary in planned pregnancy. Using data from the CRONOS registry, we compared pregnancy outcomes according to VOC and vaccination status. We found that vaccination during pregnancy reduced preterm birth rates compared with unvaccinated or vaccinated women with Omicron infection, without increasing severe neonatal outcomes. Given the risks associated with preterm birth, the study consistently supports vaccination recommendations for women planning pregnancy.

Abstract Background In mechanically ventilated neonates, the arterial partial pressure of $$\text {CO}_{2}$$ CO 2 ( $$\text {PaCO}_{2}$$ PaCO 2 ) is an important indicator for the adequacy of ventilation settings. Determining the $$\text {PaCO}_{2}$$ PaCO 2 is commonly done using invasive blood gas analyses, which constitute risks for neonates and are typically only available infrequently. An accurate, reliable, and continuous estimation of $$\text {PaCO}_{2}$$ PaCO 2 is of high interest for medical staff, giving the possibility of a closer monitoring and faster reactions to changes. We aim to present a non-invasive estimation method for $$\text {PaCO}_{2}$$ PaCO 2 in neonates on the basis of end-tidal $$\text {CO}_{2}$$ CO 2 ( $$\text {etCO}_{2}$$ etCO 2 ) with inclusion of different physiological and ventilation parameters. The estimation method should be more accurate than an estimation by unaltered $$\text {etCO}_{2}$$ etCO 2 measurements with regard to the mean absolute error and the standard deviation. Methods Secondary data from 51 preterm lambs are used, due to its high comparability to preterm human data. We utilize robust linear regression on 863 $$\text {PaCO}_{2}$$ PaCO 2 measurements below or equal to 75 mmHg from the first day of life. $$\text {etCO}_{2}$$ etCO 2 along with a set of ventilation settings and measurements as well as vital parameters are included in the regression. Included independent variables are chosen iteratively by highest Pearson correlation to the remaining estimation deviation. Results The evaluation is carried out on 12 additional neonatal lambs with 246 $$\text {PaCO}_{2}$$ PaCO 2 measurements below or equal to 75 mmHg from the first two days of life. The estimation method shows a mean absolute error of 3.80 mmHg with a 4.92 mmHg standard deviation of differences and a standard error of 0.31 mmHg in comparison to measured $$\text {PaCO}_{2}$$ PaCO 2 by blood gas analysis. Conclusions The estimation of $$\text {PaCO}_{2}$$ PaCO 2 by the proposed equation is less biased than unaltered $$\text {etCO}_{2}$$ etCO 2 . The usage of this method in clinical practice or in applications like the automation of ventilation needs further investigation.

Different pathophysiological pathways (endotypes), leading to very preterm birth may result in distinct clinical phenotypes of bronchopulmonary dysplasia (BPD). Ureaplasma is a unique player in the pathogenesis of BPD. The interaction between factors inherent to Ureaplasma (virulence, bacterial load, duration of exposure), and to the host (immune response, infection clearance, degree of prematurity, respiratory support, concomitant infections) may contribute to BPD development in a variable manner. The data reviewed herein support the hypothesis that Ureaplasma, as a representative of the infectious/inflammatory endotype, may produce pulmonary damage predominantly in parenchyma, interstitium, and small airways. In contrast, Ureaplasma may have a very limited role in the pathogenesis of the vascular phenotype of BPD. In addition, if Ureaplasma is a key factor in BPD pathogenesis, its eradication by macrolides should prevent BPD. However, various meta-analyses do not show consistent evidence that this is the case. The limitations of current definitions and classifications of BPD, based on respiratory support needs instead of pathophysiology and phenotypes, may explain this and other failures in strategies aimed to prevent BPD. The precise mechanisms through which Ureaplasma infection leads to altered lung development and how these pathways can result in different BPD phenotypes warrant further investigation.

Glacio-hydrological models combine both glacier and catchment hydrology modeling and are used to assess the hydrological response of high-mountain glacierized catchments to climate change. To capture the uncertainties from these model combinations, it is essential to compare the outcomes of several model entities forced with the same climate projections. For the first time, we compare the results of two completely independent glacio-hydrological models: (i) HQsim-GEM and (ii) AMUNDSEN. In contrast to prevailing studies, we use distinct glacier models and glacier initialization times. At first glance, the results achieved for future glacier states and hydrological characteristics in the Rofenache catchment in Ötztal Alps (Austria) appear to be similar and consistent, but a closer look reveals clear differences. What can be learned from this study is that low-complexity models can achieve higher accuracy in the calibration period. This is advantageous especially when data availability is weak, and priority is given to efficient computation time. Furthermore, the time and method of glacier initialization play an important role due to different data requirements. In essence, it is not possible to make conclusions about the model performance outside of the calibration period or more specifically in the future. Hence, similar to climate modeling, we suggest considering different modeling approaches when assessing future catchment discharge or glacier evolution. Especially when transferring the results to stakeholders, it is vital to transparently communicate the bandwidth of future states that come with all model results.

BackgroundPoractant alfa (Curosurf®) and Bovactant (Alveofact®) are two animal-derived pulmonary surfactants preparations approved for the treatment of neonatal respiratory distress syndrome (nRDS). They differ in their source, composition, pharmaceutical form, and clinical dose. How much these differences affect the acute pulmonary response to treatment is unknown.ObjectivesComparing these two surfactant preparations in two different animal models of respiratory distress focusing on the short-term response to treatment.MethodsPoractant alfa and Bovactant were administered in a 50–200 mg/kg dose range to surfactant-depleted adult rabbits with acute respiratory distress syndrome induced by lavage and to preterm lambs (127–129 days gestational age) with nRDS induced by developmental immaturity. The acute impact of surfactant therapy on gas exchange and pulmonary mechanics was assessed for 1 h in surfactant-depleted rabbits and for 3 h in preterm lambs.ResultsOverall, treatment with Bovactant 50 mg/kg or Poractant alfa 50 mg/kg did not achieve full recovery of the rabbits’ respiratory conditions, as indicated by significantly lower arterial oxygenation and carbon dioxide values. By contrast, the two approved doses for clinical use of Poractant alfa (100 and 200 mg/kg) achieved a rapid and sustained recovery in both animal models. The comparison of the ventilation indices of the licensed doses of Bovactant (50 mg/kg) and Poractant alfa (100 mg/kg) showed a superior performance of the latter preparation in both animal models. At equal phospholipid doses, Poractant alfa was superior to Bovactant in terms of arterial oxygenation in both animal models. In preterm lambs, surfactant replacement therapy with Poractant alfa at either 100 or 200 mg/kg was associated with significantly higher lung gas volumes compared to Bovactant treatment with 100 mg/kg.ConclusionAt the licensed doses, the acute pulmonary response to Poractant alfa was significantly better than the one observed after Bovactant treatment, either at 50 or at 100 mg/kg dose, in two animal models of pulmonary failure.