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BackgroundAn understanding vaccine-dependent effects on protective and sustained humoral immune response is crucial to planning future vaccination strategies against coronavirus disease 2019 (COVID-19).MethodsIn this multicenter, population-based, cohort study including 4601 individuals after primary vaccination against COVID-19 ≥ 4 months earlier we compared factors associated with residual antibody levels against severe acute respiratory syndrome coronavirus-2 receptor-binding domain (RBD) across different vaccination strategies (BNT162b2, mRNA-1273, or ChAdOx1).ResultsOur main model including 3787 individuals (2 × BNT162b2, n = 2271; 2 × mRNA-1273, n = 251; 2 × ChAdOx1, n = 1265), predicted significantly lower levels of anti-RBD antibodies after 6 months in individuals vaccinated with ChAdOx1 (392.7 binding antibody units per milliliter [BAU/mL]) compared with those vaccinated with BNT162b2 (1179.5 BAU/mL) or mRNA-1273 (2098.2 BAU/mL). Vaccine-dependent association of antibody levels was found for age with a significant predicted difference in BAU/ml per year for BNT162b2 (−21.5; 95% confidence interval [CI], −24.7 to −18.3) and no significant association for mRNA-1273 (−4.0; 95% CI, −20.0 to 12.1) or ChAdOx1 (1.7; 95% CI, .2 to 3.1). The predicted decrease over time since full immunization was highest in mRNA-1273 (−23.4; 95% CI, −31.4 to −15.4) compared with BNT162b2 (−5.9; 95% CI, −7 to −4.8).ConclusionsOur study revealed population-based evidence of vaccine-dependent effects of age and time since full immunization on humoral immune response. Findings underline the importance of individualized vaccine selection, especially in elderly individuals.

Bayley Scales of Infant and Toddler Development (Bayley-III) determines scaled scores and converts these into composite scores. It was shown that applying of the German and the US manual leads to different results. This study aims to systematically analyze the differences between the US and German Bayley-III version and to develop conversion equations.This simulation study generated a dataset of pairs of US and German Bayley III composite scores (cognitive: n=4,416, language: n=240,000, motor: n=314,000) by converting the same number of achievable tasks for 48 age groups. Bland-Altman-plots and regression analysis was performed to develop conversion equations for all age groups.German and US Bayley-III scores demonstrate distinct slope and interception for cognitive, language and motor composite scores. Lower developmental performance lead to higher composite scores with US norms compared to German norms (up to 15 points). These differences varied between age groups. With newly developed conversion equations the results can be converted (R²0.98).This study confirms systematic differences between US and German Bayley test results due to different reference cohorts. Our data considers the full age range and adds conversion equations. These findings need to be acknowledged when comparing Bayley Scores internationally.

Objectives: To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight 90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached. Results: In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier. Conclusions: We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants.

To evaluate the impact of a parenteral lipid emulsion containing fish oil compared with a soybean oil based-lipid emulsion on the cognitive outcome and behavior of preschool children with extremely low birth weight.This was a retrospective secondary outcome analysis of a randomized controlled trial performed between June 2012 and June 2015. Infants with extremely low birth weight received either a mixed (soybean oil, medium chain triglycerides, olive oil, fish oil) or a soybean oil-based lipid emulsion for parenteral nutrition. Data from the Kaufman Assessment Battery for Children II, the Child Behavior Checklist 1.5-5, and anthropometry were collected from medical charts at 5.6 years of age.At discharge, 206 of the 230 study participants were eligible. At 5 years 6 months of age, data of 153 of 206 infants (74%) were available for analysis. There were no significant differences in Kaufman Assessment Battery for Children II scores for Sequential/Gsm, Simultaneous/Gv, Learning/Glr, and Mental Processing Index (mixed lipid: median, 97.5 [IQR, 23.5]; soybean oil: median, 96 [IQR, 19.5]; P = .43) or Child Behavior Checklist 1.5-5 scores for internalizing problems, externalizing problems, or total problems (mixed lipid: median, 37 [IQR, 12.3]; soybean oil: median, 37 [IQR, 13.5]; P = .54).A RandomForest machine learning regression analysis did not show an effect of type of lipid emulsion on cognitive and behavioral outcome. Parenteral nutrition using a mixed lipid emulsion containing fish oil did not affect neurodevelopment and had no impact on child behavior of infants with extremely low birth weights at preschool age.ClinicalTrials.gov: NCT01585935.

Position paper of the Federal Association of German Hospital Pharmacists, the nutrition committees of the German and Austrian Societies of Pediatrics and Adolescent Medicine and the working group on intestinal failure of the Society of Pediatric Gastroenterology and Nutrition. In 2019 the German Federal Institute for Drugs and Medical Devices (Bundesinstitut fur Arzneimittel und Medizinprodukte, BfArM) launched a “doctors letter” (Rote-Hand-Brief) recommending light protection of all parenteral nutrition (PN) solutions during administration for preterm infants, term infants and children less than 2 years of age. The aim of the present paper is to review the available evidence and provide evidence-based recommendations for hospital and home PN light protection in children. The Federal Association of German Hospital Pharmacists, the nutrition committees of the German and Austrian Societies of Pediatrics and Adolescent Medicine and the working group on intestinal failure of the Society of Pediatric Gastroenterology and Nutrition recommend in accordance with the recommendations of the ESPGHAN, ESPEN, ESPR and CESPEN guidelines on pediatric parenteral nutrition: 1. Lipid emulsions and/or vitamins containing PN solutions should be protected from light during administration (bags and tubing) to prevent the generation of oxidants. 2. There is no conclusive evidence for recommending light protection for PN solutions without lipid emulsions and without vitamins during administration (solutions containing, e.g. amino acids, glucose, electrolytes, or trace elements). In addition, in home PN non-light-protected spiral tubing may be used because validated light-protected spiral tubing is currently not available, given that spiral tubing improves the range of motion and safety in infants and young children.

For preterm and small-for-gestational age infants on enteral nutrition, the best solution is to add human milk fortifier (HMF) to human milk (HM) which is provided by the mother or a milk bank. HMF provides a means to add additional protein, energy, and micronutrients, while maintaining HM as the main source of nutrition. Because of their rapid increase of lean body mass, preterm infants have much higher protein requirements than term infants. Recommendations on protein requirements of preterm infants are available, but protein quality - i.e. the amino acid (AA) profile in HMFs has not been systematically assessed. Present guidelines for enteral nutrition recommend protein intakes around 4 g/kg body weight (BW) for preterm infants

ZusammenfassungEine tägliche Vitamin-D-Supplementierung für Säuglinge bis zum zweiten erlebten Frühsommer zur Prävention der Rachitis und die Gabe von Vitamin K1 bei Neugeborenen zur Prävention von Vitamin-K-Mangel-Blutungen sind empfohlen.Seit einiger Zeit sind in Österreich Kombinationsprodukte der beiden fettlöslichen Vitamine D3 und K2 auf dem Markt erhältlich, die mit gesundheitsfördernden Effekten wie verbesserter Knochenmineralisation und Schutz vor vaskulärer Kalkeinlagerung beworben werden.Die Wirkung einer kombinierten Supplementierung von Vitamin D und Vitamin K2 bei Kindern ist aus physiologischer Sicht gesehen zwar potenziell sinnvoll, um Effekt, Risiken oder unerwünschte Nebenwirkungen zu evaluieren. Zuvor werden aber Dosisfindungs- und Sicherheitsstudien für die kombinierte Verabreichung benötigt. Insbesondere sind randomisierte kontrollierte Studien bei Risikokindern und Frühgeborenen notwendig. Solange diese Daten nicht vorliegen, erscheint die Gabe von Vitamin D in Kombination mit Vitamin K2 im Kindesalter nicht gerechtfertigt und kann daher auch nicht empfohlen werden.

Understanding vaccine-dependent effects on protective and sustained humoral immune response are crucial to plan further vaccination strategies against COVID-19. Population-based data comparing different vaccination strategies are lacking.This multicenter, population-based cohort study included 4,601 individuals ≥18 years of age after primary vaccination against COVID-19 at least four months ago (full immunization). We compared factors associated with residual antibody levels against SARS-CoV-2 receptor binding domain (RBD) across different vaccination strategies (BNT162b2, mRNA-1273, or ChAdOx1 nCoV-19 [ChAdOx1]).Our main model including 3,787 individuals (2xBNT162b2 n = 2,271, 2xmRNA-1273 n = 251, 2xChAdOx1 n = 1,265) predicted significantly lower levels of anti-RBD-antibodies after 6 months in individuals vaccinated with ChAdOx1 (392.7 BAU/ml) compared to those vaccinated with BNT162b2 (1179.5 BAU/ml) or mRNA-1273 (2098.2 BAU/ml). Vaccine-dependent association of antibody levels was found for age with a significant predicted difference in BAU/ml per year for BNT162b2 (-21.5 [95%CI -24.7 to -18.3]) and no significant association for mRNA-1273 (-4.0 [95%CI -20.0 to 12.1]) or ChAdOx1 (1.7 [95%CI 0.2 to 3.1]). The predicted decrease over time since full immunization was highest in mRNA-1273 (-23.4 [95%CI -31.4 to -15.4]) compared to BNT162b2 -5.9 [95%CI -7 to -4.8]). Higher antibody levels were observed for individuals with systemic adverse events upon vaccination and current smoking (BNT162b2), for days between first and second vaccination (BNT162b2 and ChAdOx1) and for absence of comorbidities (all).Our study revealed population-based evidence of vaccine-dependent effects of age and time since full immunization on humoral immune response. Findings underline the importance of an individualized vaccine selection, especially in elderly individuals.

Parenteral nutrition, usually indicated for preterm infants with a birthweight1500 g and sick newborns, enables the supply with critical nutrients. As a high degree of therapy safety is required, a European guideline provides recommendations for safe therapy procedures. The present project aimed to evaluate the implementation of the European guideline in German perinatal centers and to identify possible barriers that impede its implementation. A further goal was to develop solution approaches to overcome possible barriers.A multidisciplinary cooperation conducted an online survey questioning the current implementation procedures of the European guideline among pediatricians and hospital pharmacists. Results show barriers in the provisioning process of parenteral nutrition that hinder a guideline-compliant implementation in practice. Based on results of this survey, an expert network developed an interactive toolkit with simplified guideline recommendations, guideline-compliant advice for practice, best-practice examples, forms, and handouts. It seeks to encourage critical reflection of routine processes and provides concrete solutions to overcome barriers in practice.The current procedures related to parenteral nutrition deviate from guideline recommendations. The developed toolkit provides practice-oriented support aiming to enhance the guideline-compliant implementation of parenteral nutrition in perinatal centers.Die parenterale Ernährung (PE) ist gewöhnlich bei Frühgeborenen1500 g Geburtsgewicht und kranken Neugeborenen indiziert und gewährleistet eine Versorgung mit essentiellen Nährstoffen. Da ein hohes Maß Therapiesicherheit erforderlich ist, gibt die europäische Leitlinie Empfehlungen zur sicheren Anwendung. Dieses Projekt zielte darauf ab, die Anwendung der europäischen Leitlinie in deutschen Perinatalzentren zu evaluieren und Barrieren, die die Umsetzung erschweren oder verhindern, abzubilden. Zusätzlich sollten Lösungsansätze zur Überwindung möglicher Barrieren erarbeitet werden.In einer multidisziplinären Kooperation wurde eine Online-Umfrage durchgeführt, in der PädiaterInnen und KrankenhausapothekerInnen aus Perinatalzentren zur Umsetzung der europäischen Leitlinien befragt wurden. Die Umfrageergebnisse wiesen auf Barrieren entlang des Bereitstellungsprozesses der PE hin, die eine leitliniengerechte Anwendung erschweren. Basierend auf den Ergebnissen erarbeitete das Expertennetzwerk ein interaktives Toolkit mit vereinfachten Leitlinienempfehlungen, leitlinienkonformen Anwendungsratschlägen, Best-Practice-Beispielen, Formularen und Handouts. Es soll zur kritischen Reflexion der Routineprozesse anregen und liefert konkrete Lösungsansätze zur Überwindung der Barrieren in der Praxis.Die Anwendung der PE bei Früh- und kranken Neugeborenen weicht von den Leitlinienempfehlungen ab. Das erarbeitete Toolkit liefert praxisorientiere Hilfestellungen mit dem Ziel, eine leitliniengerechte Anwendung in Perinatalzentren zu fördern.

To determine total sodium load, including inadvertent load, during the first 2 postnatal weeks, and its influence on serum sodium, morbidity, and mortality in extremely low birth weight (ELBW, birth weight1000 g) infants and to calculate sodium replacement models.Retrospective data analysis on ELBW infants with a gestational age28 + 0/7 weeks.Ninety patients with a median birth weight of 718 g and a median gestational age of 24 + 6/7 weeks were included. Median sodium intake during the first 2 postnatal weeks was 10.2 mmol/kg/day, which was significantly higher than recommended (2-5 mmol/kg/day). Sodium intake did not affect the risk for hypernatremia. Each mmol of sodium intake during the first postnatal week was associated with an increased risk of bronchopulmonary dysplasia (45%) and higher-grade intraventricular hemorrhage (31%), during the second postnatal week for necrotizing enterocolitis (19%), and during both postnatal weeks of mortality (13%). Calculations of two sodium replacement models resulted in a decrease in sodium intake during the first postnatal week of 3.2 and 4.0 mmol/kg/day, respectively.Sodium load during the first 2 postnatal weeks of ELBW infants was significantly higher than recommended owing to inadvertent sodium intake and was associated with a higher risk of subsequent morbidity and mortality, although the study design does not allow conclusions on causality. Replacement of 0.9% saline with alternative carrier solutions might reduce sodium intake.Sodium intake in ELBW infants during the first 2 postnatal weeks was twofold to threefold higher than recommended; this was mainly caused by inadvertent sodium components. High sodium intake is not related to severe hypernatremia but might be associated with a higher morbidity in terms of BPD, IVH, and NEC. Inadvertent sodium load can be reduced by replacing high sodium-containing carrier solutions with high levels of sodium with alternative hypotonic and/or balanced fluids, model based.

Introduction: The aims of the study were to describe the neurodevelopmental outcome of extremely low birth weight (ELBW) infants with parenteral nutrition-associated cholestasis (PNAC) and to assess whether PNAC is associated with adverse neurodevelopmental outcome. Methods: The study is a secondary analysis of controlled trial (June 2012–October 2017) on PNAC incidence in ELBW infants receiving two different parenteral lipid emulsions (mixed lipid emulsion containing fish oil vs. soybean oil-based). Neurodevelopmental follow-up at 12- and 24-month corrected age was compared in infants with and without PNAC. A machine learning-based regression analysis was used to assess whether PNAC was associated with adverse neurodevelopmental outcome. Results: For assessment of neurodevelopmental outcome (Bayley-III), 174 infants were available at 12-month (PNAC: n = 21; no PNAC: n = 153) and 164 infants at 24-month (PNAC: n = 20; no PNAC: n = 144) corrected age. The neurodevelopment of ELBW infants with PNAC was globally delayed, with significantly lower cognitive, language, and motor scores at both 12- and 24-month corrected age. Regression analyses revealed that PNAC was associated with an adverse motor outcome. Conclusion: ELBW infants with PNAC are at increased risk for adverse neurodevelopmental outcome.

In term infants it is recommended to introduce solids between the 17th and 26th week of life, whereas data for preterm infants are missing. In a prospective, two-arm interventional study we investigated longitudinal growth of VLBW infants after early (10–12th) or late (16–18th) week of life, corrected for term, introduction of standardized complementary food. Primary endpoint was height at one year of age, corrected for term, and secondary endpoints were other anthropometric parameters such as weight, head circumference, BMI, and z-scores. Among 177 infants who underwent randomization, the primary outcome could be assessed in 83 (93%) assigned to the early and 83 (94%) to the late group. Mean birthweight was 941 (SD ± 253) g in the early and 932 (SD ± 256) g in the late group, mean gestational age at birth was 27 + 1/7 weeks in both groups. Height was 74.7 (mean; SD ± 2.7) cm in the early and 74.4 cm (mean; SD ± 2.8; n.s.) cm in the late group at one year of age, corrected for term. There were no differences in anthropometric parameters between the study groups except for a transient effect on weight z-score at 6 months. In preterm infants, starting solids should rather be related to neurological ability than to considerations of nutritional intake and growth.

In preterm infants, the key goals of nutrition are to establish adequate growth and to contribute to appropriate neurodevelopmental outcome. In this context, the postdischarge period is crucial to establish catch-up growth and avoid wrong metabolic programming caused by overfeeding. Breastfeeding is strongly recommended, and for preterm infants the European Society for Gastroenterology, Hepatology, and Nutrition (ESPGHAN) suggests fortifying breastmilk after discharge up to term in appropriate growing infants and up to 3 months in growth-retarded infants. If breastfeeding is not possible, postdischarge formula should be fed at least up to term. However, the effects of a higher nutrient density and energy administered by breastmilk fortification or postdischarge formula on growth and neurodevelopmental outcome are limited or missing but might have a positive impact on lung function and vision later in life. Moreover, little is known on the optimal timepoint to introduce solids in preterm infants. Data from observational studies have shown that preterm infants are weaned early in life around 13-15 weeks of corrected age. The degree of prematurity and use of formula are major determinants for early complementary feeding introduction. It is emphasized that there should be a strong focus on the infant's anatomical, physiological, and oral-motor readiness to receive foods other than breast milk or formula. Feeding problems and preterm's eating difficulties are common, and especially in the very immature population approximately 30% show oro-motor dysfunction or avoidant behavior at 3 months. An individualized approach according to the infant's neurological ability and nutritional status seems to be the best practice when introducing complementary feeding in preterm infants especially in the absence of evidence-based guidelines.

Providing a human milk fortifier once the preterm infant has started to suckle at the breast can be challenging for the mother and might shorten duration of the breastfeeding period. Fortification is recommended up to term for the normal-growing infant and up to 3 months in growth-retarded infants. After hospital discharge, some mothers may not want to pump, fortify, and bottle-feed the fortifier-milk mixture any longer. They desire to breastfeed their infants directly from the breast, but unfortunately, fortification often interferes with direct breastfeeding. Cup feeding is the most researched fortification method and appears to be safe but cannot be applied during nursing. Another alternative is the supplemental nursing systems, but only a few low-quality studies investigated the method, which is difficult to handle and requires a lot of nursing experience. The use of a finger feeder to administer a fortifier to preterm infants is a new method that enables mothers to exclusively breastfeed their infants and meet their nutritional needs. Mothers reported easy preparation and handling of the fortifier. More than 67% of the infants accepted the device and fortifier application during nursing very well. However, the development of further methods to augment preterm infant nutrition that does not interfere with breastfeeding is of great interest. Future efforts to enable fortification during breastfeeding must be linked to the development of ready-to-use devices containing liquid human milk fortification mixtures.

Zusammenfassung Hintergrund Die Leitlinien der „European Society for Paediatric Gastroenterology, Hepatology and Nutrition“ (ESPGHAN) liefern evidenzbasierte Empfehlungen zu parenteraler Ernährung (PE) von Frühgeborenen und kranken Neugeborenen. Im Jahr 2013 wurde gezeigt, dass sie in Westeuropa nur teilweise angewendet werden und ihre klinische Implementierung verbessert werden sollte. Ziel der Arbeit Ziel dieser Arbeit ist, die derzeitige Anwendung der ESPGHAN-Leitlinien in Deutschland sowie Barrieren, die die Umsetzung verhindern, abzubilden. Material und Methoden Zusammen mit einer Expertengruppe und Institutionen aus dem deutschsprachigen Raum hat die „European Foundation for the Care of Newborn Infants“ (EFCNI) eine Befragung durchgeführt. Mit einem Online-Fragebogen wurden Pädiaterinnen/Pädiater (PÄD) und Krankenhausapothekerinnen/Krankenhausapotheker (KHA) aus deutschen Perinatalzentren und Krankenhausapotheken bezüglich der Umsetzung der Leitlinien befragt. Die Ergebnisse wurden qualitativ und quantitativ ausgewertet. Ergebnisse und Diskussion Von 558 angeschriebenen Kontakten wurden 196 gültige Umfragen ausgewertet. Nach Eigenangaben wenden 77 % der PÄD und 48 % der KHA die ESPGHAN-Leitlinien an. Barrieren wurden innerhalb der klinischen Anwendung identifiziert und waren teilweise struktureller und/oder organisatorischer Natur. Verbesserungsbedarf wurde in der Bereitstellung von parenteralen Standardlösungen, insbesondere am Wochenende, und elektronischen Verordnungssystemen, der Verabreichung von Lipiden bereits am 1. Lebenstag und der regelmäßigen Beurteilung aller Laborparameter beobachtet.

Das Zytomegalievirus (CMV) kann wahrend der Laktation reaktiviert und uber Muttermilch ubertragen werden. Diese Ubertragung ist fur reife Neugeborene in der Regel unproblematisch, kann aber bei Fruhgeborenen zu einer CMV-Infektion mit Veranderungen des Blutbildes und der Leberfunktionsparameter, sepsisartigen Symptomen und gastrointestinalen Symptomen wie blutigen Stuhlen bis hin zur nekrotisierenden Enterokolitis fuhren. Je unreifer das Fruhgeborene bei der Geburt ist, umso hoher ist die Wahrscheinlichkeit einer via Muttermilch ubertragenen CMV-Infektion. Um extreme Fruhgeborene vor einer CMV-Infektion zu schutzen, empfiehlt die Ernahrungskommission der Osterreichischen Gesellschaft fur Kinder- und Jugendheilkunde, die Muttermilch von CMV-positiven Muttern (IgM-neg., IgG-pos.) bei Fruhgeborenen mit einem Gestationsalter

Objective To examine whether parenteral nutrition using a mixed lipid emulsion containing fish oil improves the neurodevelopmental outcomes of extremely low birth weight infants. Study design The study is a secondary outcome analysis of a double-blind randomized trial of 230 extremely low birth weight infants performed at a single level IV neonatal care unit (Medical University Vienna; June 2012 to June 2015). Participants received either a mixed lipid emulsion composed of soybean oil, medium chain triglycerides, olive oil, and fish oil, or a soybean oil-based lipid emulsion for parenteral nutrition. Neurodevelopment of study participants was assessed at 12 and 24 months corrected age (August 2013 to October 2017) using the Bayley Scales of Infant-Toddler Development, third edition. Results At discharge, 206 of the 230 study participants were eligible. At 12 and 24 months corrected age, 174 of 206 (85%) and 164 of 206 (80%) infants were evaluated. At 12 months, there was no significant difference in cognitive (mixed lipid: median, 95 [IQR, 85-101]; soybean oil: median, 95 [IQR, 85-100]; P = .71), language (mixed lipid: median, 86 [IQR, 77-94], soybean oil: median, 89 [IQR, 79-94]; P = .48), or motor scores (mixed lipid: median, 88 [IQR, 76-94], soybean oil: median, 88 [IQR, 79-94]; P = .69). At 24 months, there was again no significant difference in cognitive (mixed lipid: median, 95 [IQR, 80-105], soybean oil: median, 95 [IQR, 90-105]; P = .17), language (mixed lipid: median, 89 [IQR, 75-97], soybean oil 89 [IQR, 77-100]; P = .54), and motor scores (mixed lipid: median, 94 [IQR, 82-103], soybean oil: median, 94 [IQR, 85-103]; P = .53). Conclusions Parenteral nutrition using a mixed lipid emulsion containing fish oil did not improve neurodevelopment of extremely low birth weight infants at 12 and 24 months corrected age. Trial registration ClinicalTrials.gov : NCT01585935 .

Introduction Bleeds such as intra-ventricular (IVH) and pulmonary haemorrhage (PH) are life-threatening events in extremely low birth weight (ELBW) infants. Serial coagulation monitoring by measuring the international normalized ratio (INR) with small volume samples might facilitate early diagnosis and possibly prevent major bleeds. Materials and Methods This was a prospective longitudinal study performed in ELBW infants, who received serial INR monitoring by point of care testing during their first 30 days of life. The primary objective was to explore whether INR monitoring could predict major bleeding events (IVH, PH). Secondary objectives were mortality and feasibility in this patient population. Results A total of 127 ELBW infants were stratified into a bleeding and a non-bleeding group. Bleeding events occurred in 31% (39/127) of the infants, whereupon 24% developed IVH and 9% PH. Infants in the bleeding group were 4 days younger at birth (p = 0.05) and had a substantially higher mortality rate of 26% versus 5% in controls (p = 0.005). Median INR during the first 3 days before a bleeding event was 1.55 (95% confidence interval [CI]: 1.39–1.74) compared with the control group with 1.45 (95% CI: 1.44–1.58; p = 0.81). Platelet counts were significantly lower in the bleeding group on the 3rd day and during the 2nd to 4th week of life. Discussion Serial coagulation monitoring by an INR point of care testing is feasible in ELBW infants but could not predict bleeding events. Further studies with daily monitoring of INR and platelet counts during the first days of life might be able to more precisely detect a risk of major haemorrhage in ELBW infants.

BACKGROUND Preterm birth is a medical emergency and it is becoming evident that adequate nutrition starting in the first hours of life is of major importance for short and even more so for long-term health outcomes of the premature newborn. The aim was to analyze postnatal nutrient supply and growth patterns of preterm infants in response to a standardized feeding protocol during stay at neonatal intensive care unit (NICU). METHODS A prospective cohort study was conducted at NICU, Children Hospital Graz. Infants were divided in two groups

Stillen bzw. die Futterung von Muttermilch ist die optimale Ernahrung fur das Neugeborene und beeinflusst Gesundheit, Wachstum, Abwehr und Entwicklung positiv. Mutter sollten im Wochenbett bestmogliche Unterstutzung erfahren, um eine ausreichende Laktation zu etablieren. Fur die meisten Neugeborenen ist ausschliesliches Stillen wahrend der ersten Lebenstage ausreichend. Es gibt aber einige wenige medizinische Indikationen, bei denen ein kurzfristiges Zufuttern notig sein kann. Die Academy of Breastfeeding Medicine (ABM) gibt hierzu eine praktikable Hilfestellung, die unter Berucksichtigung der Kriterien der „Baby-friendly Hospital Initiative“ (BFHI) der WHO notwendige medizinische Indikationen fur Zufuttern klar definiert. Dies konnen sowohl kindliche (z. B. Gewichtsabnahme >10 %) als auch mutterliche (z. B. passagere Medikamenteneinnahme von mit dem Stillen nichtvereinbarer Medikamente) Indikationen sein. Besteht tatsachlich eine Indikation zum Zufuttern, sollte in erster Linie abgepumpte Muttermilch oder pasteurisierte Frauenmilch verwendet werden. Ist diese nicht vorhanden, stehen Formulanahrungen zur Verfugung. Auch fur die „spaten Fruhgeborenen“ (geboren zwischen der 34 + 0 und 36 + 6 Schwangerschaftswoche) ist Muttermilch die optimale Ernahrung. Aufgrund der speziellen Bedurfnisse und des erhohten Nahrstoffbedarfs dieser Patientengruppe muss diese engmaschiger uberwacht werden. Anreicherung der Muttermilch mit Muttermilchsupplementen, Nachpumpen nach dem Stillen zur Laktationsanregung und Trinkwiegungen sind hilfreiche Masnahmen, um das Gedeihen des spaten Fruhgeborenen zu uberwachen und zu optimieren.

Aim This study compared the impact of using either single donor breast milk or formula to start enteral feeding in preterm infants, on the time to full enteral feeding, growth and morbidity. The milk was provided by other preterm mothers. Methods This was an observational prospective study, carried out from June 2012 - March 2013 at the Medical University of Vienna, Austria, on the effects of preterm single donor milk on 133 very low birth weight infants with a birth weight

Several studies have shown a relation between the size of corpus callosum (CC) and outcome in preterm infants. Three-dimensional ultrasound (3D-US) offers new perspectives in cerebral imaging. To establish reference values for biometry of the CC in very low birth weight infants and to correlate these measurements to neurodevelopmental outcome at 5 years of age.Forty-three preterm infants with a gestational age32 weeks were included. Transfontanellar 3D-US measurements were obtained at nine different timepoints.3D-US-based reference values for size, length, circumference and surface area of the CC could be established. Measurements at term-equivalent age showed a correlation to neurodevelopment outcome.Reliable biometric data of the CC can be established in preterm infants by 3D-US and correlate with neurodevelopmental outcome.

Iatrogenic gastrointestinal perforations are rare, but life-threatening events in preterm infants.Aim of the study was to report on incidence, management, morbidity, and mortality.This was a retrospective analysis performed at a tertiary neonatal intensive care unit in Vienna, Austria.Extremely low birth weight infants (ELBW, birth weight 1000 g) with perforations of the upper gastrointestinal tract (GIT) caused by gastric tubes were included.All ELBW infants born within the 6-year study period were identified and their discharge summaries or notes were screened for esophageal and gastric perforations. Data on incidence, management of GIT perforations, morbidity, and mortality were obtained.During a 6-year study period 646 ELBW infants were analyzed. Incidence of perforations was 1.1% (n = 7/646). Median gestational age was 23 + 3 (range: 23 + 0-24 + 5). Perforations occurred on the third day of life (=median, range: day 2-14) and were primarily managed conservatively. Enteral feeding was stopped for 6 days (range: 4-13 days), antibiotic therapy administered for 16 days (range: 8-22 days). In one infant, gastrorrhaphy was performed.Conservative treatment of upper GIT perforations led to spontaneous recovery without major complications in 85.7%.