Abstract Introduction: There are no population-based data on neonatal outcomes of infants born in Germany at 22-25 weeks’ gestation. We set out to obtain national data on neonatal outcomes of infants born at 22-25 weeks gestation. Methods: We analyzed mandatory quality control data submitted by all neonatal intensive care units on all infants born alive in Germany at 220/7 to 256/7 weeks’ gestation and generating a neonatal case who died or were discharged between 1/1/2014 and 31/12/2023, focusing on survival to discharge/transfer and survival without severe complications of prematurity. Results: The number of live-births totaled 1889 at 22, 3405 at 23, 5193 at 24 weeks, and 5572 at 25 weeks. The proportion of infants offered intensive care at birth increased from 39.9% at 22 to 98.9% at 25 weeks. Across the 10-year study period, this proportion increased from 37.6% (2014-2018) to 42.2% (2019-2023; p=0.04) for infants born at 22 weeks, but did not change at higher gestations. Survival in those offered intensive care at birth ranged from 41.4% at 22 weeks to 84.1% at 25 weeks. Survival without severe complications of prematurity in those offered intensive care increased from 8.0% to 43.0% between 22 and 25 weeks. Conclusions: In Germany, ∼40% of infants born alive at 22 weeks were offered intensive care at birth, of whom ∼40% survived. In these survivors, about 20% were discharged without severe neonatal complications. These population-based data may help to counsel parents with imminent birth at 22-23 weeks. The low number of live births at 22 and 23 weeks may reflect withholding of proactive prenatal management. Future studies should also ascertain deaths before labor and during delivery.
Introduction: Peripherally inserted central catheters (n-PICCs) are standard in neonatal intensive care but carry high complication rates. Ultrasound-guided non-tunneled centrally inserted central catheters (nT-CICCs) offer a potential alternative. This study compared outcomes of nT-CICCs versus n-PICCs in extremely low birth weight (ELBW) neonates. Methods: This is a single-center, comparative cohort study (April 2022-October 2025) enrolling neonates <1,000 g requiring central venous access. A retrospective cohort receiving n-PICCs was compared with a prospective cohort receiving nT-CICCs. The primary outcome was central line-associated bloodstream infection (CLABSI) density rate on successfully placed catheters. Secondary outcomes included procedural success, mechanical complications, and risk factors for CLABSI. Results: We analyzed 103 catheter insertions (50 nT-CICCs, 53 n-PICCs). Procedural success was 100% for nT-CICCs and 94% for n-PICCs (3 immediate failures excluded from follow-up). Among 100 indwelling catheters, nT-CICCs showed significantly lower CLABSI rates (1.83 vs. 11.09 per 1,000 catheter-days; p = 0.038). Overall complications affected 4% of the nT-CICC group versus 64% of the n-PICC group (p < 0.001). nT-CICCs enabled therapy completion in 66% of cases compared with 12% for n-PICCs. Catheter type was the sole independent predictor of CLABSI (adjusted HR 7.1, 95% CI: 1.01-49.74; p = 0.048). Conclusions: Ultrasound-guided nT-CICCs are associated with significantly lower rates of infectious and mechanical complications compared with n-PICCs in ELBW neonates. This approach provides a safer and more durable option for central venous access in this vulnerable population.
Respiratory syncytial virus (RSV) prophylaxis with the monoclonal antibody Nirsevimab has shown high efficacy in preventing severe lower respiratory tract infections in infants. However, the sequences of immunopathological phenomena leading to breakthrough infections and the role of RSV in causing extrapulmonary disease remain poorly understood. We report on a former preterm infant who developed an unusually severe form of necrotizing enterocolitis (NEC) requiring multiple emergency laparotomies and prolonged intensive care treatment in the context of severe RSV-bronchiolitis 22 days after passive immunization with Nirsevimab. RSV RNA was retrospectively detected using a validated RSV PCR assay in resected intestinal tissue obtained during the acute disease phase but was not detected in tissue collected during later surgical reconstruction. Our case highlights the need for clinicians to maintain a high index of suspicion for intestinal complications in infants with severe RSV infection. Although these findings raise the possibility of intestinal RSV involvement, a causal relationship between Nirsevimab prophylaxis, antibody-dependent enhancement (ADE), and NEC cannot be established from this single case. Confirmation in additional clinical and translational studies is required. Further clinical and translational studies are required to clarify the potential role of RSV in intestinal disease and the mechanisms underlying severe breakthrough infections.
Introduction: An Apgar score of 0 at 10 minutes is considered an indicator of poor prognosis and has historically influenced decisions regarding neonatal resuscitation. However, mortality estimates are largely based on small heterogeneous studies. We examined infant mortality among infants with Apgar score 0 at 10 minutes and compared mortality with that among infants with Apgar scores of 1, 2, or 3. Methods: This nationwide population-based cohort study included 2,638,291 singleton live births in Sweden from 1999 to 2024. Analyses included 1,608 infants born at ≥36 weeks’ gestation with an Apgar score of 0 to 3 at 10 minutes after birth. The primary outcome was all-cause infant mortality. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) were estimated using modified Poisson regression. Results: Of 1,608 infants, 277 had an Apgar score of 0, 327 a score of 1, 398 a score of 2, and 606 a score of 3 at 10 minutes. Among infants with Apgar score 0, 143 infants (51.6%) died within the first year. The aRRs (95% CIs) for infant mortality were 1.16 (0.98-1.37) compared with Apgar score 1, 2.48 (1.99-3.09) compared with Apgar score 2, and 2.85 (2.32-3.51) compared with Apgar score 3. Conclusion: Infant mortality did not differ statistically significantly between infants with Apgar scores of 0 and 1 at 10 minutes, and was higher in both groups than among infants with Apgar scores of 2 or 3. These findings are consistent with resuscitation guidelines emphasizing individualized decision-making.
Background/Objectives Preterm survivors, with or without bronchopulmonary dysplasia (BPD) have decreased and progressive lung function decline. As neonatal care has improved survival, limited studies have compared lung function trajectories across birth epochs. Methods Retrospective study of subjects born <33 weeks who completed ≥1 pulmonary function test (PFT). BPD was classified per 2019 NICHD criteria. We analyzed spirometry values and Dysanapsis Ratio (DR). Birth epochs included Epoch A(<2000), B (2000-2009), and C(2010-2019). Results We analyzed 2,216 PFTs from 707 subjects; 319 (45.1%) had BPD. Pulmonary function decreased with increasing BPD severity. FEV1 decreased monotonically, from 92.0%(80.1-102.0) in preterm without BPD to 73.1%(57.7-84.9) in Grade 3, with consistent decreases in FVC (99.0%(87.0-110.0) to 85.2%(71.5-93.4). FEV₁/FVC remained largely constant, with a small decrease in Grade 3. Due to divergence in FEV1 and FVC trend with increasing age, FEV1/FVC yearly decline slope tripled in more recent epochs in subjects with BPD (Epoch A:-0.4%/yr(-0.8 to 0.05), B:-0.8%/yr(-1.1 to -0.5),, C:-1.4%/yr(-1.8 to -0.9). Similarly, DR decreased with age, with steeper decline in more recent epochs (Epoch A:-0.01/yr(-0.02 to -0.0004), B:-0.02/yr(-0.03 to -0.01), C:-0.04/yr(-0.05 to -0.03). Similar declines were noted for FEV1/FVC and DR in children without BPD. Conclusion In preterm survivors, lung function declined with increasing BPD severity and age. Lung function was reduced and declined in preterm children without BPD. Recent birth epochs exhibited faster decline in FEV1/FVC and worsening DR, indicating evolving airway-parenchymal growth mismatch despite advances in neonatal care, highlighting the need for longitudinal follow-up and targeted interventions to improve long-term outcomes.
