Background Surgical access to the cervico-thoracic junction in pediatric tumors presents substantial challenges due to complex anatomy and the proximity of critical neurovascular structures. To improve interdisciplinary training and minimize iatrogenic risks, we optimized a stepwise dissection protocol-referred to as the "Trail of Safety"-using formalin-fixed cadavers. Methods Sixteen bilateral cervico-thoracic dissections were conducted on eight formalin-fixed adult cadavers by a team of vascular and pediatric surgeons. A structured protocol involving supraclavicular incision, median sternotomy, and anterolateral thoracotomy was employed to sequentially expose neurovascular structures, including the common carotid, subclavian and vertebral arteries, as well as the vagus, phrenic and recurrent laryngeal nerves. Each anatomical landmark was scored for difficulty of exposure using a four-point scale. Results All targeted neurovascular structures were successfully exposed. Supraclavicular and midline approaches provided reliable access to anterior mediastinal structures without necessitating lateral thoracotomy. The vertebral artery and recurrent laryngeal nerves were consistently the most challenging to expose.The rigid lungs of formalinfixed cadavers impeded visualization of posterior mediastinal structures, which became accessible only after lung removal. Bidirectional dissection (from both cervical and thoracic fields) improved safety and exposure, particularly for nerves obscured beneath the clavicle. Conclusions The formalin-fixed cadaveric model proved effective for iterative interdisciplinary training and for refining a reproducible "Trail of Safety" protocol.This approach enhances anatomical familiarity and may contribute to safer surgical strategies for rare but complex pediatric cervico-thoracic pathologies.

Background: Pediatric emergencies remain a significant challenge for emergency services. The study aimed to retrospectively analyze invasive measures and medication administered during prehospital care. The analysis focused on invasive procedures (e.g., tracheal intubation and vascular access) performed on pediatric patients (aged 1 month to 12 years) admitted via the Central Emergency Department (ED) or directly to the University Pediatric Intensive Care Unit (PICU) of the University Hospital of Cologne. These findings provide insights into quality assurance and improvement of prehospital care and invasive emergency techniques in pediatrics. Methods: Emergency protocols were evaluated, including parameters such as the Glasgow Coma Scale (GCS) and National Advisory Committee for Aeronautics (NACA) score. Patients were categorized based on diagnosis, medication administration, and invasive emergency techniques. Results: A total of 373 patients were admitted to the ED, and 237 patients were admitted to the PICU between 01/2015 and 05/2020. Sedation was at similar in both groups, while catecholamines were more frequently used in the PICU group. Invasive procedures, such as tracheal intubation, were rare (PICU: 9.5%; ED: 5.8%; p = 0.093). Peripheral venous access was performed in 33.7% of PICU cases and 51.2% of ED cases, whereas central venous access was almost never performed. 19 children admitted to the PICU died compared to one in the ED ( p < 0.001). Conclusion: Invasive procedures are rarely performed during prehospital care for pediatric patients. Trauma cases predominated in the ED group (99.2%), whereas the PICU group exhibited greater diagnostic variability, including trauma and internal emergencies. This study identified significant gaps in medical documentation. Training for paramedics and emergency health workers should prioritize airway management, including supraglottic airway (SGA) devices, thoracic drainage, and vascular access techniques such as peripheral intravenous (PIV) and intraosseous (IO) access. Additionally, efforts to improve medical documentation should be emphasized to enhance pediatric emergency care.

BackgroundIn contrast to critical care transport of adults or newborns, transport of pediatric critical care patients in Germany is neither regulated by law nor centrally organized. Due to their different therapeutic needs compared to newborns or adults, critically ill children may receive insufficient treatment during transport. In some regions in Germany, pediatric centers provide specialized pediatric retrieval teams, while others organize each transport individually. Currently, no valid data on pediatric critical care transports in Germany are available, nor are they recorded in a structured manner.ObjectivesTo establish a nationwide registry for pediatric intensive care transports in Germany. The aim is to describe and analyze the need for and current practice of specialized transports. This data may be used for future demand planning.SettingTransports are documented by pediatric centers admitting pediatric patients via intensive care transports.Inclusion criteriaAll interhospital pediatric intensive care transports of children, aged >27 days and >41 + 0 weeks of corrected gestational, age to <18 years, are eligible for data entry.MethodsThe study is designed as a prospective, multicenter registry. Transport data will be collected locally at participating pediatric centers and then submitted digitally and anonymized via a secure, web-based platform.DiscussionWe anticipate high participation from pediatric intensive care units and expect to present valid data on the need for pediatric intensive care transports in Germany. This data may serve as a foundation for nationwide demand planning for pediatric intensive care transport resources.

Purpose In late 2022, a surge of severe S. pyogenes infections was reported in several European countries. This study assessed hospitalizations and disease severity of community-acquired bacterial infections with S. pyogenes, S. pneumoniae, N. meningitidis , and H. influenzae among children in North Rhine-Westphalia (NRW), Germany, during the last quarter of 2022 compared to long-term incidences. Methods Hospital cases due to bacterial infections between October and December 2022 were collected in a multicenter study (MC) from 59/62 (95%) children's hospitals in NRW and combined with surveillance data (2016–2023) from the national reference laboratories for streptococci, N. meningitidis , and H. influenzae . Overall and pathogen-specific incidence rates (IR) from January 2016 to March 2023 were estimated via capture–recapture analyses. Expected annual deaths from the studied pathogens were calculated from national death cause statistics. Results In the MC study, 153 cases with high overall disease severity were reported with pneumonia being most common (59%, n = 91). IRs of bacterial infections declined at the beginning of the COVID-19 pandemic and massively surged to unprecedented levels in late 2022 and early 2023 (overall hospitalizations 3.5-fold), with S. pyogenes and S. pneumoniae as main drivers (18-fold and threefold). Observed deaths during the study period exceeded the expected number for the entire year in NRW by far (7 vs. 0.9). Discussion The unprecedented peak of bacterial infections and deaths in late 2022 and early 2023 was caused mainly by S. pyogenes and S. pneumoniae . Improved precautionary measures are needed to attenuate future outbreaks.

ZusammenfassungDer prahospitale Kreislaufstillstand bei schwangeren Patientinnen ist ein sehr seltenes Ereignis. Dies limitiert die Erfahrung des Einzelnen. Strukturierte Trainingsformate zur prahospitalen perimortalen Crash-Sectio (PPCS) sind nicht etabliert. Gleichzeitig benotigt die Versorgung dieser Patientinnen sowohl prahospital als auch innerklinisch erhebliche personelle und therapeutische Ressourcen. Die Kasuistik soll fur eine deutsche Metropolregion die exemplarische Ressourcenverwendung und die zeitliche Dimension der Versorgung demonstrieren. Basierend auf einer Literaturrecherche werden alternative Therapieentscheidungen diskutiert. AbstractOut-of-hospital cardiac arrest in pregnant women is a very rare event; thus, the experience of individual people regarding this situation is limited. Structured training for prehospital perimortem caesarean section (PPCS) is not widely established. At the same time, the care of these patients requires considerable pre-hospital and in-hospital resources to be coordinated. The described case is intended to demonstrate an example of resource utilization and the duration of treatment in a German metropolitan region. Alternative therapy decisions are discussed based on the literature.

Abstract Purpose Neuroblastoma, the most common extracranial solid tumor in children under 5 years, often surrounds visceral arteries. This study aimed to analyze the working space provided by standardized surgical techniques at key arterial landmarks in adult cadavers. Methods We assessed in eight adult cadavers the mobilization of the left colon, spleen and pancreas, right colon, duodenum and mesenteric root, access to the bursa omentalis. The average working space score (AWSS) was evaluated at the left and right renal artery, left and right side of the coeliac trunk, superior mesenteric and common hepatic artery. The score was defined as: (0) vessel not visible, (1) working space at the vessel ≤ 1x diameter of the aorta, (2) < 3x the diameter of the aorta, (3) ≥ 3x diameter of the aorta. Results The maximum AWSS of 3 was achieved at key vascular landmarks through specific mobilization techniques. Conclusion Additional mobilization of spleen, pancreas and mesenteric root and access to the bursa omentalis increase surgical working space at major visceral arteries. The results of our investigation provide surgeons with a useful guide to prepare for abdominal neuroblastoma resection.

Zusammenfassung Der prähospitale Kreislaufstillstand bei schwangeren Patientinnen ist ein sehr seltenes Ereignis. Dies limitiert die Erfahrung des Einzelnen. Strukturierte Trainingsformate zur prähospitalen perimortalen Crash-Sectio (PPCS) sind nicht etabliert. Gleichzeitig benötigt die Versorgung dieser Patientinnen sowohl prähospital als auch innerklinisch erhebliche personelle und therapeutische Ressourcen. Die Kasuistik soll für eine deutsche Metropolregion die exemplarische Ressourcenverwendung und die zeitliche Dimension der Versorgung demonstrieren. Basierend auf einer Literaturrecherche werden alternative Therapieentscheidungen diskutiert.

Background Children's emergencies are still a challenge for emergency services today. Pre- hospitalisation first aid and further shock room treatment is one of the most important factors for the further outcome of a patient. The aim of these investigations is the retrospective analysis of invasive measures and medication performed pre- hospitalisation.

Background In late 2022, a surge of severe bacterial infections caused by S. pyogenes was reported in several European countries, including Germany. This study assessed disease burden and severity of hospitalizations for community-acquired bacterial infections with S. pyogenes, S. pneumoniae, N. meningitidis , and H. influenzae among children in North Rhine-Westphalia (NRW), Germany, during the last quarter of 2022 compared to long-term incidences. Methods Hospital cases due to bacterial infections between October and December 2022 were collected from 59/62 (95 %) children’s hospitals in NRW and combined with surveillance data (2016 - 2023) from the national reference laboratories for streptococci, N. meningitidis , and H. influenzae . Total cases in NRW and incidence rates from January 2016 to March 2023 were estimated by capture-recapture analyses. Expected annual deaths from the studied pathogens were calculated from national death cause statistics. Results Between October and December 2022, 153 cases with high overall disease severity were reported with pneumonia being most common (59 %, n = 91). Incidence rates of bacterial infections declined at the beginning of the COVID-19 pandemic. In late 2022 and early 2023 a massive surge to levels unprecedented since 2016 was observed, mainly driven by S. pyogenes and S. pneumoniae . Observed deaths during the study period exceeded the expected number for the entire year in NRW by far (7 vs. 0.9). Discussion The unprecedented peak of bacterial infections in late 2022 and early 2023 was caused by various mechanisms intertwined that require close surveillance and improved precautionary measures for future outbreaks.

Die ungeplante Entbindung einer Mutter mit Notfall- und Erstversorgung von Früh- und Neugeborenen in der Zentralen Notaufnahme ist ein seltenes Ereignis und stellt selbst erfahrenes Personal in ungewohnter Umgebung vor Herausforderungen. Bei Weitem nicht jedes Neugeborene benötigt Hilfe bei der Adaptation vom intra- zum extrauterinen Leben, falls jedoch eine Unterstützung notwendig werden sollte, so sind im folgenden Artikel hilfreiche Vorschläge und Anregungen gegeben.

Physical and mental disabilities resulting froma child's cardiac arrest are of exceptional family and social concern. Recent studies showed that the quality of pediatric resuscitation often does not meet recommended standards. Implementation of these 10 evidence-based measures published here can help improve survival rates and morbidity in resuscitated children. These 10 theses are intended to focus on the broad range of issues surrounding resuscitation of children and adolescents. It begins with improved prevention and recognition of life-threatening events in children to prevent respiratory and circulatory arrest. In the case of resuscitation, it can only be effective if consistent and sustained training is provided. Learning from each patient is the most important thing. The quality of resuscitation and the postresuscitation phase must be measured and evaluated to identify aspects for optimization. Structured collection of treatment and outcome data in a centralized, mandatory registry offers the opportunity to identify strengths of in-hospital and out-of-hospital care and to develop concepts for quality improvement. These theses and basic principles are also supported by the Austrian, German, and Swiss Resuscitation Councils and have already been published in Frontiers in Pediatrics.

Ein sicherer Zugang zum kardiovaskulären System des Patienten stellt gerade in Notfallsituationen eine unverzichtbare Grundlage dar. Die Zugangsanlage kann jedoch durch erschwerte Venenverhältnisse (z.B. durch Zentralisation oder generell bei pädiatrischen Patienten) zu einer Herausforderung werden. Umso bedeutender ist die Kenntnis von alternativen Zugangswegen wie dem intraossären Zugang und seinen Besonderheiten.

Safe intubation of newborns remains a challenge. This investigates the upper airway anatomy of (pre-)term infants was investigated to improve airway management and the development of airway devices. Angles and diameters of both oral and nasal intubation pathways of 22 cadavers of premature and term stillborn infants were measured, relative to their gestational age (GA) and tested for statistical significance. The systematic influence of sex on the distribution of values was examined. Cast models of the oral and nasal intubation pathway were (produced using a silicone dental impression material) 3D-scanned. No significant correlation with GA was seen in the angles studied. However, four distances around the hard and soft palate did show statistically significant positive correlations with GA. Regarding differences between the sexes, only the angle between the entrance of the trachea and the esophagus was greater for male cadavers. The angles of the ventilation pathway of (pre-)term infants do not depend systematically on GA. Anatomically, laryngeal masks might therefore also be well-suited ventilators for preterm infants. Alterations in the size but not the shape of laryngeal masks for small preterm infants is recommended. The data obtained may thus be used as a basis for the development of airway devices and airway simulators for medical education and clinical training.

BACKGROUND AND OBJECTIVES The worldwide severe acute respiratory syndrome coronavirus 2 pandemic challenges adolescents’ mental health. In this study, we aim to compare the number of pediatric ICU (PICU) admissions after suicide attempts during the first German lockdown and one year later during a second, prolonged lockdown with prepandemic years. METHODS A retrospective multicenter study was conducted among 27 German PICUs. Cases <18 years admitted to the PICU because of accidents or injuries between March 16 and May 31 of 2017 to 2021 were identified based on International Classification of Diseases, 10th Revision codes (German modification) and patient data entered into a database. This study is a subset analysis on suicide attempts in adolescents aged 12 to 17.9 years. The Federal Statistics Office was queried for data on fatal suicides, which were available only for 2020 in adolescents aged 10 to 17.9 years. RESULTS Total admissions and suicide attempts declined during the first lockdown in 2020 (standardized morbidity ratio 0.74 (95% confidence interval; 0.58–0.92) and 0.69 (0.43–1.04), respectively) and increased in 2021 (standardized morbidity ratio 2.14 [1.86–2.45] and 2.84 [2.29–3.49], respectively). Fatal suicide rates remained stable between 2017 to 2019 and 2020 (1.57 vs 1.48 per 100 000 adolescent years) with monthly numbers showing no clear trend during the course of 2020. CONCLUSIONS This study shows a strong increase in serious suicide attempts among adolescents during the course of the pandemic in Germany. More research is needed to understand the relation between pandemic prevention measures and suicidal ideation to help implement mental health support for adolescents.

Abstract The aim of this retrospective analysis was to provide information on how infections with respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) differ in symptoms, clinical course, outcome, and utilization of hospital care. We investigated 748 polymerase chain reaction results from symptomatic children aged 0–4 years in Cologne, Germany. One hundred sixty-nine patients tested positive for RSV (22.6%) and 24 children for SARS-CoV-2 (3.2%). Symptomatic patients with RSV infection were hospitalized significantly longer. RSV-positive patients needed oxygen supplementation significantly more often as well as high-flow therapy. With regard to care efforts, RSV-infected patients put higher pressure on the hospital and utilized more hospital resources.

Children’s and adolescents’ lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017–2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85–1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93–1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57–1.02 and 0.26 (0.05–0.75)), whereas household and leisure accidents increased (1.33 (1.06–1.66) and 1.34 (1.06–1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38–1.16) and 2.09 (1.19–3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42–1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51–3.02)), but decreased in adolescent girls (0.56 (0.32–0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation.

Eine erfolgreiche Kinderreanimation erfordert oft weniger Maßnahmen als bei Erwachsenen. Durch Übung, die Kenntnis klarer und einfach umsetzbarer Handlungsstränge sowie den Einsatz von Hilfsmitteln kann eine sichere Versorgung gewährleistet werden. Dieser Beitrag gibt Tipps zur Umsetzung der von den Leitlinien empfohlenen Maßnahmen und geht auf unverzichtbare Hilfsmittel sowie wesentliche Aspekte der Medikamentensicherheit ein.