An 8-year-old girl with pre-existing pulmonary illness, chronic kidney disease and known colonization with multidrug-resistant Pseudomonas aeruginosa developed severe nosocomial pneumonia requiring mechanical ventilation. Due to the variable resistance patterns of previously cultured Pseudomonas isolates, cefiderocol was used as an off-label treatment following confirmed susceptibility testing of the strain isolated from tracheal secretions. The patient showed a rapid clinical and biochemical response during treatment, which was administered in parallel with continuous veno-venous hemofiltration (CVVH).

AIM:A landmark trial published in 2021 demonstrated a 25% reduction in neonatal mortality when comparing immediate skin-to-skin contact (iSSC) to conventional care in infants with birthweight 1-1.8 kg in low- and middle-resource settings. New evidence from randomised clinical trials on iSSC in high-resource settings has recently become available. This systematic review aimed to evaluate evidence for immediate/early SSC, defined as initiated within 1 h after birth, versus conventional care in inborn preterm infants in high-resource settings. METHODS:Ten electronic databases, including PubMed, Embase, and Cochrane CENTRAL, from 2000 until February 2026, were searched. Randomised clinical trials comparing iSSC to conventional care in inborn preterm infants in high-resource settings were included. RESULTS:Four randomised clinical trials encompassing 325 infants were included. iSSC was feasible and safe. Cardiorespiratory stability, thermoregulation, breastfeeding practices, maternal-infant interaction, infant stress regulation, and parental mental health outcomes were in favour of the intervention. CONCLUSIONS:This systematic review provides updated evidence on the effectiveness of iSSC for preterm infants admitted to neonatal intensive care units in high resource settings. The findings support that there is a sensitive window in the first hours after birth when preterm infants and parents should not be separated.

Invasive fungal diseases (IFDs) cause high morbidity and mortality in children with cancer and hematopoietic cell transplantation (HCT). While international guidelines exist for prevention, diagnosis, and treatment, pediatric-specific evidence remains limited and practices vary. Geographic distribution of the 62 participating pediatric oncology centers First-line and first-line alternative antifungal treatment for candidemia and invasive pulmonary aspergillosis in 62 pediatric oncology centers In Jun-Sep 2024, we surveyed 72 pediatric oncology centers in Germany, Austria, and Switzerland (German Society for Paediatric Oncology and Haematology) using a questionnaire covering center volume, ID expertise, diagnostic tools, prophylaxis protocols, therapeutic drug monitoring (TDM), and treatment pathways for aspergillosis and candidemia. Data were analyzed descriptively; associations between center size, ID resources, and IFD incidence were tested via Mann–Whitney U and linear regression. Sixty-two centers (86% response) participated: 51 DE, 5 AT, 6 CH (Figure 1). Median new oncology cases in 2023 was 56 (IQR 40–75); 55% managed HCT. Proven or probable IFDs were reported by 89% of centers at a median incidence of 4.6% (IQR 3.0–5.9%). A pediatric ID specialist was available in 58% of centers (100% CH, 51% DE, 40% AT); 58% offered formal ID consultation (24% 24/7). Larger centers more often had ID specialists (p=0.008) and maintained antifungal SOPs (p=0.02). All centers performed culture and histopathology; galactomannan testing in 94%, β-D-glucan in 53%, PCR in 86%. In-house TDM for voriconazole was available in 52%, less frequently for posaconazole and isavuconazole. Prophylaxis strategies varied, with liposomal amphotericin B (AMB) used most frequently across risk groups. AMB was the preferred first-line therapy for invasive pulmonary aspergillosis (71% of centers) and candidemia (45%), followed by voriconazole and echinocandin, retrospectively (Figure 2). Heterogeneity exists in IFD management across pediatric oncology centers in the DACH region, influenced by center size and ID resource availability. Gaps include inconsistent SOPs, limited 24/7 ID support, and incomplete access to TDM. Strengthening oncology–ID collaborations, standardizing SOPs, and enhancing antifungal stewardship -potentially via digital platforms- may harmonize care and improve outcomes for children at risk of IFD. Oliver A. Cornely, Prof. Dr., Al-Jazeera Pharmaceuticals/Hikma: Honoraria|Basilea: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Grant/Research Support|Elion: Advisor/Consultant|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|Melinta: Advisor/Consultant|Melinta: Board Member|MSD: Honoraria|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria Andreas H. Groll, MD, Basilea: Advisor/Consultant|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Merck, Sharp & Dohme: Advisor/Consultant|Mundipharma: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria

Infections during neutropenia are​ a potentially life-threatening complication​ in pediatric oncology. International guidelines recommend antipseudomonal β-lactam monotherapy for stable patients, however, modification​ to carbapenems often occurs without confirmed infection.​ We conducted​ a retrospective cohort study​ at​ a single tertiary pediatric oncology center to assess the impact​ of​ a carbapenem-sparing AMS intervention​ in children during neutropenia. All pediatric cancer patients with​ at least one episode​ of​ suspected infection between January 2021 and October 2024 were included.​ The intervention combined training, updated standard operating procedures, multidrug-resistant (MDR) surveillance swabs, and​ a structured protocol reassessing meropenem treatment​. Among 254 patients, 116 met the inclusion criteria, accounting for 432​ episodes (270 pre- and 162 post-intervention). Re-modification​ of antimicrobial therapy from meropenem​ to piperacillin/tazobactam was achieved​ in​ 16​ of​ 50 post-intervention episodes. The median duration​ of meropenem treatment decreased from​ 9​ to​ 6 days​ (p​ = 0.006). Interrupted time series analysis showed​ a non-significant reduction​ in meropenem use, corresponding​ to​ an estimated decline​ of 40.7 days of therapy (DOT) per 1000 patient-days per quarter. Mortality was unchanged (3.8

AIM:To describe changes in peripheral oxygen saturation (SpO2) and regional cerebral oxygenation (rcSO2) during less invasive surfactant administration (LISA) in a high-level continuous positive airway pressure (CPAP) respiratory support delivery room protocol in very low birth weight infants (VLBW). METHODS:This is a secondary analysis of data from the randomized-controlled Extrauterine Placental Transfusion in Resuscitation of VLBW infants (EXPLAIN) trial. In total, 38 patients were included. The pressure and changes in heart rate, SpO2 and rcSO2 were assessed 10 min before until 10 min after the LISA procedure. Basic outcome data for the patient collective were collected. RESULTS:Mean gestational age was 27 + 6 weeks (±15 days), and mean birth weight was 995.8 g (±298.8). All infants were eligible for LISA. During LISA, heart rate, SpO2 and rcSO2 decreased significantly (mean change 32.4 (± 27.5) bpm, -14.5 (± 10.7) % and -11.9 (± 9.1) %, respectively; all p < 0.001). Moreover, two infants developed a pneumothorax and three infants required endotracheal intubation within 72 h after birth. CONCLUSIONS:With the approach of a high-level CPAP setting, we observed transient decreases in heart rate and oxygenation levels during LISA. The magnitude of these decreases was within the expected or potentially favourable range compared with prior studies. TRIAL REGISTRATION:ClinicalTrials.gov identifier:NCT03916159.

Infants born before 24 weeks’ gestational age face unique challenges compared to more mature preterm infants. This includes a higher risk of infection, which remains a leading cause of morbidity and mortality. Over the last two decades, advancements in neonatal care have resulted in higher rates of survival. However, invasive bacterial and fungal infections continue to pose significant threats. This narrative review highlights the epidemiology, microbiology, and related outcomes of bacterial and fungal infections in infants born before 24 weeks’ gestational age. This review also discusses major knowledge gaps in infection epidemiology, prevention, and management, highlighting the need for more robust international data and innovative strategies to address the unique vulnerabilities of these infants.

ABSTRACT Aim Extrauterine placental perfusion (EPP) may be a feasible cord clamping strategy in very low birth weight (VLBW) infants to support neonatal transition. However, the impact of EPP on neurodevelopment remains unclear. The study aimed to compare the effects of EPP with time‐based delayed cord clamping (DCC) on neurodevelopmental outcomes. Methods This follow‐up study of the randomised controlled EXPLAIN (Extrauterine Placental Transfusion in Resuscitation of Very Low Birth Weight Infants) trial ( ClinicalTrials.gov Identifier: NCT03916159) was conducted at a tertiary perinatal centre from 2021 to 2023. Antenatally randomised VLBW infants received either EPP or DCC (> 30 s). Neurodevelopment was assessed at 24 months of corrected age using the Bayley Scales of Infant and Toddler Development, Third Edition. Data analysis was intention‐to‐treat. Results Of 59 infants enrolled, 54 (92%) participated in the follow‐up (27 EPP, 27 DCC). Median age at assessment was 24.3 months (range 23.5–25.0); 28 (52%) were male. Infant characteristics and short‐term outcomes were similar between groups. No relevant differences were observed in median cognitive, motor or language scores or in rates of cerebral palsy, hearing, or visual impairment. Conclusion The neurodevelopment of the VLBW infants who received EPP and DCC was comparable, suggesting that EPP may be a viable alternative.

Intestinal perforation occurring in extremely low gestational age neonates is a devastating complication, associated with high mortality and morbidity. Multiple phenotypes of bowel perforation in premature infants have been described, with the most common being spontaneous, or isolated, intestinal perforation and perforated necrotizing enterocolitis. The purpose of this article is to summarize literature describing “meconium obstruction of prematurity”, increasingly recognized as a distinct clinical phenotype in the smallest and most immature neonates. The goal of this review is to improve international recognition and understanding of this high-risk clinical condition. The lack of standardized nomenclature has been an obstacle to progress in understanding, preventing, and treating this important and more frequently encountered condition. The recognition of meconium obstruction requiring medical or surgical management is a clear distinguishing factor from other bowel pathologies of prematurity.

INTRODUCTION:Daily urinary output (UOP) serves as important tool to identify acute kidney injury (AKI) in preterm infants. However, reference values for UOP, especially stratified for gestational age (GA), are missing. METHODS:This retrospective single-center study assessed UOP during the first 28 days of life in 128 very low birth weight (VLBW) infants. RESULTS:VLBW infants exhibit a highly dynamic daily UOP profile in the first 28 days of life with a maximum at day 12 with 4.78 mL/kg bodyweight/h. In the subcohort of 64 extremely low gestational age neonates (ELGANs), the highest UOP is measured during the second week of life. Infants born before 24 weeks of gestation have significantly higher UOP than more mature infants. CONCLUSION:UOP is dynamic in the postnatal period and differs significantly between GA cohorts in the subgroup of ELGANs. These data might point to an adaption of the UOP threshold for neonatal AKI in preterm infants.

We report 3 cases of probable invasive pulmonary disease caused by Bjerkandera spp. fungi in immunocompromised patients in Germany. Accurate identification required internal transcribed spacer sequencing. Response to antifungal treatment varied. Our report underlines the pathogenic potential of Bjerkandera spp. and the importance of molecular diagnostics in rare fungal infections.

BACKGROUND:Invasive fungal diseases (IFD) pose significant challenges in paediatric oncology. Their management is complicated by limited paediatric-specific evidence, lack of standardised protocols and variability in resources across centres. This study assessed current practices and addressed the challenges in the prevention, diagnosis and treatment of IFDs in paediatric oncology centres across Germany, Austria and Switzerland. METHODS:A questionnaire was distributed to senior paediatric oncologists in 70 paediatric oncology centres across Germany, Austria and Switzerland, gathering data on centre infrastructure, infectious disease (ID) expertise, annual cumulative IFD incidence in 2023, diagnostic tools, antifungal prophylaxis, treatment and follow-up practices for IFD. Responses were analysed descriptively. RESULTS:Sixty-two centres responded, with a median of 56 (IQR 40-75) new oncological diagnoses per centre; 54.8% of centres managed allogeneic HCT patients. IFDs were reported in 88.7% of centres, with a median cumulative IFD incidence of 4.6% (IQR 3.0%-5.9%). No significant association was found between cumulative IFD incidence and the number of transplants, antifungal prophylaxis protocols and availability of ID consultation services. ID consultation was available in 58.1% of centres, with 24/7 support provided in 41.7% of these centres. Larger centres more frequently had paediatric ID specialists, ID consultation services and access to therapeutic drug monitoring. CONCLUSIONS:The observed heterogeneity in mycology expertise and IFD management strategies across centres reflects the inherent complexity of IFDs and the diagnostic and therapeutic uncertainties amid limited evidence. Strengthening oncology-ID networks and implementing digital consultation platforms may promote high-quality, equitable care, particularly for those with fewer in-house resources.

Candidaemia in children is associated with high mortality. The epidemiology of Candida bloodstream infection is changing with rising rates of fluconazole resistance worldwide and the emergence of novel multidrug-resistant species such as Candida auris, which is associated with outbreaks. Guidelines on the management of candidaemia emphasise identification of species and determination of antifungal susceptibility to guide appropriate treatment, performing relevant investigations to rule out deep-seated infection, and removal of central venous catheters. However, it is difficult to apply guidelines in routine practice. The European Confederation of Medical Mycology candidaemia scoring tool (the EQUAL score) has facilitated adherence to guidelines by using a point-based system. We have designed a point-based paediatric EQUAL (paed-EQUAL) score tool for the management of candidaemia in neonates and children. The paed-EQUAL scoring tool can be applied to improve guideline adherence and facilitate antifungal stewardship.

Introduction Preterm infants, particularly those born before 29 weeks of gestation, are at increased risk of developing bronchopulmonary dysplasia (BPD) and other complications of prematurity. Substantial evidence suggests that respiratory tract colonisation with Ureaplasma species significantly contributes to pulmonary inflammation, impaired lung function and subsequent lung disease especially in very immature infants. Moreover, Ureaplasma exposure has been implicated in the pathogenesis of other inflammation-related sequelae of prematurity. Although representing a potentially actionable risk factor for adverse short-term and long-term neonatal outcome, controversies on Ureaplasma-associated morbidity remain and recommendations for screening practices in preterm infants are missing. The NEO-CONSCIOUS (Neonatal Colonisation and Infection with Ureaplasma in very immature preterm infants born <29 weeks of gestation) study aims to assess the incidence of Ureaplasma colonisation and infection in very preterm infants at high risk of adverse outcome, the extent of potentially accompanying inflammation and the impact on short-term and long-term morbidity.Methods and analysis This is a prospective observational multicentre study being conducted in level III neonatal intensive care units in Germany and Austria. In total, 400 infants born before 29 weeks of gestation are screened for Ureaplasma colonisation immediately after birth. In addition, biomarkers of systemic inflammation are determined on day 1 and day 28. The study infants are followed up until discharge and at 2 years corrected age. The primary outcome BPD and/or death is assessed at 36 weeks postmenstrual age. Secondary outcomes include systemic inflammation, secondary infections, intraventricular haemorrhage, periventricular leukomalacia, necrotising enterocolitis, retinopathy of prematurity and neurodevelopmental outcome at 24 months corrected age.Ethics and dissemination The study has been approved by the ethics committees in Würzburg and Leipzig and the local ethics committees of all participating centres. Results will be disseminated through peer-reviewed international publications and conferences. The study is registered with the German Clinical Trials Register, ID DRKS00033001.Trial registration number German Clinical Trials Register (DRKS00033001).

INTRODUCTION:Preterm infants, particularly those born before 29 weeks of gestation, are at increased risk of developing bronchopulmonary dysplasia (BPD) and other complications of prematurity. Substantial evidence suggests that respiratory tract colonisation with Ureaplasma species significantly contributes to pulmonary inflammation, impaired lung function and subsequent lung disease especially in very immature infants. Moreover, Ureaplasma exposure has been implicated in the pathogenesis of other inflammation-related sequelae of prematurity. Although representing a potentially actionable risk factor for adverse short-term and long-term neonatal outcome, controversies on Ureaplasma-associated morbidity remain and recommendations for screening practices in preterm infants are missing. The NEO-CONSCIOUS (Neonatal Colonisation and Infection with Ureaplasma in very immature preterm infants born <29 weeks of gestation) study aims to assess the incidence of Ureaplasma colonisation and infection in very preterm infants at high risk of adverse outcome, the extent of potentially accompanying inflammation and the impact on short-term and long-term morbidity. METHODS AND ANALYSIS:This is a prospective observational multicentre study being conducted in level III neonatal intensive care units in Germany and Austria. In total, 400 infants born before 29 weeks of gestation are screened for Ureaplasma colonisation immediately after birth. In addition, biomarkers of systemic inflammation are determined on day 1 and day 28. The study infants are followed up until discharge and at 2 years corrected age. The primary outcome BPD and/or death is assessed at 36 weeks postmenstrual age. Secondary outcomes include systemic inflammation, secondary infections, intraventricular haemorrhage, periventricular leukomalacia, necrotising enterocolitis, retinopathy of prematurity and neurodevelopmental outcome at 24 months corrected age. ETHICS AND DISSEMINATION:The study has been approved by the ethics committees in Würzburg and Leipzig and the local ethics committees of all participating centres. Results will be disseminated through peer-reviewed international publications and conferences. The study is registered with the German Clinical Trials Register, ID DRKS00033001. TRIAL REGISTRATION NUMBER:German Clinical Trials Register (DRKS00033001).

Introduction: Less invasive surfactant application (LISA) is associated with improved short-term outcomes in preterm infants. Data on LISA eligibility and success for infants <28 weeks of gestation are lacking. Methods: Preterm infants <28 weeks of gestation who were born and actively treated in our tertiary care center in 2018 were included in the retrospective study. We assessed baseline characteristics, delivery room (DR) management, LISA success and complications, and short-term outcome. Results: In total, 57 infants received LISA in the DR. LISA eligibility was 73% at 22 weeks, 88% at 23 weeks, and >90% at gestational ages >24 weeks. LISA was successful in 63% of infants. LISA failure was associated with increased risk for high-grade IVH (OR 17.88), death (OR 10.94), and a reduced chance for survival without complications (OR 8.75). Conclusion: Our report justifies LISA as a mode for surfactant application in preterm infants. It contributes to the call for studies to define risk factors for LISA failure.

IntroductionPremature birth may impair a sensitive, responsive, enjoyable, and regulating parenting style, potentially leading to behavioral, cognitive, and emotional deficits in children. Additionally, the emotional bond between the parent and infant may be disturbed due to the restrictions and difficulties at the neonatal intensive care unit (NICU), further negatively impacting child development. Skin-to-skin contact (SSC) directly after birth is strongly recommended also for preterm or low birth weight infants since there is high-certainty evidence that SSC has positive effects on neonatal and maternal health as well as on the quality of the parent–child relationship. The aim of this study was to examine the effect of skin-to-skin contact immediately after childbirth on the development of emotional and behavioral problems in children born preterm entering school.MethodsThis study is part of a randomized controlled delivery room skin-to-skin study (Deisy Study). A total of 33 children (aged 6–8 years) were assessed at school start. The German version of the CBCL/6-18R was used to evaluate the presence of behavior problems.ResultsThe perceived parental stress 6 months after discharge was the variable that most contributed to the variance explanation. SSC immediately after childbirth was not significant in the prediction of emotional and behavioral problems at school start.LimitationsThe study was conducted in a small study group. Partners' variables were not included. Information regarding sociodemographic variables and bonding quality was collected 6 months (corrected age) after birth. The measurement of children's behavioral problems is not objective and corresponds to the parents' perception.Clinical Trial Registrationhttps://clinicaltrials.gov, deisy study NCT01959737, deisy follow up NCT03366285.

The concept of zero separation of a mother and her preterm infant has gained increasing attention within the recent years. Early skin-to-skin contact (SSC), ideally starting from birth has positive effects on parenting and attachment. Recently, a review article summarised the existing evidence on the benefits of early SSC for all gestational ages and provided a pragmatic implementation guide.1 From 2012 to 2015, we conducted a randomised controlled delivery room skin-to-skin study2 including firstborn singletons between 25 and 32 weeks of gestation, with the purpose to evaluate a standardised SSC-intervention to improve the quality of the mother–child-Interaction and bonding and thereby to enhance the neurodevelopment of this preterm infants and to reduce possible behaviour problems. After initial stabilisation, the standard care infants were allotted 5 min of visual contact with their mothers. Infants randomised into the intervention group received 60 min uninterrupted, supervised SSC. The results of our studies on the effects of delivery room (DR)-SSC on parenting are summarised in Table 1. In detail, the intervention group benefitted from the DR-SSC regarding maternal depressive symptoms, mother child interaction (MCI) and bonding. In a second step, we compared the MCI results of both preterm groups with a group of healthy mother and term infant pairs with zero separation within the first hours after birth.3 We found that DR-SSC brought MCI of preterm infants close to normal. Since 2015, when the delivery room SSC study was completed, DR-SSC has been implemented in our delivery room protocol as standard of care for all infants regardless of gestational age and birthweight. The preferred mode of delivery for infants <30 weeks of gestation in our centre is Caesarean section. After delivery, the infants are transferred to the preheated resuscitation unit, covered with a transparent wrapping, and started on CPAP delivered via mask and Benveniste valve. After 5 min we should see a stable breathing pattern. A pharyngeal tube is inserted to continue CPAP. Of note, in our centre all infants born <28 weeks of gestation are treated with surfactant via less invasive surfactant application (LISA) in a quasi-prophylactical approach. More than 90% of premature infants with a gestational age >23 weeks who need surfactant are eligible and receive surfactant via LISA. DR-SSC is started approximately 45 min after birth and is continued for 60 min supervision by the neonatal team. For SSC, infants are placed naked on their mother's chest in comfort position (e.g. left or right lateral) and covered with a transparent polyethylene wrap and a blanket. Room temperature is set to 24°C by automatically controlled heating. Infants' heart rate, respiratory rate, FiO2 and oxygen saturation are recorded continuously. Temperature is measured by a skin sensor if the infant is placed on the delivery room unit but not during DR-SSC for technical reasons. Continuous supervision of both, mother and infant is guaranteed by the attending neonatal team. Fathers are encouraged to be present during the intervention, but DR-SSC is restricted to mothers. Potential disturbances (medical staff entering and leaving the room, frequent talking of the supervising neonatologist to staff or parents) are to be kept at a minimum to give the parents the opportunity to completely concentrate on their infant. Duration of DR-SSC is variable, but we aim for at least 30 min depending on maternal and infant stability, After DR-SSC infants are transferred to incubator care at the NICU. Early SSC can be performed safely even in extremely immature infants if the staff is trained accordingly, and continuous supervision is guaranteed.2 Although SSC in the form of intermittent Kangaroo mother care (KMC) at the NICU has become standard of care worldwide, early or delivery room SSC in immature infants directly after initial stabilisation is still limited to few centres. However, the concept of early SSC is intriguing for several reasons. First, unique neuroendocrine changes regularly take place in the mother around birth. Most important, maternal oxytocin, a hormone that facilitates maternal sensitivity, peaks during labour and after delivery. SSC after birth further activates oxytocin release and higher oxytocin levels positively affect parent infant interaction.4 A randomised controlled study including healthy term infants demonstrated that separation within the first hours after birth results in less optimal mother child interaction 1 year later.5 Secondly, it may take several days until the mother has recovered sufficiently to visit her infant at the NICU and start KMC sessions. Even in Swedish NICUs, where early and continuous SSC has strongly been promoted for decades, only 5% of infants with a gestational age <28 weeks had SSC on the first day of life.6 Although the concept of early SSC is attractive for all gestational ages a recent review article emphasised the lack of studies on the effect of SSC on parenting in very immature infants.7 For term or moderate/late preterm infants early SSC, defined as within 180 min after birth was associated with beneficial effects regarding parenting such as improved interaction and higher maternal satisfaction. For very immature infants, data is limited to our RCT2 and parental reports. A silver lining, several study protocols have been published aiming at the effects of DR-SSC on neurodevelopment and parenting in preterm infants, but results are pending. Our research demonstrated the safety and benefit of DR-SSC for infants >25 weeks of gestation. However, our results and our approach may not readily be transferable to different settings. In our centre, DR-SSC is embedded in a bundle of interventions aiming for a minimal stress transition to extrauterine life. DR-SSC is a team effort and successful implementation requires close collaboration of the experts caring for both, the neonate and the mother. Issues such as supervision and monitoring of both mother and infant, timing of surfactant application and temperature management need to be discussed and adjusted to the centre specific requirements and standards of care. Katrin Mehler: Conceptualization; writing – original draft; investigation; funding acquisition. Angela Kribs: Conceptualization; writing – review and editing; supervision. Ruth Klein: Investigation; writing – review and editing. Eva Heine: Investigation; writing – review and editing. Patricia Trautmann-Villalba: Writing – original draft; investigation; methodology; validation; data curation. No funding was received. Open Access funding enabled and organized by Projekt DEAL. None of the authors declare a conflict of interest.