Abstract Background Motor disorders resulting from extremely preterm birth (EPT; <28 weeks’ gestation) can limit daily activities, schooling and social relationships. Cerebral palsy (CP) affects about 10% of children and non-CP movement difficulties (MD) are highly prevalent, although they tend to be under-diagnosed, especially in children without other developmental difficulties. We investigated the association between motor disorders and health-related quality of life (HRQoL) among five-year-old children born EPT. Methods We included children at age five from a population-based EPT birth cohort born in 2011-2012 in 11 European countries (N = 1,021). Children without CP were classified using the Movement Assessment Battery for Children - 2nd edition as having significant MD (≤5th percentile of standardised norms) or being at risk of MD (6th-15th percentile). Parents reported on CP diagnoses and HRQoL using the Pediatric Quality of Life InventoryTM. We used linear regression to compare HRQoL scores by motor status adjusting for social characteristics. Results Children born EPT with CP, significant MD and at risk of MD had lower adjusted HRQoL total scores [95% confidence intervals] than those without MD: -26.1 [-31.0; -21.2], -9.1 [-12.0; -6.1] and -5.0 [-7.7; -2.3]. Decreases were greater for physical scores: -35.3 [-42.7; -27.9], -11.9 [-16.1; -7.8] and -5.4 [-9.1; -1.6] than psychosocial scores: -20.6 [-25.2; -16.0], -7.4 [-10.3; -4.5] and -4.9 [-7.6; -2.1]. These differences persisted after exclusion of children with other developmental difficulties. Conclusions Motor disorders among 5-year-old children born EPT were associated with lower HRQoL, even among children with less severe motor difficulties and without other developmental difficulties. Key messages

Einleitung Studien zu SARS-CoV-2-Infektionen in der Schwangerschaft und mögliche Folgen für das ungeborene Kind kommen zu unterschiedlichen Ergebnissen. Das Risiko von intrauteriner Transmission, Frühgeburtlichkeit und Totgeburt ist unklar[1], ebenso ein möglicher Einfluss des Infektionszeitpunktes in der Schwangerschaft[2]. Es werden prospektiv gesammelte Daten aus dem CRONOS-Register vorgestellt und das neonatale Outcome abhängig vom Infektionszeitpunkt der Mutter dargestellt.

Objective: Caesarean section (CS) may reduce mortality and morbidity for very preterm breech infants, but evidence is inconclusive. We evaluated neonatal outcomes for singleton breech infants by mode of delivery in a European cohort. Study design: Data come from the EPICE population-based cohort of very preterm births in 19 regions in 11 European countries (7770 live births). The study population was singleton spontaneous-onset breech births at 24-31 weeks gestational age (GA) without antenatal medical complications requiring caesarean delivery (N = 572). Mixed-effects regression models adjusting for maternal and pregnancy covariates and propensity score matching was used to examine the effect of (1) CS and (2) a unit policy of systematic CS for breech presentation by GA. The primary outcome was a composite of in-hospital mortality, intraventricular haemorrhage grades III & IV or cystic periventricular leukomalacia. Secondary outcomes were each component separately, five minute Apgar score below seven and mortality within six hours of delivery. Results: 64.4% of infants were delivered by CS with a range across regions from 41% to 100%; these infants had higher GA and were more likely to be small for gestational age, receive antenatal steroids, and have mothers who were hospitalised for more than one day before delivery compared to those delivered vaginally. CS was associated with lower risks of all outcomes in mixed-effects adjusted models (odds ratio (OR) for the composite outcome: 0.50, 95% confidence interval (Cl): 0.30-0.81), but not in propensity score matched models (OR: 0.72, 95% CI: 0.41; 1.29). A systematic CS policy was associated with lower mortality and morbidity in unadjusted, but not adjusted models (OR for composite outcome: 0.76, 95% CI: 0.44; 1.28). 35% of births 24-25 weeks were delivered by CS and protective effects were consistently stronger, but not statistically significant. Conclusions: Point estimates indicated protective effects of caesarean delivery for very preterm breech infants in conventional statistical models. However, analyses using propensity scores and based on unit policies did not confirm statistically significant associations. Prospective large-scale studies are needed to establish best practice and could be implemented in European regions where vaginal delivery remains an option. (C) 2019 Published by Elsevier B.V.

Objective To describe obstetrical care and in-hospital outcomes in very preterm triplet pregnancies in a European multiregional cohort. Methods Data from a prospective population-based study of very preterm births between 22 + 0 and 31 + 6 weeks of gestation in 19 regions from 11 European countries participating in the EPICE project in 2011/2012 were used to describe triplet pregnancies and compare them with twins and singletons. Results Triplets constituted 1.1% of very preterm pregnancies (97/8851) and 3.3% of very preterm live births (258/7900); these percentages varied from 0% to 2.6% and 0% to 6% respectively across the regions. In-hospital mortality after live birth was 12.4% and did not differ significantly from singletons or twins or by birth order. However, 28.9% of mothers with a triplet pregnancy experienced at least one neonatal death. Ninety percent of live-born triplets were delivered by cesarean. Vaginal delivery was associated with an Apgar score of less than 7, but not with in-hospital mortality. Conclusions The prevalence of very preterm triplets varies across European regions. Most triplets were born by cesarean and those born vaginally had lower Apgar scores. Overall, in-hospital mortality after live birth was similar to singletons and twins.

Background Low gestational age (GA) is the principle risk factor for poor long-term neurodevelopment among very preterm (VPT) children. Some of this effect results from a greater vulnerability to severe neonatal morbidities (SNM) which are strongly related to low GA as well as to poor neurodevelopmental outcome. We aimed to investigate how SNM mediates the relationship between GA and VPT adverse neurodevelopmental outcome at 2 years of corrected age. Methods Data come from the area-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of children born below 32 weeks' GA in 2011/2012 in 11 European countries. Perinatal data were abstracted from medical records and follow-up was conducted using parent questionnaires at 2 years of corrected age. Children unable to walk without assistance or aids, or sit or hold their head up without support were classified with severe gross motor impairment (GMI); Non-verbal cognitive impairment (NVCI) was assessed as a score <22 on the non-verbal cognition scale of the Parent Report of Children's Abilities-Revised (PARCA-R) and language impairment (LI) was defined as an expressive vocabulary of less than 10 words. SNM was defined as one or more of the following morbidities: intraventricular hemorrhage grades III & IV, cystic periventricular leukomalacia, retinopathy of prematurity stages III-V, surgical necrotizing enterocolitis or broncho-pulmonary dysplasia. An inverse odds weighting (IOW) mediation analysis was used to estimate the total effects of GA, and estimated indirect effects operating through SNM or directly through GA. CI were estimated by bootstrapping. Co-variables included perinatal risk factors and family socioeconomic characteristics. Results Of 3370 children assessed in the follow-up; 5.3% had GMI, 14.9% had NVCI and 9.4% had LI. A one-week increase in GA was associated with a decreased risk of GMI (OR=0.80; 95 CI%=0.74–0.86]), of NVCI (OR=0.85; 95 CI%=0.81–0.89]) and LI (OR=0.89; 95 CI%=0.83–0.96]). 20.4% of infants had at least one severe morbidity and this was more common among children with GMI (66.0% vs. 18.4%), NVCI (38.8% vs. 17.2%) and LI (38.4% vs. 18.4%). For GMI, almost 100% of the total effect of GA on GMI was mediated by SNM. This proportion was 70% for NVCI and 40% for LI. Conclusion Reducing SNM could lead to substantial improvements in neurodevelopmental outcomes for VPT children, especially those related to motor development.

Objective The documented benefits of maternal milk for very preterm infants have raised interest in hospital policies that promote breastfeeding. We investigated the hypothesis that more liberal parental policies are associated with increased breastfeeding at discharge from the neonatal unit. Design Prospective area-based cohort study. Setting Neonatal intensive care units (NICUs) in 19 regions of 11 European countries. Patients All very preterm infants discharged alive in participating regions in 2011–2012 after spending >70% of their hospital stay in the same NICU (n=4407). Main outcome measures We assessed four feeding outcomes at hospital discharge: any and exclusive maternal milk feeding, independent of feeding method; any and exclusive direct breastfeeding, defined as sucking at the breast. We computed a neonatal unit Parental Presence Score (PPS) based on policies regarding parental visiting in the intensive care area (range 1–10, with higher values indicating more liberal policies), and we used multivariable multilevel modified Poisson regression analysis to assess the relation between unit PPS and outcomes. Results Policies regarding visiting hours, duration of visits and possibility for parents to stay during medical rounds and spend the night in unit differed within and across countries. After adjustment for potential confounders, infants cared for in units with liberal parental policies (PPS≥7) were about twofold significantly more likely to be discharged with exclusive maternal milk feeding and exclusive direct breastfeeding. Conclusion Unit policies promoting parental presence and involvement in care may increase the likelihood of successful breastfeeding at discharge for very preterm infants.

OBJECTIVE:To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions. DESIGN:Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals. SETTING:70 hospitals in ten European regions. POPULATION:Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012). METHODS:We used McNemar's Chi2 test, paired t-tests and conditional logistic regression for comparisons over time. MAIN OUTCOMES MEASURES:Reported policies, mortality and morbidity of EPTIs. RESULTS:The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1). CONCLUSIONS:European hospitals reporting changes in management policies experienced larger survival gains for EPTIs. TWEETABLE ABSTRACT:Changes in reported policies for management of extremely preterm births were related to mortality declines.

OBJECTIVE: The objective of this study was to investigate the effects of recorded lullabies and taped maternal voice in premature infants.STUDY DESIGN: Sixty-two preterm infants in a stable condition with 30<37 weeks of gestation and <10 days of postnatal age were randomly assigned to hear (A) recorded lullabies or (B) taped maternal voice for 30 min each evening during 14 consecutive days or (C) receive no standardized acoustic stimulation (control group). Heart rate and respiratory rate were recorded daily before, during and after the intervention (A and B) or a comparable period with no intervention (C), whereas activity was measured on days 1, 7 and 14 of the intervention using accelerometers.RESULTS: Both interventions led to a significant decrease in heart rate and respiratory rate during and after the stimulation when compared with the control group. The changes were more pronounced in infants with higher gestational ages (P = 0.001). Lower activity was measured during the intervention when compared with the control group (P<0.01).CONCLUSIONS: Standardized acoustic stimulation with recorded lullabies and taped maternal voice led to a decrease in heart rate and respiratory rate, and was associated with lower activity. Whether this indicates a reduced stress reaction needs to be investigated in further studies.

Einleitung: Das Smith-Magenis-Syndrom wurde in den frühen 1980er Jahren erstmals von Ann Smith und Ellen Magenis beschrieben. Zugrunde liegt eine Mikrodeletion des kurzen Arms von Chromosom 17.

Background Strategies to prevent heat loss in the delivery room after very preterm birth have been proven effective in randomised controlled trials. Nevertheless, we hypothesise that hypothermia at admission to neonatal care is still common and contributes to mortality after very preterm birth. Methods The EPICE cohort included all births between 22+0 and 31+6 weeks of gestation in 19 regions from11 European countries in 2011–2012. We studied infants surviving to admission to neonatal care (n = 7577). The association between temperature at admission and in-hospital mortality was analysed using logistic regression. The final model adjusted for gestational age, small for gestational age (SGA), Apgarscore <7 at 5 min, infant sex and region of birth. Results Of 6639 infants with data on body temperature at admission, 1670 infants (25%) were hypothermic (<36.0° C); 6% had temperatures <35°C, 7% between 35.0 and 35.4°and 12% between 35.5 and 35.9°. Body temperature at admission was inversely related to mortality. The crude odds ratio (OR) (95% confidence interval [CI]) for mortality was 5.81(4.27–7.92) when temperature was <35°C; 3.32 (2.35–4.69) at 35.0–35.4°; and 1.61 (1.18–2.19) at 35.5–35.9°compared to normothermic infants (36.5–37.5°C). After adjustment, temperatures below 35.5°C remained significantly associated with mortality, 1.94 (1.32–2.83) at <35°C and 1.91(1.30–2.82) at 35–35.4°C compared to normothermic infants. Conclusion Hypothermia after very preterm birth contributes to mortality in modern perinatal care settings in Europe. Further studies should investigate if evidence-based heat loss prevention strategies have been implemented.