Importance The effects of contact precautions (ie, gowns and gloves) for individual patients colonized with gram - negative (GN) drug-resistant bacteria on sepsis risk in neonates requiring intensive care remain to be clarified. Objective To evaluate the noninferiority of standard hand hygiene disinfection vs standard hygiene disinfection plus extended barrier precautions for infants colonized with third-generation cephalosporins–resistant GN bacteria (3GCR-GNB). Design, Setting, and Participants This cluster-randomized clinical trial was conducted from 2020 to 2023 in 12 German tertiary care neonatal intensive units caring for neonates with high risk for infections with GNB for 24 months, with crossover after 12 months. Follow-up and data curation were completed December 31, 2024, and statistical analysis was finalized on July 31, 2025. Intervention The intervention was standard hand hygiene disinfection compared with current recommendations, ie, hygiene disinfection plus extended barrier precautions with gowns and gloves for routine care of infants colonized with 3GCR-GNB. Main Outcomes and Measures The primary outcome was the rate of health care–associated GNB bloodstream infections (BSI) at infant level in all neonates requiring intensive care in the cluster, assuming 5% as noninferiority margin delta; secondary outcomes included transmission rates of 3GCR-GNB and rates of any infection. Results The primary analysis was based on an overall sample size of 12 sites with crossover at 12 months, making 24 clusters with 9731 neonates. During the standard hand hygiene disinfection periods, 22 of 4699 infants (0.5%) developed GNB BSIs at infant level, compared with 25 of 5032 infants (0.5%) cared for during the extended barrier precaution periods (risk difference [RD], −0.03%; 95% CI, −0.43% to 0.38%; noninferiority P < .001). At least 1 nosocomial transmission with 3GCR-GNB was noted during 41 of 144 months in the intervention period and 54 of 144 months in the control period (RD, −9.03%; 95% CI, −27.79% to 9.74%), with involvement of 116 patients (2.5%) vs 149 patients (3.0%) (RD, −0.44%, 95% CI, −2.47% to 1.58%). The total rate of BSI was 2.1% in neonates during the intervention period vs 2.0% during the control period (RD, 0.12%; 95% CI, −1.39% to 1.64%). Conclusions and Relevance In this cluster-randomized clinical trial, standard hand hygiene disinfection for the care of infants colonized with 3GC-GNB was noninferior to standard hygiene disinfection plus extended barrier precautions. Trial Registration German Clinical Trials Register identifier: DRKS00019103

Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting 35% of extremely low birth weight infants and is defined by oxygen dependence at 36 weeks postmenstrual age. Preventive interventions carry severe risks and early prediction is crucial to avoid unnecessary toxicity in low-risk infants. Admission radiographs of extremely preterm infants are routinely acquired within 24 h of life and could serve as a non-invasive prognostic tool. We developed a deep learning approach using day 1 chest X-rays from 163 extremely low-birth-weight infants (<= 32 weeks gestation, 401-999 g). We fine-tuned a ResNet-50 pretrained specifically on adult chest radiographs, employing progressive layer freezing with discriminative learning rates to prevent overfitting and evaluated a CutMix augmentation and linear probing. Complementing prior insights that compare architectures and acquisition timing, we ablate the effects of initialization domain and computelight fine-tuning choices on performance on small day-1 neonatal CXR cohorts, yielding practical training guidance for site-level and federated deployment. For moderate/severe BPD outcome prediction, our best performing model with progressive freezing, linear probing and CutMix achieved an AUROC of 0.78 f 0.10, balanced accuracy of 0.69 f 0.10, and an F1-score of 0.67 f 0.11. In-domain pre-training significantly outperformed ImageNet initialization (p = 0.031) highlighting the importance of domain-specific pretraining. Routine IRDS grades showed limited prognostic value (AUROC 0.57 f 0.11), motivating learned image markers.

Importance:The effects of contact precautions (ie, gowns and gloves) for individual patients colonized with gram-negative (GN) drug-resistant bacteria on sepsis risk in neonates requiring intensive care remain to be clarified. Objective:To evaluate the noninferiority of standard hand hygiene disinfection vs standard hygiene disinfection plus extended barrier precautions for infants colonized with third-generation cephalosporins-resistant GN bacteria (3GCR-GNB). Design, Setting, and Participants:This cluster-randomized clinical trial was conducted from 2020 to 2023 in 12 German tertiary care neonatal intensive units caring for neonates with high risk for infections with GNB for 24 months, with crossover after 12 months. Follow-up and data curation were completed December 31, 2024, and statistical analysis was finalized on July 31, 2025. Intervention:The intervention was standard hand hygiene disinfection compared with current recommendations, ie, hygiene disinfection plus extended barrier precautions with gowns and gloves for routine care of infants colonized with 3GCR-GNB. Main Outcomes and Measures:The primary outcome was the rate of health care-associated GNB bloodstream infections (BSI) at infant level in all neonates requiring intensive care in the cluster, assuming 5% as noninferiority margin delta; secondary outcomes included transmission rates of 3GCR-GNB and rates of any infection. Results:The primary analysis was based on an overall sample size of 12 sites with crossover at 12 months, making 24 clusters with 9731 neonates. During the standard hand hygiene disinfection periods, 22 of 4699 infants (0.5%) developed GNB BSIs at infant level, compared with 25 of 5032 infants (0.5%) cared for during the extended barrier precaution periods (risk difference [RD], -0.03%; 95% CI, -0.43% to 0.38%; noninferiority P < .001). At least 1 nosocomial transmission with 3GCR-GNB was noted during 41 of 144 months in the intervention period and 54 of 144 months in the control period (RD, -9.03%; 95% CI, -27.79% to 9.74%), with involvement of 116 patients (2.5%) vs 149 patients (3.0%) (RD, -0.44%, 95% CI, -2.47% to 1.58%). The total rate of BSI was 2.1% in neonates during the intervention period vs 2.0% during the control period (RD, 0.12%; 95% CI, -1.39% to 1.64%). Conclusions and Relevance:In this cluster-randomized clinical trial, standard hand hygiene disinfection for the care of infants colonized with 3GC-GNB was noninferior to standard hygiene disinfection plus extended barrier precautions. Trial Registration:German Clinical Trials Register identifier: DRKS00019103.

Background Infections are highly relevant for neonatal mortality and long-term morbidities in survivors. Therefore, it is an urgent need to optimize and evaluate infection prevention and control (IPC) strategies. Several infection outbreaks in German neonatal intensive care units (NICUs) required rapid responses by hospitals and improved future preparedness. As a consequence, German authorities recommended weekly colonization screening on NICUs. This screening aims to detect multidrug-resistant organisms (MDRO) and bacteria with high transmissibility. According to these guidelines, infants colonized with multiresistant gram-negative (MRGN) bacteria with in-vitro resistance to piperacillin and cephalosporins (2MRGN) should be cared wearing non-sterile gloves and gowns in addition to standard hygiene precautions. Whether these extended IPC measures have an individual benefit for infants or contribute to the prevention of infection outbreaks has not yet been scientifically proven. This study aims to evaluate the effect of hand desinfection as compared to hand desinfection + gloves and gowns (barrier care) for the care of 2MRGN colonized infants in NICUs on infection and transmission rates through a multicenter, cluster randomized controlled trial (BALTIC study, Ba rrier protection to l ower t ransmission and i nfection rates with Gram-negative 2-MRGN in preterm c hildren). Methods 12 participating NICUs were randomly allocated to two trial arms: receiving the intervention “standard precautions with a special focus on hand desinfection” or control (standard precautions “plus” barrier care) for the care of 2MRGN positive infants. Cross over was performed after 12 months for another 12 months per site. Primary outcome was the rate of healthcare-associated (HA) Gram-negative bloodstream infections. Secondary outcomes included transmission rate with screening relevant bacteria, overall rate of clinical and culture-proven infections, number of antibiotic cycles and desinfectant use. Regular trainings and hygiene audits are standardized co-interventions. Benchmarking results According to our single center data, 9.3% of NICU-treated infants are colonized with 2MRGN during their hospital stay. BALTIC randomized the first center in October 2020 and finished data collection including close-out monitoring in January 2024. Data analysis will be completed in May 2025. Conclusions BALTIC should contribute to better evidence on the effectiveness of hand desinfection and extended barrier precautions in critically ill newborns. Further benefits include comprehensive multi-center data collection on MDRO colonization dynamics, an improved awareness on IPC strategies and establishment of network platforms including antimicrobial stewardship programs.

BACKGROUND:Tuberous sclerosis (TSC) is characterised by the formation of benign tumours across various organs, particularly in the central nervous system (CNS), where they can lead to epilepsy and neurodevelopmental disorders. TSC results from variants in either TSC1 or TSC2 genes, leading to hyperactivation of the mTORC1 pathway, which plays a pivotal role in regulating cell growth and survival. While the influence of mTOR on immune function has been extensively investigated, our understanding of the composition of immune cells in TSC patients remains limited. OBJECTIVE:Blood immune cell profiles from healthy controls, epilepsy patients, and TSC patients (with or without mTOR inhibitor therapy) were collected and analyzed via flow cytometry in a multicenter study. RESULTS:Between 12/2020 and 12/2023, 47 blood samples (mean age: 21 years, range 1-52, 72.3 % female) were analyzed via flow cytometry. Overall, we could not observe a unique immune cell profile between the subgroups as a potential distinguishing feature. However, a few cell populations (T cells, CD8+ T cells) seem to shift in patients with epilepsy (independent of TSC diagnosis) or those receiving mTOR inhibitor therapy (B cells, plasma cells) compared with healthy controls. CONCLUSION:The overall blood immune cell profile is not changed in patients with epilepsy or TSC. However, analysis of subpopulations (T cells and B cells) has revealed changes in immune cell constitution in patients with epilepsy and those receiving mTOR inhibitor therapy.

Background There is a scarcity of data available with regard to the provision of in-hospital subspecialities in the field of pediatrics in Germany. Methods We performed an electronic survey in all pediatric hospitals in Germany (n = 340 with a response rate of 146 (42.9%)). In this survey, we assessed the number of pediatric subspecialties as well as its distribution with regard to position (hyrachy) and sex. In addition, we performed a second analysis based on the data provided on the websites of all included children hospitals (data available from 303 of 314 hospitals (96.5%)). Results are given in parenthesis. Results Neonatology, pediatric intensive care medicine and neuropediatrics were by far the most common pediatric subspecialties, while immunology and haemostaseology were the most infrequent ones. According to our data analysis, there are 4.0 (6.4) neonatologists, 1.5 (2.6) pediatric intensivists, 1.3 (2.0) neuropaediatricians, and 1.2 (2.6) pediatric cardiologists available per a population of 100,000, but only 0.2 (0.6) pediatric nephrologists, 0.1 (0.2) pediatric immunologists, and 0.1 (0.2) pediatric haemostaseologists per a population of 100,000. Conclusions This highly uneven and skewed pattern in the distribution of pediatric in-hospital subspecialties appears to be reflective of the current in-hospital requirements, but may be also indicative of a lack in a comprehensive and across the board provision of high-end medical care in pediatrics. To assess the degree of both potential over- and under-provison of high-end specialiced medical care in the field of pediatrics, a systematic assessment of pediatric case loads in all pediatric subspecialties is required.

Background:The longer-term effects of early high-dose vitamin A to support lung development in preterm infants remain to be clarified. The aim of the NeoVitaA follow-up study was to assess the effects of early postnatal additional high-dose fat-soluble enteral vitamin A supplementation (HD-VitA) vs. placebo (control) for 28 days on respiratory complications and neurodevelopmental outcome in ELBW infants receiving recommended basic vitamin A supplementation, specified as secondary outcome parameters in the NeoVitaA trial. Methods:The trial was approved by the ethics committee of Saarland, Saarbruecken, Germany (file number: 70/2011) as well as by all local ethics committees and the Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM, Bonn, Germany). The NeoVitaA trial was registered with EudraCT (2013-001998-24) and DRKS (DRKS00006541). This follow-up covers secondary endpoints at 12 and 24 months as mentioned in the registration. Follow-up took place between September 2019 and June 2024. Follow-up assessment at 12 and 24 months' corrected age (CA) of infants enrolled in the NeoVitaA-trial included anthropometric data, number of antibiotic treatments, antibiotic treatments for pulmonary infections, hospital admissions, and hospital admissions for pulmonary infections, composite scores of the Bayley Scale of Infant and Toddler Development, second (Bayley-II) or third edition (Baley-III), other medical diagnoses and medical treatments. Findings:Follow-up examinations were available for 759 infants (83.0%). HD-VitA had no effect on number of antibiotics needed for pulmonary infections or number of hospital admissions for pulmonary infections at 12 or 24 months' CA. At 24 months' CA, the median number of antibiotic courses for pulmonary infections was one for both the HD-VitA and control group; the median number of hospital admissions for pulmonary infections per patient was 0 (HD-VitA) and 1 (control).Successful Bayley assessment was completed in 618/759 infants (92 Bayley-II, 526 Bayley-III). The median Mental Development Index score for Bayley-II was 95 vs. 97 (median difference -5.0, 95%-CI [-12.0, 2.0]) and Psychomotor Development Index 96 vs. 92 (median difference 3.0, 95%-CI [-4.0, 8.0]), with intervention and placebo, respectively. The median cognitive composite score for Bayley-III was 95 vs. 95 (median difference 0.0, 95%-CI [-5.0, 0.0]) and motor score was 92 vs. 92 (median difference 0.0, 95%-CI [-4.0, 3.0]), respectively. Interpretation:Early postnatal high-dose enteral fat-soluble vitamin A supplementation in ELBW infants did not affect pulmonary or developmental outcomes at 24 months' CA. Funding:The NeoVitaA trial was funded by the Deutsche Forschungsgemeinschaft ME 3827/1-1/2 and European Clinical Research Infrastructures Network.

BACKGROUND:Sturge-Weber Syndrome (SWS) is a capillary-venous malformation which includes the brain (leptomeningeal venous capillary malformation), the eye (choroidal angioma) and the skin (facial portwine birthmark, FPB). Structural epilepsy, glaucoma and FPBs pose therapeutic challenges. Considerable advances include improved neuroimaging, new antiseizure medication (ASM) and progress in epilepsy surgery. Yet, comprehensive data on epidemiology, clinical features, diagnostics, and treatment in contemporary pediatric SWS cohorts is scarce. METHODS:We conducted a multinational cross-sectional observational study in Germany, Switzerland and Austria to identify potential patients and build up a comprehensive database containing anonymized patient data. The patients' guardians and child neurologists filled in detailed questionnaires on histories, clinical features, diagnostic and therapeutic measures. RESULTS:Forty-seven SWS patients from Germany, Switzerland or Austria participated in our survey (111 notifications, i.e. the participation rate was 43 %). Prevalence was 7.37/million in Germany, 4.60/million in Switzerland, 2.61/million in Austria. Severity of skin, eye and brain involvement varied highly. Forty-three patients (91 %) were diagnosed with epilepsy. Median age at first seizure was 6.5 months. Thirty-two percent of the cohort received ASM in monotherapy, fifty-three percent received combination therapy and thirteen percent received no ASM. Eight percent underwent epilepsy surgery. CONCLUSIONS:In this European pediatric SWS cohort from a well-established tertiary child neurologist network, the condition was commonly diagnosed within the first year of life. 40 % of the cohort were seizure-free at inclusion; only 8.5 % of the cohort underwent epilepsy surgery. Our findings are concordant with published data from U.S. registries and case series. While our results indicate diagnostic improvement as compared to published studies, epilepsy management in SWS remains a challenge.

Background Sturge-Weber Syndrome (SWS) is a rare neurocutaneous disease, characterized by cerebral capillary-venous malformation, glaucoma, and facial vascular birthmark. Different types are reflected in the Roach classification. Most previous studies have focussed on classic SWS Type I, but Type III cases, lacking facial birthmark, were mostly described in case reports. We systematically compare cases with and without facial birthmark, with a focus on epilepsy variables, cerebral involvement, use of aspirin, and overall outcome. Methods Using a cross-sectional observational study conducted through a well-established child neurologists’ network, we recruited paediatric patients with clinically diagnosed SWS from Germany, Switzerland, and Austria. The patients’ guardians and attending child neurologists filled in detailed questionnaires. All patients were classified according to the Roach classification by both attending child neurologists and the study team. Results Out of 111 paediatric SWS patients identified, 47 participated (43.2%). 35 cases (74.5%) fulfilled the criteria for classic SWS (Roach Type I); six cases (12.8%) showed no skin involvement (Roach Type III), the remaining six cases had overlap/atypical phacomatoses with capillary-venous malformation. Cases without facial birthmark were older at diagnosis (p = 0.005), and none showed ophthalmologic involvement. Age at first seizure did not differ significantly after adjustment for multiple comparisons. No significant differences were observed in seizure frequency, seizures types, number of used antiseizure medication (ASM), epilepsy surgery, cerebral involvement including atrophy and calcifications, SWS neuroscores or use of supportive therapies. Multivariable logistic regression showed seizure frequency was independent of SWS type and epilepsy surgery, but positively associated with the number of ASM required for seizure control (p = 0.0056). Half of operated patients were seizure-free at inclusion. Conclusions In our multinational cohort, Type I and Type III cases showed comparable epilepsy features, SWS neuroscores, number of required ASM and supportive therapy requirements. Type III patients were older at diagnosis and showed no ophthalmologic involvement, indicating a milder phenotype. Irrespective of SWS type, patients with uncontrolled epilepsy were 3.8-times more likely to require additional ASM. Despite uncontrolled epilepsy, only few patients underwent surgical evaluation or intervention. Larger cohorts are needed to evaluate surgical outcomes across SWS subtypes.

Sturge-Weber Syndrome (SWS) is characterized by leptomeningeal capillary malformation (CM), glaucoma, and facial vascular birthmark. The Roach Scale differentiates between cases with facial birthmark (Roach Type I) versus isolated brain involvement (Type III). Most previous studies have focussed on classic SWS Type I, but Type III cases were mostly described in case reports. We systematically compare cases with and without facial birthmark, with a focus on epilepsy variables, cerebral involvement and overall outcome. Using a cross-sectional observational study conducted through a well-established child neurologists’ network, we recruited pediatric patients with clinically diagnosed SWS from Germany, Switzerland, and Austria. The patients’ guardians and attending child neurologists filled in detailed questionnaires. All patients were classified according to the Roach classification by both attending child neurologists and the study team. Our study identified 47 pediatric SWS patients (participation rate 43.2

Extreme prematurity is a multi-organ medical emergency. Most high-profile studies in this field are done as single-intervention randomised controlled trials (RCTs), often yielding negative or inconclusive results. Given the complexity of extreme prematurity, we suggest applying future RCTs using a bundle-of-care approach. Such an approach should take into consideration: (a) results from RCTs and meta-analyses demonstrating a positive, albeit non-significant effect of a specific intervention; (b) fundamental physiological aspects unique to the neonatal period; and (c) specific interventions aiming for a common outcome. Complementing and possibly supplanting the gold standard of single-intervention RCTs with a bundle-of-care approach may open new scientific avenues in neonatology.

Wir berichten über mehrere Fälle von schweren Komplikationen einer Rhinosinusitis im Schulkindalter im Winterhalbjahr 2022/23 an unserer Franz-Lust-Klinik für Kinder- und Jugendmedizin. Aufgrund der Schwere dieser Komplikationen ist bei Kindern mit V. a. komplizierte Rhinosinusitis/Orbitalphlegmone ein rasches interdisziplinäres Vorgehen erforderlich, um Spätschäden zu verhindern. Zudem konnten wir ein ungewöhnlich häufiges Auftreten einer Vielzahl anderer invasiver Streptokokkeninfektionen in diesem Zeitraum beobachten.

Summary Background Umbilical venous catheters (UVCs) are often used in preterm infants. Their use is associated with complications (infections, clot formation, organ injury). Very preterm infants with acquired bloodstream infection are at a higher risk for death and important morbidities (e.g., adverse neurodevelopmental outcomes). It is standard clinical practice to remove UVCs in the first days of life. Replacement of intravenous access is often performed using percutaneously inserted central catheters (PICCs). It is unclear whether serial central line use affects the rates of catheter-related complications. Methods A multicenter randomized controlled trial (random group assignment) was performed in 562 very premature (gestational age < 30 weeks) and/or very low birth weight infants (< 1250 g) requiring an UVC for administration of parenteral nutrition and/or drugs. Group allocation was random. Hypothesis A UVC dwell time of 6–10 days (281 infants) is not associated with an increased rate of central venous catheter (UVC, PICC)-related complications compared to 1–5 days (281 infants), and a longer UVC dwell time will significantly reduce the number of painful, invasive procedures associated with the need for vascular access as well as radiation exposure, use of antibiotics, and medical costs. Primary outcome parameter The number of catheter-related bloodstream infections and/or catheter-related thromboses and/or catheter-associated organ injuries related to the use of UVC/PICC was the primary outcome. Conclusion Extending the UVC dwell time may significantly reduce the number of painful invasive procedures, with the potential to positively impact not only long-term pain perception but also important social competencies (attention, learning, and behavior). Thus, the “UVC—You Will See” study has the potential to substantially change current neonatal intensive care practice.

Background: Vaccination is an essential preventative medical intervention, but needle fear and injection pain may result in vaccination hesistancy. Study purpose: To assess the role of magic tricks - no trick vs. one trick (,,disappearing handkerchief trick") vs. three tricks ("disappearing handkerchief trick", "jumping rubber band trick", and "disappearing ring trick") - performed by a professional magician and pediatrician during routine vaccination in reducing discomfort/pain and the stress response (heart rate, visual analogue scale (VAS), and biomarkers (cortisol, Immunoglobulin A (IgA), alpha-amylase, and overall protein concentration in saliva before and after vaccination). Patients and methods: Randomized controlled trial (RCT) in healthy children aged 6-11 years undergoing routine vaccination in an outpatient setting. Results: 50 children (26 female) were enrolled (no trick: n = 17, 1 trick: n = 16, 3 tricks: n = 17) with a median age of 6.9 years (range: 5.3-10.8 years). We detected no significant differences among the three groups in their stress reponse (heart rate before and after vaccination and cortisol, IgA, alpha-amylase, and overall protein concentrations in saliva before and after vaccination) or regarding pain assessment using the VAS. Conclusions: Although children undergoing routine outpatient vaccination appeared to enjoy a magician's presence, the concomitant performance of magic tricks revealed no significant effect on the stress response.

We report a case series of severe complications following rhinosinusitis in the winter season 2022/2023 at the Franz-Lust Hospital for children and adolescents. Due to the severity of these complications in children with suspected complicated rhinosinusitis/orbital phlegmona, an immediate interdisciplinary approach is mandatory to prevent long-term sequelae. In addition, during this time period, we observed the unusual occurrrence of a number of invasive streptococcal infections in this age cohort.

Background The diagnostics of autism spectrum disorder is complex due to missing biological markers and numerous comorbidities. The aim was to assess the role of neuropediatric diagnostics and to develop a standard operating procedure for a targeted assessment.Method All patients presenting to the neuropediatric outpatient clinic at Saarland University Hospital between April 2014 and December 2017 with ICD code F84 pervasive developmental disorders were included.Results A total of 82 patients were included (male 78%, female 22%; mean age 5.9 & PLUSMN; 2.9 years, range 2-16 years). The most frequent examination was electroencephalography (EEG) (74/82; 90.2%) with pathological findings in 33.8% (25/74). Based on the history and/or EEG epilepsy was diagnosed in 19.5% (16/82). Magnetic resonance imaging (MRI) was performed in 49/82 (59.8%) patients, 22/49 (44.9%) showed at least 1 cerebral abnormality and definite pathologies could be detected in 63.6% (14/22). A metabolic diagnostic work-up was performed in 44/82 (53.7%) cases and in 5/44 (11.4%) it resulted in a diagnosis or suspicion of a metabolic disease. Genetic testing results were available in 29/82 (35.4%) children and 12/29 (41.4%) showed abnormal results. Delay in motor development was more frequently associated with comorbidities, EEG abnormalities, epilepsy and abnormalities in metabolic and genetic testing.Conclusion Neuropediatric examination in cases of suspected autism should include a detailed history, a thorough neurological examination and an EEG. An MRI, comprehensive metabolic and genetic testing are only recommended if clinically indicated.

Background This study analyzes the RSV season 2021/2022 in a referral children's hospital, compares the epidemiology and illness severity with RSV-infected inpatients from 2016 to 2020 and audits the adherence to our internal therapy standard for RSV bronchiolitis. Material and methods Inpatients with rtPCR-confirmed RSV infection (Jan. 2016 to Jan. 2022). Results The audit comprises 306 RSV inpatients, on average 50 hospitalizations per year; in 03/2020, a rapid RSV Season-Offset was observed. In the winter season 2020/2021, no patient with RSV was hospitalized. Beginning in July, we noticed a rapid increase of RSV-admissions (most cases in Sept./Oct, duration until Dec. 2021; n=53). In 2021-2022, a significant larger share needed PICU admission (9.4% vs 3.2%, p=0.040). Adherence to the internal guidance was low; only 11.8% (n=36) of all patients received supportive treatment without inhalative or systemic medications, 37% of all patients received antibiotics. Conclusions This audit confirms the strong impact of public preventive measures directed against SARS-CoV-2 transmission on RSV epidemiology. Few weeks after easing public COVID-19 restrictions (summer 2021), RSV inpatient cases rapidly increased, lasting until Dec. 2021. The audit of bronchiolitis management revealed surprisingly low adherence to the internal guidance, despite a face-to-face educational session with the attending pediatricians in Oct. 2021. Low adherence resulted in an unnecessary exposure of RSV patients to systemic medications of questionable benefit including antibiotics. Zusammenfassung Hintergrund In dieser Studie erfolgte eine prospektive Analyse der RSV Saison 2021/2022 in einem Universitatsklinikum. Dabei wurde die klinische Epidemiologie und der Schweregrad mit Daten RSV-infizierter Patienten von 2016-2020 verglichen. Zusatzlich wurde die Adharenz zu einem internen Standard zur Therapie der RSV-Bronchiolitis uberpruft. Material und Methoden Stationare Patienten mit rtPCR-bestatigter RSV-Infektion (Jan. 2016 bis Jan. 2022) Ergebnisse Insgesamt wurden 306 stationar behandelten RSV-infizierte Patienten eingeschlossen, im Mittel 50 Kinder pro Jahr. Im Marz 2022 kam es zu einer raschen Abnahme der RSV Pravalenz. Ab Juli 2021 erfolgte dann ein steiler Anstieg mit (Maximum im Sept./Okt). dann eine abnehmende Zahl bis Dez. 2021 (n=53). 2021/2022 war der Anteil intensivmedizinisch behandelter Kinder signifikant hoher (9,4% vs. 3,2% 2016-2020, p=0,040). Die Adharenz zum klinikinternen Behandlungsstandard war niedrig, nur 11.8% der Patienten erhielten ausschlie ss lich eine supportive Behandlung ohne weitere inhalative oder systemische Therapie, 37% der Patienten erhielten Antibiotika. Zusammenfassung Dieses Audit bestatigt den starken Einfluss des SARS-CoV-2- Infektionsschutzes auf die RSV Epidemiologie. Nach Beendigung der Schutzma ss nahmen gab es im Sommer 2021 einen Anstieg stationar behandelter RSV-Infektionen bis Dez. 2021. Die Adharenz zum internen Behandlungsstandard war trotz einer erneuten Schulung des Personals (2021) niedrig, was zu einer hohen Exposition gegenuber wenig evidenz-basierten Therapien und Antibiotika fuhrte.

Background Congenital heart defects (CHD) are still associated with an increased morbidity and mortality. The aim of this study was to analyze trends of mortality rates in patients with CHD between 1998 and 2018 in Germany. Methods Data of registered deaths with an underlying diagnosis of CHD were used to evaluate annual mortality between 1998 and 2018. Polynomial regressions were performed to assess annual changes in CHD-associated mortality rates by age groups. Results During the 21-year study period, a total of 11,314 deaths were attributed to CHD with 50.9% of deaths in infants (age < 1 year) and 28.2% in neonates (age ≤ 28 days). The most frequent underlying CHDs associated with death were hypoplastic left heart syndrome ( n = 1498, 13.2%), left ventricular outflow tract obstruction ( n = 1009, 8.9%), atrial septal defects ( n = 771, 6.8%), ventricular septal defects ( n = 697, 6.2%), and tetralogy of Fallot ( n = 673, 5.9%), and others ( n = 6666, 58.9%). Among all patients, annual CHD-related mortality rates declined significantly between 1998 and 2010 ( p < 0.0001), followed by a significant annual increase until 2018 ( p < 0.0001). However, mortality rates in 2018 in all ages were significantly lower than in 1998. Conclusion Mortality in CHD patients decreased significantly between 1998 and 2010, but a substantial number of deaths still occurred and even significantly increased in the last 3 years of the observation period particularly in neonates and infants. This renewed slight increase in mortality rate during the last years was influenced mainly by high-risk neonates and infants. Assessment of factors influencing the mortality rate trends in association with CHD in Germany is urgently needed. Obligatory nationwide registration of death cases in relation to surgical and catheter interventions in CHD patients is necessary to provide additional valuable data on the outcome of CHD. Graphical abstract