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German experience in the management of ELGAN infants
1Neonatology and Ped. Intensive Care, Center for Pediatrics, University of Freiburg, Germany. submission@actabiomedica.it.
Insights
Germany
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
Background:
- Approximately 10% of infants born in Germany are preterm, with 1% being very preterm, requiring specialized care in Level 1 perinatal centers.
- Current treatment protocols for extremely preterm infants vary, with sustained lung inflation being a common delivery room procedure.
- Emerging trends include early or prophylactic surfactant administration and less invasive surfactant administration (LISA).
Purpose of the Study:
- To review current trends and recent advancements in the delivery room management of extremely preterm infants in Germany.
- To highlight the status of ongoing and completed clinical trials investigating novel treatment strategies.
- To discuss the increasing use of near-infrared spectroscopy (NIRS) for brain oxygenation monitoring and initiatives to reduce intraventricular hemorrhage (IVH).
Main Methods:
- Review of current practices in German Level 1 perinatal centers.
- Summary of completed and ongoing German and European randomized controlled trials (RCTs).
- Discussion of the application of near-infrared spectroscopy (NIRS) and multidisciplinary surveillance strategies.
Main Results:
- Preliminary results from RCTs on LISA, permissive hypercapnia, and inhaled steroids are available.
- Near-infrared spectroscopy (NIRS) is increasingly used for clinical monitoring of brain oxygenation.
- A recent initiative has significantly reduced the rate of intraventricular hemorrhage (IVH) through prospective multidisciplinary surveillance.
Conclusions:
- Several key interventions, including LISA and inhaled steroids, are being evaluated in clinical trials for extremely preterm infants.
- Monitoring brain oxygenation with NIRS is gaining clinical traction for guiding hemodynamic management.
- Multidisciplinary surveillance has proven effective in reducing IVH rates, improving outcomes for preterm infants.
Abstract:
Of 680 000 infants born in Germany a year roughly 10% are preterm and 1% are very preterm. They are treated in around 150 level 1 perinatal centers and there are various credos how to best treat the ELGAN infant. However, many centers include the use of a sustained inflation for lung aeration in the standard protocol of delivery room care in Germany. As a result of the large studies on delivery room care, a trend for earlier or prophylactic surfactant in the most immature infants can be observed, however, surfactant is increasingly given in a new less invasive way called LISA. German randomized controlled trials on LISA , on permissive hypercapnia in the premature infants and a German initiated European trial on inhaled steroids have been completed and preliminary results are available. NIRS so far mostly is used for research reasons; however, the number of centers that monitor brain oxygenation for clinical reasons to guide hemodynamic management is increasing. A recent initiative was able to tremendously reduce the rate of IVH by prospective multidisciplinary surveillance.
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