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ZusammenfassungSeit Beginn der SARS-CoV-2-Pandemie haben die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe und die Gesellschaft für Peri-/Neonatalmedizin Empfehlungen zum Umgang mit SARS-CoV-2-positiven Schwangerschaften und Neugeborenen veröffentlicht und wiederholt aktualisiert. Als Weiterführung der bestehenden Empfehlungen werden in dem aktuellen Update Schlüsselfragen zur prä-, peri- und postnatalen Versorgung von Schwangeren, Gebärenden, Wöchnerinnen, Stillenden mit SARS-CoV-2 und COVID-19 sowie deren Un- oder Neugeborenen auf der Grundlage von Veröffentlichungen bis zum September 2021 behandelt. Die Empfehlungen und Stellungnahmen wurden sorgfältig aus den aktuell verfügbaren wissenschaftlichen Daten abgeleitet und anschließend im Expertenkonsens verabschiedet. Dieser Leitfaden – hier in der Kurzfassung vorliegend – soll eine Hilfe für die klinische Entscheidungsfindung darstellen. Die Auslegung und therapeutische Verantwortung obliegen weiterhin dem betreuenden medizinischen Team vor Ort, dessen Entscheidungen durch diese Empfehlungen unterstützt werden sollen. Aufgrund der raschen Dynamik neuer Erkenntnisse kann eine Anpassung erforderlich sein. Die Empfehlungen werden durch die Zustimmung der Fachgesellschaften getragen: Deutsche Gesellschaft für Perinatale Medizin (DGPM), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Pränatal- und Geburtsmedizin (DGPGM), Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI).

ZusammenfassungSeit Beginn der SARS-CoV-2-Pandemie haben die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe und die Gesellschaft für Peri-/Neonatalmedizin Empfehlungen zum Umgang mit SARS-CoV-2-positiven Schwangerschaften und Neugeborenen veröffentlicht und wiederholt aktualisiert. Als Weiterführung der bestehenden Empfehlungen werden in dem aktuellen Update Schlüsselfragen zur prä-, peri- und postnatalen Versorgung von Schwangeren, Gebärenden, Wöchnerinnen, Stillenden mit SARS-CoV-2 und COVID-19 sowie deren Un- oder Neugeborenen auf der Grundlage von Veröffentlichungen bis zum September 2021 behandelt. Die Empfehlungen und Stellungnahmen wurden sorgfältig aus den aktuell verfügbaren wissenschaftlichen Daten abgeleitet und anschließend im Expertenkonsens verabschiedet. Dieser Leitfaden – hier in der Langfassung vorliegend – soll eine Hilfe für die klinische Entscheidungsfindung darstellen. Die Auslegung und therapeutische Verantwortung obliegen weiterhin dem betreuenden medizinischen Team vor Ort, dessen Entscheidungen durch diese Empfehlungen unterstützt werden sollen. Aufgrund der raschen Dynamik neuer Erkenntnisse kann eine Anpassung erforderlich sein. Die Empfehlungen werden durch die Zustimmung der Fachgesellschaften getragen: Deutsche Gesellschaft für Perinatale Medizin (DGPM), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Pränatal- und Geburtsmedizin (DGPGM), Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI).

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline “Intrapartum care for healthy women and babies”. Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline “Intrapartum care for healthy women and babies”. Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

With begin of the SARS-CoV-2 pandemic the german obstetric, peri-/neonatological and pediatric professional societies published recommendations for care of pregnant and newborn, as well as for necessary staff protection in March 2020 [1-3]. Because of the rapid emerging increase of knowledge an update is required. This work therefore perceives as prosecution of the existing recommendations [1-3].Worldwide national recommendations were recently compared and published in a consensual review [4]. In methodological dependence this update of recommendations comments on key questions of pre-, peri- and postnatal care at SARS-CoV-2 and COVID-19, based on publications up to 30.05.2020. Statements represent a carefully concerned expert consensus and can change contemporary as new knowledge appears.The responsibility for concrete management remains at the local medical team, decisions should be supported by these recommendations.Mit Beginn der SARS-CoV-2 Pandemie haben die deutschen geburtshilflichen und pädiatrischen Fachgesellschaften im März 2020 Empfehlungen zur Versorgung infizierter Schwangerer und deren Neugeborener, wie auch notwendige Schutzmaßnahmen für das Personal veröffentlicht [1–3]. Eine Aktualisierung ist aufgrund des rasanten Wissenszuwachses notwendig. Die vorliegende Empfehlung versteht sich daher als Fortschreibung der bereits vorliegenden Publikationen [1–3].Von der Cochrane Pregnancy and Childbirth Group wurden weltweit nationale Empfehlungen verglichen und als Review veröffentlicht [4]. In methodischer Anlehnung hieran nehmen die vorliegenden aktualisierten Empfehlungen Stellung zu den Kernfragen der prä-, peri- und postnatalen Betreuung bei SARS-CoV-2 und COVID-19, auf der Grundlage der bis zum 30.05.2020 verfügbaren Publikationen. Die Stellungnahmen basieren auf einem sorgfältig abgestimmten ExpertInnenkonsens und können sich – insofern neue Erkenntnisse veröffentlicht werden – zeitnah ändern.Die Verantwortung für das konkrete Vorgehen bleibt bei dem vor Ort medizinisch betreuenden Team, dessen Entscheidungen durch diese Empfehlung unterstützt werden sollen.

Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the short version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).Seit Beginn der SARS-CoV-2-Pandemie haben die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe und die Gesellschaft für Peri-/Neonatalmedizin Empfehlungen zum Umgang mit SARS-CoV-2-positiven Schwangerschaften und Neugeborenen veröffentlicht und wiederholt aktualisiert. Als Weiterführung der bestehenden Empfehlungen werden in dem aktuellen Update Schlüsselfragen zur prä-, peri- und postnatalen Versorgung von Schwangeren, Gebärenden, Wöchnerinnen, Stillenden mit SARS-CoV-2 und COVID-19 sowie deren Un- oder Neugeborenen auf der Grundlage von Veröffentlichungen bis zum September 2021 behandelt. Die Empfehlungen und Stellungnahmen wurden sorgfältig aus den aktuell verfügbaren wissenschaftlichen Daten abgeleitet und anschließend im Expertenkonsens verabschiedet. Dieser Leitfaden – hier in der Kurzfassung vorliegend – soll eine Hilfe für die klinische Entscheidungsfindung darstellen. Die Auslegung und therapeutische Verantwortung obliegen weiterhin dem betreuenden medizinischen Team vor Ort, dessen Entscheidungen durch diese Empfehlungen unterstützt werden sollen. Aufgrund der raschen Dynamik neuer Erkenntnisse kann eine Anpassung erforderlich sein. Die Empfehlungen werden durch die Zustimmung der Fachgesellschaften getragen: Deutsche Gesellschaft für Perinatale Medizin (DGPM), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Pränatal- und Geburtsmedizin (DGPGM), Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI).

Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).Seit Beginn der SARS-CoV-2-Pandemie haben die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe und die Gesellschaft für Peri-/Neonatalmedizin Empfehlungen zum Umgang mit SARS-CoV-2-positiven Schwangerschaften und Neugeborenen veröffentlicht und wiederholt aktualisiert. Als Weiterführung der bestehenden Empfehlungen werden in dem aktuellen Update Schlüsselfragen zur prä-, peri- und postnatalen Versorgung von Schwangeren, Gebärenden, Wöchnerinnen, Stillenden mit SARS-CoV-2 und COVID-19 sowie deren Un- oder Neugeborenen auf der Grundlage von Veröffentlichungen bis zum September 2021 behandelt. Die Empfehlungen und Stellungnahmen wurden sorgfältig aus den aktuell verfügbaren wissenschaftlichen Daten abgeleitet und anschließend im Expertenkonsens verabschiedet. Dieser Leitfaden – hier in der Langfassung vorliegend – soll eine Hilfe für die klinische Entscheidungsfindung darstellen. Die Auslegung und therapeutische Verantwortung obliegen weiterhin dem betreuenden medizinischen Team vor Ort, dessen Entscheidungen durch diese Empfehlungen unterstützt werden sollen. Aufgrund der raschen Dynamik neuer Erkenntnisse kann eine Anpassung erforderlich sein. Die Empfehlungen werden durch die Zustimmung der Fachgesellschaften getragen: Deutsche Gesellschaft für Perinatale Medizin (DGPM), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Pränatal- und Geburtsmedizin (DGPGM), Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI).

Purpose This is an official S3-guideline of the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (ÖGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline contains evidence-based information and recommendations on indications, complications, methods and care associated with delivery by caesarean section for all medical specialties involved as well as for pregnant women. Methods This guideline has adapted information and recommendations issued in the NICE Caesarean Birth guideline. This guideline also considers additional issues prioritised by the Cochrane Institute and the Institute for Research in Operative Medicine (IFOM). The evaluation of evidence was based on the system developed by the Scottish Intercollegiate Guidelines Network (SIGN). A multi-part nominal group process moderated by the AWMF was used to compile this S3-level guideline. Recommendations Recommendations on consultations, indications and the process of performing a caesarean section as well as the care provided to the mother and neonate were drawn up.

The neonatal period can be associated with a multitude of medical and social problems. Little is known about the reasons that lead to neonatal readmissions in a pediatric hospital and their individual outcomes.To record the diagnosis of neonatal admissions in a pediatric hospital after discharge from a maternity unit. Predictive parameters are to be identified and a possible trend over the years is to be examined.The medical history of newborns admitted to a pediatric hospital in the Rhine-Main area from 01/01/2004 to 31/12/2013 was retrospectively analyzed based on provided medical files.The data of 2851 newborns was recorded. 72% of the patients were delivered by vaginal birth. During the period under examination, there was a certain fluctuation although no significant trend in the number of admissions per year (p=0.062). The most frequent primary diagnoses were jaundice (27%), newborn infection (12.4%), and feeding problems (12.3%). Exclusively breastfed newborns had fewer feeding problems than newborns with a mixed or purely formula diets (p0.001).The results of this study showed that the hospital readmissions of newborns throughout the years did not increase. Unfortunately, owing to the retrospective character of the study, it is not possible to make a clear statement as to whether hospitalization can be prevented with more intensive preventative measures. A prospective study on this matter is being planned.Die Neonatalzeit kann mit vielerlei medizinischen und sozialen Problemen verbunden sein. Wenig bekannt ist, welche Erkrankungen in dieser Zeit zu einer Aufnahme in einer Kinderklinik führen und wie deren Verlauf ist.Ziel der Studie war es, die Diagnosen von Neugeborenen, die von zu Hause in einer Kinderklinik aufgenommen werden müssen, zu erfassen. Es sollten prädiktive Parameter für Erkrankungen identifiziert werden und ein möglicher Trend über die Jahre untersucht werden.Retrospektiv wurde der Krankheitsverlauf von Neugeborenen, die vom 01.01.2004 bis 31.12.2013 in einer Kinderklinik im Rhein-Main Gebiet aufgenommen wurden, anhand ihrer Patientenunterlagen analysiert.Insgesamt wurden die Daten von 2851 Neugeborenen erfasst. 72% der Patienten waren spontan zur Welt gekommen. Im untersuchten Zeitraum gab es über die Jahre eine gewisse Schwankung, aber keinen relevanten Unterschied in der Anzahl der Aufnahmen pro Jahr (p=0,062). Der Ikterus war mit 27% die häufigste Hauptdiagnose, gefolgt von der Neugeboreneninfektion (12,4%) und Ernährungsproblemen (12,3%). Kinder, die ausschließlich gestillt wurden, hatten weniger Ernährungsprobleme als Kinder, die eine Mischnahrung oder reine Formulanahrung bekamen (p0,001).In der vorliegenden Studie konnte keine Zunahme der Krankenhauseinweisungen über die Jahre beobachtet werden. Leider kann man aufgrund des retrospektiven Charakters der Studie keine sichere Aussage darüber treffen, ob Krankenhausaufenthalte durch intensivere präventive Maßnahmen vermieden werden können. Dazu ist eine prospektive Untersuchung geplant.

Aim Our aim was to analyse the diagnostic workup of hospitalised infants with symptoms of congenital cytomegalovirus (CMV) infections. Methods This retrospective study was carried out at the University Hospital Frankfurt, Germany, from 2008 to 2017 on infants aged 4 weeks to 12 months presenting with neurological symptoms consistent with congenital CMV infections. Results We studied 117 infants, and workup data for CMV infections were available for 84%. Of these, 54% were immunoglobulin G- and immunoglobulin M-seronegative for CMV or immunoglobulin G-seropositive with no viral shedding. Congenital CMV infection was excluded in these cases. In 16%, the CMV workup was incomplete, precluding a definitive diagnosis. Dried blood spots (DBS) were requested from 30%. CMV polymerase chain reaction was negative in 19 of these 29 infants, and CMV deoxyribonucleic acid detection confirmed congenital CMV infections in six patients. DBS had been destroyed in line with German law in four cases. Congenital CMV infections were diagnosed (5%) or excluded (62%) in 67% of patients and unanswered in the remaining 33%. Conclusion Diagnoses of congenital CMV infections were widely considered and found in 5%. CMV was not stringently investigated in all patients or remained elusive due to German law on destroying DBS.

Background: Levels or fluctuations in the partial pressure of CO2 (PCO2) may affect outcomes for extremely low birth weight infants. Objectives: In an exploratory analysis of a randomized trial, we hypothesized that the PCO2 values achieved could be related to significant outcomes. Methods: On each treatment day, infants were divided into 4 groups: relative hypocapnia, normocapnia, hypercapnia, or fluctuating PCO2. Ultimate assignment to a group for the purpose of this analysis was made according to the group in which an infant spent the most days. Statistical analyses were performed with analysis of variance (ANOVA), the Kruskal-Wallis test, the χ2 test, and the Fisher exact test as well as by multiple logistic regression. Results: Of the 359 infants, 57 were classified as hypocapnic, 230 as normocapnic, 70 as hypercapnic, and 2 as fluctuating PCO2. Hypercapnic infants had a higher average product of mean airway pressure and fraction of inspired oxygen (MAP × FiO2). For this group, mortality was higher, as was the likelihood of having moderate/severe bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and poorer neurodevelopment. Multiple logistic regression analyses showed an increased risk for BPD or death associated with birth weight (p < 0.001) and MAP × FiO2 (p < 0.01). The incidence of adverse neurodevelopment was associated with birth weight (p < 0.001) and intraventricular hemorrhage (IVH; p < 0.01). Conclusions: Birth weight and respiratory morbidity, as measured by MAP × FiO2, were the most predictive of death or BPD and NEC, whereas poor neurodevelopmental outcome was associated with low birth weight and IVH. Univariate models also identified PCO2. Thus, hypercapnia seems to reflect greater disease severity, a likely contributor to differences in outcomes.

Die Gesundheit von Mutter und Kind stetig zu verbessern, ist die Aufgabe der perinatalen Medizin. Und in der Tat werden verschiedene Indikatoren für diese Gesundheit wie Mortalität von Mutter und Kind oder bestimmte Komplikationen statistisch nachweisbar über die Jahre geringer. Neue medizinische Methoden, Medikamente oder diagnostische Techniken tragen zu diesen Erfolgen messbar bei. Aber auch organisatorische Veränderungen in der Medizin verbessern das Outcome der Patienten, wenngleich wir die Zusammenhänge schwerer messen und somit bewerten können. Die neuaufgelegte S2k-Leitlinie 087–001 unserer Fachgesellschaft „Empfehlungen für die strukturellen Voraussetzungen der perinatologischen Versorgung in Deutschland“, die in dieser Ausgabe der ZGN abgedruckt und auf der Homepage der AWMF abrufbar ist, ist ein wichtiges Mittel in der Gesundheitsorganisation. Sie ist das Ergebnis der Auseinandersetzung mit der medizinischen Literatur über effektive Strukturen und Organisationsformen aus dem eigenen oder anderen Ländern unter der Berücksichtigung des jeweils Machbaren.

Background Maternal CD4 + cell microchimerism may be greater after caesarean section compared to spontaneous vaginal delivery and could cause mother-to-child transmission (MTCT) in HIV-exposed newborns. Aims To evaluate maternal CD4 + cell microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section. Study design and subjects In this prospective single-centre study, neonates whose mothers were infected with HIV and had normal MTCT risk according to the German Austrian Guidelines were considered for study enrolment. Maternal CD4 + cell microchimerism in the newborns' umbilical cord blood was measured and compared by mode of delivery. Results Thirty-seven HIV-infected mothers and their 39 newborns were included in the study. None of the 17 (0.0%) newborns delivered vaginally had quantifiable maternal CD4 + cells (95% confidence interval (CI): 0.00–0.00) in their circulation at birth compared with four of 16 (25.0%) newborns delivered via planned caesarean section, who showed 0.01–0.66% maternal cells (95% CI: − 0.06–0.16; P = 0.02) in their circulation. The intention to treat analysis, which included six additional newborns delivered by unplanned caesarean section, showed quantifiable maternal CD4 + cells in one (0.05%; 95% CI: − 0.02–0.04) of 23 (4.3%) newborn at birth compared to four of 16 (25.0%) born via planned caesarean section (95% CI: − 0.06–0.16; P = 0.04). There was no MTCT in any of the newborns. Conclusion In this small cohort, spontaneous vaginal delivery in HIV-infected women with normal MTCT risk was associated with lower maternal CD4 + cell transfer to newborns compared to planned caesarean section.

zum jetzigen Zeitpunkt konnte man in PubMed unter dem Stichwort „COVID-19“ ganze 28 057 Treffer finden, und während Sie diese Zeilen lesen, werden sicher einige Hundert dazu gekommen sein. Dass in noch nicht einmal einem Jahr so viel über ein Thema in der medizinischen Literatur publiziert wurde, ist wohl einzigartig, genau wie der völlig neue Umgang mit einer Erkrankung und ihrer Ursache. Dennoch scheinen wir ihr ziemlich hilflos gegenüber zu stehen, auch wenn die bisherigen, vor allem die einfachen Hygiene-Maßnahmen vielen Menschen das Leben gerettet haben. Prävention mag unspektakulär und unbequem sein, aber sie ist effektiv. Die Kunst ist es, Empfehlungen zu geben, die angemessen und umsetzbar sind. Wie immer in der Medizin ist weder das „zu viel“ noch das „zu wenig“ das Richtige.

Our primary objective was to compare neonatal and maternal outcomes in women with twin pregnancies, beyond 32 weeks, having a planned vaginal birth or a planned caesarean section (CS). This was a retrospective cohort study from a single tertiary centre over nine years. 534 sets of twins ≥32 + 0 weeks of gestation were included. 401 sets were planned vaginally and 133 sets were planned by CS. We compared a composite adverse perinatal outcome (perinatal mortality or serious neonatal morbidity; five minute APGAR score ≤4, neurological abnormality and need for intubation) and a composite maternal adverse outcome (major haemorrhage, trauma or infection) between the groups. There were no significant differences. Given the similarity of these results with several other larger studies of twin birth, we sought to look at reasons why there is still a rising rate of CS for twin births. We further make suggestions for keeping this rate to a sensible minimum. Impact statement What is already known on this subject? The largest randomised controlled study comparing planned vaginal birth with planned CSs for lower risk twins between 32 and 39 weeks of gestation, showed no added safety from planned CS. However, in most of the Western countries this conclusion has failed to increase the number of planned vaginal births for lower risk twins. What do the results of this study add? This observational study from a single tertiary centre provides external validation of the twin trial results in a practical day-to-day setting. It also provides insights as to how planned vaginal birth can be developed and maintained, with a key focus on safety and maternal participation in decision making. It does focus on consent and providing accurate data. What are the implications of these findings for clinical practice and/or further research? There are good grounds to encourage vaginal birth for low-risk twin pregnancies. The trend of rising caesarean rates in low-risk twin pregnancies worldwide will erode important skills for the conduct of vaginal births without any clear benefit for mothers or babies. The current situation demands careful thought about implementing innovative training opportunities for younger obstetricians. Finally, we need intelligent responses to many non-evidence-based factors which can drive clinical practice.

Objectives The aim of the study was to assess pregnancy complications in HIV-positive women and changes in the rates of such complications over 11 years in the Frankfurt HIV Cohort. Methods There were 330 pregnancies in HIV-positive women between 1 January 2002 and 31 December 2012. The rate of pregnancy-related complications, such as gestational diabetes mellitus (GDM), pre-eclampsia and preterm delivery, the mode of delivery and obstetric history were analysed. Maternal and neonatal morbidity/mortality as well as HIV mother-to-child transmission (MTCT) were evaluated. Results In our cohort, GDM was diagnosed in 38 of 330 women (11.4%). Five women (1.5%) developed pre-eclamspia or hypertension. In 16 women (4.8%), premature rupture of membranes (PROM) occurred and 46 women (13.7%) were admitted with preterm contractions. The preterm delivery rate was 36.5% (n = 122), and 26.9% of deliveries (n = 90) were between 34+0 and 36+6 weeks of gestation. Over the observation period, the percentage of women with undetectable HIV viral load (VL) increased significantly (P

Objective. To assess the prevalence of prenatal screening and of adverse outcome in high-risk pregnancies due to maternal HIV infection.Study Design. The prevalence of prenatal screening in 330 pregnancies of HIV-positive women attending the department for prenatal screening and/or during labour between January 1, 2002 and December 31, 2012, was recorded. Screening results were compared with the postnatal outcome and maternal morbidity, and mother-to-child transmission (MTCT) was evaluated.Results. One hundred of 330 women (30.5%) had an early anomaly scan, 252 (74.5%) had a detailed scan at 20–22 weeks, 18 (5.5%) had a detailed scan prior to birth, and three (0.9%) had an amniocentesis. In seven cases (2.12%), a fetal anomaly was detected prenatally and confirmed postnatally, while in eight (2.42%) an anomaly was only detected postnatally, even though a prenatal scan was performed. There were no anomalies in the unscreened group. MTCT occurred in three cases (0.9%) and seven fetal and neonatal deaths (2.1%) were reported.Conclusion. The overall prevalence of prenatal ultrasound screening in our cohort is 74.5%, but often the opportunity for prenatal ultrasonography in the first trimester is missed. In general, the aim should be to offer prenatal ultrasonography in the first trimester in all pregnancies. This allows early reassurance or if fetal disease is suspected, further steps can be taken.

Tolerating higher partial pressures of carbon dioxide (PCOInfants (n=359) between 400 and 1000 g birth weight and 23 0/7-28 6/7 weeks gestational age who required endotracheal intubation and mechanical ventilation within 24 hours of birth were randomly assigned to high PCOThere were no differences in body weight, length and head circumference between the two PCOA higher PCOISRCTN56143743.

Prenatal diagnosis of generalized arterial calcification of infancy (GACI) (OMIM #208000) is difficult and rare. There are various known gene mutations in ENPP1 (ectonucleotide pyrophosphatase/phosphodiesterase 1) locus 6q22-q23. We present a case of suspected intrauterine diagnosis at 29 weeks of gestation in a consanguineous couple. The sonographic findings were fetal hydrops (hydrothorax, skin edema, ascites, pericardial effusion and polyhydramnion), echogenic great arteries and pathological Doppler findings. An intrauterine therapy with bisphosphonates was considered, but delayed due to rapid deterioration in fetal Doppler flows with suspected fetal asphyxia. The couple was informed about the most unfavorable prognosis in fetal hydrops, however, they opted for elective delivery. A cesarean section was performed. Early neonatal death occurred due to primary intracranial hemorrhage. Postmortem and genetic testing confirmed a novel mutation in the ENPP1 gene.

BACKGROUND: The aim of this study was to assess the frequency of side effects of antiretroviral treatment in transmission prophylaxis in preterm and near-term infants with a history of HIV-positive mothers. METHODS: A retrospective single-centre study of all neonates born to HIV-positive mothers between 2001 and 2005 and receiving antiretroviral prophylaxis was performed. Respiratory distress was documented as well as possible side effects from antiretroviral drug treatment, e. g., anaemia, need for transfusion, liver and kidney dysfunction, depression of white blood cell count, feeding problems and nosocomial infections. A comparison was made between a group of preterm infants of less than 35 weeks of gestation with one of near-term neonates of more than 34 weeks. To evaluate the influence of prematurity on the frequency of symptoms, a matched pairs group of 50 preterm infants was established as the control group. RESULTS: Anaemia at birth (24 vs. 27 %), transient signs of liver impairment (24 vs. 16.5 %) or kidney dysfunction (4 vs. 0.8 %) as well as nosocomial infections were not significantly more frequent in the preterm group than in near-term group of HIV-exposed infants. Respiratory distress (56 vs. 13 %), postnatal anaemia (84 vs. 27 %). leucocytopenia (36 vs. 4 %), feeding problems (88 vs. 42 %), and blood transfusion (32 vs. 7 %) were more common in the preterm infants. The frequency of feeding problems remained markedly elevated when preterm HIV-exposed neonates were compared to preterm controls. Respiratory distress in near-term infants was seen in 13 % of the cases and 2.6 % of them had to be ventilated artificially. This was a higher frequency than in babies delivered by elective Caesarean section without maternal HIV history. CONCLUSIONS: Transmission prophylaxis in offspring of HIV-positive mothers may give rise to adverse effects. Their frequency is higher in preterm infants than in near-term infants. However; this may be related to prematurity, and not to the antiretroviral treatment itself.

The severity of the clinical course in necrotizing enterocolitis (NEC) associated with Clostridium perfringens (Cp) may support the hypothesis of a specific disease. We conducted a case control study of infants diagnosed with NEC, who underwent surgical treatment over a 7-year period. Patient histories examined characteristics of the infants, bacterial infection as well as NEC's severity, antibiotic treatment, and clinical course. Infants infected with NEC associated with Cp were compared with NEC patients without Cp. The alpha toxin from Cp type A was detected in most of the isolated strains. Cp was identified as a causative agent of NEC in nine cases. As compared with the control group (n = 32), the onset of disease was earlier in life, the clinical course more severe, and patients had a larger extent of gangrene. Portal venous gas was evident in 77% of all Cp cases, as compared to 25% in the control group. The mortality rate was 44% in the Cp group, and only 18.7% in the control group. Type A Clostridium perfringens was identified in six cases. In each isolate alpha toxin production was proven, but without any correlation to the severity of the clinical course, the extent of intestinal gangrene or mortality. In premature infants NEC in conjunction with Cp seems to be more severe than other NEC cases; it also entails higher mortality and morbidity. Alpha toxin concentrations do not correlate with the severity of the disease. Portal venous gas is highly suggestive for the diagnosis of Cp infection.

Hintergrund Die Haufigkeit der Beendigung einer lebenserhaltenden Therapie bei Neugeborenen und deren Begrundungen wurden untersucht.

Fragestellung: Peripartale oder dilatative Kardiomyopathien (PPCM/DCM) in der Schwangerschaft erhohen das Fruhgeburts-, Morbiditats- und Mortalitatsrisiko. Kann ein interdisziplinares Management in der Schwangerschaft die moglichen Komplikationen fur Mutter und Kind reduzieren? Methodik: Retrospektiv erfolgte im Rahmen einer Single-Center-Studie die Analyse (2000 – 2011) von 18 Schwangeren mit Kardiomyopathien (13 PPCM/DCM, vier HCM [hypertrophe Kardiomyopathien], eine RCM [restriktive Kardio-myopathie]) in Relation zum maternalen (NYHA, Therapie, Entbindungsmodus) und fetalen (Doppler, APGAR, Blutgasparameter, neonatale Intensivuberwachung [NICU]) ante- und postpartalem Follow-up. Ergebnis: Einen komplikationslosen Schwangerschaftsverlauf mit unauffalligem maternalem und fetalem Outcome zeigten HCM und RCM Patientinnen (NYHA I-II). Bei PPCM/DCM-Patientinnen wurden bei 3 von 13 Fallen schon in der Fruhgraviditat eine Interruptio aus maternaler Indikation vorgenommen. Trotz spezifischer, kardialer Medikation war bei 60% (6/10) eine schwere Herzinsuffizienz (NYHA III-IV) nachweisbar (Ejektionsfraktion ≤40%). Bei akut abnehmender Ejektionsfraktion, sowie nach 4 – 6 wochiger mehrfach-medikamentoser Therapie in 9 von 10 Fallen erfolgte die Entbindung der PPCM/DCM-Patientinnen per Kaiserschnitt. Die Fruhgeburtenrate (26.-37. SSW) betrug dabei 50% und in 30% war eine NICU notwendig. Small-for-gestational-age (Perzentile < 10th) waren 2 von 10 Neugeborenen. Prapartale Plazentainsuffizienzzeichen lagen nicht vor. Der APGAR-Score betrug bei 9 von 10 Neugeborenen nach 5 Minuten ≥8 Punkte, eine leichte Azidose (pH-Wert < 7,20) sub partu zeigten nur 2 von 10 Neugeborenen. Todesfalle traten bei NYHA III-IV- Patientinnen und deren Neugeborenen nicht auf. Schlussfolgerung: Kardiomyopathien, insbesondere PPCM/DCM, sind eine interdisziplinare Herausforderung. Maternales und fetales Outcome konnen durch fachubergreifendes Management optimiert werden.

Background: The impact of general anesthesia is considered a risk factor for developmental delay. Very few studies have been performed to measure the neurodevelopmental outcome of patients with selected malformations. Objectives: The purpose of this ambidirectional cohort study was to measure the neurodevelopmental outcome of patients with congenital gastrointestinal-tract malformations (GIM). Methods: Forty patients with relevant congenital GIM born in the period from June 2008 to April 2011 were identified. The inclusion criteria were a gestational age >32 completed weeks and surgery that required a general anesthetic within the first 28 days of life. The neonatal characteristics and anesthesia data were retrospectively collected. Based on information about the neonatal characteristics and socioeconomic background, a matched pair was found. All participants were tested at the corrected age of 24 months with the Bayley Scales of Infant Development II assessment. Results: The outcome was split into the psychomotor index (PDI) and mental developmental index (MDI). The patient group achieved a mean PDI of 103 and the control group achieved 106, i.e. these values were not significantly different. The mean MDI was 102 in the patient group and 110 in the control group. This difference was significant (p = 0.022). Detailed analysis of the items showed no significance for nonverbal items but a significant difference for verbal items (p = 0.029). Further analysis showed no correlation between relevant anesthesia data and the neurodevelopmental outcome. Conclusions: We found lower MDI scores due to worse verbal abilities in the patient group. Children born with GIM should be considered a risk group with respect to language development.

Co-infection with CMV in HIV-positive pregnant women is associated with perinatal mother-to-child transmission (MTCT) of both viruses. This retrospective study reports on the incidence of maternal and neonatal CMV (presence of anti-CMV IgG and IgM, CMV DNA PCR and/or CMV virus isolation) in high-risk pregnancies due to maternal HIV infection, MTCT of HIV and/or CMV. One hundred and eleven maternal samples and 75 matched neonatal samples were available for HIV and subsequent CMV testing. In this cohort of HIV-positive pregnant women, 96 (86.5 %) serum samples were anti-CMV IgG positive. In nine (9.4 %) of these, anti-CMV IgM was detected, and in none of them a maternal primary CMV infection was suspected. Fifty-seven (51.8 %) maternal serum samples were tested retrospectively by CMV DNA PCR; one sample was positive (0.9 %). All matched neonates were tested for HIV by PCR in the first month of life; HIV transmission was detected in one case. In 74 (67.2 %) of neonates, CMV testing was performed. Sixty-six of these serum samples were tested retrospectively by CMV DNA PCR. Two newborns (2.7 %) showed laboratory markers for CMV infection (one by detection of CMV DNA in plasma, and one by isolation of CMV from a urine sample). In the follow-up, neither of these two showed clinical signs for active CMV disease. We discussed these findings in the light of the national official guidelines. All CMV transmissions occurred due to maternal reinfection or endogenous reactivation. This suggests the success of highly active antiretroviral therapy in preventing MTCT of HIV and CMV disease and highlights the importance of adequate care and follow-up.

Summary Background Tolerating higher partial pressure of carbon dioxide (pCO 2 ) in mechanically ventilated, extremely low birthweight infants might reduce ventilator-induced lung injury and bronchopulmonary dysplasia. We aimed to test the hypothesis that higher target ranges for pCO 2 decrease the rate of bronchopulmonary dysplasia or death. Methods In this randomised multicentre trial, we recruited infants from 16 tertiary care perinatal centres in Germany with birthweight between 400 g and 1000 g and gestational age 23–28 weeks plus 6 days, who needed endotracheal intubation and mechanical ventilation within 24 h of birth. Infants were randomly assigned to either a high target or control group. The high target group aimed at pCO 2 values of 55–65 mm Hg on postnatal days 1–3, 60–70 mm Hg on days 4–6, and 65–75 mm Hg on days 7–14, and the control target at pCO 2 40–50 mmHg on days 1–3, 45–55 mm Hg on days 4–6, and 50–60 mm Hg on days 7–14. The primary outcome was death or moderate to severe bronchopulmonary dysplasia, defined as need for mechanical pressure support or supplemental oxygen at 36 weeks postmenstrual age. Cranial ultrasonograms were assessed centrally by a masked paediatric radiologist. This trial is registered with the ISRCTN registry, number ISRCTN56143743. Results Between March 1, 2008, and July 31, 2012, we recruited 362 patients of whom three dropped out, leaving 179 patients in the high target and 180 in the control group. The trial was stopped after an interim analysis (n=359). The rate of bronchopulmonary dysplasia or death in the high target group (65/179 [36%]) did not differ significantly from the control group (54/180 [30%]; p=0·18). Mortality was 25 (14%) in the high target group and 19 (11%; p=0·32) in the control group, grade 3–4 intraventricular haemorrhage was 26 (15%) and 21 (12%; p=0·30), and the rate of severe retinopathy recorded was 20 (11%) and 26 (14%; p=0·36). Interpretation Targeting a higher pCO 2 did not decrease the rate of bronchopulmonary dysplasia or death in ventilated preterm infants. The rates of mortality, intraventricular haemorrhage, and retinopathy did not differ between groups. These results suggest that higher pCO 2 targets than in the slightly hypercapnic control group do not confer increased benefits such as lung protection. Funding Deutsche Forschungsgemeinschaft.

BACKGROUND The aim of the study was to evaluate the predictive value of grating acuity as measured by the TAC Test (TACT) at the age of 6 months corrected age and to compare grating and recognition acuities in eyes with and without ROP residua at an age of three to seven years. PATIENTS AND METHODS The development of visual acuity between 6 months and 3 - 7 years (4.5 years median) was evaluated in 87 eyes of 44 premature children born between the 24 th and 36 th week of gestation, with a birthweight ranging from 550 to 2580 g. Thirteen eyes reached threshold: ROP disease and underwent cryocoagulation. Grating acuity was measured with the TACT at 6 months corrected age and every half year up to three to seven years (median 4.5 years). Recognition acuity was measured with the Sheridan-Gardiner Test (SGT) at 4.5 years (median). TACT-results at 6 months corrected age and 3 - 7 years were compared for the group of patients with normal posterior pole and patients with ROP residua. Furthermore, SGT scores and TACT scores were compared at the 4.5 years follow-up. A visual acuity of >/= 0.1 (3 cy/ degrees ) and >/= 0.4 (13 cy/ degrees ) was considered favourable at the age of 6 months corrected age and 3 - 7 years, respectively. RESULTS The TACT scores ranged from < 0.03 to 0.2 (< 1.0 to 6.5 cy/ degrees ) at 6 months and from < 0.05 to 2.0 (< 1.6 to 57 cy/ degrees ) at 3 - 7 years. In 77 % of cases the TACT scores at 6 months had predictive value for the further TACT scores and in 78 % for the optotype acuity. There was no difference between eyes with normal posterior pole and eyes with ROP residua concerning the predictive value of non favourable optotype acuity. CONCLUSIONS Testing grating acuity at 6 months corrected age allows to roughly predict both grating and recognition acuities at the age of 3 - 7 years. No difference between patients with normal posterior pole and patients with ROP residua was found.

In a piglet model of meconium aspiration we compared lavage with surfactant with that with perflubron (PFOB) and a control group. A human meconium suspension was instilled into piglets which were randomized in 3 (n = 6 each) groups. After lung injury, the control group was ventilated with high-frequency oscillatory ventilation (HFOV) without suctioning and lavage. A second group was lavaged with 10 ml/kg diluted surfactant, a third with 10 ml/kg pre-oxygenated PFOB. Thereafter, the animals of both groups were ventilated with HFOV. After lung injury by instillation of meconium, no further improvement in oxygenation was possible in animals of the control group and 3 piglets died during the ventilation. The subjects of the surfactant group improved promptly, and at the end of the study the arterial pO2 was significantly better than immediately after injury as compared with the other groups. Lavage with PFOB had intermediate effects in gas exchange and oxygenation compared to surfactant lavage. No differences were observed in arterial blood pressure and heart rate as well as in histological lung injury score between all groups. Lavage with exogenous surfactant as well as with PFOB improve pulmonary gas exchange in a piglet model of meconium aspiration.

Aim We investigated the associations between staff work characteristics, parents' experiences and a number of medical outcome measures. Methods This explorative multicentre study took place in the neonatal intensive care units (NICUs) of five German university hospitals between 2009 and 2011. We assessed staff work characteristics by surveying 126 NICU nurses and 57 physicians and asked 214 parents about their relationships with staff. The outcome variables of 230 premature infants with birth weights of less than 1500 g were collected over a period of 18 months. We used analysis of variance (ANOVA) and regression analyses for statistical purposes. Results We found differences in outcome measures between the NICUs, particularly parameters of respiratory support, weight gain and length of stay. When we controlled for the NICUs' baseline factors, perceptions of the relationship between staff and parents (empathy, p

Cerebrovascular diseases in children include malformations such as aneurysms, arteriovenous angiomas, cavernomas, capillary telangiectasias and the vena Galen malformation. Obstructive vasculopathies comprise the moyamoya-syndrome, arterial infarction and sinus thrombosis. The chapter provides an overview on epidemiology, aetiology, clinical manifestations, diagnosis, and the current state of evidence-based therapy.

The nervous system of the premature and newborn is undergoing intense maturational processes. Therefore, neurological diseases at this age differ considerably from older individuals regarding etiology, symptoms, treatment modalities and outcome. Drug treatment has to respect the age-specific pharmacokinetics and pharmacodynamics, but also the lack of data from adequate clinical trials. It is only recently that interest rose in evidence-based treatment criteria also for the newborn. This chapter deals with the most important diseases and discusses their treatment.

Hintergrund: Die Ergebnisse der CRYO-ROP-Gruppe belegen den Nutzen der Kryokoagulation der Netzhaut fur Funktion und Morphologie bei Schwellenwert-Fruhgeborenen-Retinopathie (RPM). Untersucht wird die Sehscharfe im Alter von 2 Jahren korrigierten Gestationsalters aller 48 Augen, die wegen akuter RPM zwischen 1990 und 1994 konsekutiv in unserer Klinik kryokoaguliert wurden.

To study the effects of high frequency oscillating ventilation (HFOV) on cerebral and abdominal circulation we measured blood flow velocities in three cerebral arteries and in the A. mesenterica superior by pulsed doppler ultrasound in 13 preterm (mean gestational age 28 weeks [25-31]) and 3 term infants during conventional ventilation (intermitted positive pressure ventilation, IPPV) and HFOV. In the preterm infants systolic blood flow velocities decreased under HFOV in all cerebral arteries. Statistically significant differences were found in the A. cerebri anterior (45.8 cm/s [sd +/- 20.6] versus 34.3 [sd +/- 10.8]; p < 0.02) and in the A. basilaris (52.8 cm/s [sd +/- 26.4] versus 44.1 [sd +/- 18.7]; p < 0.05). There was also a distinct decrease of systolic blood flow velocity in the A. mesenterica (111 cm/s [ +/- 31.3] versus 61.8 cm/s [sd +/- 18.6]; p < 0.002). The enddiastolic blood flow velocity and the Resistance Index of Pourcelot did not change significantly. The systemic blood pressure did not change during conventional ventilation or HFOV. Mean airway pressure and pCO2 were lower during HFOV, but there was not strong correlation with the reduction of flow velocities in the studied arteries (r = 0.48). In the three term infants presenting with a persistent pulmonary hypertension of the newborn, there was an increase in systolic and enddiastolic flow velocities in all studied arteries under HFOV.

In 58 premature infants with a birthweight < 1500 g High-Frequency-Oscillating-Ventilation (HFOV) was initiated within the first 48 hours of life. Indications for HFOV were: no response to surfactant application (N = 41), respiratory distress syndrome without surfactant application (N = 9), pulmonary interstitial emphysema (N = 8). Mean gestational age of the enrolled patients was 27.6 weeks (24-32) and mean birthweight was 964 g (490-1450). 23 infants died, 5 from non-pulmonary causes. Of the remainder 2 had B-Strept.-septicemia, 1 lunghypoplasia, and 1 patient died on the 70th day of life from chronic lung disease. There were no statistical differences between survivors and nonsurvivors in gestational age, birthweight, umbilical pH, 1 min APGAR score or time on conventional ventilation prior to HFOV. Alveolar-arterial-O2-difference dropped in the group of surviving patients from x487 mm Hg (sd +/- 60) to 252 mm Hg (sd +/- 89) after 6 hours (p < 0.0001) and in the nonsurvivors from x517 mm Hg (sd +/- 74) to x373 mm Hg (sd +/- 106) (p = 0.002). Oxygenationindex fell from x25 (sd +/- 10) to x5 (sd +/- 1.5) in the survivors and from 25 (sd +/- 11) to x9 (sd +/- 5.5) in the nonsurvivors within 6 hours (p < 0.0001). Mean airway pressure could be lowered in survivors from x7.6 cm H2O (sd +/- 0.6) to 5.3 cm H2O (sd +/- 0.8) and in nonsurvivors from x8.6 cm H2O (sd +/- 0.6) to 5.7 cm H2O (sd +/- 0.9) (p = 0.0002). The promising results of HFOV as a rescue therapy require a controlled study for its use as a primary mode of ventilation in premature infants.

Objective. Massive hemorrhage with shock is a common problem for the intensivist. The use of recombinant activated factor VII (rFVIIa), known as efficient treatment for hemophilia, has been reported to control severe bleeding episodes in critically care patients, but never in preterm neonates. Design. Case report (two cases) and review of the literature. Setting. Neonatal intensive care unit, university teaching hospital. Patients. Two preterm neonates with life-threatening hemorrhages, from the liver and spleen in one patient and from the lung in the other. Intervention. Intravenous administration of 150/200 µg/kg of rFVIIa (Novoseven, NovoNordisk, Copenhagen, Denmark). Measurements and results. Complete hemostasis 10 min after the second bolus in the two patients. Conclusion. For the intensivist, the successful use of rFVIIa in these patients and others lacking pre-existing coagulopathies points to rFVIIa as a novel therapeutic approach for patients presenting with massive life-threatening hemorrhage.

Objective: This study aimed to know the outcome of delayed-interval delivery for twin and triplet pregnancies at 22+0 to 25+0 weeks of gestation. Study design: A retrospective cohort of twin and triplet deliveries at the 23rd to 26th weeks of gestation were managed with delayed interval delivery from 2005 to 2011. Results: From 2005 until 2011, delayed delivery in five twin pregnancies and two triplet pregnancies were performed. The interval between delivery of the first fetus and the remaining twin/triplets was 1–18 days (mean, 9.7 days). In all cases, the first fetus was born vaginally. Survival of the first twin/triplet was 14.3%, whereas 57.1% of the second born twin/triplets survived. Birth weight gained due to delayed delivery was 131 g on average. No severe maternal complications were observed. When compared with a gestation age-matched group, where the delay was not possible, the delayed twin/triplet had a higher survival rate (57.1% vs. 0%, P=0.05). Conclusion: In multiple pregnancies with preterm delivery between completed 22 and completed 25 weeks of gestational age, delayed delivery seems to be a useful therapeutic option to achieve a better outcome of the remaining fetus or fetuses.

Aims: The aim of this study was to investigate the current prenatal “off-label use” of cytomegalovirus hyperimmunoglobulin (CMV-HIG) in the prevention and treatment of congenital CMV (cCMV) infection, including the long-term outcome of the children. Methods: This retrospective observational study comprised mothers and their children, born between January 1, 2006, and October 30, 2010. Prenatal CMV-HIG was administered after diagnosis of primary CMV infection of the mother. Clinical and virological data were collected from maternal and pediatric medical and laboratory reports. Follow-up was 12–36 months after birth. Results: Forty-two women and 43 children met the study criteria. In total, 40 mothers and six unborn infants received 115 doses of CMV-HIG. The treatment group (TG; CMV-DNA polymerase chain reaction-positive amniotic fluid) included four mothers; the multinomial group (MG; CMV-positive mother and unknown CMV status of fetus) included 38 mothers (39 infants). For the four unborn infants in TG, CMV-HIG was administered either intraumbilically or into the amniotic fluid; three of the four mothers received intravenous CMV-HIG. Three children in TG remained CMV-positive and were asymptomatic at birth and during follow-up. One infant in TG had symptomatic cCMV infection in utero, at birth, and during follow-up. In MG, 37 of 38 women received intravenous CMV-HIG and two of 39 infants received CMV-HIG in utero. In total, 9 (23.1%) of 39 children in MG were positive for cCMV (including a terminated pregnancy). All eight instances of cCMV infection at birth in MG were asymptomatic at birth and during follow-up. The fetus from the terminated pregnancy showed no sonographic symptoms of cCMV infection. No severe side effect occurred in 115 CMV-HIG applications. Conclusion: CMV-HIG was well tolerated. Compared with published untreated mother-child pairs, we observed a trend toward a smaller risk for intrauterine CMV transmission following CMV-HIG application. Signs of prenatal cCMV disease were not reversed after CMV-HIG.