Observational study on the neonatal outcome during the COVID-19 pandemic in Germany.

AIM: We aimed to determine stillbirth, preterm birth, perinatal complications, and the developmental outcome of children born preterm during the COVID-19 pandemic in Germany. METHODS: National data from the perinatal survey of preterm and term infants born in 2017-2020 between 22 March and 31 December were evaluated. Neurodevelopment of preterm infants at 2 years corrected age was tested with the Parent Report of Children's Abilities-Revised questionnaire and by clinical testing with Bayley scales, either before or during the COVID-19 pandemic. Statistical significance was calculated using a Pearson's chi-square-independence test and a linear regression model. RESULTS: In 2020, there was an increase of stillbirths of 0.02% (p = 0.01) and a decrease in preterm births by 0.38% (p < 0.001). No changes were found in a representative subgroup of infants with regard to neurodevelopmental scores (mental developmental index and psychomotor developmental index) or in parent survey data (non-verbal cognition scale and language development scale). CONCLUSION: Increasing rates of stillbirths and decreasing preterm births in Germany were observed. Existing networks might stabilise neurodevelopment of preterm infants during the COVID-19 pandemic.

Blood group AB increases risk for surgical necrotizing enterocolitis and focal intestinal perforation in preterm infants with very low birth weight.

Necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) are two of the most common emergencies of the gastrointestinal tract in preterm infants with very low birth weight (VLBW, birth weight < 1500 g). Identification of risk factors among these children is crucial for earlier diagnosis and prompt intervention. In this study, we investigated a relationship between ABO blood groups and the risk for surgical NEC/FIP. We genotyped the ABO locus (rs8176746 and rs8176719) in VLBW infants enrolled in a prospective, population-based cohort study of the German Neonatal Network (GNN). Of the 10,257 VLBW infants, 441 (4.3%) had surgical NEC/FIP. In univariate analyses, the blood group AB was more prevalent in VLBW infants with surgical NEC/FIP compared to non-AB blood groups (OR 1.51, 95% CI 1.07-2.13, p = 0.017; absolute risk difference 2.01%, 95% CI 0.06-3.96%). The association between blood group AB and surgical NEC/FIP was observed in a multivariable logistic regression model (OR of 1.58, 95% CI 1.10-2.26, p = 0.013) as well. In summary, our study suggests that the risk of surgical NEC and FIP is higher in patients with blood group AB and lower in those having non-AB blood groups.

Gut Dysbiosis With Bacilli Dominance and Accumulation of Fermentation Products Precedes Late-onset Sepsis in Preterm Infants.

BACKGROUND: Gut dysbiosis has been suggested as a major risk factor for the development of late-onset sepsis (LOS), a main cause of mortality and morbidity in preterm infants. We aimed to assess specific signatures of the gut microbiome, including metabolic profiles, in preterm infants <34 weeks of gestation preceding LOS. METHODS: In a single-center cohort, fecal samples from preterm infants were prospectively collected during the period of highest vulnerability for LOS (days 7, 14, and 21 of life). Following 16S rRNA gene profiling, we assessed microbial community function using microbial metabolic network modeling. Data were adjusted for gestational age and use of probiotics. RESULTS: We studied stool samples from 71 preterm infants with LOS and 164 unaffected controls (no LOS/necrotizing enterocolitis). In most cases, the bacteria isolated in diagnostic blood culture corresponded to the genera in the gut microbiome. LOS cases had a decelerated development of microbial diversity. Before onset of disease, LOS cases had specific gut microbiome signatures with higher abundance of Bacilli (specifically coagulase-negative Staphylococci) and a lack of anaerobic bacteria. In silico modeling of bacterial community metabolism suggested accumulation of the fermentation products ethanol and formic acid in LOS cases before the onset of disease. CONCLUSIONS: Intestinal dysbiosis preceding LOS is characterized by an accumulation of Bacilli and their fermentation products and a paucity of anaerobic bacteria. Early microbiome and metabolic patterns may become a valuable biomarker to guide individualized prevention strategies of LOS in highly vulnerable populations.

Changing epidemiology of injury-related pediatric mortality in a rural state: implications for injury control.

STUDY OBJECTIVE: To document the current epidemiology of pediatric injury-related deaths in a rural state and evaluate changes over time. DESIGN: Retrospective review of injury-related deaths in children less than 15 years of age. Data were obtained from death certificates and coroner, autopsy, prehospital, and hospital records. Analysis was done of the mechanism of injury, age, sex, race, location of incident, toxicology, and safety device use. Comparisons with analogous data collected from an earlier time period were made. SETTING: The state of Montana, from October 1989 to September 1992. MEASUREMENTS: Deaths per 100,000 population, intentionality of injury, mechanism of injury, use of protective devices, and comparisons with previous data (1980-1985) collected by Baker and Waller (Childhood injury: State by state mortality facts. Baltimore: Johns Hopkins Injury Prevention Center, 1989;148-152). RESULTS: Of 121 patients reviewed, 56% were male and 44% were female. Mean age was 7.0 years (median, 8.0). Eighty-one percent of patients were Caucasian, and 16% were Native American. The leading cause of injury was motor vehicle crashes, which was followed by drowning, unintentional firearm injuries, deaths related to house fires, homicides, and suicides. Overall, 87% of injuries were unintentional and 13% were intentional, with 62% of these suicides and 38% homicides. When considered independently of intent, firearm-related injuries ranked second. Earlier data showed motor vehicle crashes ranking second, unintentional firearm injuries seventh, and homicide fourth. Comparison of death rates per 100,000 people for the two time periods showed increases in suicide deaths (3.2 vs 0.8) and unintentional firearm injury deaths (2.3 vs 0.6). CONCLUSION: The epidemiology of rural pediatric injury-related deaths has changed. Deaths related to suicide and firearms have increased. Violent deaths related to injuries caused by firearms are at a magnitude approaching all other causes. These findings have implications for public health education and injury control strategies in rural areas.