Riccardo Pfister
Hopitaux Universitaires de Genève, DEA, Department Member
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Prematurity is an important cause of perinatal mortality and morbidity. The incidence is not decreasing, despite the efforts of prevention. Few interventions were demonstrated effective to decrease the risk of preterm birth. We are... more
Prematurity is an important cause of perinatal mortality and morbidity. The incidence is not decreasing, despite the efforts of prevention. Few interventions were demonstrated effective to decrease the risk of preterm birth. We are currently conducting two randomized trials including women with preterm labor. The objective of one trial is to evaluate a psychotherapeutic intervention. The other trial is multicentric to evaluate vaginal progesterone. We hope that these two trials will provide us with valid evidence on the effectiveness of these interventions to decrease the risk of preterm delivery and of neonatal consequences.
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Prematurity is an important cause of perinatal mortality and morbidity. The incidence is not decreasing, despite the efforts of prevention. Few interventions were demonstrated effective to decrease the risk of preterm birth. We are... more
Prematurity is an important cause of perinatal mortality and morbidity. The incidence is not decreasing, despite the efforts of prevention. Few interventions were demonstrated effective to decrease the risk of preterm birth. We are currently conducting two randomized trials including women with preterm labor. The objective of one trial is to evaluate a psychotherapeutic intervention. The other trial is multicentric to evaluate vaginal progesterone. We hope that these two trials will provide us with valid evidence on the effectiveness of these interventions to decrease the risk of preterm delivery and of neonatal consequences.
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Noise Induced Hearing Loss, Medicine, Critical Care, Pregnancy, Humans, and 13 moreNoise, Female, Male, Newborn Infant, Mechanical Ventilation, Neonatal Intensive Care Unit, Oral Cavity, Respiratory distress, Continuous Positive Airway Pressure, Premature infant, Respiratory distress syndrome, Paediatrics and reproductive medicine, and Infant Premature
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We evaluated the tolerance to immunization of 64 very low birth weight preterm infants. Thirty-three of the infants experienced a cardiorespiratory event after the first vaccination, and 6 of these 33 (18%) had a recurrence after the... more
We evaluated the tolerance to immunization of 64 very low birth weight preterm infants. Thirty-three of the infants experienced a cardiorespiratory event after the first vaccination, and 6 of these 33 (18%) had a recurrence after the second vaccination, including 2 infants previously discharged to home. A cardiorespiratory event associated with the first vaccination was the sole risk factor for recurrence identified.
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Pediatrics, Medicine, Humans, Low Birth Weight, Infant, and 15 moreImmunization, Switzerland, Incidence, Risk factors, Recurrence, Newborn Infant, Retrospective Studies, Prognosis, Risk Factors, Apnea, Bradycardia, Cardiorespiratory Fitness, Premature infant, Paediatrics and reproductive medicine, and Infant Premature
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Pediatrics, Incidence Geometry, Medicine, Neonatal Necrotizing Enterocolitis, Prospective studies, and 14 morePopulation, Humans, Female, Male, Infant, Switzerland, Survival Rate, Retinopathy of prematurity, Bronchopulmonary Dysplasia, Gestational Age, Medicine and Health Sciences, Hospital Mortality, Intraventricular Hemorrhage, and Paediatrics and reproductive medicine
Le soin peau-a-peau permet une reduction de la mortalite neonatale dans les pays a faible revenu, alors que dans les pays a haut revenu il est justifie par la reduction de la morbidite et les benefices physiques et neurodeveloppementaux.... more
Le soin peau-a-peau permet une reduction de la mortalite neonatale dans les pays a faible revenu, alors que dans les pays a haut revenu il est justifie par la reduction de la morbidite et les benefices physiques et neurodeveloppementaux. Les benefices societaux, bases sur l'attachement, origine du lien familial, ont ete preconises depuis sa creation, mais restent peu etudies. La realisation et les enjeux de notre programme Kangourou camerounais nous permettent de discuter ces liens societaux a la lumiere de publications des pays a haut revenu.
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Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life.... more
Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management.
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ImportanceAppropriate use of antibiotics is life-saving in neonatal early-onset sepsis (EOS), but overuse of antibiotics is associated with antimicrobial resistance and long-term adverse outcomes. Large international studies quantifying... more
ImportanceAppropriate use of antibiotics is life-saving in neonatal early-onset sepsis (EOS), but overuse of antibiotics is associated with antimicrobial resistance and long-term adverse outcomes. Large international studies quantifying early-life antibiotic exposure along with EOS incidence are needed to provide a basis for future interventions aimed at safely reducing neonatal antibiotic exposure.ObjectiveTo compare early postnatal exposure to antibiotics, incidence of EOS, and mortality among different networks in high-income countries.Design, Setting, and ParticipantsThis is a retrospective, cross-sectional study of late-preterm and full-term neonates born between January 1, 2014, and December 31, 2018, in 13 hospital-based or population-based networks from 11 countries in Europe and North America and Australia. The study included all infants born alive at a gestational age greater than or equal to 34 weeks in the participating networks. Data were analyzed from October 2021 to M...
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Background: In recent decades there has been a major increase in multiple birth rates, and the rate of twining vary from 6-9 per thousand life births to 20 per thousand live births across differ-ent areas of the world. Many studies have... more
Background: In recent decades there has been a major increase in multiple birth rates, and the rate of twining vary from 6-9 per thousand life births to 20 per thousand live births across differ-ent areas of the world. Many studies have demonstrated higher neonatal and perinatal mortality and morbidity rates in twin deliveries compared to singleton births. This study was aimed to com-pare the outcomes of preterm twins and preterm singletons.Methods: A prospective, observational multicenter study was conducted from July 2016 to May 2018 in five tertiary hospitals in Ethiopia. All preterm, liveborn infants born at or transferred at less than 7 days of life to one of the study hospitals with an estimated gestational age below 37 weeks were included.Results: A total of 3,703 preterm neonates admitted to participating neonatal intensive care units were included in the study, of which 1171(31.6%) were twins. After adjusting for birth weight and gestational age, the mortality rate for pret...
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BackgroundNeonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation... more
BackgroundNeonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation into why neonates still become hypothermic despite awareness of the problem and established thermal care guidelines. This study aimed to explore the gaps in knowledge and practices of neonatal thermal care among healthcare workers in low-resource settings.MethodsA cross-sectional, questionnaire-based survey was performed online among healthcare workers in low-resource settings. We applied a purposive and snowballing sampling method to recruit participants through a two-round international online survey. Questionnaires were developed using themes of neonatal thermal care extracted from existing neonatal care guidelines.Results55 neonatal care professionals participated in the first-round survey and 33 in the second. Almost all participants (n=44–54/55...
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Health Care and Medicine
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L’amelioration des soins perinataux a augmente le taux de survie des nouveau-nes prematures. L’environnement a un impact sur le developpement sensorimoteur et le comportement de l'enfant durant la periode neonatale. Le concept des... more
L’amelioration des soins perinataux a augmente le taux de survie des nouveau-nes prematures. L’environnement a un impact sur le developpement sensorimoteur et le comportement de l'enfant durant la periode neonatale. Le concept des soins de developpement est une approche multidisciplinaire et individualisee integrant les parents, premiers partenaires des soins. Cette prise en charge preventive soutient un developpement harmonieux de ces enfants vulnerables.
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Infantile hemangioma (IH) is the most common vascular tumor in infancy, and its physiopathology is not fully understood. Nevertheless, a hypoxic insult may be an essential element for the formation of an IH. Herein, we describe a case of... more
Infantile hemangioma (IH) is the most common vascular tumor in infancy, and its physiopathology is not fully understood. Nevertheless, a hypoxic insult may be an essential element for the formation of an IH. Herein, we describe a case of a 25-week premature newborn who developed an IH after a post-burn scar and its evolution.
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Background. Globally, prematurity is the leading cause of neonatal mortality, and hypothermia is one of its contributing factors. The goal of this study was to determine the association between hypothermia and mortality. Methods. A... more
Background. Globally, prematurity is the leading cause of neonatal mortality, and hypothermia is one of its contributing factors. The goal of this study was to determine the association between hypothermia and mortality. Methods. A prospective, multi-center, descriptive clinical study was conducted in 5 hospitals in Ethiopia. Axillary temperatures were taken at the time of admission to the newborn intensive care units (NICU) and followed during the NICU stay. Results. A total of 3852 premature neonates (<37 weeks) were admitted to the NICUs from July 2016 to May 2018. Of these infants, 1109 (28.8%) died and 2991 (79.6%) had hypothermia. Hypothermia was associated with perinatal asphyxia (89.5%), RDS (86.2%), and resuscitation at birth (82.7%). Admission temperatures in preterm newborns were inversely associated with mortality and morbidity. Conclusion. Hypothermia at admission is associated with neonatal mortality in premature neonates in Ethiopia. RDS and perinatal asphyxia were...
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AimEpidemiological data on the incidence and risk factors of extravasation of peripheral intravenous catheters (PIVC) in neonates and children are scarce and that is what this study explored.MethodsThis was a one‐year retrospective study... more
AimEpidemiological data on the incidence and risk factors of extravasation of peripheral intravenous catheters (PIVC) in neonates and children are scarce and that is what this study explored.MethodsThis was a one‐year retrospective study of all neonates and paediatric intensive care patients with at least one recorded PIVC at the Geneva University Hospitals, Switzerland, in 2013. The extravasation rate was determined for all patients, including neonates below 28 days, and for all PIVCs. Multivariate analysis of the associated risk factors was performed.ResultsWe analysed 1300 PIVC in 695 paediatric patients with a median age of 1.5 years. The overall extravasation incidence was 17.6% for all patients and 11.7% for PIVC. The overall incidence rate of PIVC extravasation was 4.5 per 100 catheters days, and the risk was highest in the 201 neonates, at 28.4%. The incidence rate four days after insertion of the PIVC was around three times higher than on day one. Neonates and the in situ d...
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Background Differences in perception and potential disagreements between parents and professionals regarding the attitude for resuscitation at the limit of viability are common. This study evaluated in healthcare professionals whether the... more
Background Differences in perception and potential disagreements between parents and professionals regarding the attitude for resuscitation at the limit of viability are common. This study evaluated in healthcare professionals whether the decision to resuscitate at the limit of viability (intensive care versus comfort care) are influenced by the way information on incurred risks is given or received. Methods This is a prospective randomized controlled study. This study evaluated the attitude of healthcare professionals by testing the effect of information given through graphic fact sheets formulated either optimistically or pessimistically. The written educational fact sheet included three graphical presentations of survival and complication/morbidity by gestational age. The questionnaire was submitted over a period of 4 months to 5 and 6-year medical students from the Geneva University as well as physicians and nurses of the neonatal unit at the University Hospitals of Geneva. Our ...
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To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. We included 58 004 infants born weighing... more
To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. We included 58 004 infants born weighing <1500 g at 24(0)-31(6) weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses. Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite out...
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Pediatrics, Global Health, Medicine, Birth Weight, Population, and 12 moreHumans, Low Birth Weight, Female, Male, Newborn Infant, Odds ratio, Retrospective Studies, Retinopathy of prematurity, Bronchopulmonary Dysplasia, Gestational Age, Medicine and Health Sciences, and Paediatrics and reproductive medicine
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ImportanceIn light of the promising neuroprotective properties of recombinant human erythropoietin (RHEpo), the Swiss EPO Neuroprotection Trial was started to investigate its effect on neurodevelopment in very preterm infants. The results... more
ImportanceIn light of the promising neuroprotective properties of recombinant human erythropoietin (RHEpo), the Swiss EPO Neuroprotection Trial was started to investigate its effect on neurodevelopment in very preterm infants. The results of the primary and secondary outcome analysis did not show any effect of RHEpo on cognitive performance, neuromotor outcomes, or somatic growth of the study participants at ages 2 or 5 years.ObjectiveTo investigate whether early high-dose RHEpo improves behavioral outcomes and health-related quality of life (HRQoL) at age 5 years.Design, Setting, and ParticipantsThis was a prespecified secondary analysis of the double-blind, placebo-controlled, multicenter Swiss EPO Neuroprotection randomized clinical trial, which was conducted at 5 level-III perinatal centers in Switzerland. Infants born between 26 weeks 0 days’ and 31 weeks 6 days’ gestation were recruited between 2005 and 2012 and followed-up until age 5 years (last follow-up in 2018). Data were...
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Neonatal death represents a major burden in Sub-Saharan Africa (SSA), where the main conditions triggering mortality, such as prematurity, labor complications, infections, and respiratory distress syndrome, are frequently worsened by... more
Neonatal death represents a major burden in Sub-Saharan Africa (SSA), where the main conditions triggering mortality, such as prematurity, labor complications, infections, and respiratory distress syndrome, are frequently worsened by hypothermia, which dramatically scales up the risk of death. In SSA, the lack of awareness on the procedures to prevent hypothermia and the shortage of essential infant devices to treat it are hampering the reduction of neonatal deaths associated to hypothermia. Here, we offer a snapshot on the current available medical solutions to prevent and treat hypothermia in SSA, with a focus on Kenya. We aim to provide a picture that underlines the essential need for infant incubators in SSA. Specifically, given the inappropriateness of the incubators currently on the market, we point out the need for reinterpretation of research in the field, calling for technology-based solutions tailored to the SSA context, the need, and the end-user.
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AIMS OF THE STUDY: To assess whether the COVID-19 pandemic caused by SARS-CoV-2 had an impact on incidence, treatment or major adverse short-term outcome of preterm-born infants in Switzerland. METHODS: Retrospective cohort study of... more
AIMS OF THE STUDY: To assess whether the COVID-19 pandemic caused by SARS-CoV-2 had an impact on incidence, treatment or major adverse short-term outcome of preterm-born infants in Switzerland. METHODS: Retrospective cohort study of preterm infants born in 2020 based on two independent data sources from the Swiss Federal Statistics Office (FSO) and SwissNeoNet. Based on FSO data, we calculated the odds ratios for extremely preterm (22–27 weeks gestation), very preterm (28–31 weeks gestation), and late preterm (32–36 weeks gestation) births during the pandemic. Based on SwissNeoNet data of infants born between 22 and 31 weeks gestation, we compared infants born during the Swiss lockdown period in 2020 with infants born during the same period between 2015 and 2019, all infants of 2020 with all infants between 2015 and 2019 and infants born to mothers tested SARS-CoV-2 positive and negative. Possible associations with the pandemic were tested using logistic regression adjusted for case...
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Review question / Objective: What is the prevalence of drug-resistant pathogens associated with neonatal Early Onset Sepsis (NEOS) in the African continent and their likelihood of resistance to commonly used antibiotics in the NEOS, and... more
Review question / Objective: What is the prevalence of drug-resistant pathogens associated with neonatal Early Onset Sepsis (NEOS) in the African continent and their likelihood of resistance to commonly used antibiotics in the NEOS, and what is the trend through time? Condition being studied: There is no consensus on the definition of neonatal sepsis. Two main categories of neonatal sepsis are widely accepted: early-onset sepsis (EOS) defined as occurring in the first 72 hours of life, hence representing perinatal vertical infection; and late-onset sepsis (LOS), which occurs between 72 hours to 28 days and can be hospital or community-acquired. Information sources: Pubmed, EMBASE, Web of Science. All authors from papers with missing information were contacted before article exclusion.
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1. Is the question posed by the authors well defined? Discretionary Revisions: The question is fairly good defined by ‘...we investigated the major causes of neonatal mortality, which have relatively well-defined diagnostic criteria...’.... more
1. Is the question posed by the authors well defined? Discretionary Revisions: The question is fairly good defined by ‘...we investigated the major causes of neonatal mortality, which have relatively well-defined diagnostic criteria...’. It might have been useful to state at a very early stage that only pathologies requiring usually (or in Denmark) a level III facility were considered. However, the conclusion that this finding ‘indicates a gap between need for and access to specialized care’ is an answer to a question that was not clearly stated. As discussed below (point 5) this answer needs more pondering and would make more sense in form of a hypothesis than a conclusive statement.
Objective To explore the gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings. Methods We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers... more
Objective To explore the gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings. Methods We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers in neonatal care in low-resource settings globally. The questionnaire was developed using themes of neonatal thermal care extracted from existing neonatal care guidelines, including WHO’s. The survey asked multiple-choice questions, supplemented by open-ended questions to capture first hand insights and information on neonatal thermal care. Results of the survey were analysed using Microsoft Excel. Data was collated and summarized using descriptive measures. Results Almost all participants acknowledged the importance of all the WHO warm chain elements, however, fewer participants responded positively regarding the practice of this warm chain. Only 56% of the participants acknowledged the usefulness of checking the peripheral temperature by hand-touc...
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ZusammenfassungDer vorliegende Beitrag basiert auf dem Schweizer interprofessionellen Reanimationskurs für Neugeborene start4neo sowie auf den 2017 revidierten Empfehlungen der Schweizerischen Gesellschaft für Neonatologie (SGN) zur... more
ZusammenfassungDer vorliegende Beitrag basiert auf dem Schweizer interprofessionellen Reanimationskurs für Neugeborene start4neo sowie auf den 2017 revidierten Empfehlungen der Schweizerischen Gesellschaft für Neonatologie (SGN) zur Unterstützung der Adaptation und Reanimation des Neugeborenen. Das Vorgehen bei einer normalen Adaptation sowie die Indikation zu Stabilisierungs- und weiterführenden Reanimationsmaßnahmen bei gestörter Adaptation werden strukturiert anhand des T‑ABCD(„thermoregulation, airway, breathing, circulation, drugs“)-Algorithmus erläutert. Im Hinblick auf die für das Neugeborene wichtige „golden first minute“ wird der Fokus auf die korrekte Beurteilung von Atmung und vor allem Herzfrequenz gelegt, da diese klinischen Parameter wegweisend sind für den zeitgerechten Einsatz etwaiger Unterstützungsmaßnahmen. Die praktische Anwendung des im Beitrag referierten Wissens und die Fähigkeit zur situativen Beurteilung sollen basierend auf einer induktiven Lernmethode in praktischen Kursmodulen erarbeitet werden, um kompetentes Handeln in neonatalen Betreuungs- oder Reanimationssituationen zu gewährleisten.AbstractThis paper is based on the Swiss interprofessional neonatal resuscitation course start4neo and the 2017 revised guidelines of the Swiss Society of Neonatology. Both the approach to normal adaptation and the procedures for stabilization and resuscitation are presented and discussed according to the T‑ABCD (thermoregulation, airway, breathing, circulation, drugs) approach detailed in the neonatal resuscitation algorithm. In the context of “the golden first minute” after birth, the assessment of breathing and heart rate are the two most important parameters calling for initiation, escalation or de-escalation of stabilization or resuscitation measures. The practical application of the theoretical background presented in this paper and the ability to the assess the situation should be trained in a practical course, ideally based on inductive learning methods in order to ensure competent action in neonatal care or resuscitation situations.
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Medicine and Gynecology
Quality improvement in health care requires identification of areas in need of improvement by comparing processes and patient outcomes within and between health care providers. It is critical to adjust for different case-mix and outcome... more
Quality improvement in health care requires identification of areas in need of improvement by comparing processes and patient outcomes within and between health care providers. It is critical to adjust for different case-mix and outcome risks of patient populations but it is currently unclear which approach has higher validity and how limitations need to be dealt with. Our aim was to compare 3 approaches towards risk adjustment for 7 different major quality indicators in neonatal intensive care (21 models). We compared an indirect standardization, logistic regression and multilevel approach. Parameters for risk adjustment were chosen according to literature and the condition that they may not depend on processes performed by treating clinics. Predictive validity was tested using the mean Brier Score and by comparing area under curve (AUC) using high quality population based data separated into training and validation sets. Changes in attributional validity were analysed by comparing...
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Quality Improvement, Neonatology, Medicine, Logistic Regression, Standardization, and 14 moreHumans, INTENSIVE CARE, Female, Male, Infant, Newborn Infant, Newborn, Reproducibility of Results, Neonatal Intensive Care Unit, Risk Adjustment, Logistic Models, Area Under Curve, Brier score, and Paediatrics and reproductive medicine
Prematurity is an important cause of perinatal mortality and morbidity. The incidence is not decreasing, despite the efforts of prevention. Few interventions were demonstrated effective to decrease the risk of preterm birth. We are... more
Prematurity is an important cause of perinatal mortality and morbidity. The incidence is not decreasing, despite the efforts of prevention. Few interventions were demonstrated effective to decrease the risk of preterm birth. We are currently conducting two randomized trials including women with preterm labor. The objective of one trial is to evaluate a psychotherapeutic intervention. The other trial is multicentric to evaluate vaginal progesterone. We hope that these two trials will provide us with valid evidence on the effectiveness of these interventions to decrease the risk of preterm delivery and of neonatal consequences.
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Die medizinische Forschung hat generell zu verbesser ten Überlebenschancen und erhöhter Lebensqualität geführt. Da Neugeborene wegen ihrer Verletzlichkeit eines besonderen Schutzes bedürfen, wird debattiert, ob an ihnen Forschung... more
Die medizinische Forschung hat generell zu verbesser ten Überlebenschancen und erhöhter Lebensqualität geführt. Da Neugeborene wegen ihrer Verletzlichkeit eines besonderen Schutzes bedürfen, wird debattiert, ob an ihnen Forschung überhaupt zulässig sei. In dem am 7. März 2010 vom Volk mit 77% angenommenen und am 8. März 2010 in Kraft gesetzten Verfassungs artikel 118b zur Forschung am Menschen steht in Ab satz 2c: «Wenn ein Forschungsvorhaben für urteils unfähige Personen keinen unmittelbaren Nutzen bringt, dürfen Risiken und Belastungen nur minimal sein. Das bedeutet, dass in der Schweiz Forschung am Neugeborenen zwar erlaubt, jedoch stark einge schränkt ist.» Nehmen wir als Beispiel die Pharmaforschung. Neu geborene verhalten sich pharmakologisch anders als Kinder und Erwachsene. Trotzdem werden heute viele Medikamente angewandt, welche für Erwachsene entwickelt wurden, aber nicht für das Neugeborene lizenziert sind. In diesem Alter sind weder deren Pharmakokinetik bekannt n...
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INTRODUCTION: The overall demand in neonatal care is increasing in a number of countries, and the adequacy of nursing human resources to the needs is to be addressed. OBJECTIVES: To estimate demand for neonatal intensive and intermediate... more
INTRODUCTION: The overall demand in neonatal care is increasing in a number of countries, and the adequacy of nursing human resources to the needs is to be addressed. OBJECTIVES: To estimate demand for neonatal intensive and intermediate care in Geneva University Hospitals (HUG), with corresponding bed capacity. METHODS: The demand was estimated according to several methods. The first method was based on HUG statistics for both newborns cared in neonatology and those newborns which could not be cared for in HUG. The second method considered national Swiss births and early neonatal mortality rate per degree of prematurity, with estimated length of stay. The third method was based on available international benchmarks on ratio of neonatal beds per 1’000 births. RESULTS: Considering HUG statistics, the estimation of the demand in neonatal care amounted to 500 newborns, while taking into account both newborns cared in HUG and those for which care could not be given by HUG. The corresponding need for staffed beds was estimated to 34.6 beds. This result was obtained by applying average length of stay for newborns cared in HUG and estimated stay for newborns transferred to other institutions or refused by HUG. With an another method, applying Swiss distribution of prematurity to Geneva births and an estimated length of stay per degree of prematurity, the need for neonatal beds was estimated to 723 cases, corresponding to 33.6 beds.. In order to validate these estimations, an available benchmark of 5 beds per 1’000 births was applied to all births in Geneva, including newborns born but not residents in Geneva. This method led to an estimation of 31.6 beds needed for neonatology. DISCUSSION: Considering the 20 neonatal staffed beds in HUG, with additional unknown but small number of beds in private clinics, all three estimations indicate an important need of additional neonatal beds. These estimations should be further completed with a study of DRG lengths of stay, staff needs corresponding to nurse workload, and demographic trends in Geneva.
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Aim: This study aimed to investigate the safety of transfusing red blood cell concentrates (RBCCs) through small [24 gauge (24G)] and extra-small [28 gauge [28G)] peripherally inserted central catheters (PICCs), according to guidelines of... more
Aim: This study aimed to investigate the safety of transfusing red blood cell concentrates (RBCCs) through small [24 gauge (24G)] and extra-small [28 gauge [28G)] peripherally inserted central catheters (PICCs), according to guidelines of transfusion practice in Switzerland.Methods: We performed a non-inferiority in vitro study to assess the safety of transfusing RBCC for 4 h at a 4 ml/h speed through 24G silicone and 28G polyurethane PICC lines, compared with a peripheral 24G short catheter. The primary endpoint was hemolysis percentage. Secondary endpoints were catheter occlusion, inline pressure, and potassium and lactate values.Results: For the primary outcome, hemolysis values were not statistically different among catheter groups (0.06% variation, p = 0.95) or over time (2.75% variation, p = 0.72). The highest hemolysis values in both 24G and 28G PICCs were below the non-inferiority predefined margin. We did not observe catheter occlusion. Inline pressure varied between cathet...
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Introduction: Caesarean section (CS) rates are increasing worldwide and pre-labour CS do so at the highest rate. Although CS undoubtedly save some lives, it is equally true that higher neonatal mortality and morbidities, particularly in... more
Introduction: Caesarean section (CS) rates are increasing worldwide and pre-labour CS do so at the highest rate. Although CS undoubtedly save some lives, it is equally true that higher neonatal mortality and morbidities, particularly in relation to lung adaptation at birth, are associated with this mode of delivery. Despite recognition that clearance of the liquid filling the fetal lung is an essential step in the establishment of effective postnatal air-breathing, the pathophysiologic mechanisms of neonatal respiratory morbidity after CS are still under debate. We therefore lack insight for development of novel approaches to improve respiratory outcome in the newborn infant, the primary neonatal pathology. Objective: To summarises up-to-date clinical and animal research providing insight into the effect of delivery mode on lung liquid clearance and on respiratory adaptation at birth. Method: A non-systematic translational pathophysiologic review based on the last 30 years of experi...
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Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Currently, there is limited evidence to guide investigation and treatment strategies. To evaluate the parameters used to diagnose or exclude NEC, and to identify... more
Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Currently, there is limited evidence to guide investigation and treatment strategies. To evaluate the parameters used to diagnose or exclude NEC, and to identify differences between neonatologists and pediatric surgeons. A scenario-based survey was sent to neonatologists and pediatric surgeons. 173 physicians from 26 countries completed the survey (55% neonatologists and 45% pediatric surgeons). Bloody stools, abdominal tenderness, low platelet counts, and increased lactate levels increased the likelihood of NEC for 82, 72, 56, and 45% of respondents, respectively. Intestinal pneumatosis, portal venous gas, and pneumoperitoneum on X-ray increased the likelihood of NEC for 99, 98, and 92% of respondents, respectively. Clinical examination and laboratory tests were insufficient to exclude NEC, but normal intestinal movements and normal gut wall thickness on ultrasonography decreased the likelihood of NEC for 38 ...
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During the last decade, the development of "bedside" investigative methods, including indirect calorimetry, nutritional balance and stable isotope techniques, have given a new insight into energy and protein metabolism in the... more
During the last decade, the development of "bedside" investigative methods, including indirect calorimetry, nutritional balance and stable isotope techniques, have given a new insight into energy and protein metabolism in the neonates. Neonates and premature infants especially, create an unusual opportunity to study the metabolic adaptation to extrauterine life because their physical environment can be controlled, their energy intake and energy expenditure can be measured and the link between their protein metabolism and the energetics of their postnatal growth can be assessed with accuracy. Thus, relatively abstract physiological concepts such as the postnatal timecourse of heat production, energy cost of growth, energy cost of physical activity, thermogenic effect of feeding, efficiency of protein gain, metabolic cost of protein gain and protein turnover have been quantified. These results show that energy expenditure and heat production rates increase postnatally from a...
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Therapeutic hypothermia following hypoxic ischaemic encephalopathy in term infants was introduced into Switzerland in 2005. Initial documentation of perinatal and resuscitation details was poor and neuromonitoring insufficient. In 2011, a... more
Therapeutic hypothermia following hypoxic ischaemic encephalopathy in term infants was introduced into Switzerland in 2005. Initial documentation of perinatal and resuscitation details was poor and neuromonitoring insufficient. In 2011, a National Asphyxia and Cooling Register was introduced. To compare management of cooled infants before and after introduction of the register concerning documentation, neuromonitoring, cooling methods and evaluation of temperature variability between cooling methods. Data of cooled infants before the register was in place (first time period: 2005-2010) and afterwards (second time period: 2011-2012) was collected with a case report form. 150 infants were cooled during the first time period and 97 during the second time period. Most infants were cooled passively or passively with gel packs during both time periods (82% in 2005-2010 vs 70% in 2011-2012), however more infants were cooled actively during the second time period (18% versus 30%). Overall t...