Giancarlo Natalucci

OBJECTIVE: We aimed to assess physical activity and screen time in a cohort of very preterm-born children and adolescents (aged 5–16 years), in comparison with their full-term siblings. We also aimed to identify potential correlates of these lifestyle factors among the very preterm-born. DESIGN: Cross-sectional survey in the greater Zurich area of Switzerland. PATIENTS: Children born 1 hour per day) and screen time (hours per day or <2 hours per day). METHODS: Linear/logistic regression accounted for age group, sex and family unit. A classification tree analysis explored potential correlates of physical activity and screen time among the very preterm-born. RESULTS: Physical activity of very preterm-born children was similar to that of their full-term siblings, but only one-third of participants met physical activity requirements (i.e. at least 1 hour per day). Screen time was similar in both groups, but much higher among adolescents regardless of preterm birth status. Chronic conditions and respiratory symptoms were not associated with insufficient physical activity. No correlates were identified for physical activity, while age group and socioeconomic status were associated with screen time. CONCLUSIONS: No differences in physical activity and screen time were observed between very preterm-born children and their full-term siblings, but only one-third of participants met physical activity recommendations. Both groups were observed to be less active than the general population. Neither respiratory symptoms nor chronic conditions explained variation in these lifestyle outcomes. Both very preterm-born children and adolescents and their full-term siblings could benefit from better adherence to international physical activity and screen time guidelines.

Background: The 2024 Phoenix sepsis criteria define sepsis and septic shock in children as life-threatening organ dysfunction, operationalized by a Phoenix Sepsis Score of 2 or more, in presence of suspected or confirmed infection. The Phoenix sepsis criteria have not been validated in children with proven bacterial infection. Objective: To determine the diagnostic performance of Phoenix sepsis criteria in predicting mortality, and mortality or prolonged intensive care unit (ICU) stay in a population-based cohort of children with blood culture-proven bacterial infection. Methods: We assessed the discriminative power of the scores for the primary outcome, 30-day in-hospital mortality, and the secondary outcome, 30-day in-hospital mortality or ICU length of stay of 3 days or longer, after blood culture sampling, using area under the curve of receiver operating characteristic curves (AUROC) and the area under the precision recall curve (AUPRC). Logistic mixed-effects models were adjusted for age, sex, and presence of chronic medical conditions. Results: 877 bacteremia episodes in 807 children were analyzed. Mortality was 1% (4/724 episodes) in children without sepsis according to the Phoenix sepsis criteria, 18% (27/153 episodes) in children with sepsis, and 24% (25/104 episodes) in children with septic shock. For 30-day mortality, the Phoenix Sepsis Score had an adjusted AUROC of 0.89 (95% confidence interval 0.83–0.95), and an adjusted AUPRC of 0.49 (95% confidence interval 0.34–0.65), both similar to the Phoenix-8 Score and comparing favorably to IPSCC, pSOFA, PELOD-2, and PODIUM. The positive predictive value was 0.18 (95% confidence interval 0.12–0.24), higher than all other analyzed scores, and the sensitivity 0.71 (95% confidence interval 0.56–0.86) comparing favorably to IPSCC, PELOD-2, and PODIUM. For the secondary outcome, 30-day in-hospital mortality or ICU stay of 3 days or longer, the performance of the Phoenix Sepsis Score and Phoenix-8 Score was best compared to IPSCC, pSOFA, PELOD-2, and PODIUM both in terms of AUROC and AUPRC, with the Phoenix Sepsis Score again having the highest positive predictive value of all analyzed scores. Conclusions: In this independent validation of the Phoenix sepsis criteria in a national cohort of children with blood culture-proven bacterial infection, the Phoenix Sepsis Score performed best to predict 30-day mortality compared to other pediatric organ dysfunction scores.

Die gemeinsame Erforschung klinisch relevanter Fragestellungen blickt in der schweizerischen Neonatologie auf eine langjährige Tradition zurück. Bereits Mitte der 90er Jahre bildete sich unter der Leitung von Hans Ulrich Bucher, dem langjährigen Präsidenten der Schweizerischen Gesellschaft für Neonatologie, ein landesweites Netzwerk aus Neugeborenen-Intensivstationen mit dem Ziel, über regelmässige Datenerhebungen und deren Beforschung die Versorgungsqualität von Frühgeborenen in der Schweiz zu verbessern.

En Suisse 6% de tous les enfants naissent prématurément, c’est à dire avant la fin de la 37ème semaine de grossesse. 0.3-0.4% des enfants naissent avant la fin de la 28ème semaine de grossesse, en Suisse environ 290 enfants par an viennent donc au monde extrêmement prématurés. Grâce aux grands progrès de la prise en charge périnatale, survivent des enfants toujours plus immatures et dans les pays hautement développés comme la Suisse, le taux de survie des enfants prématurés extrêmes, nés de la 24ème à la 27ème semaine de grossesse, se situe à plus de 80%. Les enfants prématurés extrêmes restent néanmoins un des groupes les plus vulnérables en néonatologie, la plupart des organes, notamment le système nerveux et les organes sensoriels, étant encore en voie de développement

In der Schweiz werden etwa 6% aller Kinder zu früh, das heisst vor der vollendeten 37. SSW, geboren. 0.3-0.4% der Kinder werden vor der vollendeten 28. SSW geboren, damit kommen in der Schweiz ca. 290 Kinder pro Jahr extrem frühgeboren zur Welt. Dank erheblicher Fortschritte in der perinatalen Versorgung überleben immer unreifere Kinder und in Ländern mit hochentwickelter Medizin wie der Schweiz liegt die Überlebensrate von extrem Frühgeborenen in der 24. bis 27. SSW bei über 80 %. Dennoch bleiben extrem frühgeborene Kinder eine der gefährdetsten Gruppen in der Neonatologie, da die meisten Organsysteme, insbesondere das zentrale Nervensystem und die Sinnesorgane sich noch in der Entwicklung befinden.

La recherche conjointe sur des questions importantes possède une longue tradition dans la néonatologie suisse. Déjà dans les années 1990 s’est créé, sous la direction de Hans Ulrich Bucher, président de la Société suisse de néonatologie pendant plusieurs années, un réseau national des centres de soins intensifs pour nouveau-nés avec pour objectif d’améliorer, par la récolte régulière de données et leur analyse, la qualité de la prise en charge des enfants prématurés en Suisse.

OBJECTIVE: To characterise adaptive immunity in very and extremely preterm neonates and assess potential immunological markers that predispose them to infection. STUDY DESIGN: Peripheral blood lymphocytes in 30 very to extremely preterm neonates (mean birth weight 815 g) were analysed using 9-colour flow cytometry at days of life 0–7, 8–14, and 15–28. Patients were prospectively recruited at the University Hospital of Zurich from 2021 to 2023. Statistical analyses included group comparisons and longitudinal assessments. RESULTS: Six of the thirty preterm neonates (20%) developed early- or late-onset sepsis, of whom one (3%) also exhibited signs of necrotising enterocolitis. T and B lymphocytes were predominantly composed of naïve T cells and unswitched CD27- B cells, respectively. The CD4/CD8 ratio was initially elevated, especially in extremely preterm neonates, and declined significantly after week 1. EPT neonates also had significantly fewer natural killer cells compared with very premature infants. Although no distinct immunological features were identified as predisposing to infection, B-cell proportions were significantly higher in infected neonates during the second week of life, possibly reflecting an immune response to infection. CONCLUSION: Adaptive immunity in preterm neonates is characterised by profound immaturity, including an almost complete absence of immunological memory and low CD8 T-cell frequency, which may limit effective pathogen elimination and increase susceptibility to infection. Immunophenotyping provides valuable insights into the immune processes in this vulnerable population and, when combined with clinical observations and routine laboratory findings, could aid in the earlier identification of high-risk neonates and guide targeted interventions.

Aim: To investigate the relationship between quality of general movements and neurodevelopmental outcomes in 2‐year‐old infants born very preterm (VPT). Method: This was a retrospective cohort study including infants born before 32 weeks' gestation. General movements video recordings at 3 months corrected age were assessed with the Motor Optimality Score—Revised (MOS‐R) and child cognitive, language, and motor development at 2 years with the Bayley Scales of Infant and Toddler Development, Third Edition. Results: The study included 316 infants (52.5% male, mean [SD] gestational age 28.7 [2.3] weeks, birthweight z‐score −0.14 [0.85]). The median MOS‐R total score was 23. The mean cognitive composite, language, and motor scores were 102.0 (15.4), 92.1 (16.1), and 95.8 (15.3) respectively. Higher MOS‐R total scores were related to better cognitive ( p = 0.025) and motor development ( p = 0.042). However, associations weakened when controlling for socioeconomic status, gestational age, birthweight, sex, and number of severe neonatal morbidities (i.e. severe brain lesion, necrotizing enterocolitis, sepsis, bronchopulmonary dysplasia, and retinopathy of prematurity). Interpretation: While the quality of general movements at 3 months corrected age is associated with the infant's cognitive and motor development at 2 years corrected age, it might have no incremental predictive power beyond socioeconomic status and the number of severe neonatal morbidities.

Unlike any other great ape, humans give birth to large, secondarily altricial babies, show precocial social development, have bigger brains that require a long maturation period, and engage in cooperative breeding (CB). These traits, which characterize the human adaptive complex, are intricately linked and must have mutually reinforced each other over evolutionary time. Here, we use recent evidence from paleontology, developmental psychology, and pediatrics, complemented with comparative analyses, to ask what may have triggered this coevolutionary feedback loop: bipedality, direct selection on altriciality, a higher‐quality diet, or cooperative breeding. An early adoption of extensive allomaternal care during human evolution, that is, the CB‐first model, best accommodates the available data. In particular, CB was a catalyst enabling further increases in brain size, because even though larger brains slow down life history and neurodevelopment and thus lead to a demographic dilemma, CB enabled the necessary increase in birth rates.