Riccardo E Pfister

Hôpitaux Universitaires de Genève | HUG · Service de néonatalogie et de soins intensifs de pédiatrie

Background Early-life antibiotic exposure is disproportionately high compared to the burden of culture-proven early-onset sepsis (CP-EOS). We assessed the contribution of culture-negative cases to the overall antibiotic exposure in the first postnatal week. Methods We conducted a retrospective analysis across eleven countries in Europe, North Amer...

Background Neonatal sepsis (NS) is a global health issue, particularly in Sub-Saharan Africa, where it accounts for a substantial portion of neonatal morbimortality. This multicountry survey aimed to elucidate current practices, challenges and case definitions in managing NS among clinicians in Sub-Saharan Africa. Methods The survey targeted physi...

Inspired by the six quality-of-care goals developed by the Institute of Medicine, woman-centred care (WCC) as model of care is used in maternity services as it gives an emphasis on the woman as an individual and not her status as a patient. Bringing stronger attention to women’s needs and values, is proven to have clear benefits for perinatal outco...

Background Neonatal mortality accounts for the most significant and today increasing proportion of under-5 mortality, especially in sub-Saharan Africa. The neonatal population is a sharp target for intervention for these 2.5 million annual deaths. The limited availability of quality data on morbidities leading up to this mortality hampers the devel...

Background: The aim of this study was to evaluate the risk of catheter-associated bloodstream infection (CABSI) among different catheter types using a large prospective database in the neonatal intensive care unit (NICU) of a tertiary care centre in Switzerland. Methods: We included all neonates admitted to the NICU with at least one central int...

Extremely preterm infants are prone to hyperglycemia which is associated with increased mortality and morbidity. Insulin sensitivity is variable in extreme prematurity, and its monitoring, prevention, and treatment are a significant challenge in the NICU. Frequent changes in fluid composition and volumes, as well as large growth and adaptational nu...

Temperature monitoring is essential for assessing neonates and providing appropriate neonatal thermal care. Thermoneutrality is defined as the environmental temperature range within which the oxygen and metabolic consumptions are minimum to maintain normal body temperature. When neonates are in an environment below thermoneutral temperature, they r...

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...

Hypothermia occurs frequently among clinically unstable neonates who are not suitable to place in skin-to-skin care. This study aims to explore the existing evidence on the effectiveness, usability, and affordability of neonatal warming devices when skin-to-skin care is not feasible in low-resource settings. To explore existing data, we searched fo...

Importance In 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, neuro...

Importance Appropriate 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 a...

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...

Background Neonatal 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 guideli...

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)...

(1) Background: Every year, 2.5 million neonates die, mostly in low- and middle-income countries (LMIC), in total disregard of their fundamental human rights. Many of these deaths are preventable. For decades, the leading causes of neonatal mortality (prematurity, perinatal hypoxia, and infection) have been known, so why does neonatal mortality fai...

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 prev...

Background: Diaphragmatic paralysis (DP) is a rare cause of respiratory distress in newborns with potentially severe outcome. Two cases illustrate the clinical presentation, etiology, evaluation, treatment, and outcome of diaphragmatic paralysis in newborn. Cases presentation: First, a 890 g male preterm of 26 weeks who developed a left DP after pl...

Variability of arterial blood pressure (ABP) has been associated with intraventricular hemorrhage in very preterm neonates (VPT) and may predict other brain lesions assessed at term-equivalent of age (TEA). This was a prospective single-center study including VPT with early invasive continuous ABP monitoring and assessed at TEA using brain magnetic...

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 th...

Background: Hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. Despite the recognition of the importance of thermal care for neonates a century ago and the established WHO guidelines, a high prevalence of neonatal hypothermia is still regularly reported. Hypothermia is a...

Aims of the study: To develop a screening tool to optimise neonatal drug prescription, which is often based on low-quality evidence. Methods: Neonatal pharmacotherapy recommendations were identified by literature review and synthesised into NeoCheck tool statements. In a two-round modified Delphi process, experts from Swiss neonatal intensive ca...

Objective To assess patent ductus arteriosus (PDA) treatment variation between Swiss perinatal centers and to determine its effect on outcome in a population-based setting. Study design Retrospective cohort study of infants born below 28 weeks of gestation between 2012-2017. Outcomes between surgically ligated and pharmacologically treated infants...

Objective To assess patent ductus arteriosus treatment variation between Swiss perinatal centers and to determine its effect on outcome in a population-based setting. Study design This was a retrospective cohort study of infants born less than 28 weeks of gestation between 2012 and 2017. Outcomes between surgically ligated and pharmacologically tre...

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 safet...

Aim: The aim of this study is to examine possible associations between the transfusion of RBC or platelets (PLTs) and the development of retinopathy of prematurity (ROP) in infants. Methods: This retrospective, national, case-control study included all live births in Switzerland between 2013 and 2018. We investigated preterm infants at a gestati...

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...

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.

Background and importance Neonatal pharmacotherapy is challenging and often based on little evidence. Off label use of drugs is common practice and patients are at a high risk of medication errors and drug-related problems. Prescription-screening tools are used in geriatrics, internal medicine and pediatrics to optimize drug prescribing. Aim and o...

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...

Background Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality....

Der 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 St...

Background: The current standard treatment of neonates with intestinal perforation is surgery. However, the mortality rate after surgical treatment for intestinal perforation is very high for very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates. In this review, conservative treatment of pneumoperitoneum among VLBW and ELBW n...

Background: Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality...

Background: Infants born very preterm are at higher risk of long-term neurodevelopmental problems than children born at term. Although there are increasing numbers of reports on outcomes from international cohorts of premature infants, a Swiss national report on infants after 2 years of age is lacking. Aims of the study: To describe neurodevelop...

Background: Respiratory distress in newborns at term is strongly associated with high mortality rates in resource constrained countries. This study aimed at studying the prevalence, clinical profile and predictors of mortality among term newborns admitted at the neonatal unit of the Gyneco-Obstetrics and Paediatrics Hospital in Douala, Cameroon. Me...

Background: The incidence of retinopathy of prematurity (ROP) and ROP screening criteria differ between countries. We assessed whether ROP screening could be reduced based on the local ROP incidence. Methods: Observational cohort study of infants born in Switzerland between 2006 and 2015 <32 0/7 weeks. Chronological and postmenstrual ages at ROP...

Aim: Epidemiological 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. Methods: This was a one-year retrospective study of all neonates and paediatric intensive care patients with at least one recorded PIVC at the Geneva Uni...

The improvement in perinatal care has increased the survival rate of premature newborns. The environment has a significant impact on the sensori-motor development and behaviour of the infant. The concept of developmental care is a multidisciplinary, individualized approach, enabling parents to become the prime partners in providing care. The develo...

The benefits of skin-to-skin care on neonatal mortality have been demonstrated in low income countries; the effects on morbidity and the physical and neuro-developmental benefits are argued in high income countries. The societal benefits, based on attachment, origin of the family bond, have been advocated since its creation but remain little invest...

[This corrects the article DOI: 10.1186/s13756-017-0285-x.].

During the past year, we have renewed interest in old well-known problems. New studies and guidelines have been issued about lung maturation in cases of preterm delivery after 37 weeks of gestation. Short term benefits have been proven but the number of cases needed to treat to prevent one case of respiratory complications is high and with possible...

Background: Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-based from non-evidence-based criteria. This study a...

Development and Application of these Recommendations. A working group of the Swiss Society of Neonatology (SSN) first published national recommendations on the care and resuscitation of the newborn infant in 2000. After two revisions (2007/2012), these recommendations are being updated, based on the evidence arising from a critical appraisal of the...

Background: Necrotizing enterocolitis (NEC) is a serious complication of prematurity. Currently, there is limited evidence to guide investigation and treatment strategies. Objectives: To evaluate the parameters used to diagnose or exclude NEC, and to identify differences between neonatologists and pediatric surgeons. Methods: A scenario-based...

Background Many outbreaks due to Serratia marcescens among neonates have been described in the literature but little is known about the role of whole genome sequencing in outbreak analysis and management. Methods Between February and March 2013, 2 neonates and 2 infants previously hospitalised in the neonatal unit of a tertiary care centre in Switz...

Background Retinopathy of prematurity (ROP) is a severe complication of preterm birth and can lead to severe visual impairment or even blindness if untreated. The incidence of ROP requiring treatment is increasing in some developed countries in conjunction with higher survival rates at the lower end of gestational age (GA). Material and methods Th...

Objectives The aim of this research is to assess causes and circumstances of deaths in extremely low gestational age neonates (ELGANs) born in Switzerland over a 3-year period. Design Population-based, retrospective cohort study. Setting All nine level III perinatal centres (neonatal intensive care units (NICUs) and affiliated obstetrical service...

The use of umbilical venous catheters (UVC) in neo- natology is common practice but not without risks. We report the case of an unusual and potentially lethal complication of a centrally positioned UVC. We will review the literature for this specific complication and discuss risks of UVC placement in general, as well as the best way to verify cathe...

Background: Sepsis is an important cause of morbidity and mortality in neonates and clinicians are typically required to administer empiric antibiotics while waiting for blood culture results. However, prolonged and inappropriate use of antibiotics is associated with various complications and adverse events. Better tools to rapidly rule out bacter...

We report a case of carbamazepine withdrawal syndrome following in utero exposure to carbamazepine related to a pharmacogenetic predisposition factor. The infant was born at 37 1/7 weeks’ gestation by cesarean section to a mother treated for epilepsy with carbamazepine. One hour and thirty minutes after birth, the infant presented a respiratory dis...

Einführung Entstehung und Anwendung dieser Empfehlungen Eine Arbeitsgruppe der Schweizerischen Gesellschaft für Neonatologie (SGN) hat erstmals im Jahr 2000 Empfehlungen zur Betreuung und Reanimation von Neugeborenen für die Schweiz ausgearbeitet. Diese Empfehlungen werden nun nach zwei Revisionen (2007/2012) erneut angepasst, basierend auf den Evi...

L’utilisation de médicaments injectables en néonatologie pose des défis particuliers conduisant à des difficultés de préparation et d’administration et à un risque d’erreurs médicamenteuses élevé. L’administration intraveineuse simultanée de médicaments et de mélanges de nutrition parentérale (NP), avec ou sans lipides, est une pratique courante en...

Background. In premature infants, maintaining blood partial pressure of carbon dioxide (pCO2) value within a narrow range is important to avoid cerebral lesions. The aim of this study was to assess the accuracy of a noninvasive transcutaneous method (TcpCO2), compared to blood partial pressure of carbon dioxide (pCO2). Methods. Retrospective observ...

Importance Very preterm infants are at risk of developing encephalopathy of prematurity and long-term neurodevelopmental delay. Erythropoietin treatment is neuroprotective in animal experimental and human clinical studies. Objective To determine whether prophylactic early high-dose recombinant human erythropoietin (rhEPO) in preterm infants improve...

Objective To report the population-based, gestational age (GA)-stratified mortality and morbidity for very preterm infants over 13 years in Switzerland. Design A prospective, observational study including 95% of Swiss preterm infants (GA <32 weeks) during three time periods: 2000–2004 (P1), 2005–2008 (P2) and 2009–2012 (P3). Setting The Swiss Neona...