[... because We Should not Forget! Neonatal Organ Donation]. / ... denn wir dürfen sie nicht vergessen! Organspende in der Neonatologie.

Obwohl sich fast 40% aller Todesfälle im Kindes- und Jugendalter während der Neugeborenenperiode ereignen, kommt es in der Neonatologie nur selten zur Organspende. Wir berichten über ein Neugeborenes, bei dem nach perinataler Asphyxie der endgültige, nicht behebbare Ausfall der Gesamtfunktion des Großhirns, des Kleinhirns und des Hirnstamms ("Hirntod") gemäß Transplantationsgesetz diagnostiziert wurde. Das Herz wurde nach der sogenannten zweiten richtliniengemäßen "Hirntoddiagnostik" zur Organspende entnommen und erfolgreich transplantiert. Besondere juristische Herausforderungen ergaben sich aus dem Umstand der anonymen Geburt, den notwendigen Regelungen der Vormundschaft sowie der Zuordnung des Totenfürsorgerechts. Medizinisch standen die speziellen Regelungen der Diagnostik des irreversiblen Hirnfunktionsausfalls bei Neugeborenen und der optimale Erhalt der Organfunktion vor Entnahme im Vordergrund. Für die Pflegenden stellte sich der Ablauf grundlegend anders dar als bei einer Therapiezieländerung mit anschließender palliativen Versorgung in Anwesenheit der Eltern. Angesichts der großen emotionalen Herausforderungen erwiesen sich die Einbindung aller Beteiligten in die Entscheidungsabläufe und die Übernahme der besonderen Verantwortung als hilfreich.Although almost 40% of all deaths prior to 18 years of age occur within the neonatal period, organ donation is rare in neonatology. Herein we report about a newborn infant with perinatal asphyxia and permanent, irreversible loss of brain function (cerebrum, cerebellum and brain stem), managed according to the criteria and instructions defined by the German law of donor organ transplantation. After confirmation of irreversible loss of brain function, the heart was successfully transplanted. Specific legal challenges resulted from the instance of an anonymous birth, the guardianship required, and the specific regulations of welfare of the deceased individual. The most prominent medical challenges consisted in the specific regulatory purposes for the diagnosis of the irreversible loss of brain function in neonates and the optimal maintenance of organ functions prior to donation. From the nursing point of view, the proceeding differed entirely compared to redirection of care into palliation while parents are present. Involving all stakeholders in every step of decision making was regarded as emotionally helpful.

Good handling practice of parenterally administered medicines in neonatal intensive care units - position paper of an interdisciplinary working group.

This position paper, developed by an interdisciplinary expert group of neonatologists, paediatric infectious disease physicians, clinical pharmacists and specialists for the prevention and control of nosocomial infections, describes the "Good handling practice of medicines parenterally administered to patients on NICUs". It takes equal account of patient safety and the specialties of neonatal intensive care regarding feasibility and proportionality. The overall concept is perceived as a "learning system", in which open communication within the health-care team relating to medication errors and critical incidents enables continuous development and improvement to ensure patient safety. In our opinion, pharmacists, who are responsible for the supply of ready-to-administer parenteral medicinal products for neonatal intensive care patients, as well as the hygiene staff responsible on site are integral parts of the interdisciplinary treatment team. Risks of the current clinical practice of parenteral treatment of NICU patients are discussed in detail and recommendations for safety-relevant procedures are given.

[Special care needs of very low birthweight preterm infants calculated from routine data: A 5-year analysis]. / Kalkulierter Pflegebedarf für Frühgeborene mit sehr geringem Geburtsgewicht aus Routinedaten: Eine 5-Jahresanalyse.

BACKGROUND: The quality assurance directive for very low birthweight preterm infants (QFR-RL) by the German Federal Joint Committee calls for fixed nurse-to-patient ratios (NPRs) in neonatal intensive care, leading to considerable difficulties for staff planners, especially in smaller hospitals, as an extensive pool of nursing staff is required to ensure compliance with guidelines. Reliable parameters are therefore needed to provide a valid basis for staff planning. OBJECTIVE: To calculate the number of nurse full-time equivalents (FTE) required to meet the demands of the QFR-RL for individual diagnosis-related groups (FTE-debit) and in relation to relative caseweight (FTE-debit / RW); to compare the calculated estimates with real hospital expenses (FTE-real) with nurse-relevant DRG proportions calculated by the Institute for the Hospital Remuneration System (FTE-norm). METHODS: We included all very low birthweight infants (VLBW, <1,500 g) treated between 08/2013 and 07/2018. FTE-debit was determined on the basis of shifts with 1 : 1, 1 :2, and 1 : 4 NPR using the time infants underwent invasive or non-invasive mechanical ventilation, had a birthweight below 1,000 g, or with imminent death. FTE-real was extracted from hospital cost accounting, and FTE-norm was determined as nurse-relevant DRG proportions calculated by the Institute for the Hospital Remuneration System. RESULTS: 856 (50.1 % female) VLBW preterm infants were analysed. Calculated FTEs varied from 0.02 (95% confidence interval (CI) 0.02-0.02) to 1.16 (95%-CI 0.96-1.37) between individual DRGs. Calculated estimates (FTE-debit) were consistent with real expenses (FTE-real) and calculated nurse-relevant DRG-proportions (FTE-norm). In relation to the relative caseweight, an average demand of nurse FTE of about 0.02 FTE / relative weight point (FTE-debit / RW) was identified. CONCLUSIONS: This approach facilitates prospective planning which is in line with the FTEs required by the QFR-RL and based on remunerated DRGs; however, it is not supposed to replace shift-specific documentation.