Article Text

Download PDFPDF
Active perinatal care of preterm infants in the German Neonatal Network
  1. Alexander Humberg1,
  2. Christoph Härtel1,
  3. Tanja K. Rausch2,
  4. Guido Stichtenoth1,
  5. Philipp Jung3,
  6. Christian Wieg4,
  7. Angela Kribs5,
  8. Axel von der Wense6,
  9. Ursula Weller7,
  10. Thomas Höhn8,
  11. Dirk M. Olbertz9,
  12. Ursula Felderhoff-Müser10,
  13. Rainer Rossi11,
  14. Norbert Teig12,
  15. Friedhelm Heitmann13,
  16. Susanne Schmidtke14,
  17. Bettina Bohnhorst15,
  18. Matthias Vochem16,
  19. Hugo Segerer17,
  20. Jens Möller18,
  21. Joachim G Eichhorn19,
  22. Jürgen Wintgens20,
  23. Ralf Böttger21,
  24. Mechthild Hubert22,
  25. Michael Dördelmann23,
  26. Georg Hillebrand24,
  27. Claudia Roll25,
  28. Reinhard Jensen26,
  29. Michael Zemlin27,
  30. Michael Mögel28,
  31. Claudius Werner29,
  32. Stefan Schäfer30,
  33. Thomas Schaible31,
  34. Axel Franz32,
  35. Michael Heldmann33,
  36. Silke Ehlers34,
  37. Olaf Kannt35,
  38. Thorsten Orlikowsky36,
  39. Hubert Gerleve37,
  40. Katja Schneider38,
  41. Roland Haase39,
  42. Kai Böckenholt40,
  43. Knud Linnemann41,
  44. Egbert Herting1,
  45. Wolfgang Göpel1
  1. 1 Paediatrics, University of Lübeck, Lübeck, Germany
  2. 2 Institute for Medical Biometry and Statistics Lübeck, Lübeck, Germany
  3. 3 Pediatrics, University Hospital Schleswig-Holstein, Lübeck, Germany
  4. 4 Children’s Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany
  5. 5 Neonatology and Pediatric Intensive Care, University Hospital of Cologne, Cologne, Germany
  6. 6 Department of Neonatology, Children’s Hospital Hamburg-Altona, Hamburg, Germany
  7. 7 Department of Paediatrics, Evangelical Klinikum Bethel, Bielefeld, Germany
  8. 8 Department of Paediatrics, University of Düsseldorf, Düsseldorf, Germany
  9. 9 Department of Neonatology, Klinikum Südstadt Rostock, Rostock, Germany
  10. 10 Department of Neonatology, University Hospital of Essen, Essen, Germany
  11. 11 Vivantes Klinikum Neukölln, Berlin, Germany
  12. 12 Paediatrics, University Hospital, Bochum, Germany
  13. 13 Department of Paediatrics, Klinikum Dortmund, Dortmund, Germany
  14. 14 Department of Neonatology, Asklepios Hospital Hamburg-Barmbek, Hamburg-Barmbek, Germany
  15. 15 Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany
  16. 16 Department of Neonatology, Olgahospital Stuttgart, Stuttgart, Germany
  17. 17 Neonatology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
  18. 18 Department of Paediatrics, Saarbrücken General Hospital, Saarbrücken, Germany
  19. 19 Department of Paediatrics, Klinikum Leverkusen gGmbH, Leverkusen, Germany
  20. 20 Department of Paediatrics, Hospital Mönchengladbach, Mönchengladbach, Germany
  21. 21 Department of Neonatology, Universitatsklinikum Magdeburg, Magdeburg, Germany
  22. 22 Department of Neonatology and Pediatric Intensive Care, DRK Children’s Hospital, Siegen, Germany
  23. 23 Department of Paediatrics, Diakonissen Hospital Flensburg, Flensburg, Germany
  24. 24 Department of Paediatrics, Hospital Itzehoe, Itzehoe, Germany
  25. 25 Neonatology and Paediatric Intensive Care, Vest Children’s Hospital Datteln, University Witten-Herdecke, Datteln, Germany
  26. 26 Department of Paediatrics, Westküstenklinikum Heide, Heide, Germany
  27. 27 General Pediatrics and Neonatology, Saarland University, Homburg/Saar, Germany
  28. 28 Department of Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany
  29. 29 Department of Paediatrics, University of Münster, Münster, Germany
  30. 30 Children’s Hospital (Städtisches Klinikum) Nürnberg, Nürnberg, Germany
  31. 31 Department of Paediatrics, University Medical Center Mannheim, Mannheim, Germany
  32. 32 Neonatology, University of Tübingen, Tübingen, Germany
  33. 33 HELIOS Children’s Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
  34. 34 Department of Neonatology, Bürgerhospital Frankfurt, Frankfurt, Germany
  35. 35 Helios Klinik Schwerin, Schwerin, Germany
  36. 36 Neonatology, University of Aachen, Aachen, Germany
  37. 37 Department of Paediatrics, Christophorus Kliniken Coesfeld, Coesfeld, Germany
  38. 38 Department of Paediatrics, GFO Hospitals Bonn, Bonn, Germany
  39. 39 Children’s Hospital, University of Halle, Halle/Saale, Germany
  40. 40 Children’s Hospital of the City of Cologne, Köln, Germany
  41. 41 Department of Paediatrics, University of Greifswald, Greifswald, Germany
  1. Correspondence to Dr Alexander Humberg, Department of Paediatrics, University Hospital of Schleswig-Holstein, Lübeck 23538, Germany; alexander.humberg{at}


Objective To determine if survival rates of preterm infants receiving active perinatal care improve over time.

Design The German Neonatal Network is a cohort study of preterm infants with birth weight <1500 g. All eligible infants receiving active perinatal care are registered. We analysed data of patients discharged between 2011 and 2016.

Setting 43 German level III neonatal intensive care units (NICUs).

Patients 8222 preterm infants with a gestational age between 22/0 and 28/6 weeks who received active perinatal care.

Interventions Participating NICUs were grouped according to their specific survival rate from 2011 to 2013 to high (percentile >P75), intermediate (P25–P75) and low (<P25) survival. We compared these survival rates with data in 2014–2016.

Main outcome measures Death by any cause before discharge.

Results Total survival increased from 85.8% in 2011–2013 to 87.4% in 2014–2016. This increase was due to reduced mortality of NICUs with low survival rates in 2011–2013. Survival increased in these centres from 53% to 64% in the 22–24 weeks strata and from 73% to 84% in the 25–26 weeks strata.

Conclusions Our data support previous reports that active perinatal care of very immature infants improves outcomes at the border of viability and survival rates at higher gestational ages. The high total number of surviving infants below 24 weeks of gestation challenges national recommendations exclusively referring to gestational age as the single criterion for providing active care. However, more data are needed before recommendations for parental counselling should be reconsidered.

Trial registration Approval by the local institutional review board for research in human subjects of the University of Lübeck (file number 08–022) and by the local ethic committees of all participating centres has been given.

  • epidemiology
  • mortality
  • neonatology
  • outcomes research

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Conceived and designed the experiments: WG, EH, AH, CH. Analysed the data: WG, CH, AH, TKR. Contributed reagents/materials/analysis tools: EH, WG, CH, ChW, VDW, AK, GS, DMO, UW, TH, DMO, UF-M, RR, NT, FH, KL, SuS, BB, MV, HS, JM, JGE, JW, RB, MeH, MD, GH, CR, RJ, MZ, MM, CW, StS, TS, AF, MH, SE, OK, TO, HG, RH, KB, KL, KS, PS. Wrote the paper: AH, CH, WG, EH. The authors have given final approval of the version to be published. Each author participated sufficiently in the work to take public responsibility for appropriate portions of the content, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The German Neonatal Network is funded by the German Ministry of Education and Research (BMBF grant no: 01ER0805 and 01ER1501). The funder had no involvement in this study.

  • Disclaimer The sponsor had no role in study design; collection, analysis and interpretation of data; writing of the report; and the decision to submit the paper for publication.

  • Competing interests None declared.

  • Ethics approval Written informed consent was obtained from the parents on behalf of the infants enrolled in our study. The study parts were approved by the local committee on research in human subjects of the University of Luebeck (08–022; 03.12.2010) and the local ethical committees at the other study centres, specifically the Ethical Board of the Medical Chamber of the North Rhine region, Ethical Board of the University of Aachen, Ethical Board of the University of Bonn, Ethical Board of the Medical Chamber of the federal state of Mecklenburg-Vorpommern, Ethical Board of the Medical Chamber of Berlin, Ethical Board of the University of Magdeburg, Ethical Board of the University of Halle, Ethical Board of the University of Tübingen, Ethical Board of the Medical School Hannover, Ethical Board of the University of Cologne, Ethical Board of the University of Essen, Ethical Board of the Medical Chamber of the Westphalia-Lippe region, Ethical Board of the Medical Chamber of Hamburg, Ethical Board of the Medical Chamber of the federal state of Hessen, Ethical Board of the Medical Chamber of the federal state of Baden-Württemberg, Ethical Board of the Medical Chamber of the federal state of Bavaria, and Ethical Board of Saar University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets generated and analysed during the current study are not publicly available but can be reviewed on reasonable request.

  • Patient consent for publication Not required.

Linked Articles

  • Fantoms
    Ben J Stenson