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EFCNI roundtable on neonatal parenteral nutrition

EFCNI roundtable on neonatal parenteral nutrition

On 4 July 2018, experts from various European countries came together in Munich, Germany, for the EFCNI roundtable on neonatal parenteral nutrition. Parenteral nutrition is a feeding therapy that provides nutrition through the veins to preterm or severely ill babies, who cannot (yet) be adequately fed by mouth or through a feeding tube.

Group picture of the EFCNI roundtable on neonatal parenteral nutrition

Participants of the EFCNI roundtable on neonatal parenteral nutrition

Among the 15 experts who attended the roundtable were neonatologists, pharmacists, and parent representatives from the United Kingdom, Sweden, Italy, Spain, France, Hungary, and Germany. The goal of the roundtable was to develop a concept for a position paper, which will highlight the importance of this life-saving treatment for preterm and severely ill babies and present strategies that support the implementation of the ESPGHAN guidelines as well as the development and implementation of national guidelines accordingly. Within the next months, the expert panel will write the position paper. Stay tuned for regular updates.

We would like to thank all participants for the fruitful discussions, their valuable contributions, and ideas. A warm thank you also goes out to Baxter for supporting this project with an unrestricted educational grant.

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There is a great need for urgent pan-European harmonisation

An interview with Professor Charles Christoph Roehr, President of the European Society for Paediatric Research, on the topic Medical care and clinical practice

In terms of medical practice in neonatology – in which fields do you see the most significant disparities between European countries?

Professor Charles C Roehr

Professor Charles C Roehr

This is a very good question. We see significant disparities on many levels, starting from the recognition of Neonatology as an individual Paediatric subspecialty. There are still a number of European countries in which the need for specialists in Neonatology is not formally recognised, with which come significant differences in the training of neonatal doctors and nurses, the acquisition of their skill sets and confidence levels. Dr Morten Breindahl and co-workers, as well as others, have flagged this as an important gap in the provision of medical care to neonatal patients and their families (Breindahl M et. al. Neonatology 2012; 103(1):74-82). This disparity is striking, since the European member states had previously agreed on a common European Neonatal Curriculum, as proposed by the European Society for Neonatology (now renamed into European Board of Neonatology, EBN – the educational arm of the European Society for Paediatric Research, ESPR). Given these structural uncertainties, it is comprehensible how difficult it is to formulate binding educational recommendations on a national and international level. The ESPR, via the EBN through its Chairman, Professor Maximo Vento (Valencia, Esp.), is doing its best by designing a common European Neonatal Curriculum (publication expected in April 2019) and by providing a university accredited online learning platform, NOTE (Neonatal Online Training and Education, University of Southampton) offering an evidence-based, University accredited, European curriculum to its participants.  

 

In your opinion, is there a need for pan-European harmonisation?
Indeed, I strongly believe there is a great need for urgent pan-European harmonisation: Newborn infants and their families should be able to expect the same level of proficiency and professionalism in care throughout Europe. Likewise, training on neonatal care should be according to a uniformly accepted syllabus, for doctors and nurses, as outlined above. The recognition of Neonatology as a Paediatric subspecialty should ideally be universal throughout Europe to ensure that a common standard is followed. Only in this way can patients receive the same level of care wherever their child is born, be it in Malaga (Spain), Malmö (Sweden), Bari (Italy), Bath (UK), Bucharest (Romania) or Tallinn (Estonia). The need for harmonisation of care within Europe has long been voiced by many eminent proponents within the neonatal community, i.e. from doctors, nurses and parent groups alike. Finally, a joint effort to build up a common syllabus of European Standards of Care for Newborn Health has been initiated. Expertly facilitated and led with great passion by EFCNI, a group of international experts is currently working on such standards, which will eventually ensure similar outcomes for all neonates born in Europe. 

How does the ESPR promote Paediatric research on a European level?
The ESPR is the biggest, most prolific and scientifically vibrant Paediatric research society in Europe. We are extremely proud of our extraordinarily active membership base and a faculty of highly respected international scientists from all over Europe and beyond. We stimulate scientific discourse first and foremost through our renowned annual conferences, the Congress of the European Academy of Paediatric Societies (EAPS) and the Congress of joint European Neonatal Societies (jENS), as well as Spring and Autumn Schools, in our membership discussion forum and though individual discourse. The ESPR is therefore the Paediatric society for active research in Europe. Recognising the strong desire for collaboration and exchange, the ESPR has initiated a generous European Research Grant programme. This programme has successfully funded several large, collaborative research projects with a budget of over 350,000 Euro in 2017 alone. The calls for this year will be published on our website www.espr.eu as well as the ESPR social media channels in the coming weeks.

In which fields do you perceive transnational progress and where are backlogs?
The biggest backlog we see in the European landscape of Paediatrics is the disparity of national subspecialty recognition and the lack of an accepted Paediatric syllabus with pan-European endorsement throughout all member states of the European Union. However, progress is on the move with the installation of agreed European Standards of Care for Newborn Health. Now international and national policy-makers can refer to a very strong manuscript, endorsed by over 100 international specialists and organisations, to formulate uniform training guidelines and research conformity guidelines.

What is your wish for the future of neonatology? How would you wish the field to develop?
My vision for the future of Neonatal Medicine is for this great profession to evolve into a healthcare service which encompasses the care for a patient’s disease specific needs at the time of occurrence whilst fully embracing the need of his or her family to be involved in the planning and provision of care as partners. I wish for every newborn to be able to receive a common, high standard of care and thus to be given equal opportunity of positive outcomes, wherever they should be born on Europe, and beyond. Hence, I wish for every neonatal team to have adequate access to information on the care and training of care provision, be it nursing, medical, psychosocial or physical care to reach the one common goal, a healthy newborn in a healthy family and eventually contributing to a thriving human society which respects and cares for the needs of all its members.

Special thanks to
Professor Charles Christoph Roehr
President of the European Society for Paediatric Research (ESPR)
www.espr.eu

 

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Surfactant replacement therapy – a milestone in neonatology

The Respiratory Distress Syndrome (RDS) is a lung disorder that is mostly seen in preterm babies, especially those born before week 30. It is caused by a lack of surfactant, which is a substance that coats the inside of the lungs and prevents the small air sacs (alveoli) from collapsing.1

Drawn baby with highlighted lungsIn preparation for breathing air, fetuses begin producing surfactant during the third trimester of pregnancy through labour and delivery. Depending on the level of prematurity, the lungs of a baby born preterm may not be able to make (sufficient) surfactant, causing breathing difficulties within the first hours after birth. The resulting lack of oxygen can damage the baby’s brain or organs and lead to death if not treated properly.1

Nowadays, the surfactant replacement therapy is a crucial part of the management of RDS.2 The development of this therapy based on the discovery of surfactant is one of the biggest milestones in neonatology. Although it is still in the process of being further enhanced, surfactant replacement therapy has substantially reduced neonatal mortality in preterm babies over the last decades.3

The story of surfactant

The story of surfactant goes back to 1929, when the Swiss physiologist Kurt von Neergaard first suggested the presence of pulmonary surfactant based on his experiments with the lung of a pig.4,5 Similar experiments with the lungs of stillborn babies were repeated and further investigated by the pathologist Peter Gruenwald in New York after the second world war.5,6 Important contributions to the understanding of pulmonary surfactant and its importance in lung stability and mechanics of respiration came from Richard Pattle in England, Charles Macklin in Canada, and John Clements in the USA in the 1950s.5,7–9 In 1959, the American researchers Mary Allen Avery and Jere Mead discovered that a lack of surfactant is the cause of RDS.10 Despite the knowledge that RDS was a major problem and the cause of many deaths in preterm babies, their finding wasn’t taken much into account until a tragic event happened four years later.

Tragic death of John F. Kennedy’s son

Jacqueline Bouvier Kennedy, wife of John Fitzgerald Kennedy who was the president of the United States at that time, gave birth to their son Patrick on August 7th, 1963 at 35 weeks. Only two days after birth, Patrick died from RDS, back then known as hyaline membrane disease.5,11 Due to this event, RDS received public attention and became the focus of neonatal research.

The development of a therapy

Clinical trials with synthetic surfactant were started. The first successful observation in lambs was reported by Graham Liggins.12 In 1980, Tetsuro Fujiwara was the first who published results of a successful trial of surfactant treatment for respiratory distress syndrome in babies born preterm.13 This is when natural surfactant was launched as a treatment for RDS. Several surfactants have been developed and tested since then One of the most used surfactants was developed by Tore Curstedt and Bengt Robertson. The market approval for their medication was received in Europe in 1992 and in the USA in 1999.14

In general, natural, animal-derived surfactants containing proteins have turned out to be more effective than protein-free synthetic products.15 However, newer synthetic surfactants with protein analogues are being developed.5,16

Another focus of current research is the method of administration and in particular less invasive approaches. Whereas most preterm babies were intubated and ventilated in the first stages of the surfactant replacement therapy, it is now known that mechanical ventilation should be avoided whenever possible. Methods of maintaining babies on less invasive respiratory support have shown advantages in short and long-term outcomes, e.g. greater comfort and less chronic lung disease such as Bronchopulmonary dysplasia (BPD).2,17–20 The Less Invasive Surfactant Application (LISA) protocol developed by Angela Kribs et al. offers potential for the preservation of spontaneous breathing and the avoidance of mechanical ventilation (as already reported, see interview with A. Kribs ).17,18,20 It combines the administration of surfactant with continuous positive airway pressure (CPAP), which is a noninvasive form of respiratory assistance that supports spontaneous breathing. Surfactant is applicated during CPAP via a thin catheter.

It will be very exciting to see further developments, improvements and future innovations in this area!

A true lighthouse “project”

RDS used to be the leading cause of death in preterm babies.14 Saving hundred thousands of lives, the development of the surfactant replacement therapy for preterm babies suffering from RDS is a true lighthouse project for this month’s topic “Medical care & clinical practice”. Every step from the initial discovery of surfactant to the continuing development of less invasive administration methods has contributed greatly to the life of many children and families.

 

We’d like to thank Professor Christoph Härtel for his kind support and advice on this article.

Lighthouse Medical care and clinical practise

 

  1. pmhdev. Respiratory Distress Syndrome. PubMed Health. June 2014. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0062982/. Accessed May 30, 2018.
  2. Sweet DG, Carnielli V, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2016 Update. Neonatology. 2017;111(2):107-125. doi:10.1159/000448985
  3. Polin RA, Carlo WA, Newborn C on FA. Surfactant Replacement Therapy for Preterm and Term Neonates With Respiratory Distress. Pediatrics. 2014;133(1):156-163. doi:10.1542/peds.2013-3443
  4. Von Neergaard K. Neue Auffassungen über einen Grundbegriff der Atemmechanik. Die Retraktionskraft der Lunge, abhängig von der Oberflächenspannung in der Alveolen. Z Gesamte Exp Med. 1929;66:373-394.
  5. Halliday HL. The fascinating story of surfactant. J Paediatr Child Health. 2017;53(4):327-332. doi:10.1111/jpc.13500
  6. Gruenwald P. Surface tension as a factor in the resistance of neonatal lungs to aeration. Am J Obstet Gynecol. 1947;53(6):996-1007.
  7. Pattle RE. Properties, function and origin of the alveolar lining layer. Nature. 1955;175(4469):1125-1126.
  8. Macklin CC. The pulmonary alveolar mucoid film and the pneumonocytes. Lancet Lond Engl. 1954;266(6822):1099-1104.
  9. Clements J. Dependence of pressure-volume characteristics of lungs on intrinsic surface. Am J Physiol. 1956;187:592.
  10. Avery ME, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. AMA J Dis Child. 1959;97(5, Part 1):517-523.
  11. Altman LK, M.D. A Kennedy Baby’s Life and Death. The New York Times. https://www.nytimes.com/2013/07/30/health/a-kennedy-babys-life-and-death.html. Published July 29, 2013. Accessed June 5, 2018.
  12. Liggins GC. Premature delivery of foetal lambs infused with glucocorticoids. J Endocrinol. 1969;45(4):515-523.
  13. Fujiwara T, Maeta H, Chida S, Morita T, Watabe Y, Abe T. Artificial surfactant therapy in hyaline-membrane disease. Lancet Lond Engl. 1980;1(8159):55-59.
  14. Europäisches Patentamt/European Patent Office. Atemhilfe für Neugeborene: Tore Curstedt als Finalist für den Europäischen Erfinderpreis 2016 nominiert. http://www.epo.org/news-issues/press/releases/archive/2016/20160426l_de.html. Accessed June 12, 2018.
  15. Halliday HL. History of surfactant from 1980. Biol Neonate. 2005;87(4):317-322. doi:10.1159/000084879
  16. Curstedt T, Halliday HL, Speer CP. A unique story in neonatal research: the development of a porcine surfactant. Neonatology. 2015;107(4):321-329. doi:10.1159/000381117
  17. Kribs A, Roll C, Göpel W, et al. Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr. 2015;169(8):723-730. doi:10.1001/jamapediatrics.2015.0504
  18. Göpel W, Kribs A, Härtel C, et al. Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta Paediatr. 2015;104(3):241-246. doi:10.1111/apa.12883
  19. Dargaville PA, Aiyappan A, De Paoli AG, et al. Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed. 2013;98(2):F122-126. doi:10.1136/archdischild-2011-301314
  20. Härtel C, Paul P, Hanke K, et al. Less invasive surfactant administration and complications of preterm birth. Sci Rep. 2018;8(1):8333. doi:10.1038/s41598-018-26437-x
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Lighthouse project: a baby saving innovation – the Embrace infant warmer

One of our lighthouse projects in the field of Medical care is the Embrace warmer. It was designed to improve healthcare in low-resource settings to help vulnerable newborns survive and thrive.

Image: Embrace co-founder and Chief Business Officer Jane Chen with a baby kept in an Embrace warmer. © Embrace Innovations

When infants are born preterm, they lack the body fat that is necessary to regulate their own temperature. As a consequence, room temperature can feel freezing cold. Many hospitals in developing countries do not have consistent electricity and are unable to transport hypothermic newborns to get the care they need. A team around Jane Chen, co-founder of Embrace, a non-profit organisation with the mission of advancing maternal and child health by delivering innovative solutions to the world’s most vulnerable populations, has worked on a solution for this challenge. Their aim is to reduce the number of deaths each year among the 1 million preterm newborns in developing countries who don’t have access to lifesaving medical technology.

The Embrace warmer is an easy-to-use, portable, sleeping-bag-like transport incubator (humidicrib) and infant warmer that does not need continuous power supply. As a medical device designed for hospitals and ambulances, it is used in neonatal intensive care units and wards, as well as for transport, when skin-to-skin care (a part of Kangaroo Mother Care / KMC) is not possible. The Embrace warmer thus helps combat preventable and treatable complications related to prematurity and low birth weight, including neonatal hypothermia, a medical emergency that occurs when the body temperature drops too low, of less than about 95 F (35 C).

In an interview, co-founder Jane Chen talked about her vision: “One piece of my legacy will be making the Embrace warmer a standard of care, one that complements existing natural practices like skin-to-skin care. I want to ensure that every baby in need of temperature regulation can get it and that no baby dies from being cold. Beyond that, my legacy is about building a platform by which we, as an organisation, innovate really disruptive technology that can save babies and mothers around the world.”

The Embrace warmer was developed within a design class at Stanford University called Design for Extreme Affordability. The challenge was to build a baby incubator that costs less than 1 % of the cost of a traditional incubator, which is $20,000. This technology by Chen and her team has gained international recognition. Chen has even been honoured by former US President Obama at the White House, and her project is supported by numerous organisations, like the Clinton Global Initiative, and celebrities, like the singer Beyoncé. It has also been featured in various media around the globe.

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EFCNI at the annual meeting of the GNPI

The 44th annual meeting of the GNPI (Society for Neonatology and Pediatric Intensive Care Medicine) took place from 7 – 9 June 2018 in Rostock, Germany. About 1,300 experts were on site and informed about the latest scientific findings with the goal to strengthen interdisciplinary collaboration. Chairwoman of EFCNI Silke Mader and Vice Chair Nicole Thiele took the chance to introduce current projects of the foundation:

EFCNI at the GNPI meeting

Silke Mader and Nicole Thiele together with Dr Mike Possner from the Nestlé Nutrition Institute

In October and November 2018, EFCNI will hold the first workshops in line with the newly starting “EFCNI Academy”. In the one-day workshop Setup and operation of human milk banks renowned experts will give valuable insights into the work of existing human milk banks. The workshop is mainly aimed at doctors, lactation consultants and other professionals who want to set up their own human milk bank. It will take place in Frankfurt am Main and Munich, Germany. Further workshops are planned. View more about our international project to support clinical centres in Germany, Switzerland and Austria in the setup and operation of human milk banks on a national level: https://www.efcni.org/activities/projects/milk-banks/


In addition, the third edition of our large-scale initiative A Strong Start for little Heroes was launched. As from now, hospitals with neonatal intensive care units in Germany, Austria, and Switzerland that want to organise in-house events on the occasion of World Prematurity Day on 17 November 2018 are invited to register. Participants will get a comprehensive action package including promotional material, presents for parents of hospitalised infants, and give-aways for visitors. View more about A Strong Start for little Heroes 

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BOOK REVIEW: “Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines”

Koletzko B, Poindexter B, Uauy R (eds.): Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. World Rev Nutr Diet. Basel, Karger, 2014, vol 110.

 

The book Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines (Volume editors: B. Koletzko, B. Poindexter, R. Uauy) provides a detailed overview on nutrient requirements and the practice of nutritional care in preterm infants, with a particular focus on very low birth weight infants.

In 22 chapters written by various experts from all over the world, it summarises current knowledge on the role of different nutrients in preterm babies and their nutritional needs. Additionally, it focuses on the complexity of determining and meeting these needs without interfering with the metabolism of any other nutrient, as well as on the importance and practice of nutrition support (enteral and parenteral nutrition).

Following the aim of developing practical and useful information for the clinical setting, each chapter presents unambiguous conclusions to scientific deliberations. The book is written in plain and intelligible language and explains the complex field of nutritional care in preterm infants in a comprehensive manner, without leaving out important details.

It is a useful reference book for everybody who works in the field of neonatology or otherwise deals with the topic of nutrition in preterm infants.

https://www.karger.com/Book/Home/261508

Statement of the book editor:

Editor Prof. Berthold Koletzko, Professor of Paediatrics

Prof. Berthold Koletzko, Professor of Paediatrics, Dr. von Hauner Children’s Hospital, Ludwig Maximilian University (LMU) Munich 

“For preterm infants, nutritional care is key for optimal growth, health and their long-term development and quality of life. The quality of nutrition support is both particularly important and particularly challenging in infants with very and extremely low birthweight. My co-editors, co-authors and I wrote this book aiming to summarize current knowledge on nutrient requirements and the practice of nutritional care, and to translate knowledge into advice on practical clinical application. We are overwhelmed by the enormous positive response by readers and users, and the huge number of copies sold around the world not only in the English language, but also in translated versions in the Spanish and Chinese Mandarin languages. We hope that the global spreading of this information leads to improvements in the daily care of the many small infants that depend so much on it!”

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SHIPS (Screening to Improve Health in Very Preterm Infants in Europe) meeting in Antwerp

At the beginning of June 2018 all members of the SHIPS project – Screening to Improve Health in Very Preterm Infants in Europe (SHIPS) – met in Antwerp, Belgium, for the second last two-day meeting. SHIPS has almost finished data collection and the results are about to accede, first analyses of data are already ongoing. A strategic action plan for analysis and reporting as well as priority research themes for the coming year has been developed.
Furthermore, concrete steps how and where to disseminate results and derived recommendations were defined. Stimulating visions from elsewhere were provided by two invited researchers from Japan and Australia introducing their work on longer-term neurodevelopment of very preterm infants. Our special thanks go to all partners for their valuable input and contributions.

To learn more about SHIPS, please visit our project website and the official SHIPS website.

 

Please note: This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 633724

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Lighthouse project in NICU design: the new Parents, Baby and Family Centre at the Children’s Hospital Dritter Orden Passau, Germany

Lighthouse graphicAfter five years of intensive planning and construction work, last year the Dritter Orden Clinic in Passau, South Germany,  celebrated the opening of its new Parents-Baby-and Family centre. Realising this lighthouse project in the field of NICU design was a task that brought varied specialists from many different subjects like medical engineers, architects and interior designers as well as medical staff, together in order to make this intensive care unit a place that meets the needs of both the small patients and their parents. A big challenge was to combine highest medical standards with a homey atmosphere. We had the opportunity to bring together three different perspectives and interviewed Professor Matthias Keller, head physician and clinical manager of the Children’s Hospital Dritter Orden Passau, architect Roland Schuster from g|s architects in Büchlberg, Germany, as well as Sigrid Stjerneby who was responsible for the interior architecture of this unique unit. We spoke about the particularities, but also challenges in this project, and much more.  To read the full interviews, please click on the links below. 

 

Professor Matthias Keller, head physician and clinical manager of the Children’s Hospital Dritter Orden Passau: “The core concept and intention are obvious: This is a matter of optimally supporting the development of preterm and ill born babies, to improve their life chances. Our aspiration is care and medicine on a peak level, so that ill and preterm born babies develop in a proper manner, grow and get healthy quickly.  This requires a developmentally supportive environment as well as the presence and support of the parents. Therefore, during a process of several years, a new type of intensive care unit concept was developed and implemented in Passau, which merges various fields of expertise like medical technology, architecture, interior design and a team of doctors and nurses. As a result, intensive care has been reconciled with cosiness, processes have been oriented towards children and parents, and the prerequisites have been created, so that parents can always be with their children, forming a bond with their child from the very beginning – and of course that the family really can be a family in a physical sense. Because: Ill children need their parents!” 
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Roland Schuster, g|s architects in Büchlberg, Germany: “The Parents, Baby, and Family Centre (Eltern-, Baby- und Familienzentrum, abbreviated as EBZ) in the Children’s Hospital Dritter Orden Passau was destined to be a very special project from the very beginning. Making it happen required assembling a planning team, which would be willing to embark on this adventure. With the starting point being the defined processes and procedures, we began planning the floor plan and room concept. During this preliminary design phase, it became clear to us, that in addition to the usual specialist planners like HLS (heating, ventilation, sanitation), electronic, medicine technology, building physics and static, we needed to bring an interior designer on board. The well-being of the patients or parents, respectively, should be first priority.” 
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Sigrid Stjerneby, interior planner, Germany: “The particular challenge in designing a neonatology unit probably basically lies in the complexity by the various specialist planners who particularly focus on technical or hygienic aspects. This can lead to limitations when it comes to imaginative design. The governmental and legal requirements might cause further restrictions. In the project in Passau, we jumped on the bandwagon. The floorplan had already been defined and the construction team had already widely been formed. The vision of Professor Keller, who had „infected“ us with the idea of a family-centred unit, had a huge impact on everything. We often had to go to the limits of the possible to come within reach of this vision, that is for example, to bring together the technical requirements and the ideas regarding design while at the same time everything had to remain within the given budget.” 
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Images Children’s Hospital Dritter Orden Passau: Marcel Peda, pedagrafie

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An interior planner‘s view on the new Parents, Baby, and Family Centre in the Children’s Hospital Dritter Orden Passau

An interview with interior planner Sigrid Stjerneby

As an interior architect, which special requirements did you face in this project?

I would like to point out that I am not an interior architect in a classical sense. I have a background in free arts, I am a painter and sculptor and 25 years ago I founded a planning office together with my husband because we do not understand art within architecture (so called „Kunst am Bau“) as some kind of decoration, but consider the whole space/building itself as a work of art. The needs of the users provide the basis from which the design develops. 

The particular challenge in designing a neonatology unit probably basically lies in the complexity by the various specialist planners who particularly focus on technical or hygienic aspects. This can lead to limitations when it comes to imaginative design. The governmental and legal requirements might cause further restrictions.

In the project in Passau, we jumped on the bandwagon. The floorplan had already been defined and the construction team had already widely been formed. The vision of Professor Keller, who had „infected“ us with the idea of a family-centred unit, had a huge impact on everything. We often had to go to the limits of the possible to come within reach of this vision, that is for example, to bring together the technical requirements and the ideas regarding design while at the same time everything had to remain within the given budget. Especially with regard to the furniture for the parents and child rooms, we often reached our limits. Chosing the right colours is a tricky issue, as people often are quite sensitive about this subject. But this is not primarily determined by personal taste, but more about the effects of colours, light, and forms. The ambient design should gently and quietly accomodate the child and reaffirm the staff on the unit in their approach. It has also been an enormous effort to reconstruct the unit while it continued in operation. I have great respect for the architect, the specialist planner, the craftsmen involved and the staff at the unit, who at the same time had to run their normal day-to-day operations!


Could you please elaborate on the spatial concept of the new EBZ, focusing on the interior design aspects?

The parent-child-retreat is in the foreground and forms the centre of all functional spaces of the unit and that allow for short communication channels and distances for the staff. Through seating areas and colour and light designs, an inviting reception area, and an open base, we created a rhythmic structure of the long corridors. Our “Room of Tranquility” is one of the centrepieces of the building. We intensively discussed the design of this room together with the team. It should be luminous, provide strength, interconfessional, and not closed. A place that can potentially also serve as a place of retreat for staff members. Overall, I would have wished the unit to be provided with more space.


Given the challenges of combing the highest medical equipment for an intensive care unit and of at the same time creating a homely atmosphere, how did you manage to find an appropriate design solution?

I think the key lies in giving up on a fixed idea of what a neonatal intensive care unit should look like. In the beginning, I always chose a design based on a theme which covers the vision the house stands for. You can consider this as ist corporate identity.

In Passau, the monastic house and its patron saint, were my point of reference. The patron saint of this house is St Francis of Assisi. It was immediately clear for everyone that the basic atmosphere of the unit could be based on the Canticle of Brother Sun by St Francis. I carefully listed to the atmosphere in a workshop of different staff members, to get an idea of what the „sound of the unit“ could be like and from this, I composed a melody. It is a subtle interaction between colour, form, and light design.

In general, chosing the right colour is of vital importance. This concerns the colour composition, but also the application of paint. In the corridor areas, we used the glazing technique. The complete colour wheel extends through the unit with its discreet motifs taken from flora, fauna, and astronomy. The light design and all surfaces, like the floor, tiles, furniture, for example, up to the door labels all refer to one special sound. We designed special panel curtains that create a pleasant warm atmosphere. In Passau, special attention was given to integrating the medical equipment into the furniture. This was a particular challenge which could only be accomplished with the support of experts and furniture makers from the hotel and boat building industry and the architect, while involving the staff members of the unit.

Could you give us an insight into the collaboration with the architects during the reconstruction process?

For architects and specialist planners, a holistic design approach, which we aspire, is not common.  That means that everyone needs to show willingness to carefully listen to the construction meetings. For an artist, this likewise is a good exercise to get a better understanding of the thoughts and language of the specialist engineers. I shall not hide the fact that we sometimes had to overcome difficulties, but ultimately, however, we have always found a good solution.

Which challenges did you face during the interior design process?

It is a balancing act between DIN standards, hygiene standards, costs, and the „simple“ wish to create a temporary home for parents and children, as well as to build an optimal work space for the staff. When one thinks about home, often feelings, memories of odours, sounds, colours, come up because this emotionally touches us. This is exactly what we wanted to achieve at the new unit, expressing by creative means: here, you are welcome and safe. At the same time, we also wanted to provide future visitors an element of personal freedom; therefore the furniture leaves room for personal things, also in the sanitary facilities. I was personally committed to leaving marks which express: this space was created by people for people. This is why we painted over 50 panels with different motifs and, this way, gave every room a personal touch. A photo exhibition in sub-areas of the corridors also bears witness to the personalities of our little patients.

Which experience did you gain in this project that you would like to share with other builders and users of similar projects?

Certainly, neonatology units are comparable in many respects, but ultimately, (re-)building such a unit is a very individual task which is strongly influenced by the concept or corporate culture that is lived there. Whether you deal with a new or an existing building, also is crucially important. Last, but not least, the region is decisive and can also be a source of inspiration. I recommend to allow time for a so called planning stage 0, in which the task can be determined from different perspectives. Include, even if only partially, all staff members and leave space for creativity. In a project that extends over a period of 2 or 3 years, new developments and experiences have to be considered.

In my view, the given government-funded financial scope often does not cover the real demand. Some areas are configured too small. This complicates work processes and also has an effect on the well-being of people. If, for example, handovers have to take place in a comparatively small room, you often have the feeling of „thick air“ despite the ventilation system. Man, after all, is a sentient being. From the outside, it is often difficult for me to have understanding for the given regulations when experiencing the everyday conditions at the unit. There I would wish for more exchange between payers, users, and planners. We rely upon teamwork. When everyone gives their best, you achieve a smooth result.

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An architect‘s view on the new Parents, Baby, and Family Centre in the Children’s Hospital Dritter Orden Passau

An interview with Roland Schuster from g|s architects in Büchlberg, Germany


Which special challenges did you meet as the architect of this project?

The Parents, Baby, and Family Centre (Eltern-, Baby- und Familienzentrum, abbreviated as EBZ) in the Children’s Hospital Dritter Orden Passau was destined to be a very special project from the very beginning. Making it happen required assembling a planning team, which would be willing to embark on this adventure. With the starting point being the defined processes and procedures, we began planning the floor plan and room concept. During this preliminary design phase, it became clear to us, that in addition to the usual specialist planners like HLS (heating, ventilation, sanitation), electronic, medicine technology, building physics and static, we needed to bring an interior designer on board. The well-being of the patients or parents, respectively, should be first priority.

Could you tell us more about the architectural aspects of this project?

At this point I would like to focus on some constructional aspects, which were very important to us. Particular attention was given to airflow or more precisely, draughts, in the rooms. There shouldn’t occur any uncomfortable appearances of draught while bonding. In most cases, the openings for fresh air were unconventionally installed into the walls, rather than, as usual, into the ceiling.

Waste- and laundry chutes with electric opining mechanisms were integrated into the built-in furniture, to avoid unnecessary noise. All drawers and cabinet doors were equipped with “soft close”. Here again special attention was given to noise reduction. Every door that leads from the corridor into a patient room was constructed highly sound insulating. Particularly high attention was given to the implementation of the footfall sound insulation. The screed and floor covering from the corridor to patient rooms are sound isolated from each other. The partition walls between the patient rooms, too, were realised with even higher requirements as DIN 4109 (noise protection in structural engineering).

All patient rooms are equipped with specially designed built-in furniture. As far as possible, the medical technology was hidden in the furniture. After all, the design complies with the requirements for a five-star hotel room. To avoid noise in the corridors, all disinfectant dispensers are automatic. While designing the corridors, we laid particular value on recesses and corners, to ensure lounge quality.

Which challenges did you meet during the reconstruction of the unit?

The biggest challenge was organising the reconstruction during ongoing operation. We are all very proud of our project, even with the challenges to integrate the station in an already existing building, to cleverly take advantage of the existing geometry.

Which valuable experience from this project would you like to pass on to other colleagues?

My advice for colleague: Carefully listen to the users and builders.

Text: Roland Schuster
Translation: Manuel Kreitmair

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