Gaertner Lab

Emmy-Noether Research Group

Clinical research group assessing lung physiology and optimizing clinical care of newborn infants

PI: Vincent Gaertner

Research topics

Understanding the physiology of fetal-to-neonatal transition
Advancing clinical knowledge on neonatal resuscitation and stabilization after birth
Illuminating (patho-)physiology of different ventilation techniques in preterm infants
Supporting clinical decision-making by performing randomized clinical trials and systematic meta-analyses

Contact

Vincent D. Gaertner, MD BSc

Principal Investigator

Lindwurmstr. 4
80337 Munich
089-4400-52811
Dr. Bärbel Maag

Clinician Scientist

Susanne Reinfeld

Clinician Scientist

Katharina Stöckemann

Clinician Scientist

Maria Wall

Doctoral Student
Fields of research

Understanding the physiology of fetal-to-neonatal transition

The day we are born is the single most dangerous day in our life with the highest mortality rate. Accordingly, birth asphyxia and its complications are the most important factor for childhood mortality worldwide. This is due to the complex transition the lung needs to undergo within seconds after birth: Before birth, the lung is liquid-filled and oxygenation occurs via the placenta. After birth, the infant needs to start crying to aerate the lung. We are committed to unraveling the detailed pulmonary mechanisms of this unique moment in life. To do this, we collect various physiological data in human infants immediately after birth, starting with the first breath to better understand initial lung aeration and pulmonary perfusion. This will help us improve neonatal respiratory management during the transitional period.

Advancing clinical knowledge on neonatal resuscitation and stabilization after birth

Approximately 5-10% of newborn infants require some form of assistance in order to transition from a liquid-filled lung to an air-filled lung which is the prerequisite to successfully initiate oxygenation and ventilation. Failure to aerate the lung necessitates additional support using stimulation, respiratory support and in few selected cases, cardiopulmonary resuscitation. Due to the emergency nature of the situation, there are still many open questions with regard to the initial management of term and preterm infants immediately after birth. Our research group is dedicated to improving newborn health by critically appraising the steps in the neonatal resuscitation algorithm and by rigorously evaluating possibilities to improve the cardiorespiratory management. This includes observational studies as well as clinical trials which will allow improvement in immediate clinical management in the future.

Illuminating (patho-)physiology of different ventilation techniques in preterm infants

Very preterm infants have a low lung compliance but a high chest wall compliance making them prone to (micro-)injuries. Accordingly, almost all very preterm infants require some form of (ideally non-invasive) respiratory support. The mode and settings of this respiratory support and the timing and modalities of additional medical management (caffeine, surfactant, etc) are based on current guidelines but there are still many unanswered questions in terms of respiratory management of the most vulnerable population. Thus, there is still a large need for patient-centered outcome-driven trials to improve respiratory management. Also, (patho-)physiology of different ventilation techniques as well as during various interventions needs to be understood better in order to improve patient outcomes. Accordingly, physiological studies in human infants are needed in order to tease out the ideal management in an individualized manner.

Supporting clinical decision-making by performing randomized clinical trials and systematic meta-analyses

Clinical decision-making should always be supported by the best available clinical data. We are committed to translating pre-clinical data as well as clinical data from observational studies to randomized clinical trials in order to implement novel ideas into clinical practice. Currently, we are evaluating the effect of a higher vs lower pressure immediately after birth in very preterm infants in a multicenter, randomized controlled trial (LEOPARD trial, see below). Also, we are combining data from RCTs into systematic reviews by collaboration with the Cochrane Library.

Current projects

LEOPARD trial

The LEOPARD trial is a large, multi-center, international randomized controlled trial initiated by this research group comparing a high (10-12 cmH2O) vs low (5-7 cmH2O) positive end-expiratory pressure during the first ten minutes after birth in very preterm infants (24 0/7 to 31 6/7 weeks gestational age at birth). As a pragmatic trial, all other interventions are at the discretion of the treating clinical team. Primary outcome is a clinically important DOOR outcome at 36 weeks corrected postmenstrual age including death, moderate/severe bronchopulmonary dysplasia, severe brain lesions, long-term mechanical ventilation, pneumothoraces and respiratory failure. The study will be conducted in several centres in Germany, Switzerland and Australia.

EAGLE study

The EAGLE study is a prospective observational study assessing electrical impedance tomography (EIT) of healthy term infants after vaginal delivery. In this study, EIT recordings will be performed immediately after birth and starting before the first breath in order to understand changes in lung aeration and pulmonary perfusion in healthy infants which will increase our understanding of this crucial moment in life.
Current status: recruitment finished, manuscript submitted

ALBATROSS study

The ALBATROSS study is a prospective observational study in late preterm and term infants assessing EIT data immediately after birth after cesarean section in order to decipher intrapulmonary volume changes in infants with respiratory distress and compare them to infants without respiratory distress.
Current status: recruitment finished, manuscript phase

RAVEN study

The RAVEN study is an observational study in healthy term infants after birth assessing electrical impedance tomography (EIT) recordings to describe differences between infants born vaginally and infants born via cesarean section.
Current status: recruitment finished, manuscript phase

LION study

The LION study is a prospective observational study in preterm infants undergoing surfactant application. In this study, we aim to assess electrical impedance tomography (EIT) recordings during intratracheal surfactant application in order to assess lung volume changes during distinct manipulations such as laryngoscopy, surfactant instillation, etc
Current status: protocol phase

COAT review

The COAT review is a systematic review with meta-analysis in conjunction with the Cochrane collaboration where we critically appraise the evidence on air versus additional oxygen supplementation in term infants needing resuscitation immediately after birth
Current status: protocol published, currently extracting data

Further projects

EPSILON study: recruitment phase
PHOENIX study: recruitment phase
INSTANT study: recruitment phase
DOOR studies: protocol phase
ELEPHANT review: in revision
MRSOPA review: manuscript phase
RELAX study: protocol phase
INSPIRE 2.0 study: protocol phase
Sync_HFO study: protocol phase
Selected publications
Gaertner VD, Büchler VL, Waldmann AD, Bassler D, & Rüegger CM (2024). Deciphering Mechanisms of Respiratory Fetal-to-Neonatal Transition in Very Preterm Infants. American Journal of Respiratory and Critical Care Medicine
Gaertner VD, Waldmann AD, Davis PG, Bassler D, Springer L, Thomson J, Tingay DG, & Rüegger CM (2021). Transmission of oscillatory volumes into the preterm lung during noninvasive high-frequency ventilation. American Journal of Respiratory and Critical Care Medicine
Rüegger CM, Dawson JA, Cracknell J, Fiander M, Davis PG, & Gaertner VD (2024). Air versus supplemental oxygen for resuscitation of term or late preterm infants at birth. Cochrane Database for Systematic Reviews
Gaertner VD, Minocchieri S, Waldmann A, Mühlbacher T, Bassler D, & Rüegger CM for the SUNSET study group (2022). Prophylactic surfactant nebulisation for the early aeration of the preterm lung: a randomised clinical trial. Archives of Disease in Childhood: Fetal and Neonatal Edition
Gaertner VD, Thomann J, Bassler D, Rüegger C (2021). Surfactant nebulization to prevent intubation in preterm infants: A systematic review and meta-analysis. Pediatrics
Gaertner VD, Waldmann AD, Davis PG, Bassler D, Springer L, Tingay DG, & Rüegger CM (2022). Lung volume changes during apnoeas in preterm infants. Archives of Disease in Childhood: Fetal and Neonatal Edition
Gaertner VD, Waldmann AD, Davis PG, Bassler D, Springer L, Tingay DG, & Rüegger CM (2022). Lung volume distribution in preterm infants on non-invasive high-frequency ventilation. Archives of Disease in Childhood: Fetal and Neonatal Edition
Gaertner VD, Rüegger CM, Bassler D, O'Currain E, Kamlin COF, Hooper S, Davis PG, & Springer L (2021). Effects of tactile stimulation on spontaneous breathing during face mask ventilation. Archives of Disease in Childhood: Fetal and Neonatal Edition
Gaertner VD, Rüegger CM, O’Currain E, Kamlin COF, Hooper S, Davis PG, & Springer L (2020). Physiological responses to facemask application in newborns immediately after birth. Archives of Disease in Childhood: Fetal and Neonatal Edition
Belting C, Rüegger CM, Waldmann AD, Bassler D, & Gaertner VD (2024). Rescue nasopharyngeal tube for preterm infants non-responsive to initial ventilation after birth. Pediatric Research
Gaertner VD & Rüegger CM (2023). Optimising success of neonatal extubation: respiratory support. Seminars in Fetal and Neonatal Medicine
Gaertner VD, Helwig ED, Manley BJ, Kamlin COF, Kraus A, & Rüegger CM (2022). “Harry Potter and the Multitudinous Maladies” – Evaluation of morbidity and mortality among witches and wizards: A Retrospective Population-Based Observational Study. Medical Journal of Australia
Gaertner VD, Mühlbacher T, Waldmann AD, Bassler D, & Rüegger CM (2023). Early prediction of pulmonary outcomes in preterm infants using electrical impedance tomography. Frontiers in Pediatrics
Mutesu-Kapembwa K, Lakhwani J, Benkele RG, Machona S, Shamalavu MS, Chintende JM, Chisela SM, Kapoma S, Mwanza J, Chelu W, Mwendafilumba M, Kapembwa K, & Gaertner VD (2022). Bridging the gap in neonatal resuscitation in Zambia. Frontiers in Pediatrics
Gaertner VD, Restin T, Bassler D, Fauchère JC, & Rüegger CM (2022). Case Report: Intrapulmonary Tidal Volumes in a Preterm Infant with Chest Wall Rigidity. Frontiers in Pediatrics
Gaertner VD, Waldmann AD, Bassler D, Hooper S, & Rüegger CM (2022). Intrapulmonary Volume Changes during Hiccups versus Spontaneous Breaths in a Preterm Infant. Neonatology
Gaertner VD, Bassler D, Zimmermann R, & Fontijn J (2021). Reference values for umbilical artery lactate by mode of delivery and gestational age – a retrospective observational study. Neonatology
Gaertner VD, Bassler D, Rüegger CM (2021). Does surfactant nebulization prevent early intubation in preterm infants? A protocol for a systematic review and meta-analysis. Systematic Reviews
Plastina L*, Gaertner VD*, Waldmann A, Thomann J, Bassler D, & Rüegger CM (2021). The DELUX study – Development of Lung volumes during extubation of preterm infants. Pediatric Research
Büchler V, Gaertner VD, Thomann J, Bassler D, & Rüegger CM (2024). Lung volume changes in stable preterm infants weaned from nCPAP to high-flow: a prospective cohort study. CHEST Pulmonary
Mileder L, Wagner M, Kaufmann M, Gaertner VD, Rüegger CM, & Springer L (2023). How should we perform neonatal mask ventilation during MR SOPA corrective steps? Resuscitation Plus
Thomann J, Rüegger CM, Gaertner VD, O'Currain E, Kamlin COF, Davis PG, & Springer L (2022). Tidal volumes during delivery room stabilization of (near) term infants. BMC Pediatrics
Thomann J, Gaertner VD, Waldmann AD, Plastina L, Bassler D, & Rüegger CM (2023). Nasal high frequency oscillatory highflow therapy in preterm infants: A randomized crossover trial. Pediatric Pulmonology
Mühlbacher T, Gaertner VD, Bassler D (2020). History of caffeine use in neonatology and the impact of the CAP trial. Seminars in Fetal and Neonatal Medicine
Wellmann S, Manegold-Bauer G, Fischer T, Schaeffler L, Gaertner VD, Fill Malfertheiner S, & Burkhardt T (2021). Improving neonatal and maternal outcome by inducing mild labor before elective cesarean section: the LACARUS randomized controlled trial. Neonatology

Full list of publications
February 2025

Vincent Gaertner funded by the German Research Foundation (DFG)
The research project “From EAGLE to LEOPARD” by DZL researcher Vincent Gaertner, doctor at the Dr. von Hauner Children's Hospital (LMU) and principal investigator at the DZL Munich site (CPC-M), is funded by the German Research Foundation (DFG) as an Emmy Noether Research Group over a period of six years: Dr Gaertner wants to improve our understanding how this transition works and how premature babies can be optimally supported in the delivery room. The aim is to improve medical care in this unique and critical phase of life, thereby increasing the chances of survival and the later quality of life of newborns.
Read full text at DZL website

November 2024

Vincent Gaertner is awarded the Future-of-Paediatric-Care Grant and the Early Career Investigator Prize by the European Society for Paediatric Research

September 2024

Vincent Gaertner receives the Adalbert-Czerny-Medal of the German Society for Pediatric and Adolescent Medicine
Vincent Gaertner, MD (35) was awarded with the Adalbert-Czerny-Medal 2024 by the German Society for Pediatric and Adolescent Medicine. The prize, which comprises 10'000 euro and a medal of Adalbert Czerny, rewards particularly important scientific achievements in the field of pediatrics.
Read full text here
Watch interview
Funding

This research group is funded by various public agencies including the German Research Foundation via the Emmy-Noether-Programme, the European Society for Paediatric Research, the LMU Hospital, the Friedrich-Baur-Stiftung and the German Center for Lung Research.

Collaborations

We are collaborating closely with our partners in University Hospitals and Universities from the entire world, from San Diego, California, via several European sites, Lusaka in Zambia down to Melbourne, Australia. Together with our partners, we develop important clinical trials, have trainee partnerships to improve learning from our students and organize various annual meetings.
Open positions:
We are actively looking for researchers at all levels (postdocs, clinician scientists, PhD and MD students, interns, study nurses). We offer an excellent research atmosphere in a clinical research group and we are looking for highly motivated individuals who
Are interested in neonatal care and/or lung physiology
Want to work in a research atmosphere where clinically important questions are answered
Want to see their research output translated into clinical care immediately
Enjoy working in a collaborative team surrounded by a vibrant scientific environment

Our group is dedicated to better understand the physiology of cardiopulmonary adaptation during fetal-to-neonatal transition and to optimize clinical respiratory care for both term and preterm infants. We perform large and small clinical trials with clinically pressing questions, translate findings into cutting-edge systematic reviews supporting international clinical guidelines, and try to understand lung pathophysiology during clinical interventions. To do this, we collaborate with a wide scientific network in Munich, Germany and worldwide.

Please do not hesitate to get in touch via email if you are interested in working with us or if you want to discuss collaboration projects.

Gaertner Lab

Emmy-Noether Research Group

PI: Vincent Gaertner

Research topics

Contact

Fields of research

Current projects

February 2025

November 2024

September 2024

Funding

Collaborations

CCRC Hauner