Infant Neurodevelopment and Neonatal Outcomes

Dear Colleagues,

In recent decades, perinatal medicine has shifted focus from immediate neonatal survival to the long-term impact of perinatal factors on neurocognitive development and neonatal outcomes. The mode of delivery and, particularly, the anesthesia technique are major determinants in this context.

For the anesthesiologist, choosing between regional and general anesthesia in obstetric emergencies requires balancing maternal safety, rapid intervention, and fetal protection. Numerous studies have shown that perinatal hypoxia and ischemia, frequently encountered in critical situations, can significantly influence neurodevelopment. Additionally, the pharmacokinetics and pharmacodynamics of anesthetic agents in pregnant women raise specific concerns regarding placental transfer and neonatal effects.

Modern obstetric anesthesia practices increasingly rely on evidence regarding the impact of anesthesia type on neonatal transition, Apgar scores, the incidence of respiratory depression, and, in the long term, neurodevelopmental outcomes. In this setting, the intensive care physician plays a central role not only in emergency management but also in optimizing neonatal outcomes and minimizing risks that may affect long-term child development.

In emergency cesarean sections, the decision-to-delivery interval is crucial. General anesthesia may be preferred for speed, but it carries higher risks for the newborn, including respiratory depression, the need for resuscitation, low Apgar scores, and NICU admission.

Regional anesthesia (spinal or epidural), even in emergency cesareans, tends to be associated with better neonatal outcomes if it can be instituted quickly and effectively.

This Special Issue will focus on the impact of delivery mode and anesthesia choice in obstetric emergencies on infant neurodevelopment and neonatal outcomes. We welcome articles that address the following topics:

• Effects of general versus regional anesthesia on neonatal adaptation and neurodevelopment;
• Influence of emergency cesarean sections and critical obstetric situations on neonatal health;
• Interdisciplinary perspectives from obstetrics, anesthesiology, intensive care, neonatology, and developmental pediatrics;
• Original research, systematic reviews, or analyses proposing clinical strategies to optimize neonatal outcomes and long-term neurodevelopment.

Our goal is to provide new evidence and guidelines for anesthetic and obstetric practices that reduce risks and improve long-term outcomes for infants.

This Special Issue welcomes cutting-edge research exploring how modes of delivery, anesthesia types, and obstetric emergencies influence infant neurodevelopment and neonatal outcomes. Examples of innovative topics include the following:

• Real-time neonatal cerebral monitoring during obstetric emergencies (e.g., NIRS, EEG) and correlations with anesthesia choice;
• Long-term impacts of modern anesthetic techniques on neurodevelopment, assessed via biomarkers or advanced neuroimaging;
• Development of AI-based predictive models for neonatal outcomes based on perinatal and anesthetic variables;
• Multicenter longitudinal cohort studies tracking cognitive and motor development beyond the neonatal period;
• Personalized perioperative strategies to minimize hypoxia and optimize neonatal outcomes in urgent cesarean sections.

This Special Issue will highlight research that not only improves immediate neonatal care but also advances our understanding of long-term neurodevelopmental trajectories in the context of obstetric anesthesia.

We invite submissions that provide new insights into how modes of delivery, anesthesia types, and obstetric emergencies affect neonatal outcomes and infant neurodevelopment. We welcome original research, systematic reviews, case reports, translational studies, and expert perspectives. Topics of interest include clinical and mechanistic studies, innovative monitoring techniques, AI-based predictive models, and strategies to optimize neonatal adaptation and long-term neurodevelopment. We particularly encourage interdisciplinary approaches integrating anesthesiology, obstetrics, neonatology, and pediatric neurology.

Dr. Anamaria Harabor
Dr. Ingrid Andrada Vasilache
Dr. Ana Maria Adam
Guest Editors

Manuscript Submission Information

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• obstetric emergencies
• cesarean section
• obstetric anesthesia
• neonatal outcomes
• neurocognitive development
• teamwork