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Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis...
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Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment (Second Edition)

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 2043

Special Issue Editor

Prof. Dr. Stefan Grosek

E-Mail Website
Guest Editor
1. Neonatology Section, Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Šlajmerjeva 3, 1000 Ljubljana, Slovenia
2. Department of Paediatrics, Faculty of Medicine, University of Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
3. Department of Medical Ethics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
Interests: critically ill newborn infants and children; transportation medicine; medical and research ethics; adult, pediatric and neonatal intensive care medicine; palliative care medicine; philosophy; medical ethics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Critically ill neonates born prematurely and at term represent a major challenge for healthcare professionals. Critically ill neonates are infants with a broad spectrum of diseases and disorders that emerge pre-, peri-, or postnatally and who need life support treatment in the neonatal intensive care unit (NICU). The NICU is a place where initial and final diagnoses, carried out many times with the involvement of an interdisciplinary team, are confirmed and treatment is ongoing. Great advances and improvements in diagnostics and treatment with modern technical devices have allowed us to support and save many infants with neonatal disorders that would not have been imaginable years ago. Treatment options involving modern life support systems (mechanical ventilation, extracorporeal membrane oxygenation, blood purification techniques, etc.), surgeries, and the most advanced medicines are also available in the NICU. The treatment and prevention of pain, combatting nosocomial infections, and total parenteral nutrition are also of great importance. Healthcare professionals’ support for the families of critically ill neonates is a prerequisite for the completeness of the care of critically ill neonates. Additionally, different ethical issues may arise during intensive treatment in the NICU.

Considering the success and popularity of the first edition of our Special Issue, entitled "Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment", published in the journal Children (https://www.mdpi.com/journal/children/special_issues/47F5MYZ592), we are pleased to announce a second edition, where we aim to collate more publications containing interesting research that may cover any aspects related to diagnostics and treatment options, as well as outcomes and follow-up, for critically ill neonates in the NICU.

Prof. Dr. Stefan Grosek
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neonatal transport
  • SIRS
  • induced therapeutic hypothermia
  • ECMO
  • surfactant
  • congenital defects
  • total parenteral nutrition
  • inhaled nitric oxide
  • outcome
  • sedation and analgesia
  • ethics in NICU

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Further information on MDPI's Special Issue policies can be found here.

Related Special Issue

Published Papers (4 papers)

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Research

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10 pages, 1078 KB  
Article
Echocardiographic Determination of Umbilical Catheter Tip Location Mitigates Complications: A Randomized, Controlled Trial
by Yi-Jhen Lin, Yu-Chen Liu, Hsin-Chun Huang, Yao-Sheng Wang, Hwa-Shiu Wu, Yu-Han Su, Yu-Chen Hsu and I-Lun Chen
Children 2025, 12(11), 1509; https://doi.org/10.3390/children12111509 - 7 Nov 2025
Viewed by 453
Abstract
Background/Objectives: Umbilical venous catheters (UVCs) and umbilical artery catheters (UACs) are essential for neonatal care, facilitating medication delivery, nutritional support, and blood pressure monitoring. However, malposition and prolonged catheter dwell time can lead to severe complications, including central line-associated bloodstream infections (CLABSIs). [...] Read more.
Background/Objectives: Umbilical venous catheters (UVCs) and umbilical artery catheters (UACs) are essential for neonatal care, facilitating medication delivery, nutritional support, and blood pressure monitoring. However, malposition and prolonged catheter dwell time can lead to severe complications, including central line-associated bloodstream infections (CLABSIs). This study aims to evaluate the benefits of ultrasound in confirming catheter tip location, which may impact infection risk, and to assess the effectiveness of modification of the securing method. Methods: This prospective randomized controlled study was conducted from May 2022 to December 2024 at an NICU in Taiwan. Neonates requiring umbilical catheters were randomly assigned to three groups. In Group 1, the catheter length was calculated using a formula, X-ray confirmation was used, and the catheter was secured with traditional tape. In Group 2, ultrasound confirmation was used and the catheter was secured with FoamLite™ sterile dressing and transparent film. In Group 3, ultrasound confirmation was used and the catheter was secured with traditional tape. The outcomes were the rate of complications of the catheters. Results: Groups 2 and 3 demonstrated significantly lower malposition rates, microbial colonization, and CLABSI incidence compared to Group 1 (p = 0.001, 0.006, and 0.026, respectively). No significant difference was observed between Groups 2 and 3, suggesting that accurate tip positioning was more influential in reducing CLABSIs than the securing method itself. Conclusions: Ultrasound guidance improves catheter placement accuracy, minimizes malposition, lowers CLABSI risk, and reduces radiation exposure, supporting its broader implementation in NICUs. Full article
(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment (Second Edition))
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15 pages, 380 KB  
Article
The Incidence of Pulmonary Hypertension and the Association with Bronchopulmonary Dysplasia in Preterm Infants of Extremely Low Gestational Age: Single Centre Study at the Maternity Hospital of University Medical Centre Ljubljana, Slovenia
by Tomaž Križnar, Štefan Grosek and Tina Perme
Children 2025, 12(11), 1441; https://doi.org/10.3390/children12111441 - 24 Oct 2025
Viewed by 492
Abstract
Background: Pulmonary hypertension (PH) occurs in ~25% of infants with moderate-to-severe bronchopulmonary dysplasia (BPD) and is associated with substantial morbidity and mortality. The American Heart Association and American Thoracic Society recommend routine echocardiographic screening for PH in preterm infants with BPD at [...] Read more.
Background: Pulmonary hypertension (PH) occurs in ~25% of infants with moderate-to-severe bronchopulmonary dysplasia (BPD) and is associated with substantial morbidity and mortality. The American Heart Association and American Thoracic Society recommend routine echocardiographic screening for PH in preterm infants with BPD at 36 weeks’ postmenstrual age (PMA), yet the true incidence remains unclear owing to non-uniform diagnostic criteria. Emerging evidence suggests a potential role for earlier screening. Objectives: (i) to determine the incidence of pulmonary hypertension (PH) and bronchopulmonary dysplasia (BPD) in preterm infants of extremely low gestational age; (ii) to determine the incidence of PH among infants diagnosed with BPD (BPD-PH); and (iii) to evaluate the utility of early screening at 7 days of life and late screening at discharge in relation to subsequent BPD. Methods: We conducted a prospective cohort study of all infants born at 22 + 0 to 28 + 6 weeks’ gestation and admitted to our tertiary NICU between 1 September 2022 and 31 December 2024. Clinical and echocardiographic assessments for PH and BPD were performed by neonatologists trained in neonatal echocardiography. Results: Seventy-eight infants born at 22 + 0–28 + 6 weeks’ gestation were enrolled; 71 underwent early screening and 57 underwent late screening. Early echocardiography at day 7 and late screening at discharge identified no cases of PH. PH was diagnosed clinically and/or echocardiographically in 10 infants before day 7 and in one infant at 38 weeks’ PMA. BPD developed in 42 of 57 infants (73.7%). Conclusions: In this cohort of extremely low-gestational-age infants, echocardiographic screening performed by neonatologists detected no PH at day 7 and only one case at late screening (at 38 weeks’ PMA/before discharge). Most PH was identified prior to day 7 on clinical and/or echocardiographic grounds. Full article
(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment (Second Edition))
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Other

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7 pages, 553 KB  
Case Report
Purpura Fulminans in an Extremely Premature Infant: A Case Report
by Anna Rojas Roig, Eduardo Costa Félix de Oliveira, Cristina Borràs-Novell, Anna Álvarez Martínez, Ana Espinosa Gimenez, Miguel Bejarano Serrano, Gemma Pérez Acevedo, Carmen Gracia, Àfrica Pertierra Cortada and Miguel Alsina Casanova
Children 2025, 12(11), 1546; https://doi.org/10.3390/children12111546 - 15 Nov 2025
Viewed by 277
Abstract
Neonatal purpura fulminans is a rare and challenging diagnosis due to its resemblance to other necrotizing skin conditions and the immature coagulation system in newborns. Early multidisciplinary intervention is key. We present the case of an extremely premature infant, born at 24 + [...] Read more.
Neonatal purpura fulminans is a rare and challenging diagnosis due to its resemblance to other necrotizing skin conditions and the immature coagulation system in newborns. Early multidisciplinary intervention is key. We present the case of an extremely premature infant, born at 24 + 3 weeks’ gestation and weighing 520 g. Clinical evolution, diagnostic approach, and therapeutic strategies are described. By day 5, the infant developed hemorrhagic-necrotic skin lesions. Diagnosis of purpura fulminans led to broad-spectrum antibiotics, anticoagulation, supportive care, and surgery. Despite complications such as osteomyelitis and scarring, the patient’s condition improved. Genetic testing ruled out congenital protein C/S deficiency, suggesting an infectious etiology. Therapeutic decisions were guided by ethical considerations, prioritizing family-centered care and patient comfort. This case adds to the limited literature on purpura fulminans in preterm infants and, to our knowledge, represents the smallest patient reported to date. Full article
(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment (Second Edition))
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12 pages, 694 KB  
Systematic Review
Therapeutic Hypothermia in Sudden Unexpected Postnatal Collapse: Feasibility, Risks, and Long-Term Outcomes—A Systematic Review
by Enrico Cocchi, Aurora Brighi and Gina Ancora
Children 2025, 12(10), 1422; https://doi.org/10.3390/children12101422 - 21 Oct 2025
Viewed by 632
Abstract
Background/Objectives: Sudden unexpected postnatal collapse (SUPC) is a rare but catastrophic event affecting apparently healthy neonates during the first days of life. Therapeutic hypothermia has been increasingly applied in this setting due to pathophysiological overlap with hypoxic–ischemic encephalopathy, but its effectiveness remains [...] Read more.
Background/Objectives: Sudden unexpected postnatal collapse (SUPC) is a rare but catastrophic event affecting apparently healthy neonates during the first days of life. Therapeutic hypothermia has been increasingly applied in this setting due to pathophysiological overlap with hypoxic–ischemic encephalopathy, but its effectiveness remains uncertain. The aim of this review is to systematically identify, appraise, and synthesize the evidence on therapeutic hypothermia for SUPC. Methods: We searched MEDLINE, Scopus, Embase, Web of Science, and Cochrane up to February 2025. Eligible studies included term or near-term infants with SUPC within seven days of life who underwent therapeutic hypothermia. Data were extracted on demographics, collapse circumstances, therapeutic hypothermia protocol, mortality, seizures, neuroimaging, and neurodevelopment. Results: Thirteen studies were included, encompassing 70 infants. Most events occurred within two hours of life, during skin-to-skin or breastfeeding, and were strongly associated with primiparity. Therapeutic hypothermia was typically initiated within six hours of collapse, using whole-body cooling at 33–34 °C for 72 h. Mortality was approximately 10% (widely ranging from 0 to 50%). Seizures were frequent (70–90%), and MRI abnormalities were reported in about half of cases. Approximately half of survivors demonstrated normal neurodevelopment at one year. Study quality was low to moderate, and risk of bias substantial. Conclusions: Therapeutic hypothermia is feasible in SUPC and survival with favorable outcomes has been documented, but the certainty of evidence is very low. Given recurrent risk factors such as primiparity and early skin-to-skin/breastfeeding, enhanced vigilance and preventive strategies are essential. Therapeutic hypothermia should be considered case by case, ideally within specialized centers and supported by registries. Full article
(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment (Second Edition))
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