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

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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 9795

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Special Issue Editor

Prof. Dr. Stefan Grosek

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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
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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

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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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Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment in Children (7 articles)

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13 pages, 2971 KB

Open AccessArticle

Artificial Intelligence-Based Video Analysis for Assessing Sucking Behavior in Preterm Infants: A Feasibility Study

by Ji Ae Kim, Jihye Chae, Su Min Kim, Eui Kyun Lee, Seung Hak Lee, Seungwoo Cha, Garam Hong, Jihoon Kweon and Eun Jae Ko

Children 2026, 13(4), 479; https://doi.org/10.3390/children13040479 - 30 Mar 2026

Viewed by 586

Abstract

Background/Objectives: Preterm infants often experience impaired swallowing function, and objective assessments for this population remain limited. In this prospective single-center study, we aimed to propose and validate an automated framework that quantitatively assesses neonatal sucking behavior by tracking facial key points in bottle feeding videos. Methods: Fifty-eight preterm infants (corrected age [CA] ≤ 2 months) were enrolled, and 2 min videos of bottle-feeding were recorded. Certified therapists manually evaluated the videos using the Neonatal Oral Motor Assessment Scale (NOMAS), and an artificial intelligence (AI)-based analysis classified the videos into the following three groups: Normal, Disorganization, and Dysfunction. At 12 months CA, developmental outcomes were assessed using the Mental Development Index (MDI) and the Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development, Second Edition (BSID-II). Results: Among the 58 infants, the AI-based tool correctly classified 47 and misclassified 11. The classification accuracy was 82.76 for the Normal group, 82.76 for Disorganization, and 96.55 for Dysfunction. The mean PDI was lower in the Dysfunction group than in other groups; however, the differences were not statistically significant. Conclusions: This novel AI-based video analysis demonstrates preliminary potential as a noninvasive tool for evaluating sucking behavior in preterm infants, potentially enabling early identification of dysphagia even by non-specialists in the neonatal intensive care unit (NICU) without hazard exposure. This feasibility study demonstrates preliminary technical viability of a video-based framework for neonatal sucking behavior assessment; however, further validation is required before clinical implementation. 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, 265 KB

Open AccessArticle

Early Neonatal Hyperglycemia, Risk Factors, and Adverse Outcomes in Extremely Preterm Infants: A Propensity-Matched Cohort Study

by Safaa M. G. A. Alsayigh, Nuha Nimeri, Alaa Almashhadani, Amna Abdelgadir Mohamed, Omar Haidar, Muhammed Talha Hepsen and Ashraf Gad

Children 2026, 13(3), 387; https://doi.org/10.3390/children13030387 - 10 Mar 2026

Viewed by 766

Abstract

Background: Neonatal hyperglycemia is a common metabolic complication in extremely preterm (EP) infants; however, early risk factors and associated outcomes remain incompletely defined. Objective: To evaluate the association between neonatal hyperglycemia in the first postnatal week and key neonatal morbidities including early neurodevelopmental risk in EP infants. Methods: We conducted a retrospective cohort study of EP infants born in 2018–2019 at the Women’s Wellness and Research Center. Neonatal hyperglycemia was defined as a blood glucose level > 8.3 mmol/L. Maternal factors, delivery room interventions, early physiological markers, neonatal morbidities, and follow-up outcomes were compared. Propensity score matching was applied to balance the baseline demographic and perinatal differences. Results: Among 225 EP infants, 131 (58.2%) developed neonatal hyperglycemia in the first week (mild, 21.4%; moderate, 42%; severe, 36.6%). Before matching, infants with neonatal hyperglycemia had lower gestational age and birth weight and required more delivery-room surfactant, and their mothers had lower rates of premature rupture of membranes. After matching, neonatal hyperglycemia was associated with higher rates of ventilator-associated pneumonia (1.45 vs. 0.37; IRR 6.2, 95% CI 1.4–27.6), longer duration of invasive ventilation (19.8 ± 25.3 vs. 8.9 ± 24.8 days; mean difference −10.9 days; p = 0.042), higher postnatal steroid exposure (18.2% vs. 5.5%; OR 4.6, 95% CI 1.6–14.4; p = 0.040), and severe retinopathy of prematurity (ROP) (21.6% vs. 6.4%; OR 4.0, 95% CI 1.0–15.5; p = 0.032). A trend toward moderate-to-severe bronchopulmonary dysplasia was observed (33.3% vs. 15.9%; p = 0.054). Mortality did not differ significantly between groups; however, among non-survivors, age at death was higher in the neonatal hyperglycemia group. Conclusions: In EP infants, early neonatal hyperglycemia is associated with higher respiratory morbidity and severe ROP even after propensity score matching. These findings support neonatal hyperglycemia as a clinically relevant early risk marker and justify further prospective and interventional studies. Full article

(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment (Second Edition))

15 pages, 1404 KB

Open AccessArticle

Survival, Mortality Predictors, and Morbidity in Extremely Low Birth Weight Neonates: A Retrospective Cohort Study at a Tertiary Hospital in the Eastern Cape, South Africa

by Sithembinkosi Manyoni Gonya, Kim Harper and Isabel Michaelis

Children 2026, 13(3), 317; https://doi.org/10.3390/children13030317 - 25 Feb 2026

Viewed by 636

Abstract

Background: Extremely low birth weight (ELBW) neonates (<1000 g) contribute significantly to global neonatal and under-five mortality, with heightened vulnerability in resource-limited settings. Objectives: The overall aim of this manuscript is to evaluate the survival outcomes and associated factors among ELBW infants in a resource-limited tertiary care setting in South Africa. Methods: This retrospective cohort study examined survival outcomes, causes of death, and associated morbidities among 192 ELBW infants admitted to Frere Hospital, South Africa (SA), between January 2020 and February 2025. Kaplan–Meier survival analysis and multivariable Poisson regression were used to identify predictors of mortality. Results: Overall, 42% of neonates survived to discharge. Common morbidities included respiratory distress syndrome (78%) and extreme prematurity (30%). Extreme prematurity (<28 weeks) was associated with a markedly increased risk of mortality (adjusted IRR = 0.20; 95% CI: 0.08–0.53; p < 0.001), while caesarean section conferred a protective effect compared to vaginal delivery (adjusted IRR = 0.38; 95% CI: 0.23–0.64; p < 0.001). Conclusions: The findings highlight that strengthened antenatal care, consistent neonatal resuscitation, and equitable intensive care remain essential. Policy-driven investment in surfactant therapy, CPAP, and infection control is critical; without such measures, ELBW infants’ mortality will continue to be disproportionately high in resource-limited settings. 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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10 pages, 570 KB

Open AccessArticle

Evaluating the Effectiveness of Ibuprofen Versus Acetaminophen in Closing Patent Ductus Arteriosus in Preterm Neonates

by Shaimaa Alsulami, Mona Aljehani, Najla Alotaibi, Mohammed Y. Al-Hindi and Mohammed Alharbi

Children 2026, 13(2), 257; https://doi.org/10.3390/children13020257 - 12 Feb 2026

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Abstract

Background/Objective: Patent Ductus Arteriosus (PDA) is a common congenital heart defect causing high morbidity and mortality in preterm neonates. IV ibuprofen is the standard treatment, with acetaminophen as a potential alternative when ibuprofen is contraindicated. However, evidence for acetaminophen’s effectiveness is inconclusive. This study aimed to compare the efficacy and safety of IV acetaminophen versus IV ibuprofen as the initial treatment for PDA closure in preterm neonates. Methods: A retrospective cohort study was conducted at a tertiary Saudi hospital. This study included preterm neonates with a gestational age of ≤32 weeks diagnosed with PDA and treated with IV ibuprofen or IV acetaminophen. The primary outcome was to evaluate the efficacy of ibuprofen versus acetaminophen for treating PDA. Results: A total of 95 courses were included. Of these, 49 neonates received ibuprofen, and 18 neonates received acetaminophen as first therapy. The mean age at the initial course was 5.47 ± 10.30 days for the ibuprofen group and 5.22 ± 6.43 days for the acetaminophen group. In most neonates, the hemodynamic significance of the PDA was confirmed by ultrasound examination. As a result, 35 of 49 neonates treated with ibuprofen experienced successful full PDA closure, with a rate of 71.4%, compared to 10 of 18 in the acetaminophen group, which had a rate of 55.6%. However, this difference was not statistically significant (p-value = 0.35). Conclusions: A trend toward higher PDA closure with ibuprofen was observed compared to acetaminophen, without a statistically significant difference. Both treatments showed comparable safety. Further studies are needed to confirm these findings and optimize acetaminophen dosing. 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, 580 KB

Open AccessArticle

Pain, Opioids, and Functional Connectivity in Preterm Infants

by Caterina Coviello, Lorenzo Frassineti, Camilla Fazi, Silvia Lori, Giovanna Bertini, Simona Montano, Simonetta Gabbanini, Clara Lunardi, Valentina Guarguagli, Antonio Lanata and Carlo Dani

Children 2026, 13(2), 210; https://doi.org/10.3390/children13020210 - 31 Jan 2026

Viewed by 523

Abstract

Aim: To investigate the impact of pain on some electroencephalographic (EEG) features at term equivalent age (TEA) and, second, to assess if the proposed EEG analysis may be predictive of the neurodevelopmental outcome at 24 months corrected age. Methodology: Infants born < 32 weeks of gestational age, without major brain injury, were studied with an 8-channel EEG recording at TEA. The number of skin-breaking procedures from birth to the EEG recording was collected, as well as opioid administration. The following EEG-based indexes were investigated: Brain Simmetry Index (BSI) and Circular Omega Complexity (COC). Multivariate statistical analysis was performed. Results: Seventy-seven preterm newborns were enrolled. The multivariate models showed that higher pain exposure resulted in higher BSI, lower COC μ (mean), and lower COC values related to δ waves (all p < 0.05). Fentanyl was associated with increased BSI values related to α and β waves (all p < 0.05). Morphine showed a positive effect on BSI and a negative effect on OC μ and COC on all frequency bands (all p < 0.05). COC related to δ waves was positively associated with cognitive outcomes (p = 0.034). Conclusions: Pain and opioids might impact brain dynamics in preterm infants. Quantitative multivariate EEG indexes may be helpful to characterize the neurodevelopmental outcomes. 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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11 pages, 517 KB

Open AccessArticle

Pulse Oximetry Histogram Profiles Before and After Red Blood Cell Transfusion in Very Preterm Infants: A Prospective Observational Cohort

by Nevra Çolak, Murat Konak and Saime Sündüs Uygun

Children 2026, 13(2), 167; https://doi.org/10.3390/children13020167 - 25 Jan 2026

Viewed by 459

Abstract

Background/Objectives: Red blood cell (RBC) transfusion is frequently used to treat anemia of prematurity, yet bedside metrics that capture its short-term impact on oxygenation stability are limited. We assessed whether pulse oximetry histogram-derived oxygen saturation (SpO₂) exposure changes after transfusion and whether responses differ across clinical subgroups. Methods: This prospective observational cohort included preterm infants born <32 weeks’ gestation who received a standardized RBC transfusion (15 mL/kg). Continuous SpO₂ histograms quantified the percentage of monitored time spent in hypoxemia (<85%), normoxemia (86–95%), and hyperoxemia (≥96%) during four intervals: 24 h pre-transfusion and 24, 48, and 72 h post-transfusion. Repeated-measures and subgroup analyses (BPD, sex, birth weight < 1000 g) were performed. Results: Thirty-three infants were analyzed (gestational age 29.4 ± 2.1 weeks; birth weight 1220.6 ± 316.9 g). Hemoglobin increased from 8.6 ± 1.1 to 11.7 ± 1.0 g/dL (p < 0.001). Cohort-level histogram shifts were modest: normoxemia increased from 68.4 ± 12.1% to 72.6 ± 11.4% at 24 h (p = 0.18), hypoxemia decreased from 10.3 ± 6.5% to 6.6 ± 4.8% (p = 0.09), and hyperoxemia remained stable (21.3 ± 9.2% to 20.8 ± 8.5%; p = 0.44). Infants with BPD and those <1000 g showed persistently higher hypoxemia and/or hyperoxemia at 72 h compared with counterparts. Exploratory ROC analyses showed modest discrimination of 24 h hypoxemia for ROP (AUC 0.71) and 72 h hyperoxemia for BPD (AUC 0.74). Conclusions: RBC transfusion corrected anemia but did not produce a consistent cohort-level improvement in SpO₂ histogram stability. Histogram metrics may help characterize heterogeneous oxygenation responses and support hypothesis generation for individualized monitoring strategies. 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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11 pages, 900 KB

Open AccessArticle

Short-Term Neonatal Outcomes Following Early-Term vs. Full-Term and Late-Preterm Births: Insights from a Retrospective Cohort Study

by Nadav Kadosh, Ron Zeitouni, Roni Shlesinger Schwartz, Smadar Eventov-Friedman and Noa Ofek Shlomai

Children 2025, 12(12), 1693; https://doi.org/10.3390/children12121693 - 15 Dec 2025

Viewed by 1206

Abstract

Background: Conceptualizing gestation as a developmental continuum highlights that even among term infants, distinct subgroups—such as early-term and full-term infants—may exhibit meaningful differences in morbidity and clinical outcomes. Objective: To compare early neonatal outcomes among late-preterm (LP), early-term (ET), and full-term (FT) infants. Methods: A retrospective observational study analyzed data of infants born between 34⁺⁰ and 41⁺⁶ weeks at Hadassah Medical Centers in 2023. Infants were stratified by gestational age. Late-preterm was defined as birth between 34 − 36 + 6 weeks of gestation, early-term 37 − 38 + 6 weeks, and term birth between 39 − 41 + 6 weeks. Primary outcome was length of stay (LOS), secondary outcomes included NICU admissions, respiratory support, feeding type, weight loss, and re-hospitalizations within the first year following discharge. Results: ET infants had intermediate outcomes between LP and FT groups. LOS and respiratory support needs were higher in ET than FT infants. NICU admissions were significantly more frequent in LP infants; ET infants exhibited higher weight loss and more frequent elective cesarean deliveries compared to FT infants. Readmission rates were higher in ET compared to FT infants. Conclusions: ET infants, while more stable than LP infants, experienced increased short-term morbidity compared to FT neonates. These findings support minimizing elective delivery before 39 weeks unless clinically indicated. 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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10 pages, 1078 KB

Open AccessArticle

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 918

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). 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

Open AccessArticle

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 1109

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 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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7 pages, 553 KB

Open AccessCase 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 826

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 + 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

Open AccessSystematic 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 1303

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 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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