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Risk Factors in Neonatal Intensive Care
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Risk Factors in Neonatal Intensive Care

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: 20 February 2027 | Viewed by 4415

Editors

Prof. Dr. Gabriela C. Zaharie

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Guest Editor
Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
Interests: neonatology; neonatal outcome; neonatal resuscitation; preterm infants; mechanical ventilation; maternal child; resuscitation; nosocomial infection; maternal pathology; newborn at risk
Special Issues, Collections and Topics in MDPI journals
Dr. Melinda Matyas

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Guest Editor
Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
Interests: neonatology; bronhopulmonary displasia; oxidativ stress in newborn; neonatal hemodinamics; neurological impairment

Special Issue Information

Dear Colleagues,

Fortunately, 90% of newborns do not need resuscitation in the delivery room. However, the rest need help during the transition to extrauterine life.

Newborns at risk are a special group in need of neonatal intensive care.

The categories of newborns at risk are represented by the following:

  • Premature newborns, especially below 32 weeks of gestation;
  • Newborns with intrauterine growth restriction;
  • Newborns with birth asphyxia;
  • Newborns requiring respiratory support;
  • Newborns with malformations (CNS, cardiac, digestive, respiratory, etc.);
  • Newborns with Rh isoimmunization;
  • Newborns with infections;
  • Newborns from families with precarious socio-economic conditions, from non-survey pregnancies (disorganized families, poverty, etc.);
  • Newborns from mothers with diabetes, pre-eclampsia, or other severe pathologies.

Admission to intensive care means separation from the mother, with the mother–child contact being more restrictive. In these cases, the newborn will undergo a large number of invasive or less invasive procedures.

Therefore, the risks related to newborns being admitted to neonatal intensive care is a topic that remains within the scope of neonatologists, practitioners, and researchers, with its importance being represented by the effect on a newborn’s prognosis.

Prof. Dr. Gabriela C. Zaharie
Dr. Melinda Matyas
Guest Editors

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-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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 intensive care
  • infant birth
  • preterm
  • neonatal resuscitation
  • neonatal outcome
  • growth restriction
  • prenatal diagnosis
  • severe maternal pathology and its effects on a newborn
  • therapeutical hypothermia
  • parenteral nutrition
  • neonatal infection
  • retinopathy of prematurity

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Published Papers (4 papers)

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Research

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13 pages, 511 KB  
Article
Small-for-Gestational-Age Status and Adverse Clinical Outcomes in Preterm and Very Preterm Infants: A Propensity Score-Matched Cohort Study
by Manapat Praditaukrit, Anucha Thatrimontrichai, Praew Chareesri, Pattima Pakhathirathien, Gunlawadee Maneenil and Supaporn Dissaneevate
J. Clin. Med. 2026, 15(12), 4798; https://doi.org/10.3390/jcm15124798 (registering DOI) - 20 Jun 2026
Viewed by 149
Abstract
Background/Objectives: Preterm (<37 weeks) and very preterm (<32 weeks) infants face considerably higher mortality and morbidity rates than full-term infants. We compared clinical outcomes between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants. Methods: This retrospective cohort study used a prospectively collected database, obtained [...] Read more.
Background/Objectives: Preterm (<37 weeks) and very preterm (<32 weeks) infants face considerably higher mortality and morbidity rates than full-term infants. We compared clinical outcomes between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants. Methods: This retrospective cohort study used a prospectively collected database, obtained from 2014 to 2025. Propensity score matching (PSM), multivariate regression, and subgroup analyses of very preterm infants were performed to minimize confounding. Results: Among the 5890 neonatal admissions, 2331 preterm infants met the inclusion criteria. After PSM, 298 SGA and 298 AGA preterm infants were analyzed. Multivariate analysis showed that SGA preterm infants had significantly higher risks of the composite outcome of mortality or major morbidity (adjusted risk ratio [aRR], 1.89; 95% confidence interval [CI], 1.18–3.02), mortality (aRR, 3.53; 95% CI, 1.57–7.95), and mortality or moderate-to-severe bronchopulmonary dysplasia (aRR, 2.13; 95% CI, 1.30–3.48). In the subgroup analysis after PSM, 190 very preterm infants showed similar results, with SGA infants having increased risks of the composite outcome of mortality or major morbidity (aRR, 1.81; 95% CI, 1.02–3.23), mortality (aRR, 3.23; 95% CI, 1.09–9.62), mortality or moderate-to-severe bronchopulmonary dysplasia (aRR, 2.03; 95% CI, 1.10–3.72), and mortality or treated retinopathy of prematurity (aRR, 2.62; 95% CI, 1.03–6.65). Conclusions: SGA status is associated with a higher risk of mortality and major morbidity in preterm and very preterm infants. In resource-limited settings, the focused management of SGA infants is critical to improving short- and long-term outcomes. Full article
(This article belongs to the Special Issue Risk Factors in Neonatal Intensive Care)
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Graphical abstract

14 pages, 280 KB  
Article
Morbidity, Mortality, and Short-Term Outcomes of Preterm Infants ≤ 25 Weeks of Gestation
by Melinda Matyas, Florica Ramona Dorobantu, Madalina Valeanu, Monica G. Hasmasanu, Nicoleta Grosu, Adelina Tutu, Anna D. Jakab and Gabriela Zaharie
J. Clin. Med. 2026, 15(9), 3198; https://doi.org/10.3390/jcm15093198 - 22 Apr 2026
Viewed by 787
Abstract
Background: Short-term morbidities and mortality decreased significantly in the past decade at preterm born < 25 weeks of gestation. Severe lifelong morbidities affect an important part of these patients. Objective: to investigate the in-hospital morbidity, mortality, and short-term complications of preterm neonates born [...] Read more.
Background: Short-term morbidities and mortality decreased significantly in the past decade at preterm born < 25 weeks of gestation. Severe lifelong morbidities affect an important part of these patients. Objective: to investigate the in-hospital morbidity, mortality, and short-term complications of preterm neonates born ≤25 weeks of gestation. Methods: A prospective longitudinal cohort study was conducted in children born 2021–2024, ≤25 weeks of gestation, admitted to a 3rd-level unit, and care till discharge. Pregnancy complications’ effect on neonatal evolution was analyzed, six main in-hospital morbidities specific for preterm birth and other aggravating circumstances, with a possible effect on the evolution were analyzed, as follows: inflammatory syndrome, early pulmonary or digestive hemorrhages, and early inotropic support. The neurological development in the first year of life was analyzed through theparticipation of premature infants in the follow-up program after discharge. Results: Forty-nine premature infants were enrolled, with a mean gestational age of 24.37 ± 0.76 weeks and an average weight of 665 ± 143 g. Most newborns required intubation at birth (42/49), and 33/49 received 2-dose surfactant therapy postnatally. NEC was present in 26.5% of the group, being more common in patients with inflammatory syndrome—increase in procalcitonin (PCT), and those who received a higher number of blood transfusions. The BPD and ROP, as well as the severity of the latter, correlated with the oxygen requirement on the 28th day of life. BPD was more common in infants associated with PDA requiring combination treatment. ROP increased with the number of transfusions required by patients. At the follow-up at the first timepoint evaluation, were 51% of the study group, and 30.6% of them had normal neurological development. At 12 months of age, however, the neurological examination was normal in only three patients (23.08%) but only 36.5% of the study group attended the follow-up. Neurodevelopmental disorders were present in 10 of the patients, one with spastic diplegia. Conclusions: In the hospital, the morbidity and survival rate of the group was like other studies. The small number of follow-up participants does not allow the generalization of the data, but as far as neurological development is concerned, it is like that of other studies. Full article
(This article belongs to the Special Issue Risk Factors in Neonatal Intensive Care)

Review

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26 pages, 946 KB  
Review
Umbilical Cord Biomarkers of Nutritional and Metabolic Status in Neonates with Intrauterine Growth Restriction
by Ioana Hermina Toth, Manuela Marina Pantea, Ileana Enatescu, Angelica Teodora Filimon, Flavia Yasmina Kali and Oana Belei
J. Clin. Med. 2026, 15(3), 1043; https://doi.org/10.3390/jcm15031043 - 28 Jan 2026
Cited by 1 | Viewed by 1079
Abstract
Background: Intrauterine Growth Restriction (IUGR) is associated with a distinct neonatal metabolic profile, attributable to chronic intrauterine nutritional deprivation and suboptimal placental nutrient exchange. Upon delivery, IUGR neonates typically present with depleted nutrient stores, dysregulated endocrine activity, and a spectrum of micronutrient deficiencies, [...] Read more.
Background: Intrauterine Growth Restriction (IUGR) is associated with a distinct neonatal metabolic profile, attributable to chronic intrauterine nutritional deprivation and suboptimal placental nutrient exchange. Upon delivery, IUGR neonates typically present with depleted nutrient stores, dysregulated endocrine activity, and a spectrum of micronutrient deficiencies, factors that collectively compromise metabolic homeostasis and significantly influence subsequent health trajectories. Methods: This narrative review systematically synthesizes the current body of evidence from clinical, biochemical, and translational investigations pertaining to the micronutrient status and pivotal endocrine markers in neonates affected by intrauterine growth restriction. The collected findings were integrated to elucidate metabolic adaptation mechanisms, immediate clinical ramifications, and the potential pathways linking neonatal biochemical patterns to long-term metabolic programming. Results: IUGR neonates consistently exhibit reduced cord-blood concentrations of essential micronutrients, including vitamin D, iron (Fe), zinc (Zn), magnesium (Mg), folate (vitamin B9), and cobalamin (vitamin B12), reflecting compromised placental nutrient transfer and limited fetal reserves. Concomitantly, endocrine alterations—most notably reduced insulin (INS) and C-peptide (C-pep) levels—indicate suppressed pancreatic β-cell activity and a prevailing hypoanabolic adaptive state. In parallel, disturbances in mineral metabolism, characterized by lower calcium (Ca) concentrations and increased alkaline phosphatase (ALP) activity, suggest impaired bone mineralization during the critical phase of early postnatal adaptation. Collectively, these biochemical patterns increase vulnerability to early clinical complications such as neonatal hypoglycemia and bone demineralization, disrupt early growth trajectories, and are associated with an elevated long-term risk of insulin resistance and adverse cardiometabolic programming. Conclusions: IUGR neonates consistently demonstrate a synergistic interplay of micronutrient deficiencies and adaptive endocrine responses, profoundly impacting immediate postnatal metabolic stability and predisposing them to long-term health challenges. Therefore, early biochemical screening, followed by tailored nutritional and hormonal interventions, may assist restore metabolic balance, promote growth and decrease long term risk for metabolic diseases. Full article
(This article belongs to the Special Issue Risk Factors in Neonatal Intensive Care)
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Other

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14 pages, 639 KB  
Systematic Review
Prevalence and Factors Associated with Neonatal Hypothermia in Sub-Saharan Africa: Systematic Review and Meta-Analysis
by Hundessa Daba Nemomssa, Frederick Bossuyt, Bjorn Vandecasteele, Herbert De Pauw, Netsanet Workneh Gidi and Pieter Bauwens
J. Clin. Med. 2026, 15(5), 1818; https://doi.org/10.3390/jcm15051818 - 27 Feb 2026
Viewed by 1698
Abstract
Background/Objectives: Neonatal hypothermia remains a significant contributor to neonatal mortality and morbidity mainly in low and middle-income countries, such as those in sub-Saharan Africa. The objective of this systematic review and meta-analysis is to assess the prevalence of neonatal hypothermia and its [...] Read more.
Background/Objectives: Neonatal hypothermia remains a significant contributor to neonatal mortality and morbidity mainly in low and middle-income countries, such as those in sub-Saharan Africa. The objective of this systematic review and meta-analysis is to assess the prevalence of neonatal hypothermia and its risk factors in sub-Saharan Africa. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA) guideline was used to search databases (PubMed, Scopus, Cocrane library and Google Scholar) for studies reporting both the prevalence and factors associated with neonatal hypothermia in sub-Saharan Africa. We have included cross-sectional, cohort and descriptive studies published between 1 June 2014 and 31 May 2024. The Joanna Briggs Institute (JBI) quality appraisal checklist was used for the appraisal of studies. Subgroup analysis was conducted by country, study design and population. A total of 21 articles with 12,803 participants from 9 countries were included in the analysis. Results: The pooled prevalence of neonatal hypothermia was 55.39% (95% CI: 48.52, 62.25). Preterm birth (odds ratio (OR): 3.49; 95% CI: 1.98–6.16), low birth weight (OR: 3.56; 95% CI: 2.36–5.39), no skin-to-skin contact (OR: 1.31; 95% CI: 0.55–3.13), lack of resuscitation (OR: 2.56; 95% CI: 1.75–3.76), delayed initiation of breast feeding (OR: 2.38; 95% CI: 1.57–3.61), admission during cold season (OR: 1.80; 95% CI: 1.33–2.44), home delivery (OR: 1.94; 95% CI: 1.51–2.50) and early bathing (OR: 3.03; 95% CI: 0.98–9.38) were the factors significantly associated with neonatal hypothermia. Conclusions: The observed high prevalence of hypothermia was associated with physiological, behavioral and environmental factors. Full article
(This article belongs to the Special Issue Risk Factors in Neonatal Intensive Care)
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