Neonatal Morbidity: Current Advances, New Perspectives and Future Challenges

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

Deadline for manuscript submissions: 5 January 2025 | Viewed by 3574

Special Issue Editors

Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
Interests: midwifery care; high-risk intrapartum care; intrapartum-related complications; emergencies in the perinatal period; special populations
Department of Midwifery, University of West Attica, 12243 Athens, Greece
Interests: midwifery care; perinatal care; neonatal care; infectious diseases; neonatal intensive care; critically-ill neonates; neonatal brain injury; biomarkers

Special Issue Information

Dear Colleagues,

Although significant advances have been achieved in perinatology and intensive neonatal care, rates of neonatal morbidity and adverse sequelae remain high, underlining the need for interdisciplinary cooperation to improve neonatal health outcomes. Scientific fields and technologies related to the measurement of biological molecules are rapidly evolving, and offer ever-expanding information for a comprehensive understanding of the neonatal biological system, thus contributing to the early identification of neonates at high risk of developing complications and life-threatening diseases. This knowledge could assist clinicians and neonatal intensive care unit (NICU) staff to plan individualized interventions which will either prevent or optimize neonatal outcomes.

Systematic antenatal care, the diagnosis and treatment of maternal infections, the detection of perinatal risk factors and focused neonatal care are key aspects of both reducing neonatal morbidity and improving neonatal prognosis. Intrapartum- and prematurity-related complications are closely related to neonatal morbidity, highlighting the necessity of skilled obstetricians and midwives, evidence-based and up-to-date guidelines, effective prevention methods and high-quality healthcare facilities. A number of protective actions are now at the center of early intervention programs in the NICU, and their goal is to sustain preterm neonates’ development by empowering their potentialities. It is now evident that the environment and the sensory stimuli, predominantly during the perinatal period, have an impact on neonate development. Parents do not simply facilitate environmental stimuli, but are part of the environment itself, changing their interaction according to the neonate’s needs, reactions, and requests and impacting on its socio-emotional development. Lastly, an imperative goal for healthcare professionals to consider is the reduction of the economic, social and, above all, family burden resulting from neonatal morbidity. 

This Special Issue of Children is an update on current advances pertaining to the prevention, prevalence, risk factors, diagnosis, etiology, pathophysiology, treatment, as well as short- and long-term neurodevelopmental outcomes of several neonatal critical conditions. We also encourage submissions that investigate and demonstrate new perspectives and discuss future challenges regarding neonatal morbidity. Finally, this Special Issue aims to highlight the pivotal role of the interdisciplinary team in the neonatal period, raise awareness of novel biomarkers and effective pharmacological and non-pharmacological therapies, and enhance the understanding of family dynamics in special populations such as high-risk and critically-ill neonates. We invite researchers and colleagues to submit original research articles, reviews and case reports that address relevant topics.

We wish for a pleasant collaboration and look forward to receiving your contributions.

Prof. Dr. Katerina Lykeridou
Guest Editor

Dr. Dimitra Metallinou
Guest Editor Assistant

Manuscript Submission Information

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Published Papers (3 papers)

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12 pages, 1391 KiB  
Article
Intermittent High-Dose Vitamin D3 Administration in Neonates with Multiple Comorbidities and Vitamin D Insufficiency
by Catalin Cirstoveanu, Iulia Ionita, Carmina Georgescu, Carmen Heriseanu, Corina Maria Vasile and Mihaela Bizubac
Children 2024, 11(3), 328; https://doi.org/10.3390/children11030328 - 09 Mar 2024
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Abstract
Background: Neonates have an increased risk of vitamin D insufficiency due to the inadequate supplementation of mothers and infants after birth. Insufficiency of vitamin D is frequently detected in critically ill patients and is associated with disease severity and mortality. There is yet [...] Read more.
Background: Neonates have an increased risk of vitamin D insufficiency due to the inadequate supplementation of mothers and infants after birth. Insufficiency of vitamin D is frequently detected in critically ill patients and is associated with disease severity and mortality. There is yet to be a consensus on the appropriate regimen of vitamin D3 supplementation in high-risk infants. Aim: The main objectives of this study were to determine the prevalence of vitamin D insufficiency in neonates with severe comorbidities and to evaluate whether high-dose vitamin D3 oral administration leads to normal plasmatic concentrations without side effects. Methods: The current study was a randomized, prospective trial of 150 patients admitted to the Neonatal Intensive Care Unit (NICU) at Maria Sklodowska Curie Emergency Children’s Hospital in Bucharest. Patients were divided into three subgroups based on the chronological order of their admission date. Each subgroup received a different pharmaceutical product of vitamin D3. We administered a dosage of 10,000 IU/kg of vitamin D3 orally in three steps, as follows: at admission, one week after admission, and one month from the first administration, targeting a serum 25-hydroxyvitamin D concentration of at least 40 ng/mL. Results: Most neonates (68%) achieved an optimum vitamin D level after one month, even though only 15% of patients had an optimum concentration at admission. After the first high dose of vitamin D3, there was a 27% increase in the mean vitamin D plasmatic level compared to admission levels. However, after one month, the concentrations decreased in all subgroups due to the gap of three weeks between the last two administrations. Conclusions: An intermittent, weekly high-dose vitamin D3 oral administration leads to a steadier increase and normalization of vitamin D concentration in most critically ill neonates. However, high-dose vitamin D3 administered orally after three weeks decreases vitamin D levels in this high-risk population. Full article
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12 pages, 20294 KiB  
Article
The Molecular and Histopathological Assessment of Inflammatory Status in Very and Extremely Premature Infants: A Prospective Study
by Claudia Ioana Borțea, Ileana Enatescu, Manuela Pantea, Mirabela Dima, Emil Radu Iacob, Catalin Dumitru, Alin Popescu, Florina Stoica, Rodica Elena Heredea and Daniela Iacob
Children 2023, 10(2), 352; https://doi.org/10.3390/children10020352 - 10 Feb 2023
Cited by 1 | Viewed by 1136
Abstract
Prematurity comes with a varying range of complications, implying a high prevalence of complications and mortality and depending on the severity of prematurity and the sustained inflammation among these infants, which recently sparked an important scientific interest. The primary objective of this prospective [...] Read more.
Prematurity comes with a varying range of complications, implying a high prevalence of complications and mortality and depending on the severity of prematurity and the sustained inflammation among these infants, which recently sparked an important scientific interest. The primary objective of this prospective study was to establish the degree of inflammation in very (VPIs) and extremely preterm infants (EPIs) in association with the histology findings of the umbilical cord (UC), while the secondary objective was to study the inflammatory markers in the neonates’ blood as predictors of fetal inflammatory response (FIR). A total of thirty neonates were analyzed, ten of them being born extremely premature (<28 weeks of gestation) and twenty very premature (28–32 weeks of gestation). The EPIs had considerably higher levels of IL-6 at birth than VPIs (638.2 pg/mL vs. 151.1 pg/mL). The CRP levels at delivery did not vary substantially across groups; however, after days, the EPIs had significantly higher CRP levels (11.0 mg/dL vs. 7.2 mg/dL). In contrast, the LDH was considerably higher in the extremely preterm infants at birth and four days after birth. Surprisingly, the proportions of infants with pathologically increased inflammatory markers did not differ between the EPIs and VPIs. The LDH increased considerably in both groups, although the CRP levels increased exclusively among the VPIs. The stage of inflammation in the UC did not vary substantially between the EPIs and VPIs. The majority of infants were identified with Stage 0 UC inflammation (40% in EPI vs. 55% in VPIs). There was a substantial correlation link between gestational age and newborn weight and a significant inverse correlation among gestational age and IL-6 and LDH levels. There was a strong negative association between weight and IL-6 (rho = −0.349) and LDH (rho = −0.261). The stage of the UC inflammation demonstrated a statistically significant direct connection with IL-6 (rho = 0.461) and LDH (rho = 0.293), but none with the CRP. Further studies involving a bigger population size of preterm newborns are required to validate the findings and analyze more inflammatory markers, while prediction models on inflammatory markers that are measured expectantly, before the onset of preterm labor, need to be created. Full article
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8 pages, 1732 KiB  
Case Report
Autosomal Dominant Hypocalcemia Type 1 and Neonatal Focal Seizures
by Raluca Ioana Teleanu, Marlene Alexandra Sarman, Diana Anamaria Epure, Margarita Matei, Ioana Roşca and Eugenia Roza
Children 2023, 10(6), 1011; https://doi.org/10.3390/children10061011 - 03 Jun 2023
Cited by 1 | Viewed by 1285
Abstract
Autosomal dominant hypocalcemia type 1 (ADH1) is a rare form of hypoparathyroidism that is characterized by gain-of-function mutations in the CASR gene, which provides instructions for producing the protein called calcium-sensing receptor (CaSR). Hypocalcemia in the neonatal period has a wide differential diagnosis. [...] Read more.
Autosomal dominant hypocalcemia type 1 (ADH1) is a rare form of hypoparathyroidism that is characterized by gain-of-function mutations in the CASR gene, which provides instructions for producing the protein called calcium-sensing receptor (CaSR). Hypocalcemia in the neonatal period has a wide differential diagnosis. We present the case of a female newborn with genetic hypoparathyroidism (L125P mutation of CASR gene), hypocalcemia, and neonatal seizures due to the potential correlation between refractory neonatal seizures and ADH1. Neonatal seizures were previously described in patients with ADH1 but not in association with the L125P mutation of the CASR gene. Prompt diagnosis and management by a multidisciplinary and an appropriate therapeutic approach can prevent neurological and renal complications. Full article
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