High-risk pregnancies (HRPs) constitute a significant global health issue due to their strong association with increased maternal and neonatal morbidity and mortality. Although pregnancy is generally characterized by positive expectations, the presence of maternal comorbidities, gestational complications, or adverse socioeconomic and environmental conditions can markedly elevate the probability of unfavorable outcomes. HRPs contribute disproportionately to complications such as preterm birth, fetal growth restriction, low birth weight, and congenital anomalies, which are key determinants of neonatal mortality and long-term developmental and health challenges. A broad spectrum of risk factors as well as insufficient prenatal care, underscores the complex nature of HRPs. These conditions necessitate a multidisciplinary management approach encompassing early risk identification, continuous monitoring, and individualized interventions. The neonatal prognosis in such contexts is strongly influenced by gestational age at delivery, birth weight, the standard of neonatal care, and the underlying etiological factors driving preterm or complicated deliveries. Preventive strategies including comprehensive prenatal screening, systematic antenatal follow-up, and timely referral to specialized perinatal care centers are essential for reducing the burden of HRPs. Furthermore, addressing social determinants of health—such as low socioeconomic status and limited access to healthcare—is critical for optimizing maternal and neonatal outcomes. This review consolidates current evidence on the epidemiology, etiological factors, and clinical implications of high-risk pregnancies, emphasizing the necessity of an integrative, preventive, and multidisciplinary framework to mitigate adverse neonatal outcomes and improve long-term health trajectories.

Bordetella pertussis is the causative agent of pertussis or whooping cough, an acute and highly contagious respiratory infection that can have serious and fatal complications such as pneumonia, encephalopathy, and seizures, especially for newborns. The disease is endemic not only in the European Union (EU)/European Economic Area (EEA) but also globally. Larger outbreaks are anticipated every three to five years, even in countries where vaccination rates are high. Despite the high pertussis vaccination coverage in developed countries and a low rate of pertussis incidence for many years, especially during the COVID-19 pandemic, the incidence of pertussis has been on the rise again, with outbreaks in some places, which is referred to as “re-emergence of pertussis”. The aim of this review is to underscore the critical importance of achieving high vaccination coverage, particularly among pregnant women, to safeguard vulnerable neonates from pertussis during their early months, before they are eligible for vaccination. This aligns with the need to address diagnostic challenges, mitigate disease severity, and strengthen public health strategies in light of the ongoing 2024 Bordetella pertussis resurgence.

Background/Objectives: Necrotizing enterocolitis (NEC) is a severe, potentially fatal gastrointestinal disease that primarily affects preterm neonates, especially those with very low birth weight (<1500 g). Despite extensive research, its pathophysiology remains unclear, with NEC considered a spectrum of disorders driven by systemic inflammation, microbiota dysregulation, and intestinal hypoxic injury. Diagnosis is challenging due to its subtle presentation and reliance on clinical and radiographic findings, underscoring the urgent need for reliable early biomarkers. Complete blood count (CBC) is one of the most frequently performed laboratory tests in neonatal care, providing valuable insights associated with hematologic alterations associated with NEC. Given its cost-effectiveness, accessibility, and rapid turnaround time, CBC parameters have been increasingly investigated for their diagnostic and prognostic potential in NEC. This systematic review consolidates existing evidence on the diagnostic and prognostic utility of CBC parameters in NEC, examining their association with disease onset, progression, and outcomes. Methods: A systematic review of the literature in PubMed and Scopus databases was conducted, between February 25 and December 2024. Results: Following a PRISMA-compliant search strategy, 77 eligible studies were included, analyzing data from 295,195 neonates, of whom 14,570 had NEC. Among the 77 studies, 17 examined NEC-associated mortality as a primary outcome, while 13 studies focused on the development of predictive models incorporating CBC parameters alongside other clinical and laboratory data to assess NEC severity and prognosis in neonates. The findings highlight the potential of CBC-derived markers to facilitate early NEC detection and risk stratification. However, variations in study design and diagnostic criteria highlight the need for prospective studies to validate their clinical use. Conclusions: Despite advancements in understanding NEC, its diagnosis remains challenging due to the absence of fully reliable biomarkers. CBC parameters show promise in offering early diagnostic and prognostic insights. However, further validation is needed for their routine integration into NICU practice. Given the persistent challenges in NEC diagnosis and management, our findings highlight the necessity for integrated scoring systems that combine hematologic, clinical, and radiologic data to enhance early detection and optimize neonatal care. Further research is essential to refine these predictive models, enabling timely interventions and improving survival rates in NEC-affected neonates.

Human metapneumovirus (hMPV), a member of the Pneumoviridae subfamily, has emerged as a significant etiological agent of acute respiratory tract infections across diverse age groups, particularly affecting infants, the elderly, and immunocompromised individuals. Since its initial identification in 2001, hMPV has been recognized globally for its seasonal circulation pattern, predominantly in late winter and spring. hMPV is a leading etiological agent, accounting for approximately 5% to 10% of hospitalizations among pediatric patients with acute respiratory tract infections. hMPV infection can result in severe bronchiolitis and pneumonia, particularly in young children, with clinical manifestations often indistinguishable from those caused by human RSV. Primary hMPV infection typically occurs during early childhood; however, re-infections are frequent and may occur throughout an individual’s lifetime. hMPV is an enveloped, negative-sense RNA virus transmitted through respiratory droplets and aerosols, with a 3–5-day incubation period. The host immune response is marked by elevated pro-inflammatory cytokines, which contribute to disease severity. Advances in molecular diagnostics, particularly reverse transcription–quantitative polymerase chain reaction (RT-qPCR) and metagenomic next-generation sequencing (mNGS), have improved detection accuracy and efficiency. Despite these advancements, treatment remains largely supportive, as no specific antiviral therapy has yet been approved. Promising developments in vaccine research, including mRNA-based candidates, are currently undergoing clinical evaluation. This review synthesizes current knowledge on hMPV, highlighting its virological, epidemiological, and clinical characteristics, along with diagnostic advancements and emerging therapeutic strategies, while underscoring the critical role of continued research and sustained preventive measures—including vaccines, monoclonal antibodies, and non-pharmaceutical interventions—in mitigating the global burden of hMPV-related disease.

The transfusion of platelets and fresh frozen plasma (FFP) to critically ill neonates in neonatal intensive care units (NICUs) is a common intervention, yet it is still widely performed without adhering to international guidelines. The guidance itself on the therapeutic management of neonatal coagulation disorders is generally limited due to the absence of strong indications for treatment and is mainly aimed at the prevention of major hemorrhagic events such as intraventricular hemorrhage (IVH) in premature neonates. Historically, the underrepresentation of neonates in clinical studies related to transfusion medicine had led to significant gaps in our knowledge regarding the best transfusion practices in this vulnerable group and to a wide variability in policies among different neonatal units, often based on local experience or guidance designed for older children or adults, and possibly increasing the risk of inappropriate or ineffective interventions. Platelet transfusion and, particularly, FFP administration have been linked to potentially fatal complications in neonates and thus any decision needs to be carefully balanced and requires a thorough consideration of multiple factors in the neonatal population. Despite recent advances toward more restrictive practices, platelet and FFP transfusions are still subject to wide variability in practices. This review examines the existing literature on platelet and FFP transfusions and on the management of massive hemorrhage in neonates, provides a summary of evidence-based guidelines on these topics, and highlights current developments and areas for ongoing and future research with the aim of improving clinical practices.

Background: Systemic Candida infection (SCI) is the third most common cause of late-onset sepsis in Neonatal Intensive Care Units (NICU). While platelet involvement in fungal infections has been extensively studied, evaluation of the hemostatic mechanism in Candida infections, especially in neonates, has not been widely investigated. The aim of the current study was to evaluate the hemostatic profile of neonates with SCI through rotational thromboelastometry (ROTEM), a laboratory method that assesses the viscoelastic properties of blood. Methods: This is a single-centered prospective cohort study including a group of neonates with SCI (n = 21); the control group consisted of healthy neonates (n = 24). Demographics, clinical parameters, and laboratory data were recorded at the disease onset. Neonatal scores for the assessment of disease severity (Modified NEOMOD, nSOFA, and NeoBAT) were also calculated. ROTEM parameters of neonates with SCI were compared to those of healthy neonates. Results: ROTEM parameters differed between neonates with SCI and healthy neonates, indicating a hypocoagulable profile of infected neonates. Specifically, neonates with SCI had significantly prolonged clotting time (CT) and clot formation time (CFT), as well as lower clot amplitude at 10 min (A10) and maximum clot firmness (MCF) when compared to healthy neonates (p values < 0.05), findings that remained consistent after adjusting for confounding factors such as gestational age, birth weight, and sex. In addition, a strong correlation was noted between ROTEM parameters and disease severity based on the modified NEOMOD, nSOFA, and NeoBAT scores. Conclusions: ROTEM parameters revealed a hypocoagulable profile in neonates during the early stages of SCI, which is also associated with disease severity. The results of this study highlight the need for monitoring of hemostatic status of this vulnerable group of patients and indicate that ROTEM analysis may have a role in the early detection of the hemostatic derangements associated with SCI in neonates, in order to ensure timely diagnosis and targeted therapeutic intervention.