Background and Objectives: Early recognition of life-threatening organ dysfunction is central to modern sepsis frameworks. We systematically reviewed the prognostic performance and clinical utility of the Neonatal Sequential Organ Failure Assessment (nSOFA) for mortality and major morbidity in NICU populations. The search identified 939 records across databases; after screening and full-text assessment, 16 studies met the inclusion criteria. Methods: Following PRISMA guidance, we searched major databases (2019–2025) for observational or interventional studies reporting discrimination or risk stratification using nSOFA in neonates. Populations included suspected/proven infection and condition-specific cohorts. Heterogeneity in timing, thresholds, and outcomes precluded meta-analysis. Results: A cumulative sample exceeding 25,000 neonates was identified across late- and early-onset infection, all-NICU admissions, necrotizing enterocolitis, respiratory distress, and very preterm screening cohorts. Across settings and timepoints, nSOFA demonstrated consistent, good-to-excellent mortality discrimination, with reported AUROCs ≥ 0.80 and upper ranges near 0.90–0.92; serial scoring within the first 6–12 h generally improved risk classification. Disease-specific applications (NEC, early-onset infection) showed similar discrimination for death or composite adverse outcomes. Conclusions: Evidence from diverse NICU contexts indicates that nSOFA is a pragmatic, EHR-ready organ dysfunction score with robust discrimination for mortality and serious morbidity, supporting routine, serial use for risk stratification and standardized endpoints in neonatal sepsis pathways, aligned with contemporary organ dysfunction–based pediatric criteria.

Background/Objectives: The early neonatal respiratory transition involves rapid changes in lung aeration and respiratory mechanics, but serial diaphragm-ultrasound trajectories in term neonates remain incompletely characterized. To describe bilateral diaphragmatic thickness, excursion, and diaphragmatic thickening fraction (DTF) during the first 48 h after birth. Methods: This prospective, single-center observational study analyzed 112 term neonates with complete ultrasound examinations at 1, 24, and 48 h of life. Bilateral thickness, excursion, DTF, and lung ultrasound score (LUS) were assessed during quiet spontaneous breathing. Serial comparisons used the Friedman test. No a priori sample-size calculation was reported. The analysis included all eligible neonates with complete serial data. Results: Right and left excursion increased from 5.65 ± 0.71 and 5.64 ± 0.69 mm at 1 h to 5.91 ± 0.58 and 5.91 ± 0.54 mm at 48 h, respectively (p = 0.024 and p = 0.033; Kendall’s W = 0.033 and 0.031). These effect sizes were small. DTF remained stable, whereas LUS decreased from 7.01 ± 2.64 at 1 h to 0.09 ± 0.35 at 48 h (p < 0.001; Kendall’s W = 0.885). Conclusions: In this single-center cohort, lung aeration changed substantially during the first 48 h, whereas diaphragm-ultrasound changes were small. These preliminary trajectories are descriptive and require standardized, multicenter validation before they can be used as reference values or guide clinical decisions.

Background: Neonates evaluated for infection undergo rapid physiologic transition, making isolated measurements difficult to interpret. Because a positive culture field does not by itself establish clinical sepsis, we explored whether physiologic and laboratory trajectories differed by recorded culture status during the first three postnatal days. Methods: This single-center prospective observational longitudinal study included 65 neonates with linked measurements on days 1, 2, and 3. The exposure was a binary culture field in the source database; specimen source, organism identity, and pathogen-versus-contaminant adjudication were unavailable. Group-specific medians were summarized, and gestational-age-adjusted linear models with patient-clustered robust standard errors tested culture status, time, and culture-status-by-time effects. Results: The cohort included 26 culture-positive and 39 culture-negative neonates. On day 1, the culture-positive group had lower median systolic blood pressure (48.5 vs. 57.0 mmHg), diastolic blood pressure (24.5 vs. 33.0 mmHg), and MAP (31.0 vs. 41.0 mmHg), more negative base excess (−7.65 vs. −3.60 mmol/L), and lower platelet counts (219 vs. 282 × 10⁹/L). Diastolic pressure rose in both groups and converged by day 3; the adjusted culture-status-by-time interaction was significant (p = 0.012). MAP increased over time, but its interaction was not significant (p = 0.244). Culture-positive status was associated with a lower day-1 platelet count (adjusted beta, −73.0 × 10⁹/L; 95% CI, −128.1 to −17.8; p = 0.010), without evidence of a differential platelet trajectory (interaction p = 0.623). CRP was retained as a descriptive outcome only because of lower-limit censoring. Conclusions: Recorded culture status was associated with selected early hemodynamic, metabolic, and hematologic differences in this small exploratory cohort. These associations cannot be considered sepsis-specific and require confirmation after clinical culture adjudication, standardized timestamping and blood-pressure measurement, inclusion of fatal cases, and adjustment for illness severity and treatment exposures.

Background/Objectives: Neonatal diaphragm ultrasound measurements may vary with body size. We examined associations between birth weight and repeated bilateral diaphragm measurements during the first 48 h after birth. Methods: This exploratory secondary post hoc analysis included 116 term neonates assessed at approximately 1, 24, and 48 h (348 examinations). Associations of birth weight with diaphragm thickness, diaphragmatic thickening fraction (DTF), and excursion were estimated using generalized estimating equations adjusted for gestational age, sex, and assessment time. Mean bilateral end-expiratory thickness was a derived post hoc summary, and absolute inspiratory thickening (ΔT) was examined additionally. Results: Across the 12 exploratory birth-weight outcome tests, none remained below 0.05 after global Holm correction, and this global result is the primary summary of this analysis. The post hoc mean bilateral end-expiratory thickness summary showed a nominal positive association with birth weight (β = 0.0876 mm/kg; 95% CI, 0.0112–0.1640; nominal p = 0.0246; global Holm-adjusted p = 0.2465); this is reported as a descriptive, hypothesis-generating observation and not as the main finding. All four side-specific thickness coefficients were nominally positive, but none remained below 0.05 after global adjustment. Birth weight showed little evidence of association with excursion or ΔT. Right-sided DTF showed an inverse nominal association (β = −1.4779 percentage points/kg; 95% CI, −2.5933 to −0.3624; nominal p = 0.0094; global Holm-adjusted p = 0.1130); given unresolved DTF provenance uncertainty (see Methods), this estimate is not used to support any physiological conclusion. Conclusions: None of the 12 exploratory birth-weight associations remained below 0.05 after global Holm correction, and this negative global result, rather than any single nominal association, is the principal finding of this analysis. The post hoc bilateral thickness association is reported descriptively and should not be regarded as a main finding; ΔT and DTF are reported as auxiliary post hoc observations. These findings are incremental and hypothesis-generating and require prospective, prespecified validation.

Background/Objectives: Serial laboratory measurements may capture within-episode changes not represented by a single baseline value, while routine markers from different biological domains may not evolve concordantly. Methods: We retrospectively analyzed 100 hospital admission episodes in which the source infection field explicitly recorded sepsis. A complete source-record re-audit confirmed sepsis wording in all 100 episodes and identified no severe-infection-only subgroup. Because complete SOFA components were unavailable, Sepsis-3 criteria were not retrospectively adjudicated. Procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC), platelet count, and serum creatinine were evaluated across three ordered recorded assessment points using random-intercept linear mixed-effects models, with Holm correction across five primary global tests and generalized estimating equations as robustness analyses. Results: PCT geometric means decreased from 0.925 to 0.306 ng/mL (Holm-adjusted p = 0.000052), CRP from 104.2 to 36.0 mg/L (p < 0.001), and serum creatinine from 1.49 to 1.10 mg/dL (p = 0.000074). Platelet count increased on the additive scale (p = 0.000237) but not after logarithmic transformation, whereas the full-cohort primary WBC model was non-significant (p = 0.0743). Conclusions: Routine laboratory markers showed heterogeneous cohort-level longitudinal patterns, supporting marker-specific rather than uniform interpretation of serial measurements.

Background and Objectives: Very preterm infants are vulnerable to late-onset infection and prolonged NICU exposure, with potential downstream effects on caregiver health. We evaluated neonatal outcomes and caregiver psychosocial status across culture-confirmed infection phenotypes. Methods: We investigated a single-center prospective cohort (March 2023–December 2025) of 87 preterm infants assigned to one of three groups: no proven infection (n = 44), bacterial sepsis (n = 31), or candidemia (n = 12). Neonatal outcomes included a composite adverse endpoint (death or major morbidity) and resource utilization. Caregivers completed the SF-36, WHOQOL-BREF, HADS, PHQ-9, GAD-7, and Body Image Scale near discharge. Results: Candidemia occurred later than bacterial sepsis (day of life 17.8 ± 4.8 vs. 10.1 ± 3.9; p < 0.001) and had a longer time to effective therapy (23.3 ± 9.5 vs. 13.3 ± 5.3 h; p = 0.004). The composite adverse outcome was 27.3% in the no-infection group versus 54.8% in the bacterial group and 58.3% in the candidemia group (p = 0.025); ROP requiring treatment increased from 4.5% to 29.0% and 25.0% (p = 0.012). Length of stay rose from 39.7 ± 10.2 to 50.1 ± 11.9 and 60.9 ± 13.1 days (p < 0.001), and ventilation days from 15.7 ± 7.6 to 23.3 ± 7.5 and 34.2 ± 10.4 (p < 0.001). Caregiver SF-36 mental health (MCS) scores decreased from 44.7 ± 7.5 to 38.5 ± 6.0 and 36.7 ± 6.4 (p < 0.001), while PHQ-9 scores increased from 9.4 ± 3.9 to 11.6 ± 3.3 and 15.5 ± 4.6 (p < 0.001); NICU burden correlated with PHQ-9 scores (r = 0.52, p < 0.001). Conclusions: Culture-confirmed infection, particularly candidemia, was associated with higher neonatal morbidity, markedly greater resource use, and substantial caregiver distress at discharge.