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: Sepsis is a dynamic clinical syndrome characterized by a rapidly evolving inflammatory response, where early identification of patients at risk for adverse outcomes remains a major challenge. While inflammatory biomarkers are widely used, their prognostic value at baseline is limited. This study aimed to evaluate whether early changes in inflammatory biomarkers, particularly the neutrophil-to-lymphocyte ratio (ΔNLR), provide additional prognostic value in predicting short-term outcomes in patients with sepsis. Methods: A retrospective longitudinal observational study was conducted, including 168 adult patients admitted with sepsis at a tertiary infectious diseases hospital. Inflammatory biomarkers (CRP, procalcitonin, leukocyte subpopulations, and NLR) were assessed at admission and at 48–72 h. Early changes (Δ values) were calculated and analyzed in relation to a composite adverse outcome, including ICU admission, vasopressor requirement, mechanical ventilation, or in-hospital mortality. Logistic regression and ROC curve analyses were used to evaluate predictive performance. Results: Patients with adverse outcomes had significantly higher baseline inflammatory markers and severity scores. Early reductions in CRP and NLR were more pronounced in survivors, whereas non-survivors showed persistently elevated or minimally decreasing values. In multivariate analysis, ΔNLR remained independently associated with in-hospital mortality (OR 0.91, 95% CI 0.84–0.98, p = 0.015), alongside Sequential Organ Failure Assessment (SOFA) score and septic shock. ΔNLR demonstrated better discriminative performance (AUC 0.74) compared to baseline markers and improved predictive accuracy when combined with SOFA score (AUC 0.81). Higher baseline NLR quartiles were associated with a stepwise increase in adverse outcomes. Conclusions: Early changes in inflammatory biomarkers, particularly ΔNLR, provide clinically relevant prognostic information beyond baseline measurements and severity scores in sepsis. Dynamic assessment of immune response may improve early risk stratification and support more individualized clinical decision-making.

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.

Early identification of newborns at risk for respiratory support remains challenging. Lung ultrasound (LUS) provides real-time information on pulmonary aer

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.