Background and Objectives: Electronic fetal heart rate monitoring is mandatory for preterm labor. Moderate to late preterm neonates have an increased risk of overall morbidity, neonatal intensive care (NICU) admission, and consequently, medication use. The outcome of preterm neonates > 32 weeks of gestation in relation to three-tiered fetal heart rate (FHR) categorization was analyzed. Materials and Methods: This was a single-center, retrospective case-control study conducted from January 2021 to December 2023. The study included 25 FGR and 131 control cases born from 33 to 36 6/7 gestational weeks. Outcome was defined as the need for assistance after birth in first 15 min of life, respiratory outcome, and first day dopamine use and fresh frozen plasma transfusion. Maternal characteristics as risk factors for non-normal categories within three-tiered FHR categorization were also analyzed. Results: There was no significant difference in neonatal outcome among groups, except significantly lower 1 min APGAR and longer LOS in the FGR group. An increasing category within the three-tiered FHR categorization positively correlated with the need for assistance after birth, respiratory outcome, dopamine use, fresh frozen plasma transfusion, and length of hospital stay. Negative correlations were revealed between the increasing category within the three-tiered FHR categorization and first and fifth minute APGAR scores. Oligohydramnios and male sex were risk factors for non-normal categories within three-tiered FHR categorization. The correlation was tested using the Spearman correlation coefficient. A logistic regression model was employed to identify maternal risk factors for the non-normal category within three-tiered FHR categorization. All differences were statistically significant (p < 0.05). Conclusions: The increasing category within three-tiered FHR categorization may alert neonatologists to be highly suspicious of RDS, respiratory support, dopamine use, and fresh frozen plasma transfusion in neonates born from 33 to 36 6/7 gestational weeks. Oligohydramnios and male sex increase the probability for non-normal categories in the three-tiered FHR categorization.

Background/Objectives: Early neonatal hypocalcemia is a common metabolic disorder in premature neonates with various risk factors, including perinatal asphyxia and fetal growth restriction (FGR). We aimed to investigate the incidence of early neonatal hypocalcemia in preterm neonates with and without FGR and to explore several maternal and neonatal risk factors for early neonatal hypocalcemia. Cardiotocography (three-tiered fetal heart rate categorization) was a novel risk factor. Materials and methods: This was a secondary analysis of the retrospective, single-center, case-control study of neonates admitted to a neonatal intensive care unit (NICU) between January 2021 and December 2023. The study included 24 neonates with FGR and 124 control neonates without FGR born at 33 to 36 6/7 gestational weeks. Results: Total serum Ca was significantly lower in control neonates (2.042 (SD 0.208)) compared to neonates with FGR (2.178 (SD 0.180)) (p = 0.004), and early neonatal hypocalcemia was significantly higher in control neonates (42.75%) compared to neonates with FGR (4.35%) (p < 0.001). There was no statistical difference in acid base and blood gas analysis between FGR and control (p > 0.05). Logistic regression with the backward method showed that FGR reduces the probability of early neonatal hypocalcemia by 96.3% (t = 9.679, p = 0.001), and cesarean delivery increases it by 2.702 times (t = 6.963, p = 0.004). Conclusions: In this observational study, FGR was found to reduce and cesarean delivery was found to increase the probability of early neonatal hypocalcemia in moderate and late neonates. Clinicians should consider screening neonates born by cesarean delivery for early neonatal hypocalcemia. Three-tiered fetal heart rate categorization and acid base and blood gas analysis upon NICU admission cannot alert neonatologists to early neonatal hypocalcemia.

Background: Preterm infants are vulnerable to brain injury because of immature white matter, vascular regulation, and neuroprotective mechanisms. White matter injury (WMI), formerly known as periventricular leukomalacia, is a major cause of cerebral palsy and neurocognitive impairment, while perinatal stroke is an important cerebrovascular cause of adverse outcomes. White matter injury: WMI is linked to hypoxia–ischemia, inflammation or infection, oxidative stress, and impaired oligodendrocyte maturation. It may be cystic or diffuse non-cystic, which is now the most common phenotype. Cystic lesions are strongly associated with motor impairment and spastic cerebral palsy, whereas diffuse injury is increasingly related to cognitive, behavioral, and language deficits. Diagnosis relies on cranial ultrasonography and MRI; prevention focuses on optimized perinatal care, infection control, respiratory stabilization, and neuroprotection. Perinatal stroke: Stroke in preterm infants may occur antenatally or neonatally and includes periventricular hemorrhagic infarction, perinatal arterial ischemic stroke, and cerebral sinovenous thrombosis. Periventricular hemorrhagic infarction is the most common subtype and is often associated with germinal matrix hemorrhage–intraventricular hemorrhage. Risk factors are multifactorial, including fetal, neonatal, placental, thrombotic, infectious, and hemodynamic contributors. Clinical signs may be subtle, making neuroimaging central to classification and prognosis. Conclusion: Despite advances in neonatal care, WMI and perinatal stroke remain major causes of long-term neurological morbidity in preterm infants. Early recognition, systematic neuroimaging, risk stratification, and multidisciplinary follow-up are essential. Future research should identify reliable biomarkers and targeted neuroprotective therapies.