Background: some consensus guidelines include C-reactive protein (CRP) in the diagnostic workup of early-onset neonatal sepsis (EOS), but its routine use remains debated due to variable diagnostic performance. The experiences and data from individual centers can help clarify its clinical utility and inform local practice. Methods: Retrospective analysis at a level III center assessing the impact of discontinuing routine C-reactive protein (CRP) testing for suspected early-onset sepsis (EOS). Laboratory use, antibiotic therapy, and outcomes in neonates of all gestational ages were compared before (2021–2022) and after (2024–2025) the policy change. Results: A total of 638 neonates were included (period 1, n = 348; period 2, n = 290). CRP testing decreased markedly (218/348 in period 1 vs. 40/290 in period 2; p < 0.001), alongside a significant reduction in the number of complete blood counts performed (285/348 vs. 214/290; p = 0.02). Concurrently, both the proportion of short antibiotic courses (≤48 h) initiated within the first 3 days of life (98/181 vs. 88/133) and the median duration of antibiotic therapy (48.0 h vs. 40.0 h; p < 0.001) decreased without worsening outcomes. The duration of antibiotic therapy was even shorter in infants born before 34 weeks’ gestation (48.0 h vs. 37.5 h; p < 0.001). Conclusions: Restricting the use of CRP in the evaluation of EOS was associated with a reduction in unnecessary antibiotic exposure. This strategy may be considered a core component of neonatal antibiotic stewardship programs.

Neonatal seizures represent the most common neurological emergency in the neonatal period and arise within a uniquely immature and highly dynamic brain. Their recognition is challenging due to frequent electroclinical dissociation, with many seizures remaining purely electrographic and therefore detectable only through continuous electroencephalogram (cEEG) monitoring. This narrative review provides an integrated and updated overview of neonatal seizures, bridging developmental neurobiology, diagnostic challenges, etiological classification, and therapeutic strategies. The immature brain is characterized by an imbalance between excitation and inhibition, transient network architectures, and activity-dependent developmental processes, all of which contribute to the distinct electroclinical features of neonatal seizures. cEEG remains essential for accurate diagnosis and quantification of seizure burden, which may influence outcome. Etiology represents the primary determinant of prognosis, with hypoxic–ischemic encephalopathy (HIE), stroke, and genetic disorders among the most frequent causes. Advances in genetic testing have improved diagnostic precision and enabled targeted therapies in selected cases, supporting a precision medicine approach. Several key findings emerge from the current evidence base: (i) the neonatal brain is a developmentally constrained system in which excitation–inhibition imbalance, transient circuits and immature long-range connectivity shape an electroclinically distinct seizure phenotype; (ii) cEEG is the gold standard for detection and quantification of seizure burden, since the majority of neonatal seizures are electrographic-only and bedside clinical recognition systematically underestimates true seizure burden; (iii) etiology—chiefly HIE, stroke, and genetic causes—remains the strongest determinant of outcome, while seizure burden acts as an independent and potentially modifiable prognostic modifier; (iv) phenobarbital retains an evidence-based advantage in acute electrographic seizure control, whereas levetiracetam offers a favorable safety profile in the absence of robust long-term human neurotoxicity data; (v) rapid genomic diagnostics, artificial intelligence-assisted EEG analysis and multimodal neuromonitoring are converging toward a precision-neonatology framework, but their translation into routine practice requires validation, standardization, and equitable access. Future neonatal seizure care should extend beyond seizure control to the preservation and optimization of neurodevelopmental outcomes.

Background: Hypertriglyceridemia (HiTG) is a frequent metabolic complication in preterm neonates receiving parenteral nutrition (PN), with potential implications for respiratory outcomes. However, predisposing factors and the clinical impact of HiTG in this population remain poorly defined. Objectives: To identify factors predisposing preterm neonates to HiTG development and to assess the association between HiTG and neonatal respiratory morbidity. Methods: A retrospective matched cohort study was conducted, nested within a single-center cohort of neonates receiving routine parenteral nutrition (PN) and on respiratory support, with gestational age ≤ 32 weeks and/or a birth weight ≤ 1500 g, consecutively admitted between January 2015 and May 2023 into the Neonatal Intensive Care Unit (NICU) of ‘Umberto I’ University Hospital, Sapienza University of Rome. HiTG was defined as at least one serum triglyceride (TG) value > 180 mg/dL during the first 7 days of life. TG levels were measured from morning samples collected alongside routine laboratory draws; for borderline values (180–200 mg/dL), a confirmatory sample was obtained after a 4 h lipid-free interval. Neonates with HiTG were classified as cases; newborns without HiTG served as controls, matched 1:1 for gestational age and birth weight. Results: A total of 110 neonates were enrolled (55 cases, 55 controls). HiTG was independently associated with bronchopulmonary dysplasia (BPD) (OR 29.46; 95% CI 5.82–149.07; p < 0.001) and prolonged invasive mechanical ventilation (pIMV) (OR 4.85; 95% CI 1.69–13.89; p = 0.003), after adjustment for surfactant administration and extremely low birth weight. Time to achieve full enteral feeding (FEF) was independently associated with HiTG development (β = +0.153; p < 0.001), whereas parenteral lipid intake during the first week of life was inversely associated (β = −0.081; p = 0.039). Conclusions: HiTG is independently associated with BPD and prolonged invasive mechanical ventilation in preterm neonates. Parenteral lipid intake during the first week was not higher in infants who developed HiTG. Delayed achievement of FEF was also associated with HiTG, but it occurred after the exposure window and cannot therefore be regarded as a predisposing factor. These findings are hypothesis-generating. Randomized trials are needed to assess whether closer monitoring of triglyceride levels and early advancement of enteral feeding in preterm neonates may help reduce BPD.