Journal of Neonatology

Sepsis is a major contributor to neonatal mortality. The emergence of multidrug-resistant bacteria poses difficulty in choosing empirical antibiotics. This study aimed to determine the microbiological profile and antibiotic sensitivity pattern of neonatal sepsis.

This retrospective descriptive study was done in a level III neonatal unit in South India, from January 2013 to June 2020. Neonates with a single known pathogenic organism in blood culture were included. The following data were collected: demographic details, change in microbial profile and antibiotic sensitivity pattern over time, and incidence of multidrug resistance (MDR) with resistance to any three antibiotic classes.

There were 228 neonates with 258 blood culture-positive bacterial sepsis. Among all neonatal intensive care unit admissions, 13.7% of neonates had culture-positive sepsis, with late-onset sepsis being predominant (72%). The most common organism was Klebsiella species (25.6%), followed by coagulase-negative staphylococcus (21.6%). The gram-negative bacteria showed the highest sensitivity to colistin (95%). All gram-positive bacteria were susceptible to vancomycin and linezolid. Prolonged empirical use of amikacin and/or ciprofloxacin as first-line antibiotics diminished microbes’ sensitivity to its action, which improved once they were discontinued as first-line drugs. MDR was seen in 47.8% and 39.2% of gram-negative and gram-positive organisms, respectively. MDR was highest among Enterobacter species (68.4%). Klebsiella species had the highest incidence of resistance due to extended-spectrum beta-lactamases (21.7%) and Amp-C (3.7%). Carbapenem resistance was seen in 22.5% of Acinetobacter species.

This study identified temporal changes in microbial patterns and antibiotic sensitivity. There is an increase in resistance to first-line antibiotics along with the emergence of multidrug-resistant strains. Continuous surveillance of antibiotic sensitivity patterns and periodic revision of empirical antibiotics are needed to combat sepsis in neonates.

While advancements in premature neonatal care have led to a reduction in mortality and respiratory distress syndrome (RDS), the incidence of bronchopulmonary dysplasia (BPD) has remained unchanged over the past few decades. Few small, randomized trials have shown intratracheal budesonide in a surfactant vehicle as a promising treatment to reduce the incidence of BPD.

To investigate whether intratracheal administration of surfactant combined with budesonide results in decreased incidence of BPD, death, and other morbidities in preterm infants who were born <28 weeks and <1 kg.

Prospective two-arm pilot randomized controlled trial with concurrent parallel design.

This study included extreme preterm (<28 weeks) and extreme low birth weight newborns with severe RDS. Neonates were randomly allocated to one of two groups (60 intervention and 61 control). The intervention group received intratracheal surfactant and budesonide, while the control group received only surfactant.

The study population had a mean gestational age of 26.1 ± 0.2 weeks and birth weight of 766.1 ± 29.1 g. Death (RR 0.61 (0.1-3.62); P = 1.00) and combined BPD or death (RR 0.86 (0.55-1.33); P = .88) exhibited a nonsignificant decreasing trend. However, any intraventricular hemorrhage (IVH), severe brain injury (≥III IVH or periventricular leukomalacia), oxygen requirement at 24 h of life, and ventilation days were significantly lower in the intervention group.

Intratracheal budesonide and surfactant did not reduce BPD or death. As a pilot study, this study speaks about the trend and was not powered to comment on the significance of the result. Oxygen, ventilation needs, and preterm brain injury are considerably lesser with when budesonide is combined with surfactant among extreme preterm newborns.

The LATCH score is a reliable tool for assessing breastfeeding efficiency. The objectives of this study were to identify risk factors for hypernatremic dehydration in exclusively breastfed neonates, including the correlation between serum sodium levels and LATCH scores.

This single-center, hospital-based, case-control study (February 2022 to March 2024) enrolled 37 exclusively breastfed neonates with hypernatremic dehydration as cases, and 37 healthy, exclusively breastfed neonates without any signs or symptoms of dehydration and with normal serum sodium levels as controls. LATCH scores were assessed and correlated with serum sodium levels.

The mean ± SD serum sodium levels were 171 ± 9.95 mEq/L in cases and 143 ± 3.53 mEq/L in controls. Univariate analysis revealed that poor attachment, delayed initiation of breastfeeding, lower feeding frequency, jaundice, irritability, convulsions, hypertonia, poor suck, and a hyper alert state were significantly associated with hypernatremic dehydration. Poor attachment/sucking at the breast, irritability and hyper alert state emerged as independent predictors of hypernatremia. A higher proportion of babies with hypernatremic dehydration (54%) had poor LATCH scores (<7) as compared to controls (45.95%). Among cases, a moderate negative correlation (r = –0.400) was observed between serum sodium levels and LATCH scores. Moderate inverse correlations were also observed with the T (–0.41) and C (–0.43) components, while the L (–0.10) and H (–0.23) components showed weak correlations. No correlation was noted with the A component (–0.02).

Hypernatremic dehydration in exclusively breastfed neonates is significantly associated with poor feeding behaviors and certain clinical signs. A combination of clinical vigilance and breastfeeding assessment (including tools like the LATCH score) can aid in the early identification and prevention of this potentially serious condition.

To determine the effectiveness of a training program on knowledge and skills related to developmentally supportive feeding practices for preterm infants among neonatal nurses.

A training program on developmentally supportive feeding practices using paladai (a special cup used in South India) was developed. A knowledge questionnaire and skills checklist were also developed to evaluate the training outcomes. Sixty-nine nurses completed the knowledge assessment before, immediately after completion of training and after 1 month. A subgroup of 13 nurses completed the skill assessment before and after the training.

Knowledge of nurses significantly increased from pre-training [Mdn = 5; interquartile range (IQR) = 4, 7] to immediate post-training (Mdn = 9; IQR = 8, 10) and 1-month post-training (Mdn = 8.5; IQR = 7, 10) (P < .001). Similarly, the post-training skills score was significantly higher (Mdn = 11; IQR = 7.5, 12) than the pre-training scores (Mdn = 7; IQR = 6.5, 8.5) (P < .05).

The training program effectively imparted knowledge and skills related to developmentally supportive feeding practices. However, continued skill-based training on implementing developmentally supportive practices is needed for effective system-wide practice changes.

Neonatal airway disorders frequently pose a serious risk to life and create difficult diagnostic and therapeutic concerns, contributing to significant neonatal mortality and morbidity.

To describe the clinical profile, management, and outcomes of neonatal airway anomalies and to determine the predictors of mortality in neonates with airway anomalies.

We conducted a medical record-based retrospective observational study at a tertiary care outborn neonatal unit in India, which included neonates diagnosed with airway anomalies as per the International Classification of Diseases (ICD) code, admitted from October 2013 to March 2023. Our outcome was to describe the clinical profile, management, and outcomes and to determine the predictors of mortality in neonates with airway anomalies.

Among the 307 neonates studied, 56% were males, and the median age at admission was 6 days. The most frequent indication for direct laryngoscopy (DLS) and fiber-optic bronchoscopy was stridor with retractions. Laryngomalacia (81%) and sub-glottis stenosis (8%) were most common among the upper and lower airway anomaly findings, respectively. Among our dataset, 287 (93%) were discharged and 20 (7%) succumbed. The need for resuscitation and the presence of other systemic anomalies were independently associated with mortality.

Laryngomalacia accounted for the majority of cases. However, morbidity and mortality were high in those with synchronous-airway anomalies and when associated with other systemic anomalies. The presence of stridor and retractions mandated the airway evaluation procedures, which were safe and crucial in early diagnosis and intervention.

The neonatal period represents a critical developmental phase where skin health significantly impacts infant outcomes, particularly for preterm neonates with underdeveloped epidermal barriers.

This cross-sectional survey evaluated neonatal skin care awareness among 325 pediatricians/neonatologists in Gujarat, India, recruited through the National Neonatology Forum database. Participants completed a validated 25-item questionnaire assessing physiological knowledge, clinical recognition, preventive practices, and management strategies using mixed-methods analysis.

Results demonstrated near-universal recognition of preterm skin fragility (98.77%) and stratum corneum functions (96.92%). However, critical gaps emerged in identifying clinical signs of skin damage, with only 50.77% correctly excluding increased skin temperature as an indicator. The study highlights a disconnect between theoretical knowledge and practical application.

These findings underscore the necessity for context-specific training programs that integrate standardized assessment protocols. This work aims to fill critical gaps in Indian neonatal dermatology literature to optimize skin care practices for vulnerable preterm populations in resource-limited environments.

To analyze 20 years of experience of Bell’s stage 3b necrotizing enterocolitis (NEC) from a single center.

A total of 57 Bell’s stage 3b NEC cases were included in this study. The clinical records, operative findings, and outcomes of babies admitted to the neonatal intensive care unit (NICU) were tabulated and recorded retrospectively in the EXCEL database. All deaths and leaves against medical advice were recorded, and clinical outcomes at day 30 and 1 year post-operative were recorded.

The mean gestational age (GA) and mean birth weight of the mortality group were 30 ± 3.5 weeks and 1.105 ± 0.479 kg, respectively. The most common surgery performed in the mortality group was subtotal colectomy with ileostomy (31%). The day 30 (D30) and 1 year (D365) post-operative mortality were 24.5% and 28%, respectively. The most common complication post-surgery was short bowel syndrome (100%) and failure to thrive (43.9%). Klebsiella was the most common growth in blood culture in both survivor and mortality groups. After 1 year, 14.2% had moderate to severe, and 4.76% had mild developmental delay as per the Development Assessment Scale for Indian Infants (DASII), despite several days of ventilator requirement with inotropes in almost all babies. At the end of 1 year, 72% of babies who underwent surgery for this common, disastrous emergency in neonatal practice were alive and thriving.

This study reflects the outcome of severe NEC from an Indian university teaching center in neonatology and compares favorably with several landmark articles from the Western world.

India faces a critical shortage of neonatologists, despite significant reductions in infant mortality since 1947. With 24 million annual births and persistent neonatal mortality challenges, expanding the neonatology workforce is essential for achieving the India Newborn Action Plan (INAP) target of <10 neonatal deaths per 1,000 live births by 2030.

Data were analyzed from the National Medical Commission (NMC), National Board of Examinations in Medical Sciences (NBEMS), and international sources to quantify neonatology training capacity. Birth records, infant mortality rates (IMRs), and alternative training pathways through the National Neonatology Forum (NNF) and Indian Academy of Pediatrics (IAP) were evaluated for workforce assessment and international comparisons.

India currently has 138 recognized neonatology seats (103 DM, 35 DrNB) for 24 million annual births, yielding 5.75 seats per million newborns compared to 84.7 in the United States. Substantial interstate variations were also observed. Non-accredited NNF and IAP fellowship programs have trained over 1,200 specialists in the past decade, representing substantial, untapped workforce potential.

Interventions, including extending teacher eligibility qualifications (TEQ) to include fellowship-trained neonatologists through a structured recognition process with standardized assessment and mentorship requirements, could significantly address India’s neonatology workforce shortage. Mandating the establishment of Neonatology Departments as the fourth unit in medical colleges with at least 200 or 250 Bachelor of Medicine, Bachelor of Surgery (MBBS) seats could potentially increase the number of neonatology seats to 390, substantially improving the neonatologist-to-neonate ratio to 16.25 per million newborns.

Umbilical cord blood gas and lactate levels reflect the fetus’s well-being in utero and at the time of delivery. Various cutoff levels have been reported for umbilical cord blood lactate to determine the severity of perinatal asphyxia, but their association with early neonatal outcomes has not been understood.

This prospective observational study was carried out in the delivery room of a tertiary care hospital in North Karnataka. Umbilical cord arterial blood was collected from double-clamped cord segments after neonatal delivery by trained nursing staff. Cord lactate levels were measured using an automated analyzer (Xpress2 Lactate Analyzer R) located in the delivery ward.

The median cord blood lactate was significantly higher among neonates who were admitted to the neonatal intensive care unit (NICU) with the diagnosis of birth asphyxia (52; Q1, Q3: 41.3, 91) when compared to those without birth asphyxia (29; Q1, Q3: 18, 44). Also, cord blood lactate was significantly higher for those who had a low appearance, pulse, grimace, activity, and respiration (APGAR) score at 5 min, those who required bag and mask ventilation (BMV) and ventilatory support [including continuous positive airway pressure (CPAP) for transient tachypnea of the newborn].

An optimal cutoff of 41.5 mg/dL (4.6 mmol/L), with sensitivity of 78.6% and specificity of 71.5%, area under the curve (AUC) 0.77 [95% confidence interval (CI): 0.64, 0.91], was predictive of significant birth asphyxia at birth. This study provides the data to determine the cutoff for cord lactate to be used in busy delivery rooms and peripheral health setups for early recognition of significant perinatal asphyxia for prompt referral of the newborn to avail adequate post-asphyxia care.

Kangaroo mother care (KMC) is a multimodal stimulation therapy that satisfies principles of neurodevelopmental supportive care, and if continued at home, can increase the chances of intact survival and promote optimum growth. About 2.5 million and 23,091 newborns die every year due to low birth weight (LBW) across the world. For optimum implementation of home KMC, it is necessary to identify the enablers and barriers of home KMC, as well as the effectiveness of home KMC on LBW babies’ growth parameters.

Implementation of KMC at home.

A prospective cohort study included 180 mother-LBW baby dyads and KMC was started as soon as possible during the hospital stay. Data regarding KMC practice at home were recorded after discharge by weekly visits till 4 weeks and those who could not come for follow-up were interviewed by phone calls and encouraged to come for the next visit. Growth monitoring of babies was done and analyzed statistically (paired t-test).

The overall weight gain, irrespective of gestation, was 25.59 g/day with an average KMC duration of 6.7 ± 2.02 h/day at home. Barriers documented were household chores (22.78%), lack of privacy (9.44%), baby crying in the KMC position (14.44%), lack of family support (0.56%), and fear of handling small babies (0.56%). Enablers were counseling by healthcare workers and KMC experience during hospital stay (98.33%), KMC experience by other mothers during neonatal intensive care unit (NICU) (2.77%), and family support (40%).

KMC at the community level is feasible with counseling of mothers and family members, encouraging enablers, and identifying and addressing barriers for the same. Hence, ensuring exclusive breastfeeding, optimal growth, and intact survival is possible by implementing KMC at home.

Accurate organ measurement is essential in neonatal ultrasound in order to guide clinical decisions. However, interobserver variability remains a challenge, especially in preterm infants, where small organ dimensions and technical limitations can affect reproducibility. Consistent agreement between examiners is crucial to ensure reliable and standardized assessments. This prospective observational study evaluates interobserver agreement in ultrasound measurements of the liver, kidney, and spleen in preterm infants.

In this prospective observational study, a total of 74 ultrasound examinations were performed in 30 preterm infants, with seven infants being measured twice. The 37 paired assessments included independent measurements of the liver (midsternal line (MSL), midclavicular line (MCL), and anterior axillary line (AAL)), kidneys, and spleen by two experienced examiners. Statistical analyses included the Wilcoxon matched-pairs signed rank test, paired t-test, Pearson correlation coefficient (PCC), intraclass correlation coefficient (ICC), and Bland–Altman analysis.

No significant differences were found between examiners (P > .05), except for the generally least reproducible liver length in the MCL. PCC and ICC values for all measurements exceeded 0.929, indicating excellent interobserver agreement.

Ultrasound investigations remain a reliable and reproducible tool for organ size assessment in neonatal care, even in extremely low birth weight infants with tiny anatomical structures. The strong interobserver agreement emphasizes the importance of standardized measurement protocols and ultrasound training, ensuring consistency in clinical practice.

Neonates, particularly those born preterm, undergo multiple painful procedures in neonatal intensive care units (NICUs). Evidence shows that such exposures are not transient but induce long-lasting neuroimmune and epigenetic changes, creating a phenomenon termed “pain memory,” with effects on brain development and behavior.

This scoping review was conducted using a PICOT framework. Population: neonates (preterm and term); Intervention: procedural or surgical pain and its management (pharmacological and non-pharmacological); Comparator: infants with lower/no pain exposure or alternative management; Outcomes: (a) biological mechanisms, (b) neurodevelopmental and behavioral sequelae such as anxiety and dysregulation, (c) demographic/sex-specific differences, (d) clinical management strategies; Timeframe: immediate to long-term follow-up. Searches of PubMed, Embase, Web of Science, Scopus, and Cochrane (1990-May 2025) identified 342 records. Following duplicate removal, 270 abstracts were screened, 90 full texts were reviewed, and 30 studies were included. Screening was performed independently by two reviewers, with conflicts resolved by a third adjudicator. Data were charted for design, demographics, interventions, outcomes, and limitations.

Studies have revealed that early nociceptive injury primes microglia and reprograms macrophages through epigenetic pathways. Clinical cohorts showed cumulative pain exposure associated with altered thalamic/cortical development, reduced white-matter integrity, lower cognitive scores, and higher risks of anxiety and behavioral dysregulation. Females exhibited stronger immune-mediated programming, while extremely preterm infants were most vulnerable. Non-pharmacological strategies (skin-to-skin, breastfeeding, sucrose), alongside judicious pharmacological use, reduced acute pain and may influence long-term outcomes.

Neonatal pain memory represents durable biological and behavioral alterations. Multimodal, family-centered approaches should be standard, while future trials must clarify whether early interventions reduce later neurodevelopmental risks and how sex-specific mechanisms can inform personalized care.

The lack of guidelines for early feeding assessment has a significant impact on infants and mothers, as incomplete or inadequate feeding evaluations can result in incorrect diagnoses, making feeding difficulties unmanageable.

The aim of this systematic review was to analyze the literature on what tools are currently used, how comprehensive and person-centred they are, and which disciplines are currently involved with neonatal feeding assessment during hospital stay after birth.

A systematic review was proposed to analyze all articles published between 2012 and June 2022. Databases included PubMed, MedLine, and Web of Science. Included articles assessed feeding difficulties in infants (12 months or younger) during hospital stays after birth in maternity hospitals or neonatal intensive care units (NICUs). Articles in languages other than the primary languages of the authors (i.e., English and Portuguese), review articles, book chapters, commentaries, and letters to the editor were excluded from the present research. The initial search yielded a total of 698 articles for review, with an additional 10 articles found through the gray literature search. Thirty-three articles were removed after deduplication, and the remaining studies (675) were included for title and abstract screening.

Two authors independently conducted 84 full-text reviews, and a total of 40 articles were included in the present study. Thirteen observational assessment tools, five clinical bedside assessments, five questionnaires or interview methods, four instrumental assessments, and four other types of assessment tools or methods were identified.

The variability of feeding assessment methods and tools for infants indicates a lack of standardization in breastfeeding assessment. The results of this research suggest that all described feeding or breastfeeding assessment tools are not comprehensive or person-centered, as they do not include all major aspects that can impact breastfeeding. Therefore, a consistent approach to breastfeeding assessment in hospitals is recommended to increase the incidence of breastfeeding success in the first 6 months of life. Finally, healthcare professionals who would like to promote, assess, and treat breastfeeding difficulties should pursue additional training or credentialing in breastfeeding and maternal-infant health.