{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:19:18Z","timestamp":1785410358569,"version":"3.56.0"},"reference-count":32,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy, Timi\u0219oara"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Gram-negative neonatal sepsis remains a cause of morbidity and mortality in preterm infants, yet the relationship between early clinical severity and long-term neurodevelopmental outcomes is incompletely defined. This study aimed to characterize Gram-negative sepsis in preterm infants and to evaluate its short-term and 18\u201324-month neurodevelopmental consequences. Methods: We conducted a retrospective observational cohort study of preterm infants admitted to a tertiary neonatal intensive care unit between 1 January 2022 and 31 December 2023. Infants with culture-proven Gram-negative neonatal sepsis, including both early-onset sepsis (EOS) and late-onset sepsis (LOS), were included. Clinical, microbiological, therapeutic, and laboratory data were collected, and survivors were assessed at 18\u201324 months\u2019 corrected age using the Bayley Scales of Infant and Toddler Development. Results: Among infants with culture-proven Gram-negative sepsis, late-onset cases were more frequent than early-onset cases, and Klebsiella pneumoniae was the most common pathogen (38.0%). Multidrug-resistant organisms were associated with 52.0% of infections. In-hospital mortality was 26.0%. Major short-term complications included intraventricular hemorrhage (24.0%), severe intraventricular hemorrhage (20.0%), necrotizing enterocolitis (12.0%), bronchopulmonary dysplasia (20.0%), and meningitis (10.0%). Among survivors who underwent neurodevelopmental assessment, neurodevelopmental impairment was observed in 38.0%, most frequently affecting the language (22.5%) and cognitive (20.0%) domains. Infants with neurodevelopmental impairment had significantly lower gestational age and birth weight and higher inflammatory biomarker levels. In multivariable analyses, lower gestational age emerged as the strongest independent predictor of both mortality (adjusted OR 0.19, 95% CI 0.04\u20130.99) and neurodevelopmental impairment (adjusted OR 0.12, 95% CI 0.02\u20130.71). Conclusions: Gram-negative neonatal sepsis in preterm infants was associated with substantial mortality, severe neonatal complications, and a high burden of later neurodevelopmental impairment. Lower gestational age was independently associated with adverse short- and long-term outcomes. These findings support early recognition, targeted antimicrobial therapy, and structured neurodevelopmental follow-up in this high-risk population.<\/jats:p>","DOI":"10.3390\/children13070850","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:43:57Z","timestamp":1782463437000},"page":"850","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Gram-Negative Neonatal Sepsis to Neurodevelopmental Impairment: A Retrospective Cohort Study in Preterm Infants"],"prefix":"10.3390","volume":"13","author":[{"given":"Mihaela","family":"Zaharie","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Neonatology and Preterm Department, \u201cLouis \u0162urcanu\u201d Children Emergency Hospital, 300011 Timisoara, Romania"},{"name":"Clinic of Neonatology, \u201cPius Brinzeu\u201d County Clinical Emergency Hospital, 300723 Timi\u0219oara, Romania"},{"name":"Center for Multidisciplinary Research and Management in Pediatric Surgical Conditions (CCMMA\u2013CHIR-PED), 300011 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marioara","family":"Boia","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Neonatology and Preterm Department, \u201cLouis \u0162urcanu\u201d Children Emergency Hospital, 300011 Timisoara, Romania"},{"name":"Center for Multidisciplinary Research and Management in Pediatric Surgical Conditions (CCMMA\u2013CHIR-PED), 300011 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniko","family":"Manea","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Neonatology and Preterm Department, \u201cLouis \u0162urcanu\u201d Children Emergency Hospital, 300011 Timisoara, Romania"},{"name":"Center for Multidisciplinary Research and Management in Pediatric Surgical Conditions (CCMMA\u2013CHIR-PED), 300011 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana Maria","family":"Jeleriu","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirabela Adina","family":"Dima","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Clinic of Neonatology, \u201cPius Brinzeu\u201d County Clinical Emergency Hospital, 300723 Timi\u0219oara, Romania"},{"name":"Center for Multidisciplinary Research and Management in Pediatric Surgical Conditions (CCMMA\u2013CHIR-PED), 300011 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ileana","family":"Enatescu","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Clinic of Neonatology, \u201cPius Brinzeu\u201d County Clinical Emergency Hospital, 300723 Timi\u0219oara, Romania"},{"name":"Center for Multidisciplinary Research and Management in Pediatric Surgical Conditions (CCMMA\u2013CHIR-PED), 300011 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2468-6003","authenticated-orcid":false,"given":"Daniela","family":"Iacob","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania"},{"name":"Clinic of Neonatology, \u201cPius Brinzeu\u201d County Clinical Emergency Hospital, 300723 Timi\u0219oara, Romania"},{"name":"Center for Multidisciplinary Research and Management in Pediatric Surgical Conditions (CCMMA\u2013CHIR-PED), 300011 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102840","DOI":"10.1016\/j.eclinm.2024.102840","article-title":"Global, Regional, and National Burden of Preterm Birth, 1990\u20132021: A Systematic Analysis from the 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Dis."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/7\/850\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T10:27:00Z","timestamp":1782469620000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/7\/850"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["children13070850"],"URL":"https:\/\/doi.org\/10.3390\/children13070850","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}