{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:58:48Z","timestamp":1785419928082,"version":"3.56.0"},"reference-count":37,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u2018Victor Babes\u2019 University of Medicine and Pharmacy Timisoara"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Gram-negative neonatal infections are associated with severe clinical courses and frequently require respiratory support. However, factors associated with the requirement for invasive mechanical ventilation (IMV) after infection onset remain incompletely characterized. This study evaluated maternal and neonatal variables associated with respiratory severity in neonates with confirmed Gram-negative infections. Methods: A retrospective cohort study was conducted in a tertiary neonatal intensive care unit and included 98 neonates with microbiologically confirmed Gram-negative infections between January 2021 and December 2024. The primary outcome was the requirement for IMV during the early NICU course. Maternal, perinatal, and neonatal characteristics were analyzed using univariate and multivariable logistic regression. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis and an exploratory ridge logistic regression model. Results: Sixty-five neonates (66.3%) required IMV, while 90 (91.8%) required some form of respiratory support. Ventilated neonates had a lower gestational age than non-ventilated neonates (35 vs. 38 weeks, p = 0.02). In univariate analysis, decreasing gestational age was associated with higher odds of IMV (OR 0.87 per week increase, 95% CI 0.77\u20130.98, p = 0.03), while maternal premature rupture of membranes (PROM) was associated with increased ventilation requirements (OR 6.39, 95% CI 1.39\u201329.36, p = 0.02). Cesarean delivery was also associated with higher odds of IMV (OR 2.81, 95% CI 1.19\u20136.62, p = 0.02). In multivariable analysis, neither gestational age (adjusted OR 0.87, 95% CI 0.74\u20131.01, p = 0.07) nor PROM (adjusted OR 2.10, 95% CI 0.65\u20136.80, p = 0.21) remained independently associated with IMV. Gestational age demonstrated the highest discriminative performance for predicting IMV (AUC = 0.73), followed by birth weight (AUC = 0.65). The exploratory ridge model achieved an apparent AUC of 0.76, with an optimism-corrected AUC of 0.70. Mortality occurred in 24 neonates (24.5%), all of whom required IMV. Conclusions: Early respiratory severity was common among neonates with Gram-negative infections, with nearly two thirds of infants requiring IMV. Lower gestational age, PROM, and cesarean delivery were associated with greater respiratory support requirements in unadjusted analyses, although these associations were attenuated after multivariable adjustment. The exploratory prediction model demonstrated moderate discriminative performance. Larger multicenter studies are needed to validate these findings and improve early risk stratification.<\/jats:p>","DOI":"10.3390\/jcm15145534","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:29:39Z","timestamp":1784100579000},"page":"5534","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated with Severe Respiratory Support Requirement in Neonates with Gram-Negative Infections: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Mihaela","family":"Zaharie","sequence":"first","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, 300041 Timi\u0219oara, Romania"},{"name":"Neonatology and Preterm Department, \u201cLouis \u0162urcanu\u201d Children Emergency Hospital, 300011 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniko Maria","family":"Manea","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, 300041 Timi\u0219oara, Romania"},{"name":"Neonatology and Preterm Department, \u201cLouis \u0162urcanu\u201d Children Emergency Hospital, 300011 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u0103rioara","family":"Boia","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, 300041 Timi\u0219oara, Romania"},{"name":"Neonatology and Preterm Department, \u201cLouis \u0162urcanu\u201d Children Emergency Hospital, 300011 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4916-0912","authenticated-orcid":false,"given":"Nicoleta","family":"Lungu","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, 300041 Timi\u0219oara, Romania"},{"name":"Neonatology and Preterm Department, \u201cLouis \u0162urcanu\u201d Children Emergency Hospital, 300011 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florina","family":"Doandes","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, 300041 Timi\u0219oara, Romania"},{"name":"Neonatology and Preterm Department, \u201cLouis \u0162urcanu\u201d Children Emergency Hospital, 300011 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4986-8025","authenticated-orcid":false,"given":"Daniela-Eugenia","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Puericulture, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, 300041 Timi\u0219oara, Romania"},{"name":"Medici\u2019s MedLife Hospital Timi\u0219oara, Ciprian Porumbescu Street No. 9, 300236 Timi\u0219oara, 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 of Timisoara, 300041 Timi\u0219oara, Romania"},{"name":"Clinic of Neonatology, \u201cPius Brinzeu\u201d County Clinical Emergency Hospital, 300723 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kariniotaki, C., Thomou, C., Gkentzi, D., Panteris, E., Dimitriou, G., and Hatzidaki, E. 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