Galactosialidosis presenting as non-immune hydrops.

Hydrops fetalis is an abnormal accumulation of fluid in two or more foetal compartments which is easily detected using prenatal ultrasonography. It can be categorised into immune and non-immune. The non-immune hydrops can result from various aetiologies, including cardiovascular, respiratory, genitourinary infections, chromosomal anomalies and metabolic causes. The metabolic causes, including lysosomal storage disorders (LSD), are increasingly being recognised as the causes of non-immune hydrops. The hydrops fetalis associated with metabolic disorders is usually severe with huge ascites, hepatosplenomegaly, thick skin, renal abnormalities, increased nuchal translucency, renal abnormalities and skeletal deformities. In this report, we describe a case of LSD, that is, galactosialidosis presenting as non-immune hydrops and its diagnosis. In utero diagnosis of the disorder without an index case is challenging. The definitive diagnosis is important for planning and management of future conceptions.

The fundamentals of a parental peer-to-peer support program in the NICU: a scoping review.

PURPOSE AND BACKGROUND: Parental peer support is part of the Family Integrated Care model in NICUs. However, little attention has been devoted to the specific content and organization of parental peer support programs. This scoping review aimed to identify (1) the preferred content of a parental peer support intervention, (2) the organizational processes, and (3) the suggested educational curriculum for peer support providers within existing programs in neonatal care. DISCUSSION: Parental peer support programs have the goal to provide emotional support, information and assistance, and are to empower parents in the NICU. To achieve these goals, veteran parents receive training in communication skills, roles and boundaries, mental health, (non)medical aspects in the NICU and post-discharge preparation. Data on the organizational components remain limited. Hence, the question remains how the organization of a parental peer support program, and the training and supervision of veteran parents should be managed. IMPLICATIONS FOR RESEARCH AND PRACTICE: This scoping review provides a variety of aspects that should be considered when developing and implementing a parental peer support program in the NICU. Program development preferably involves NICU staff at an early stage. Future research should focus on the support of diverse populations in terms of culture, social economic status and gender, and on the effects of parental peer support on parent and infant.

Novel methylenetetrahydrofolate reductase (MTHFR) mutation presenting with neonatal encephalopathy, hair loss and marfanoid features.

We present a case of a male term neonate with lethargy, hypotonia, hypoventilation and severe encephalopathy. The infant had a history of two siblings who died in the neonatal period from unclear causes. The infant exhibited skin and hair abnormalities, including desquamation of the extremities, angular stomatitis, cheilitis, neonatal acne and thin, sparse hair. Additionally, the infant had a tall stature; long, slender fingers and toes; and facial dysmorphism characterised by a long, narrow face with increased interpalpebral distance. The condition deteriorated rapidly, and unfortunately, death occurred before a definitive diagnosis could be established. Tandem mass spectrometry suggested low methionine and clinical exome sequencing identified a nonsense mutation in the MTHFR gene.

"Sink or swim": mothers' experiences of extremely preterm infants after 15 years from birth.

OBJECTIVES: To evaluate the experience of parenting a preterm infant from birth to adolescence and to raise awareness of the complexity of premature birth and the child's subsequent developmental journey for the entire family. STUDY DESIGN: A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was adopted to obtain retrospective, in-depth narratives. Seven mothers of adolescents born preterm with extremely low birth weight (ELBW) and admitted to a neonatal intensive care unit (NICU) participated in the study. Interviews were conducted by a trained researcher in qualitative methods, and independent coders performed data analysis. RESULTS: Three phases and eight core themes, chronologically organized, emerged from the thematic analysis: starting from preterm birth (panic, fear and uncertainty; hope and a positive attitude to the future; altered parental role), transitioning to life after hospitalization (fatigue and worry about an uncertain future; need of support), and extending into adolescence (adolescents' fragility; overprotection; post-traumatic personal growth). CONCLUSIONS: The birth of a preterm baby has significant repercussions for the entire family, not only in the period immediately following birth but also for many years afterwards, as the traumatic event is retraced with memories that remain both painful and vivid. These findings should be acknowledged by professionals working in the NICU to foster the development of targeted interventions that help parents build resilience, including from a personal growth perspective.

Providing very low-birth-weight infants with fast enteral feeding reduced how long they needed a central venous catheter.

AIM: To determine the impact of the protocol change from slow to fast enteral feeding progression on duration of central venous catheter placement, and the rates of late-onset sepsis and necrotising enterocolitis. METHODS: We compared the evolution of all very low-birth-weight infants admitted on their first postnatal day in neonatal intensive care unit during a 12-month period, before (2021 Cohort) and after (2022 Cohort) implementation of a new feeding protocol. Linear regression model was used to adjust for confounding factors. RESULTS: A total of 343 VLBW infants were included (median gestational age ± SD 28.3 ± 1.7 weeks; median birth weight ± SD 980 ± 300 g). Median initial duration of central venous catheter was 5 days in 2022 cohort compared with 9 days in 2021 cohort (unadjusted p = 0.006, adjusted p = 0.001). Median time to achieve full enteral feeding was 8 days versus 12 days, p < 0.001, with no significant difference in late-onset sepsis or necrotising enterocolitis rates. CONCLUSION: The change from slow to fast enteral feeding progression for very low-birth-weight infants significantly decreased the central venous catheter duration with no adverse outcomes. This is consistent with recent randomised study results and supports the safe implementation in neonatal intensive care units.

Efficacy and Safety of Esmolol in Neonatal Cardiac Surgery with Cardiopulmonary Bypass (CPB) for d-Transposition of the Great Arteries (d-TGA).

OBJECTIVE: D-Transposition of the great arteries (d-TGA) is the most common congenital heart disease requiring surgical correction within the neonatal period. Sinus tachycardia often persists postoperatively, potentially affecting cardiac function. This study aimed to investigate the efficacy and safety of the short-acting beta-1-selective beta-blocker esmolol in controlling heart rate in neonatal cardiac surgery with cardiopulmonary bypass (CPB). METHODS: A retrospective cohort study was conducted on neonates undergoing surgery for d-TGA. The study cohort included 112 patients, divided into an esmolol intervention group (n = 57) and a control group (n = 55). Baseline characteristics, hemodynamic parameters and outcome measures were assessed. RESULTS: In the esmolol group, median heart rate at ICU admission was significantly higher compared to the control group (155 vs. 147 bpm, p = 0.018). After a median time of 11 h, heart rate was lower among the esmolol patients (135 vs. 144 bpm, p < 0.001). There were no differences in other hemodynamic parameters between the two groups. Patients treated with esmolol required longer catecholamine support while no difference regarding survival, duration of invasive ventilation and ICU stay were noticed. CONCLUSION: No relevant hemodynamic difference was seen between neonates treated with perioperative esmolol and the control group and outcome did not differ. This indicates non-inferiority of perioperative betablocker therapy in young age. Prospective and placebo-controlled assessment of perioperative esmolol therapy in neonates is needed.

Experiences of parents with very premature-born children at risk of neurodevelopmental disorders: A qualitative study.

BACKGROUND: Premature birth is a traumatic and stressful situation for parents who are immediately separated from their infant because of the newborn's need for specialized care. The staff of these units are in charge of following the principles of family-centred care and practices for neonates at risk of neurodevelopmental disorders, including providing training to the family during their hospital stay and after being discharged. AIMS: The aim of this study is to explore the perceptions of parents of premature children at risk of neurodevelopmental disorders in regard to care, interventions and assistance provided during the first months of their child's life. STUDY DESIGN: A qualitative descriptive study was carried out through individual interviews. The data analysis was conducted through a thematic analysis. The methodology and results were reported following the standards for preparing qualitative research reports and recommendations. RESULTS: Twenty-one parents of premature children were interviewed. From these interviews, three main themes emerged: (i) parents' perspectives on preterm birth risk communication, (ii) navigating parental support and early interventions in preterm birth and (iii) perceptions of preterm birth protective and challenging factors. CONCLUSIONS: The parents of premature children need to receive better communication about the care and interventions for their child, and it is necessary that health personnel are better trained in terms of management and administration of public resources. Strategies must be implemented that continuously guide parents on the follow-up and care of their premature child not only during their first moments of life but also after being discharged from the hospital. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need to improve care for parents with premature infants at risk, emphasizing the necessity for health care system reforms and support structures, allowing health care professionals to enhance attention and care.

The Role of Early Intervention Therapy in Neurodevelopmental Outcomes of Premature Infants.

Neurodevelopmental impairments are known to be more common in premature infants. Premature and low birth weight babies are now more likely to survive because of modern technologies and advancements in perinatal and postnatal care. However, long stays and exposure to harsh stimuli in neonatal intensive care units are known to have a negative impact on the developing neonatal brain. Therefore, the goal of early intervention (EI) is to assist an infant and their family in achieving the greatest potential outcome. This encompasses a broad spectrum of strategies and structured programs that might differ in many aspects, such as who should implement them, where they should take place, and when they should begin. They aid in minimizing brain damage and optimizing growth via varied sensory and motor stimuli. Current evidence supports the initiation of EI therapy soon after birth, starting from neonatal intensive care units and continuing post-discharge. This research is important, especially in developing countries like ours, owing to the increasing number of premature deliveries due to multiple reasons. The focus of this article is to analyze the various protocols and applications available to us for the implementation of EI therapies and their benefits.

Cue-based feeding in the NICU-a pathway to earlier oral feeding of preterm infants.

Aim: To compare volume-driven and cue-based feeding of low birth weight preterm infants, regarding short-term outcomes, including transition to oral feeds, weight gain, and length of stay. Methods: This was a retrospective cohort study. Feeding and weight gain outcomes were compared between infants fed by volume-driven and cue-based feeds. The groups were subdivided by birth weight categories. Results: The study group included 240 low birth weight preterm infants born before 34 weeks of gestation, 120 infants fed by volume-driven feeding were compared to 120 infants fed by cue-based feeding. The groups were sub-analyzed by birth weight categories: <1,500 g and 1,500-2,500 g. Study groups were comparable regarding baseline characteristics and neonatal morbidities. Infants fed by cue-based feeding were more likely to achieve full oral feeding faster and at an earlier gestational age. Infants with a birth weight <1,500 g were less likely to experience adverse respiratory episodes during cue-based feeding. Although the rate of weight gain was reduced in cue-based feeding in the heavier infant group, discharge weight, breastfeeding rates, and length of stay were comparable between the groups. Conclusions: Cue-based feeding results in faster transition to full oral feeding in very low birth weight preterm infants and at an earlier gestational age.

WGS Analysis of Staphylococcus warneri Outbreak in a Neonatal Intensive Care Unit.

Purpose: Staphylococcus warneri is an opportunistic pathogen responsible for hospital-acquired infections (HAIs). The aim of this study was to describe an outbreak caused by S. warneri infection in a neonatal intensive care unit (NICU) and provide investigation, prevention and control strategies for this outbreak. Methods: We conducted an epidemiological investigation of the NICU S. warneri outbreak, involving seven neonates, staff, and environmental screening, to identify the source of infection. WGS analyses were performed on S. warneri isolates, including species identification, core genome single-nucleotide polymorphism (cgSNP) analysis, pan-genome analysis, and genetic characterization assessment of the prevalence of specific antibiotic resistance and virulence genes. Results: Eight S. warneri strains were isolated from this outbreak, with seven from neonates and one from environment. Six clinical cases within three days in 2021 were linked to one strain isolated from environmental samples; isolates varied by 0-69 SNPs and were confirmed to be from an outbreak through WGS. Multiple infection prevention measures were implemented, including comprehensive environmental disinfection and stringent protocols, and all affected neonates were transferred to the isolation wards. Following these interventions, no further cases of S. warneri infections were observed. Furthermore, pan-genome analysis results suggested that in human S. warneri may exhibit host specificity. Conclusion: The investigation has revealed that the outbreak was linked to the milk preparation workbench by the WGS. It is recommended that there be a stronger focus on environmental disinfection management in order to raise awareness, improve identification, and prevention of healthcare-associated infections that are associated with the hospital environment.

Fragmentation of payment systems: an in-depth qualitative study of stakeholders' experiences with the neonatal intensive care payment system in Iran.

BACKGROUND: Iran's fee-for-service (FFS) payment model in neonatal intensive care units (NICUs) is contentious due to the involvement of multiple stakeholders with differing interests, leading to increased costs, fragmentation, and reduced quality of care. This study explores the experiences and challenges of stakeholders with the NICU payment system and considers alternative payment methods. METHOD: A qualitative research approach was used, involving key informant interviews with stakeholders at various levels of the health system. Data were collected between March 2022 to September 2023 using a purposive sampling method with a snowball strategy. The transcribed data were analyzed using an inductive thematic approach in MAXQDA, with themes and sub-themes emerged and assessed by two independent coders. Four trustworthiness criteria were applied to ensure the quality of the results. RESULTS: The study involved 23 participants with diverse NICU payment backgrounds, identifying issues related to service accessibility, rising costs, neonatologists' income, and service quality. Stakeholders held differing views on the best payment model: health insurance executives favored a prospective payment method, faculty members favored supported modified FFS or per diem, and neonatal specialists expressed concerns about low tariffs and delayed payments. CONCLUSION: Iran's NICU payment system is unsatisfactory and requires urgent reform. Although stakeholders disagree on the best approach, reforms must be evidence-based and collaborative, addressing structural and cultural issues within the health system. The identification of an optimal payment system is essential for supporting neonatal care, benefiting newborns, families, society, and the broader health system.

Systematic review of environmental noise in neonatal intensive care units.

AIM: To systematically review the literature on noise exposure within the neonatal intensive care unit/special care nursery settings, specifically to describe: noise characteristics, sources of noise and ways of measuring noise. METHODS: Systematic searches were conducted through databases Medline, Embase and PubMed. Studies were included if they met the inclusion criteria (1) reported noise characteristics; (2) reported noise exposure measurements; (3) in the neonatal intensive care unit/ special care nursery settings. Methods and key findings were extracted from included studies. Quality analysis was done using a modified version of the Newcastle-Ottawa Scale. RESULTS: We identified 1651 studies, screened 871, reviewed 112 and included 47. All reported NICU average equivalent sound levels were consistently louder than recommended guidelines (45 dB). The most consistent association with higher sound pressure levels were noise sources grouped under people congregation. Half of the studies did not use measuring devices adhering to international sound level meter (SLM) standards. CONCLUSION: All NICUs exceeded recommended accumulative sound levels. People were the most consistent source of noise. Sound pressure levels need to be consistently measured with devices adhering to international SLM standards in future studies.

Consequences of NICU Intubations: Incidence, Identifications, and Interventions.

OBJECTIVE: Prolonged intubation often leads to laryngeal injuries such as subglottic stenosis (SGS), especially in neonates with prematurity and congenital defects key for tissue healing. Recognizing at risk patients in the neonatal intensive care unit (NICU) is not well studied. The study's goals were to determine intubation risk factors, characterize laryngeal injuries, and calculate the incidence of intervention. STUDY DESIGN: Retrospective case review. SETTING: Quaternary pediatric referral center. METHODS: This retrospective study included all intubated patients in the NICU from April 1, 2020 to 2023. Electronic records were reviewed for demographics and intubation details. Patients were categorized to into intubation only or intervention groups, including direct laryngoscopy and bronchoscopy (DLB) and tracheostomy history. RESULTS: A total of 441 patients were identified with 94 (21%) neonates undergoing DLB. Characteristics impacting intervention included older gestational age, genetic syndromes, and congenital heart disease. Significant risk factors were older age at first intubation, recurrent intubation events, longer intubation duration, and larger endotracheal tube (ETT) diameter, but not birth weight or intubation attempts. Otolaryngology was more likely to intubate the intervention cohort. SGS overall incidence was 2.95% with balloon dilation in 6.4%. Two-thirds of neonates with DLB ultimately required tracheostomy, in which all variables remained significant risk factors except for gestational age. CONCLUSION: Older age at first intubation, more intubation events, longer intubation duration, and larger ETT increased risk for future DLB and tracheostomy but not birth weight or number of intubation attempts. Most NICU patients selected for DLB ultimately required further procedures.

Development of a machine learning model to identify intraventricular hemorrhage using time-series analysis in preterm infants.

Although the prevalence of intraventricular hemorrhage (IVH) has remained high, no optimal strategy has been established to prevent it. This study included preterm newborns born at a gestational age of < 32 weeks admitted to the neonatal intensive care unit of a tertiary hospital between January 2013 and June 2022. Infants who had been observed for less than 24 h were excluded. A total of 14 features from time-series data after birth to IVH diagnosis were chosen for model development using an automated machine-learning method. The average F1 scores and area under the receiver operating characteristic curve (AUROC) were used as indicators for comparing the models. We analyzed 778 preterm newborns (79 with IVH, 10.2%; 699 with no IVH, 89.8%) with a median gestational age of 29.4 weeks and birth weight of 1180 g. Model development was performed using data from 748 infants after applying the exclusion criteria. The Extra Trees Classifier model showed the best performance with an average F1 score of 0.93 and an AUROC of 0.999. We developed a model for identifying IVH with excellent accuracy. Further research is needed to recognize high-risk infants in real time.

Efficacy of antimicrobial-impregnated catheters in preventing sepsis post epicutaneo-caval catheter (ECC) removal in neonates: A retrospective study.

BACKGROUND: Epicutaneo-caval catheters (ECC) are vital in neonatal intensive care units (NICU) in enabling prolonged venous access. Despite their benefits, central line-associated bloodstream infections (CLABSI) pose a potential risk. The ECC removal procedure may contribute to an increased risk of post removal sepsis through biofilm release. Antimicrobial-impregnated ECCs have been proposed as a potential solution to prevent this complication, but research on their effectiveness in neonates is limited. OBJECTIVE: To compare post-ECC or neonatal peripherally inserted central catheter (n-PICCs) removal sepsis rates when using conventional or antimicrobial-impregnated catheters in neonates. METHODS: A retrospective, single center cohort analysis using 2019 data from 421 neonates after successful ECC insertion at the Women's Wellness and Research Center, a large tertiary level NICU in Qatar. The study systematically collected data on demographics, insertion, and removal as well as microbiology, and infection data. Statistical analyses compared conventional and antimicrobial ECCs, with a focus on the incidence of sepsis within 72 hr post-removal. RESULTS: After excluding non-eligible, 349 cases were included in the analysis (138 conventional, 211 antimicrobial-impregnated). There were no significant demographic differences between the two groups. The CLABSI incidence was higher amongst the antimicrobial ECC group (4% vs 0.6%, p = 0.031). Among the included neonates, the confirmed post-removal sepsis incidence was 4.3% (6 cases) for the conventional and 10% (21 cases) for the antimicrobial ECC groups, which was not statistically significant (p = 0.055). CONCLUSION: The study noted a higher, but statistically insignificant, incidence of post removal sepsis when using antimicrobial-impregnated ECCs. This finding raises questions about the effectiveness of antimicrobial ECCs in preventing post-removal sepsis in this patient population. Further randomized trials are needed to assess the role of antimicrobial ECCs amongst neonates and to refine neonatal ECC care strategies.

Neonatal Markers of Prematurity as Predictors of Permanent Childhood Hearing Loss and Neurodevelopmental Impairment in Children Admitted to the Neonatal Intensive Care Unit.

Need for admission to the neonatal intensive care unit (NICU) confers an increased risk of hearing loss in the newborn and of later neurodevelopmental impairment. In this retrospective longitudinal case-controlled study, we assess how the degree of prematurity, measured via gestational age, birth weight, and z-scores, in 138 infants admitted to the NICU are associated with permanent childhood hearing loss (PCHI) and 2-year developmental outcomes. Logistic regression analyses, Kruskal-Wallis analysis of variance, and Chi-squared tests were used. Independent of prematurity, PCHI and NICU admission were predictive of poor developmental outcomes. Twenty-one (47%) children with PCHI had a moderate-to-severe developmental delay, compared to three (7%) matched controls. Days in the NICU but not z-scores predicted PCHI. Z-score was not prognostic of moderate or severe developmental impairment in children with PCHI. The odds ratio of moderate-to-severe neurodevelopmental impairment with PCHI was high, at 12.48 [95% CI = 3.37-46.40]. Children with PCHI were significantly more likely to have cerebral palsy than their matched counterparts (30% vs. 2%). These findings challenge the conventional focus on gestational age and birth weight on neurodevelopmental outcomes for children with PCHI and NICU admission. A more nuanced approach to monitoring and intervention is needed.

Insights into the relationship between professional values and caring behavior among nurses in neonatal intensive care units.

OBJECTIVE: Professional values are crucial for delivering high-quality care in neonatal intensive care units while caring behavior impacts nurses' performance and well-being. The purpose of this study was to assess the relationship between professional values and caring behavior among nurses in neonatal intensive care units. METHODS: A cross-sectional study involving 172 nurses was conducted using the Nursing Professional Value Scale and Caring Behaviors Assessment Tool. The study was carried out between 1 October and 5 December 2023. RESULTS: Nurses demonstrated a moderate to high degree of professional commitment, with a mean professional value score of 91.1 ± 11.1. The mean score for caring behavior was 99.7 ± 12.4. The highest-rated domain was setting up a supporting, protective, and corrective environment, with a mean score of 22.8 ± 2.7. A low positive relationship was found between the supportive, protective, and corrective environment domain and nurses' professional value (r = 0.18, p = 0.017), as well as between overall caring behavior and nurses' professional value (r = 0.16, p = 0.038). CONCLUSION: The results indicate a favorable relationship between professional values and caring behavior, especially in areas like establishing a supportive workplace. However, both professional value and caring behavior needs improvement in certain aspect. Enhancing these aspects could further strengthen their relationship, ultimately improving the quality of care provided to newborn patients and their families. PRACTICE IMPLICATIONS: To cultivate a positive work environment and instill caring behaviors and professional values among NICU nurses, it is imperative to allocate sufficient time and resources. This investment is necessary for nurturing a culture of care, improving patient outcomes, and fostering a supportive environment for NICU nurses, newborn, and their families.

Assessing the Impact of Different Levels of Parental Involvement in the NICU on Neonatal Outcomes and Parental Mental Health.

Background: Parental involvement in the neonatal intensive care unit (NICU) has been recognized as crucial for neonatal outcomes and parental mental health. Materials and Methods: A retrospective cohort study was conducted, involving 300 neonates admitted to the NICU over 1 year. Parental involvement was categorized into three levels: high, moderate, and low, based on the frequency and intensity of parental participation in neonatal care. Neonatal outcomes including the length of hospital stay, incidence of complications, and parental mental health outcomes measured through standardized scales were compared among the three groups. Results: Neonates with high parental involvement had a significantly shorter length of hospital stay (mean difference = 5 days, P < 0.001) compared to those with moderate or low involvement. Complication rates were also lower in the high involvement group (20%) compared to moderate (35%) and low (45%) involvement groups. Parental mental health scores were the highest in the high involvement group (mean score = 75), followed by moderate (mean score = 60) and low (mean score = 45) involvement groups. Conclusion: Higher levels of parental involvement in the NICU are associated with improved neonatal outcomes and better parental mental health.

Bloodstream Infections in the Neonatal Intensive Care Unit: A Systematic Review of the Literature.

Bloodstream infections represent a significant concern in neonatal intensive care units (NICUs), constituting a leading cause of morbidity and mortality among neonates. This study aimed to elucidate the etiology, prevalence, and antimicrobial resistance patterns of bloodstream infections in NICU settings. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines using the PubMed database to source relevant studies published between 2019 and 2023. Keywords related to bloodstream infections, neonates in NICUs, pathogens, resistance, and susceptibility were employed. Out of the 73 identified articles, eight met the inclusion criteria. Findings revealed a predominance of late-onset sepsis in hospitalized neonates, with Escherichia coli, Klebsiella pneumoniae, coagulase-negative staphylococci, Group B Streptococcus, Acinetobacter species, Serratia marcescens, Staphylococcus aureus, and Enterobacter cloacae being the most commonly isolated pathogens. Antimicrobial susceptibility profiles demonstrated resistance among bacteria to ampicillin, gentamicin, and penicillin, while fungi exhibited resistance to amphotericin B, fluconazole, flucytosine, itraconazole, and voriconazole. These findings underscore the persistent challenge of bloodstream infections in the NICUs, particularly late-onset sepsis, emphasizing the importance of early detection and appropriate antimicrobial therapy in neonatal care management.

Assessment of the clinical and laboratory risk factors for thrombosis in neonates admitted to neonatal intensive care unit (two Egyptian tertiary centers experience).

In neonates admitted to the neonatal intensive care unit (NICU), arterial and venous thromboembolism is a major cause of morbidity and death which could be attributed to multiple risk factors exposure. This study aimed to evaluate the clinical characteristics, laboratory and radiological assessments, predisposing risk factors, and outcomes of thrombosis in neonates admitted to NICU. This prospective cohort study was conducted at NICU, Minia, and Alexandria University Children's Hospital. Screening of 886 patients admitted to NICU over one year with different clinical presentations, patients were classified into the thrombotic and non-thrombotic groups based on the presence or absence of thrombosis. Thrombosis was diagnosed based on clinical, laboratory and different radiologic assessments. Genetic testing for factor V Leiden mutations G1691A, prothrombin mutation G20210A, protein C, protein S, and antithrombin III gene mutations were performed for patients with a family history of thrombosis. Out of a total of 886 neonatal admissions, 36 patients were diagnosed with evident thrombosis (40 per 1000 NICU admissions). The sites of venous thrombosis detection were Portal vein thrombosis in 11 patients (30.6%), superior vena cava thrombosis in 7 patients (19.4%), deep venous thrombosis in 5 patients (13.9%), central venous thrombosis in 5 patients (13.9%), intra-cardiac thrombosis in 3 patients (8.3%) and necrotic skin patches in one patient (2.8%). Only 69% of enrolled thrombosis patients showed genetic mutations the most common of which was factor V Leiden mutation (52.3%). Sepsis, central venous line (CVL) insertion, C reactive protein (CRP), and duration of NICU admission were significantly more common in the thrombotic group (p < 0.001) and were associated with a higher risk of thrombosis (ORs: 1.02, 7.7, and 1.11, respectively) (p < 0.001). Higher mortality occurred in thrombosis neonates compared with a non-thrombotic group (52.8% versus 17.4%) (p < 0.001). NICU-admitted neonates are exposed to multiple overlapped risk factors, the detection of which is important for preventing potential thrombosis and improving the patient's outcomes. The complexity of sepsis pathogenesis and management could potentiate multiple acquired risk factors. inherited thrombophilia detection is required for prevention of further morbidities.