Neonatal sepsis remains a leading cause of neonatal mortality in India, contributing to approximately 30%–40% of all neonatal deaths despite advances in neonatal care. This preventable condition disproportionately affects newborns in resource-limited settings where inadequate infection control, delayed care-seeking, suboptimal intrapartum practices and limited access to tertiary neonatal care converge to create a high disease burden. This narrative review examines the epidemiology of neonatal sepsis in India, analysing incidence rates, causative organisms, antimicrobial resistance patterns and regional variations. We synthesise evidence on risk factors operating at maternal, intrapartum, neonatal and healthcare system levels, including premature rupture of membranes, maternal infections, low birth weight, preterm delivery, unhygienic cord care practices, home deliveries and delayed referrals. The review explores the evolving microbiological landscape, with increasing predominance of Gram-negative organisms and alarming rates of multidrug-resistant pathogens, including extended-spectrum beta-lactamase producers and carbapenem-resistant organisms. We analyse the challenges of early diagnosis in resource-limited settings, examining the performance and limitations of clinical criteria, labouratory biomarkers and blood culture practices. Critical gaps in neonatal care delivery are identified, including inadequate infection prevention practices, suboptimal hand hygiene compliance, overcrowding in neonatal units, understaffing and limited availability of appropriate anti-microbials. The review presents evidence-based preventive strategies spanning the continuum from preconception through postnatal care, including antenatal infection screening and treatment, clean delivery practices, early breastfeeding initiation, rational antibiotic use and strengthening of infection control measures. We examine successful intervention models, including quality improvement initiatives, hand hygiene campaigns, kangaroo mother care programmes and community-based newborn care. Special emphasis is placed on anti-microbial stewardship as both a clinical and public health imperative to combat rising resistance.
A cyst related to the umbilical cord is referred to as any cystic pathology that is related to the umbilical cord. There are two types of cord cyst as: pseudocysts or true cysts. An Up-to-date, Europe PMC, Google Scholar and PubMed using the search terms ‘omphalocele associated with umbilical cord cyst’. We reviewed the findings for 19 cases of omphalocele associated with umbilical cord cyst reported in literatures. The present case was diagnosed at birth with normal karyotyping anomalies, and surgical intervention was performed by omphalocele sac, which was opened and the intestines were reduced to the peritoneal cavity with excision of the cord cyst. Due to its few of knowledge and scarce documentation in the literature, a literature review is conducted to increase awareness of the omphalocele, combining umbilical cord cyst. We conclude two hypotheses. Foetal umbilical cord examination is an important part of prenatal sonography assessment. Karyotyping is mandatory when an umbilical cord cyst, combining an omphalocele, is detected.
Neonatal hypoglycemia is a common and serious metabolic disorder, affecting up to 15% of newborns and a higher proportion of those with risk factors. Severe or prolonged episodes can cause lasting neurodevelopmental impairment, including cerebral palsy and developmental delay. Management remains complex due to the absence of a universal definition, standardized screening methods, and treatment protocols, resulting in significant variation across major pediatric guidelines. This review summarizes current evidence and guidelines on the management of neonatal hypoglycemia, emphasizing the ongoing debate over its definition – particularly the traditional threshold of <2.6 mmol/L versus the higher, age-specific targets recommended by the Pediatric Endocrine Society for improved neuroprotection. Management focuses on proactive screening of at-risk infants, including those born to diabetic mothers and preterm infants. Treatment follows a stepwise approach, with 40% buccal dextrose gel as an effective, non-invasive first-line therapy that reduces the need for intravenous glucose, which is reserved for severe, symptomatic, or persistent cases. Long-term studies indicate that even treated hypoglycemia may be associated with later neurodevelopmental challenges, underscoring the importance of prevention. Although management of neonatal hypoglycemia has advanced with the adoption of less invasive approaches such as buccal dextrose gel, the lack of a universal definition remains a major challenge. Future research should aim to harmonize international guidelines, integrate tools such as continuous glucose monitoring, and explore preventive strategies to enhance neurodevelopmental outcomes in at-risk newborns. The overarching goal remains the prompt identification, screening, and treatment of vulnerable infants.
When faced with uncertainty surrounding a life-threatening or life-limiting neonatal condition, timely referral to a palliative care team – either antenatally or postnatally – is crucial to support informed decision-making for both the neonate and the family. Delays in initiating this process may result in missed opportunities for critical decisions, potentially resulting in outcomes that are more strenuous on the neonate, family and healthcare team. The window for such decision-making is often narrow; however, when appropriate choices are made within this period, the overall medical, ethical and emotional burden on the neonate, the family and the healthcare team can be significantly reduced. This reflective piece highlights the unique value of palliative care across the antenatal, perinatal and neonatal periods.
Congenital lobular capillary hemangioma or cutaneous pyogenic granuloma is rare and can occur on the head. A differential diagnosis may include occipital encephalocele. A full-term newborn presented with a tumor in the occipital region. An ultrasound at 26 weeks' gestation showed a large occipital mass, and the main hypothesis was that it was an encephalocele. Surgical excision was performed, and pathology confirmed the diagnosis of congenital cutaneous pyogenic granuloma with negative GLUT-1 and positive CD34 immunohistochemistry. Congenital pyogenic granuloma is rare and is usually multiple, friable, pedunculated, or a tumorous lesion that tends to grow and develop new lesions after the 6th month of life. In the case reported herein, the granuloma was solitary and presented as a sessile, friable, and ulcerative mass in the occipital region. Surgical excision was performed, and, unlike some neural tube defects, it has a good prognosis.
Neonatal hypoglycaemia is a common metabolic emergency; however, persistent or refractory hypoglycaemia should prompt evaluation for endocrine and metabolic disorders. We report a case of a term female neonate with early-onset symptomatic hypoglycaemia found to be resistant to escalating glucose infusion rates and ultimately diagnosed with cortisol deficiency secondary to a hypothalamic hamartoma. Steroid therapy stabilised the blood glucose levels. This case underscores the importance of considering central endocrine causes in refractory neonatal hypoglycaemia and the role of neuroimaging in identifying rare aetiologies.
Background: Vitamin D is well-known for its crucial role in modulating immune response and inflammation, both of which are vital for lung health. Objectives: This study examined the relationship between low neonatal Vitamin D levels and the incidence and severity of respiratory distress syndrome (RDS) in preterm infants. Subjects and Methods: This cross-sectional study was conducted at the Namazee Neonatal Intensive Care Unit in Southwestern Iran, enrolling premature infants diagnosed with RDS and a control group of sex- and age-matched healthy newborns. Data from all premature newborns were collected, and the severity of RDS was assessed in affected infants. Vitamin D levels were measured within the first 24 h after birth. Results: The study included 60 premature neonates with RDS (29 females, 31 males; mean gestational age 31.6 +/- 2.3 weeks) and 60 without RDS (30 females, 30 males; mean gestational age 31.4 +/- 2.8 weeks). The mean Vitamin D levels in infants with RDS were 28.52 +/- 21.66 ng/mL, compared to 23.33 +/- 19.18 ng/mL in the control group. No significant relationship was found between Vitamin D levels and the presence of RDS (P = 0.44). No correlation was observed between RDS severity score and Vitamin D levels; however, a strong correlation was identified between Vitamin D levels and birth weight (P < 0.001). Conclusion: The study found no significant association between Vitamin D levels and RDS; further research is necessary to elucidate this complex relationship.
Background and Objective: Preterm birth is a leading cause of neonatal morbidity and mortality worldwide. Very low birth weight (VLBW, <1500 g) infants born at <= 32 weeks' gestation are at a particularly high risk of complications. Design and Setting: This retrospective cohort study evaluated the short-term outcomes of VLBW infants at a tertiary neonatal intensive care unit (NICU) in Madinah, Saudi Arabia, over a 10-year period (January 1, 2015-December 31, 2024). During this interval, the average annual live birth rate was 1,582. The resulting VLBW incidence of 0.85% aligns with international benchmarks of 0.8%-1.0%.Methods:All infants with VLBW <1500 g with gestational ages <= 32 weeks requiring NICU admission were included (divided into two groups 24-<28 weeks and 28-32 weeks). Data on survival, respiratory support, and major complications of prematurity, including intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP), early and late onset sepsis, were analyzed and compared with published global benchmarks. Infants with confirmed major congenital anomalies incompatible with life were excluded from the study. Only two such cases were identified and excluded: one infant with Edwards syndrome (Trisomy 18) and another with Potter sequence. Results: A total of 134 infants were included. Survival was higher than global averages at both 24- <28 weeks (75.8% vs. 55%) and 28-32 weeks (99.0% vs. 85%). Major morbidities were generally lower in our cohort: IVH (18.2% vs. 20.3% at 24-<28 weeks; 5.0% vs. 15.0% at 28-32 weeks), NEC (9.1% vs. 10.0%; 3.0% vs. 4.5%), and ROP (33.3% vs. 70.9%; 1.0% vs. 21.8%). Intubation rates were low at 24-<28 weeks (81.8%) and significantly low at 28-32 weeks (24.8%), both were lower than global figures. Conclusion: Survival of VLBW infants at Prince Sultan Armed Forces Hospital was superior to world benchmarks, with lower rates of IVH, NEC, and ROP.
Aims:To assess the organisation, logistics and quality of neonatal transport services in Oman.Methods:A validated online survey was distributed to 96 healthcare institutions providing maternity and pediatric services across all 11 Omani governorates, including primary health centers, extended polyclinics and secondary and tertiary hospitals. The survey assessed team composition, equipment availability and reported outcomes.Results:The response rate was 64.6%, with most responses from Dhofar and South Sharqiyah governorates. Over 80% of institutions lacked a designated neonatal transport leader. Team composition varied, but 83.9% included both a physician and a nurse. Major resource gaps were identified: 61.3% of institutions lacked specialised neonatal transport vehicles, 62.9% lacked transport incubators and 61.3% lacked transport ventilators. While 83% reported no transport-related mortality, institutional self-reported transport-related deaths were attributed to equipment shortages (50%), untrained staff (25%) and equipment malfunction (12.3%).Conclusion:Based on this institutional self-report and compared with established systems in high-income countries, Oman's neonatal transport services show significant deficiencies in staffing, equipment and standardised protocols. A coordinated national strategy is urgently needed to strengthen neonatal transport through the establishment of dedicated teams, implementation of evidence-based guidelines and investment in essential equipment to improve outcomes and reduce preventable morbidity and mortality.
Congenital toxoplasmosis often presents with a broad clinical spectrum. Symptomatic infection is the presence of the classic triad: intracranial calcifications, hydrocephalus, and chorioretinitis. Here, we report the first case of a neonate presenting with isolated hepatic calcification and neonatal hepatitis associated with congenital toxoplasmosis. This rare case presentation emphasizes the need for meticulous antenatal screening and comprehensive neonatal evaluation in such cases. Toxoplasmosis has long-term sequelae that can be mitigated by early detection and treatment.
Background:Delayed cord clamping (DCC) at birth has been shown to improve cardiovascular stability in neonates. However, reference ranges for respiratory and heart rates (HRs) in term neonates following DCC have not been established. We describe respiratory and HR changes during the first 24 h in healthy term neonates following DCC.Methods:This study was conducted at a tertiary care hospital in Northern Rajasthan from January 2022 to July 2023. We included 200 full-term neonates delivered through uncomplicated vaginal delivery who underwent DCC of 60 s. Respiratory rate (RR) was measured by observation and by auscultation. HRs and RRs were recorded at 2, 4, 8, 12, 16, and 24 h after birth while in Prechtl's behavioral states 1-4. Percentile curves were estimated using the generalized additive model for location, scale, and shape.Results:HR and RR data from 200 infants were recorded. Mean observed RR declined from 49.44 to 42.18 breaths/min between 2 and 24 h and mean auscultated RR declined from 50.18 to 43.20 breaths/min. Mean HR decreased from 145.80 to 128.94 beats/min over the same period. RRs were higher in neonates with meconium-stained amniotic fluid at all time points (P < 0.001), no sex-based differences detected.Conclusions:The reference ranges and percentiles for respiratory and HR derived in this study support early postnatal assessment and help identify abnormal patterns warranting further evaluation.
Anorectal malformation is an important congenital condition characterized by an absent anal opening. Among its varied presentations, rectal atresia (RA) is a type in which the rectum terminates blindly without a fistulous connection. However, the anus is present and is patent for about 1-2 cm. Congenital pouch colon (CPC) is a rare condition associated with anorectal agenesis, characterized by an abnormal colon dilation. This abnormal pouch terminates in the urethral tract through a fistula. The association of RA with CPC is extremely uncommon. We operated on a male neonate having RA associated with a CPC. The diagnosis of pouch colon was suspected based on an X-ray, and it was confirmed intraoperatively. Being an extremely uncommon clinical entity, it is presented with a review of the relevant literature.
Background:Low birth weight (LBW) is a well-established risk factor for neonatal mortality, particularly among preterm infants. However, regional trends and the burden of LBW-related neonatal deaths remain underexplored in the Middle East and North Africa (MENA) region. This study examines the trends in LBW-related preterm neonatal mortality across 21 MENA countries during 1990-2021.Aims:This study aims to assess the temporal trends and geographic disparities in LBW-related preterm neonatal mortality across 21 MENA countries from 1990 to 2021, using data from the Global Burden of Disease (GBD) database, to identify high-burden countries and inform targeted public health interventions.Methodology:Data from the GBD database were analyzed for 21 MENA countries, covering 1990-2021. A Bayesian dynamic model was applied to evaluate temporal changes and geographic patterns across the included countries.Results:Yemen and Sudan exhibited the highest positive deviations, with mortality burdens 213.4% and 207.8% above the regional trend, respectively (P < 0.05). In contrast, Qatar, Bahrain, and Kuwait showed the most substantial negative deviations, with burdens 60.3%, 56.0%, and 55.0% below the regional average, respectively (P < 0.05). Some countries, including Egypt, Jordan, Lebanon, and Tunisia, revealed no statistically significant deviation from the regional trend.Conclusion:While overall LBW-related neonatal mortality has declined in the MENA region, substantial disparities remain between countries. Targeted public health interventions are necessary, particularly in high-burden countries such as Yemen and Sudan, to reduce preterm neonatal mortality. These findings provide evidence to guide policy and prioritize resources to improve neonatal health outcomes across the region.
Background:Very low birth weight (VLBW) neonates are at increased risk for developing inflammatory conditions, complications from parenteral nutrition (PN), and cholestasis. Clinicians lack reliable, noninvasive biomarkers to monitor these conditions effectively. Fecal metabolomics, particularly the targeted analysis of sphingomyelins, presents a promising noninvasive diagnostic strategy to evaluate both intestinal and systemic health in this population.Methods:This prospective cohort study enrolled 45 preterm infants weighing <1500 g at birth. Stool samples were collected twice weekly and underwent targeted metabolomic analysis, quantifying 17 sphingomyelin species. Logistic regression models, adjusted for birth weight, assessed associations between sphingomyelin concentrations and three clinical outcomes: inflammatory conditions, prolonged PN, and cholestasis.Results:The cohort had a median gestational age of 26 weeks and median birth weight of 870 g. Higher fecal sphingomyelin levels generally correlated with fewer inflammatory complications, lower incidence of prolonged PN, and a decreased frequency of cholestasis, although these associations were modest. Multivariate analyses indicated that sphingomyelin 20:4 was significantly associated with cholestasis, although with wide confidence intervals. In addition, sphingomyelin 23:0 exhibited a notable inverse relationship with inflammatory conditions, suggesting a possible protective role. Other species showed weak and inconsistent correlations with clinical outcomes, underscoring the complexity of sphingomyelin metabolism.Conclusion:Although most associations were not statistically significant, trends observed across multiple sphingomyelins suggest that fecal lipid profiles may reflect underlying inflammatory and hepatobiliary processes in this population. Fecal sphingomyelins, particularly 20:4 and 23:0, demonstrate potential as noninvasive biomarkers for inflammation and cholestasis in VLBW neonates.
Context: Azithromycin (AZM) is a promising anti-inflammatory medication that may mitigate bronchopulmonary dysplasia (BPD) in very preterm newborns. Aim: The objectives were to assess the effectiveness and safety of AZM in BPD prevention in preterm neonates. Settings and Design: Prospective randomized-controlled-trial conducted at the Neonatal-Intensive-Care Unit of Alexandria-University-Maternity-Hospital from November 2024 to May 2025.Methods:A total of 100 neonates with gestational age <32 weeks, still requiring respiratory support at day 7, were randomized into two groups: the AZM and control groups to receive nebulized AZM in a dose of 20 mg/kg/day for 3 weeks. Extended lung ultrasound was performed at days 7, 14, and 28 postnatally. Primary outcomes centered around the occurrence of BPD at 36 weeks' post-menstrual age (PMA), as well as the need for postnatal steroids. A comparative analysis was conducted among these groups. Results: The mean (standard deviation) gestational age for the entire population was 29.52 +/- 1.05 weeks. Thirteen neonates (27.1%) among the AZM group developed BPD compared to 14 (31.1%) in the control group (P = 0.669). BPD severity at 36 weeks' PMA and postnatal steroid use showed no significant difference between study groups. Conclusions: Routine administration of AZM for BPD prevention cannot be endorsed in clinical practice; however, it was generally found to be safe for use in preterm infants. The study was registered at http://www.clinicaltrials.gov with ID number: NCT06584474. In October 2024, with URL: Https://cdek.pharmacy.purdue.edu/trial/NCT06584474/.
Background:Neonatal mortality continues to be a significant public health concern in the low- and middle-income countries, especially in neonates requiring interfacility transport.Objective:To determine the predictors of mortality, early morbidity (hypoglycemia, hypothermia, or shock within 72 h of admission), and unplanned discharge among outborn neonates referred to a tertiary neonatal intensive care unit (NICU) in northwestern India.Methods:This prospective observational study was conducted in the emergency room and NICU of a tertiary center (June 2022-July 2023). Pretransport stabilization was defined as the documentation of thermal protection, airway clearance, glucose monitoring, and oxygen/intravenous access before interfacility transfer. Multivariable logistic regression identified predictors of mortality, early morbidity, and unplanned discharge.Results:Mortality, early morbidity, and unplanned discharge were found in 52 (22.5%), 110 (47.6%), and 53 (22.9%) neonates, respectively, among the total of 231 neonates included. Mortality predictors: gestational age <32 weeks (adjusted odds ratio [AOR]: 4.39; P = 0.01), lack of stabilization (AOR: 3.13; P = 0.02), low socioeconomic status (SES; AOR: 3.90; P = 0.01), and resuscitation (AOR: 18.6; P < 0.001). Early morbidity was associated with no pretransport stabilization (AOR: 5.67; P < 0.001) and very low birth weight <1.5 kg (AOR: 3.64; P = 0.002). Unplanned discharge was predicted by low SES (AOR: 5.58; P < 0.001) and no stabilization (AOR: 5.34; P < 0.001).Conclusion:Socioeconomic disparities and inadequate pretransport stabilization were key predictors of adverse neonatal outcomes. By including unplanned discharge as an indicator of care continuity, this study shows how social and transport factors collectively influence neonatal outcomes in resource-limited settings.
A late preterm male neonate, weighing 2300 g, was delivered vaginally at 34 weeks of gestation to a 25-year-old primigravida in a nonconsanguineous marriage due to prolonged prelabor rupture of membranes. The antenatal period was uneventful with regular antenatal visits. The neonate was vigorous at birth and was shifted with the mother to the postnatal unit. The neonate was discharged after an uneventful postnatal period at 48 h of delivery on exclusive breastfeeding. There was no follow-up immediately postdischarge from the hospital. On day of life 7, the mother noticed yellowish discoloration of the neonate's trunk, followed by the sclera, for which she approached the pediatrician. Following the preliminary evaluation, the neonate was referred to our hospital for the management of severe jaundice. At admission, the head circumference and length were 32 cm and 40 cm, respectively (both falling between the 50th and 95th percentiles on the modified Fenton's chart). The total serum bilirubin was reported to be critically high with value of 35 mg/dL of which the indirect component is 32.9 mg/dL. Clinical examination reveals persistent irritability, generalized hypertonia, retrocollis, and occasional opisthotonus with bilirubin-induced neurological dysfunction score of three. There was no hepatosplenomegaly, pallor, bleeding tendency, or clinical seizure. There was no dysmorphism noted in the neonate. Maternal and neonate blood groups are B-positive. The direct Coombs test was negative. The preliminary evaluation revealed the diagnosis of nonhemolytic jaundice. The Whole exome sequence revealed the mutation of uridine glucuronosyltransferase 1A1, suggesting the diagnosis of Crigler-Najjar (CN) Syndrome. We report a rare case of genetically confirmed CN syndrome type 2 (CN-2) presenting with severe hyperbilirubinemia and kernicterus, emphasizing the importance of early follow-up and genetic evaluation in persistent neonatal jaundice, the case discussed describes the rare combination of symptoms that CN-2, despite being the milder form, can still lead to catastrophic neurological injury when the diagnosis is delayed and hyperbilirubinemia is left untreated. It underscores the critical need for a high index of suspicion and immediate, aggressive intervention for severe neonatal jaundice before the definitive subtyping is achieved, to prevent irreversible brain damage.
Background:The COVID-19 pandemic and subsequent social distancing measures have disrupted various aspects of child development, with particular concern for infants in neonatal intensive care units (NICUs), where heightened vulnerabilities and limited external stimuli may exacerbate neurodevelopmental risks.Objective:The objective of this study was to examine the impact of the COVID-19 pandemic on neurodevelopmental outcomes in infants admitted to NICUs at birth, comparing neurodevelopmental indicators from before and during the pandemic period.Materials and Methods:A retrospected matched cohort study was conducted on infants admitted to NICUs at birth during the COVID-19 pandemic, with neurodevelopmental evaluations carried out at 6 and 12 months of age. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III, 2006).Results:From September 2020 to December 2021, a total of 114 infants were consecutively enrolled in the study, with a matched control group selected. Analyses revealed no significant differences in Bayley-III scores between infants in the pandemic group and those in the control group.Conclusion:Short-term neurodevelopmental outcomes for NICU infants were unexpectedly unaffected by the additional stress of pandemic-related restrictions.
Background:Neonatal conjunctivitis (NC) affects newborns within the first 4 weeks of life and can lead to serious ocular complications and blindness if not treated promptly. The specific organisms responsible for these infections can vary across different populations and clinical settings. The current recommendation is to administer eye ointment prophylaxis to all newborns to prevent NC.Aim:Study the local epidemiology and Susceptibility Patterns of pathogens causing NC and to assess the role of routine prophylaxis.Materials and Methods:This retrospective multicenter cohort study was conducted at two tertiary care centers in Saudi Arabia over 3 years. All neonates with positive eye cultures within the first 28 days of life were included.Results:The total number of NC cases was 244 out of 32,365 live births, which is approximately 754 per 100,000 live births. Staphylococcus aureus (19%) was the most frequently isolated organism, followed by Klebsiella pneumoniae (17%), Escherichia coli (13%), Pseudomonas aeruginosa (11%), Haemophilus influenzae (7%), and Enterobacter cloacae (7%). Only one case of isolated Neisseria gonorrhea was observed. Gentamicin was more than 80% effective against most detected pathogens.Conclusion:NC is a relatively common infection, and healthcare providers can improve patient outcomes by aligning antibiotic recommendations with current microbiological data. Gentamicin is a suitable empirical local antibiotic for NC in our population. Our local data show a scarcity of documented cases of NC caused by gonococcal infection despite no prophylaxis being administered; therefore, routine prophylaxis should be reconsidered.
Preterm birth remains a major global health concern, particularly in low- and middle-income countries, where nearly 15 million babies are born preterm each year. Monitoring postnatal growth in these infants is critical, as early identification of growth faltering or extrauterine growth restriction (EUGR) influences clinical management, nutritional strategies, and long-term neurodevelopmental outcomes. Over the years, several growth references have been developed, with the Fenton 2013 and INTERGROWTH-21 st (2015) charts being the most widely used. This narrative review synthesises evidence on their methodology, clinical applications, and implications for neonatal care. The Fenton 2013 charts, derived from meta-analysis of international birth size data, align preterm growth with intrauterine expectations and WHO child growth standards at 50 weeks postmenstrual age. While widely adopted, they often classify a higher proportion of infants as EUGR. In contrast, the INTERGROWTH-21 st standards were constructed from longitudinal postnatal data of stable preterm infants under optimal care conditions across diverse populations, overlapping seamlessly with WHO standards at 64 weeks. These charts reflect realistic early postnatal growth, including physiological weight loss, thereby reducing overclassification of growth failure. Comparative studies highlight significant discrepancies in growth classification, with Fenton identifying up to threefold more EUGR cases than INTERGROWTH-21 st . This divergence has major implications for feeding strategies, discharge readiness, and long-term labelling. Ultimately, no single chart is universally superior; the choice should be tailored to clinical context, infant characteristics, and monitoring goals. Awareness of each chart’s conceptual foundation, strengths, and limitations is essential to guide evidence-based neonatal growth monitoring
