Survival without Major Morbidity or Neurodevelopmental Impairment in Preterm Infants – Current Landscape, Challenges, and Future Directions

The paradigm for evaluating success in neonatology has definitively shifted from survival alone to the achievement of intact survival—specifically, "Survival Without Major Morbidity or Neurodevelopmental Impairment" (SWMM-NDI). This composite endpoint, now central to major trials and quality benchmarks, rigorously defines the absence of severe bronchopulmonary dysplasia (BPD), serious brain injury, necrotizing enterocolitis requiring surgery, severe retinopathy of prematurity, nosocomial infection, and significant cognitive or motor impairment at 18-24 months.

While overall survival rates for extremely preterm infants have improved, gains in SWMM-NDI have not kept pace. For example, in infants born at 22-24 weeks' gestation, survival may exceed 50% in high-resource settings, yet the rate of SWMM-NDI often remains below 30%. This gap underscores a critical reality: many lifesaving interventions, from prolonged ventilation to postnatal corticosteroids, carry inherent risks for the very morbidities this outcome seeks to avoid. Consequently, contemporary neonatal care is characterized by a delicate and often conflicting balance between immediate life support and the prevention of long-term sequelae, making SWMM-NDI the most relevant but challenging measure of true therapeutic success.

Goal

The primary objective of this Research Topic is to critically examine and advance the paradigm of intact survival in preterm infants. Despite technological advances, a persistent and significant gap remains between improved survival rates and the proportion of infants who survive free of major complications and neurodevelopmental impairment. This disconnect highlights a fundamental challenge in neonatal-perinatal medicine: how to reconcile immediate, life-sustaining interventions with their potential to contribute to the long-term morbidities we seek to prevent. Our purpose is to synthesize evidence, identify key modifiable factors, and explore innovative strategies that specifically target the SWMM-NDI endpoint. We aim to move the field from a focus on survival alone towards integrated care pathways designed to optimize the lifelong health and neurodevelopmental trajectory of preterm infants.

Scope and Information for Authors

This Research Topic solicits manuscripts that directly investigate the determinants, measurement, and improvement of the composite outcome Survival Without Major Morbidity or Neurodevelopmental Impairment (SWMM-NDI) in preterm infants. We welcome original research, reviews, and perspectives that address specific, actionable themes, including:

Antenatal & Perinatal Determinants: The impact of precise gestational age, chorioamnionitis phenotypes, antenatal steroid timing, and magnesium sulfate regimens on SWMM-NDI.
Postnatal Care Bundles: Analysis of integrated interventions (e.g., non-invasive respiratory support, early enteral nutrition, pain management) and their synergistic effect on reducing the overall burden of morbidity.
Pharmacological Neuroprotection: Evaluation of caffeine, erythropoietin, and other agents specifically on the SWMM-NDI endpoint, including dose-response and timing.
Disparities & Equity: Investigations into the social, racial, and geographic disparities in SWMM-NDI rates and interventions to promote equity.
Long-term Follow-up & Metrics: Critical appraisal of current neurodevelopmental assessment tools, the definition of "impairment," and strategies for effective, standardized post-discharge surveillance.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Major Morbidity, Preterm Infants, Neonatal Outcomes, Perinatal Challenges, Neurodevelopmental Impairment

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.