Long-term outcomes and rehabilitation perspectives in children after neonatal sepsis: a systematic review

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Abstract

Neonatal sepsis remains a significant cause of mortality and long-term complications in newborns. However, evidence-based approaches to the rehabilitation of children surviving sepsis remain insufficiently developed, highlighting the need to synthesize available data. This review summarizes current evidence on the long-term outcomes and rehabilitation opportunities in children who experienced sepsis during the neonatal period. A scientific data search covering 2019–2024 was conducted in PubMed and eLibrary.ru databases using keywords related to rehabilitation, sepsis, and neonates. After removing duplicates and applying multi-stage screening for relevance to the review topic, 55 publications were included for analysis. The review revealed a high risk of long-term multi-organ sequelae after neonatal sepsis, including neurological impairments (cognitive deficits, cerebral palsy), sensory deficits, bronchopulmonary dysplasia, and cardiovascular dysfunction. It also highlights the lack of unified criteria and methodology for diagnosing neonatal sepsis, as well as protocols for assessing immediate and long-term outcomes in newborns who survived sepsis, and convincing evidence regarding the effectiveness of specific rehabilitation methods. The challenge of implementing modern rehabilitation in neonates is emphasized, since most existing scientific and practical approaches are based on extrapolation of data obtained from the rehabilitation of preterm infants or patients with other conditions, and are not supported by high-quality randomized controlled trials specifically in the population of children after sepsis. The review outlines the current three-stage rehabilitation model (in the intensive care unit, during inpatient care, and in outpatient settings) and discusses several key directions: neurorehabilitation (neuroprotective agents, kinesiotherapy, sensory integration), nutritional support (enriched feeding, optimization of protein–energy balance, prebiotics and probiotics), and psychological support (family-centered early intervention model). Promising approaches that require further investigation include novel neuroprotective agents (xenon, darbepoetin, topiramate, melatonin, caffeine, metformin, hydrocortisone, RLS-0071, stem cells, and sovateltide) and mesenchymal stromal cell secretome therapies. Despite the importance of this issue, the rehabilitation of children after neonatal sepsis remains a field with a low level of evidence. This review systematizes the available evidence, highlights the need for further research to develop evidence-based rehabilitation programs, and to establish individualized rehabilitation trajectories aimed at improving long-term outcomes and quality of life in neonates.

About the authors

Alexandr V. Golomidov

S.V. Belyaev Kuzbass Regional Clinical Hospital

Author for correspondence.
Email: golomidov.oritn@yandex.ru
ORCID iD: 0000-0001-7522-9094
SPIN-code: 4406-2065

MD, Cand. Sci. (Medicine)

Russian Federation, Kemerovo

Evgeny V. Grigoriev

Research Institute for Complex Issues of Cardiovascular Diseases

Email: grigorievev@hotmail.com
ORCID iD: 0000-0001-8370-3083
SPIN-code: 2316-2287

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the RAS

Russian Federation, Kemerovo

Vadim G. Mozes

Kemerovo State University

Email: vadimmoses@mail.ru
ORCID iD: 0000-0002-3269-9018
SPIN-code: 5854-6890

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Kemerovo

Kira B. Mozes

S.V. Belyaev Kuzbass Regional Clinical Hospital

Email: kbsolo@mail.ru
ORCID iD: 0000-0003-2906-6217
SPIN-code: 7479-6695
Russian Federation, Kemerovo

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