Delirium prevalence and associated factors in critically ill neonates hospitalized in the NICU and their neurodevelopmental implications

Despite the vulnerability of the developing neonatal brain, delirium remains a largely unrecognized complication in the NICU, with its prevalence and associated factors still poorly characterized. This condition is increasingly recognized as a potential indicator of acute brain dysfunction. However, evidence regarding its neurodevelopmental consequences remains speculative and requires longitudinal investigation.

Accordingly, this study aimed to identify factors associated with the development of delirium in neonates admitted to the NICU and to explore their neurodevelopmental implications. This prospective observational study with a cross-sectional analytical design was conductedin three Level III NICUs between November 2023 and January 2025. A total of 243 neonates were included.

Data were collected using a demographic questionnaire and the Cornell Assessment of Pediatric Delirium (CAPD) scale. Statistical analysis included descriptive statistics. A multivariable logistic regression model was developed, with covariates selected a priori based on a Directed Acyclic Graph (DAG) to minimize bias.

The model’s quality was assessed using the Hosmer-Lemeshow test, Area under the Curve (AUC), and Nagelkerke R2. The final multivariable logistic regression model identified several independent factors: Corrected Age (OR 0.964, 95% CI 0.941–0.989, p = 0.004) and Birthweight (OR 0.872 per 100 g increase, 95% CI 0.815–0.933, p