Neonatal sepsis is a major cause of mortality and morbidity, representing a critical emergency that demands swift diagnosis and intervention. Recent trend shows increasing resistance to commonly used antibiotics. To study the antimicrobial resistance pattern in blood culture positive neonatal sepsis in outborn and inborn neonates and to compare the clinical profile in neonates with proven sepsis. Bacterial cultures of the blood samples received from neonates with suspected sepsis was performed and antimicrobial susceptibility testing of blood culture positive neonates was done. Antibiotic sensitivity tests were done as per Clinical and Laboratory Standards Institute (CLSI) 2023 guidelines. Of the 100 participants, 34 were early onset neonatal sepsis and 66 were late onset neonatal sepsis. 35% of the delivery were vaginal whereas 65% of the deliveries were by Caesarean section. 17% of the total neonates delivered had to undergo neonatal resuscitation and 36% of the neonates had birth asphyxia. The most commonly isolated organisms were Coagulase-negative Staphylococcus species (CoNS) (30%) followed by Klebsiella pneumoniae (21%) and Acinetobacter baumannii complex (20%). 45.1% were Extended Spectrum beta lactamase (ESBL) producers and 58% were AmpC beta lactamases producers. Case fatality rate was highest with Klebsiella pneumoniae i.e. 34.6% followed by Acinetobacter baumannii complex i.e. 23.07%. Increase in antibiotic resistance organisms can lead to an increase in the neonatal case fatality rate (CFR), so regular surveillance is needed. Comparison between the resistance profile between inborn and outborn neonates provides an insight into the difference in the variety of organisms isolated and also the difference in resistance shown by community acquired and hospital acquired organisms.

TREM-1: A potential prognostic marker in newborns with late-onset sepsis.

Pro-adrenomedullin as a Marker for Diagnosis of Neonatal Sepsis

Inflammation in neonatal sepsis triggers cytokine-driven disruption of erythropoiesis, producing a mix of immature and damaged red cells. Objectives: To determine the diagnostic accuracy of RDW for early onset neonatal sepsis (EONS) in term newborns, taking culture-proven EONS as the gold standard. Methods: This prospective validation study was conducted at the Department of Neonatology of Children's Hospital, Institute of Child Health, Multan. A total of 147 term neonates with suspected EONS were enrolled consecutively. Neonates with asphyxia, meconium aspiration, major congenital malformations, or hemolytic disease were excluded. Clinical and laboratory data, including RDW, were collected. Blood, urine, and cerebrospinal fluid cultures were performed as per CLSI guidelines. EONS was confirmed by positive blood culture. A cutoff value of RDW ≥17% was used for labelling EONS. Data were analyzed using SPSS version 25.0, and the diagnostic accuracy of RDW was calculated, taking culture-proven neonatal sepsis as the reference standard. Results: The mean postnatal age was 3.7±1.4 days. The mean RDW was 16.9 ± 1.9%. RDW of ≥17% was observed in 54.4% of the neonates. Culture confirmed EONS was diagnosed in 59.9%. RDW showed sensitivity of 84.1% (95% CI: 74.8-91.0%), specificity of 89.8% (95% CI: 79.2-96.2%), positive predictive value of 92.5%, negative predictive value of 79.1%, and diagnostic accuracy of 86.4%. The area under the ROC curve was 0.87 (95% CI: 0.81 – 0.93, p<0.001). Conclusions: RDW ≥17% demonstrated high diagnostic accuracy as an early predictor of culture-confirmed EONS in term neonates.

Background Neonatal sepsis caused by multidrug-resistant organisms (MDROs) is a significant cause of morbidity and mortality. Research on MDRO sepsis risk factors in the UAE is limited; hence, proper evaluation for targeted therapy is needed. Objective This study aimed to identify risk factors for MDRO in late-onset neonatal sepsis. Methods This case–control study was carried out in NICU of Tawam Hospital, and data from culture-positive LOS patients were collected between January 2015 and February 2019, including Patient demographics, clinical findings, and presence of antibiotic resistance. The cases were those neonates with late-onset sepsis (LOS) due to MDRO, and the controls were those non-MDRO. Antibiotic regimens for LOS management and mortality rates were collected. Chi-square, independent t-test, Kruskal–Wallis, and Logistic regression were performed as appropriate. Results Of the 172 neonates with LOS episodes (29 cases and 143 controls), 49.0% were female, 82.0% were preterm, the median age was 24 days, IQR (10–75), and the median weight was 1,042.0 g; IQR(700–1860). Extended-spectrum beta-lactamases (45.0%) and cephalosporin-resistant Klebsiella spp. (17.0%) were the most common MDROs in our hospital. The incidence of resistance to empiric antibiotic regimens was 7.0% in the case group and 9.0% in the control group. The independent risk variables for MDRO sepsis were female sex (OR 2.67; 95% CI 1.13–6.25), necrotizing enterocolitis (OR 4.54; 95% CI 1.98–10.4), and the use of umbilical arterial catheters (OR 5.02; 95% CI 1.09–23.11). The overall mortality rates (41.0% vs. 40.0%) and 72-hour mortality rates (17.0% vs. 14.0%) exhibited no significant differences between the MDRO and non-MDRO cohorts. Conclusion The study identified extended-spectrum beta-lactamase Enterobacteriaceae as the predominant MDRO in the unit. It highlighted several independent risk factors associated with MDRO infections; hence, longer hospital stays, including female sex, NEC, and UAC. These results support the integration of risk-based empirical antibiotic regimens in NICUs.

Letter to the editor regarding ‘Clinical value of procalcitonin-to-albumin ratio for identifying sepsis in neonates with pneumonia’

Objectives: To determine the diagnostic accuracy of red cell distribution width in the detection of presence of sepsis in neonates. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Pediatrics, Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2021 to Feb 2022. Methodology: A total of 77 neonates suffering from acute febrile illness were included for study. Neonates born premature, low birth-weight, with meconium aspiration, or suffered from iron deficiency or haemoglobinopathies were excluded. The diagnosis of sepsis was established clinically using the 2005 International Pediatric Sepsis Consensus Conference guidelines. All patients were tested for red cell distribution width index via a phlebotomy on admission. Results: The mean age of patients in our study was 16.38±6.71 days, of whom 44(57.1%) were male. A total of 27(35.1%) of patients had a family history of febrile seizures. The mean red cell distribution width of the patients was 17.71±2.89% and of these, 37(48.1%) patients had a value above the 18.0% cut-off level. Sepsis was present in 41(53.2%) cases. Red cell distribution width with a cut-off of value of greater than 18.0% as an indicator of the presence of neonatal sepsis had a sensitivity of 58.4%, specificity of 63.9% and a diagnostic accuracy of 61.0%. Conclusion: Red cell distribution width is a useful marker in the detection of the presence of sepsis, but lacks the appropriate diagnostic accuracy, precluding its use in isolation as a single marker for sepsis.

Background Candidemia poses a significant health challenge in neonates. This study evaluates a modified version of the Candida Score to enhance early detection and guide antifungal therapy decisions. Objective To assess the accuracy of a revised Candida Score® that integrates thrombocytopenia and patient origin into the original parameters. Methods A retrospective case-control study was conducted at the Harapan Kita National Women and Children Health Centre (HKNWCHC) from 2017 to 2023. The study involved 32 neonates diagnosed with candidemia and 29 with bacterial sepsis. The original Candida Score – comprising total parenteral nutrition (TPN), surgery, multifocal colonisation, and severe sepsis – was modified by adding platelet count and patient origin. Multivariate logistic regression identified predictive factors, while ROC curve analysis validated the revised scoring system. Results Severe thrombocytopenia (AOR 7.153; p = 0.043) and outborn status (AOR 6.035; p = 0.014) were significantly associated with candidemia. The revised Candida Score® showed sensitivity of 81.3%, specificity of 58.6%, positive predictive value (PPV) of 68.4%, negative predictive value (NPV) of 62.9%, and an area under the curve (AUC) of 0.743 (p = 0.001). Conclusion Incorporating outborn status and thrombocytopenia improved early identification of neonatal candidemia. The revised Candida Score® is a practical tool for empirical antifungal guidance in resource-limited settings. Its high sensitivity makes it an effective screening tool, despite moderate specificity.

Neonatal sepsis remains a major cause of morbidity and mortality, with diagnosis complicated by nonspecific clinical signs and limited reliability of conventional laboratory tests. This study aimed to evaluate and compare the diagnostic efficacy of biomarkers tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and procalcitonin (PCT) with traditional sepsis screening parameters in neonates. This hospital-based case-control study was conducted in the neonatal intensive care unit of a North Indian tertiary care medical university between September 2023 and March 2025. A total of 300 neonates were screened, of which 100 were diagnosed with sepsis (cases) and the remaining 200 served as controls. Sepsis screening, TNF-α, IL-6, PCT, and blood culture were performed to diagnose neonatal sepsis. Results of this study showed significantly higher levels of all tested biomarkers and sepsis parameters in cases compared with controls. Among biomarkers, TNF-α demonstrated the highest accuracy [area under the curve of the receiver operating characteristic (AUROC) 0.99, sensitivity 94%, specificity 100%], followed by PCT (AUROC 0.82, sensitivity 80%, specificity 82.5%) and IL-6 (AUROC 0.79, sensitivity 86%, specificity 74.5%). The study concludes that TNF-α is the most reliable biomarker for diagnosing neonatal sepsis, although a multimodal approach integrating conventional parameters with cytokines and PCT offers the best diagnostic yield. Combining early biomarkers with standard screening may improve early recognition, reduce unnecessary antibiotic exposure, and strengthen antimicrobial stewardship.

Premature Rupture of Membranes (PROM) is one of the obstetric complications that often causes morbidity and mortality in both mothers and infants. This condition occurs when the amniotic membranes rupture before the onset of labor contractions or before the gestational age reaches 37 weeks. PROM increases the risk of intrauterine infection, preterm labor, neonatal sepsis, and asphyxia if not properly managed. This case study aims to describe the application of Evidence Based Practice (EBP) in midwifery care for a woman in labor with PROM at Al-Fatah General Hospital Ambon. The case involved Mrs. D, a 22-year-old woman, G2P1A0, at 34 weeks of gestation, who was admitted to the hospital with complaints of watery discharge from the birth canal accompanied by lower abdominal pain and blood-stained mucus. Examination revealed cervical dilation of 7 cm, absence of membranes, fetal head at Hodge III, and a fetal heart rate of 145 beats per minute. The diagnosis was established as intrapartum stage I active phase with preterm premature rupture of membranes (PPROM). Midwifery management included close observation of labor progress, administration of Ringer’s Lactate infusion, and prophylactic intravenous Cefotaxime according to WHO guidelines. After four hours without progress, collaboration was carried out with an obstetrician, and a cesarean section (SC) was performed due to inadequate labor progression and risk of intrauterine infection. The implementation of EBP in this case proved to enhance maternal and neonatal safety through rapid, rational, and collaborative clinical decision-making. This evidence-based approach reflects Al-Fatah General Hospital Ambon’s commitment to providing safe, effective, and high-quality midwifery care.

Time to recovery and predictors of neonatal sepsis among neonates admitted to intensive care units in Southern ethiopia: multicenter study

Early-onset disease (EOD) remains one of the most common causes for initiating antibiotics. In response, diagnostic approaches such as the guidelines by the National Institute for Health and Care Excellence (NICE) and the American Academy of Pediatrics (AAP) have been proposed. The Kaiser-Permanente model by the AAP estimates the probability of EOD per 1000 births in neonates born at ≥34 weeks' gestation. This study aims to evaluate the antibiotic use in a neonatal department for suspected EOD cases and to compare the existing practice-a combination of NICE guidelines and individual physician judgement-with the official guidelines of NICE and AAP for initiating treatment. A retrospective study was conducted at the Neonatology Department of the National and Kapodistrian University of Athens, Aretaieio Hospital, from January 2018 to December 2021. Among the participants (N = 259), 21.2% received antibiotics, but only 13.5% in full accordance with NICE guidelines. The remaining cases were treated based on physician discretion, outside NICE or AAP criteria. The Kaiser model resulted in the lowest antimicrobial use (10.9%), compared with the risk-based (58.2%) and the serial physical examination (SPE) strategies (60%) for the treated neonates. Only the SPE method accurately identified the single confirmed case of EOD. The combination of Kaiser and SPE models was associated with low antimicrobial use (13%) and early detection of true GBS-EOD. Antimicrobial use in neonates should adhere only to established guidelines, by NICE or AAP. However, combining Kaiser and SPE strategies may minimize the antimicrobial overuse and ensure timely treatment for confirmed EOD.

Neonatal doses for the off-patent antibiotics fosfomycin and flomoxef, which offer coverage against many extended-spectrum beta-lactamase (ESBL)-producing organisms, are based on limited data. We performed a pharmacokinetic (PK) and safety study of fosfomycin and flomoxef to confirm proposed neonatal dosing before further investigation in a trial (NeoSep1, ISRCTN48721236). Neonates with suspected sepsis, weighing more than 1,000 g, were sequentially enrolled into three antibiotic treatment cohorts: fosfomycin and amikacin (Cohort 1), flomoxef and amikacin (Cohort 2), and flomoxef and fosfomycin (Cohort 3), and followed for 28 days. Plasma samples were taken for PK assessment, with population PK modeling and simulations performed. Sixty-two neonates (48/62 [77%] preterm; 48/62 [77%] ≤7 days postnatal age [PNA]) received at least one dose of study antibiotics. Fosfomycin and flomoxef plasma concentrations were best described by a two-compartment and a one-compartment model, respectively, with postmenstrual age and PNA significantly influencing clearance. The probability of target attainment for fosfomycin was 100% for minimum inhibitory concentrations (MICs) of up to 8 mg/L, and for flomoxef, it was 100% for MICs of up to 0.5 mg/L. Adverse events (AEs) were common in this critically ill cohort. Thirteen (21%) neonates developed 19 trial antibiotic-related AEs (17 with grade ≤2, and 2 of grade 3), none of which required modification or discontinuation of allocated treatment. Seven neonates (11.6%) died. In this predominately preterm population, fosfomycin and flomoxef were safe, with drug exposures similar to published studies supporting the proposed doses for the larger, randomized NeoSep1 trial.This study is registered with ISRCTN48721236.

Aims/Background Early diagnosis of neonatal sepsis is hindered by nonspecific clinical signs and suboptimal biomarkers. Therefore, this study aimed to evaluate the diagnostic accuracy of serum procalcitonin (PCT) and C-reactive protein (CRP), both individually and in combination, and assess the robustness and clinical utility of a combined predictive model. Methods This single-center retrospective cohort (2022-2025, Longyan First Hospital Affiliated to Fujian Medical University, China) included 293 neonates (161 with sepsis and 132 controls). Univariate logistic regression was applied to compare the clinical and laboratory parameters between the sepsis and control groups. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curves, contingency tables, and the DeLong tests. A logistic regression-based combined prediction model was developed using a 7:3 stratified random split into training and validation sets. Model robustness was assessed via calibration plots, decision curve analysis (DCA), and visualized as a nomogram. Subgroup and culture-confirmed-only sensitivity analyses further assessed the consistency of the combined predictive model. Results Sepsis cases exhibited significantly higher PCT, CRP, and white blood cell (WBC), and lower hemoglobin (Hb) and platelet (PLT) (all p < 0.001). Univariate logistic regression confirmed PCT [odds ratio (OR) = 3.32, 95% confidence interval (CI): 2.23-4.93, p < 0.001] and CRP (OR = 1.03, 95% CI: 1.01-1.05, p = 0.003) as significant predictors of neonatal sepsis. The combined PCT-CRP model provided better diagnostic performance, achieving a significantly greater area under the curve (AUC) of 0.94 (95% CI 0.92-0.97) than either marker alone (0.88 for PCT, 0.87 for CRP) as shown by DeLong test (p < 0.001). Furthermore, the model maintained higher sensitivity (82.61%) while significantly improving specificity (93.18%) and overall diagnostic accuracy (87.36%). The nomogram, validated in both sets, exhibited good calibration and net clinical benefit in DCA. Subgroup analysis confirmed consistent predictive performance across gestational age, delivery mode, and sex, with CRP more pronounced in preterm infants. Sensitivity analyses using culture-confirmed sepsis validated model robustness (AUC = 0.94). Conclusion PCT and CRP are key diagnostic biomarkers for neonatal sepsis. Their integration as a combined predictive model significantly enhances diagnostic performance and clinical applicability, providing a practical framework for early sepsis identification and potential for clinical implementation.

BackgroundEpidural-related maternal fever (ERMF) is a common complication of labour analgesia. In vitro evidence suggests ropivacaine provokes inflammatory cytokine release, while lidocaine may exert anti-inflammatory effects. We hypothesized that the addition of lidocaine to a ropivacaine-based epidural solution would reduce the incidence of ERMF.MethodsIn this randomised, double-blind trial, 400 parturients received epidural analgesia with 0.075% ropivacaine and 0.5 μg/mL sufentanil, with or without 0.5% lidocaine. The primary outcome was the incidence of ERMF (tympanic temperature ≥38.0°C).Results ERMF incidence was significantly lower in the lidocaine group (14.1%) than in the control group (28.3%), with an absolute risk reduction of 14.2% (95% CI: 5.6–22.7; P=0.0013). No significant differences were found in maternal antibiotic use or neonatal sepsis evaluations.ConclusionThe addition of lidocaine to ropivacaine for epidural labour analgesia significantly reduced the incidence of ERMF. This finding suggests a simple and promising strategy for preventing this common complication, warranting further investigation into its mechanisms and clinical utility.

Objective:To describe the clinical and laboratory characteristics of Gram-negative neonatal infections and to identify risk factors associated with multidrug-resistant (MDR) Gram-negative infections at the Pediatric Center, Bach Mai Hospital, during 2023–2025. Methods:A cross-sectional study combined with a case–control design was conducted among neonates (&lt;28 days old) diagnosed with neonatal sepsis. The case group included 60 infants with culture-confirmed MDR Gram-negative infections, and the control group consisted of 180 infants with negative cultures. Clinical manifestations, laboratory findings, and potential risk factors were collected and statistically analyzed. Results:Among 60 cases of Gram-negative neonatal infections, late-onset sepsis accounted for 78.9%, while early-onset sepsis accounted for 21.1%. Klebsiella pneumoniae was the most common pathogen (42.3%). The predominant clinical features were respiratory distress (83.3%), tachypnea ≥60 breaths/min (75%), chest retraction (73.3%), SpO₂ &lt;90% (56.7%), poor feeding (56.7%), and jaundice (35%). Laboratory abnormalities included leukocytosis (43.3%), thrombocytopenia (40%), hypoalbuminemia (66.7%), elevated CRP (78.3%), and coagulopathy(70%).Significant risk factors for MDR Gram-negative infection (p &lt;0.05) included age at admission ≥7 days, late-onset sepsis, bag-mask ventilation or re-intubation, blood transfusion, parenteral nutrition, umbilical or central line catheterization, invasive mechanical ventilation ≥7 days, use of vasopressors, and exposure to ≥2 antibiotics or antibiotic regimen changes during treatment. Conclusion:Gram-negative neonatal infections, particularly those caused by Klebsiella pneumoniae, are common and mainly associated with late-onset sepsis. Respiratory symptoms predominate, often accompanied by hematologic, biochemical, and coagulation abnormalities. Early identification and close monitoring of high-risk neonates, adherence to aseptic techniques, effective infection control, and rational antibiotic use are essential to improve outcomes and reduce mortality.

Preterm infants are at high risk of morbidity and mortality, with early-onset neonatal sepsis (EOS) being a major concern. Antimicrobial resistance from extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) further complicates treatment. This study aimed to evaluate maternal ESBL-E colonization, vertical transmission and associated neonatal outcomes. A prospective cohort study was conducted between October 2023 and November 2024 at Ramathibodi Hospital, Bangkok, Thailand. Pregnant women <37 weeks' gestation admitted with preterm labor or preterm prelabor rupture of membranes were screened for vaginal ESBL-E colonization at admission, with repeat swabs if hospitalization exceeded 72 hours. Neonatal surface cultures were obtained at birth. Maternal risk factors and neonatal outcomes were compared between colonized and noncolonized groups. Among 155 deliveries, 6.4% (10/155) of mothers were colonized with ESBL-E, with a vertical transmission rate of 20% (2/10). Risk factors included cervical cerclage or pessary placement (20% vs. 2.1%, P = 0.03) and prior Group B Streptococcus (GBS) colonization (40% vs. 11%, P = 0.03). Infants born to colonized mothers had earlier gestational age (33.3 weeks [interquartile range (IQR) 32.9-33.7] vs. 35.3 weeks [IQR 33-36.8]; P = 0.04), higher cesarean delivery rates (100% vs. 59.3%, P = 0.01), lower birth weights (1870 g [IQR 1485-2440] vs. 2360 g [IQR 1900-2780], P = 0.03), and longer hospital stays (17 days [IQR 10-27] vs. 5 days [IQR 3-18], P = 0.01). Cervical procedures and prior GBS colonization were associated with maternal ESBL-E colonization. Infants born to colonized mothers experienced poorer outcomes, underscoring the need for targeted screening and consideration of broader empiric antibiotic coverage in at-risk preterm infants.

Systematic review of methodological approaches in economic evaluations of maternal and neonatal sepsis interventions in low- and middle-income countries.

ObjectiveHELLP syndrome, a severe complication of preeclampsia, is associated with increased maternal and neonatal morbidity and mortality. This study aims to evaluate maternal and perinatal outcomes in preeclamptic women with and without HELLP syndrome in Indonesia.MethodsA multicenter retrospective cohort study was conducted across 30 hospitals in Indonesia from January 2022 to December 2023. Data from 1,808 preeclamptic women were analyzed, with 219 (12.1%) classified as having HELLP syndrome. Maternal and perinatal outcomes were compared between the HELLP and non-HELLP groups.ResultsWomen with HELLP syndrome had significantly higher risks of severe complications, including eclampsia (p < 0.001; aOR: 2.5 (1.5–4.18)), acute kidney injury (p < 0.01; aOR: 4.11 (2.07–8.15)), emergency hypertension (p = 0.048; aOR: 1.42 (1.01–2.01)), preterm birth < 37 weeks (p = 0.013; aOR: 1.54 (1.1–2.17)), and preterm birth < 34 weeks (p < 0.001; aOR: 1.8 (1.28–2.53)). HELLP syndrome increased the risk of Intra-uterine fetal death (p = 0.01; aOR: 2.18 (1.21–3.95)) and neonatal sepsis (p = 0.011; aOR: 2.32 (1.21–4.42)). Although the multivariate analysis did not yield any significant results, the HELLP syndrome group has a substantially higher prevalence of maternal death (3.7% vs 1%; p = 0.005) and neonatal death (11.6% vs 6.4%; p = 0.005).ConclusionHELLP syndrome significantly worsens maternal and neonatal outcomes in preeclampsia, reflecting a need for improved early detection of ‘high-risk’ preeclamptic women like sFlt1/PLGF ratio and perhaps other laboratory tests like haptoglobin and D-dimer’s. Many of these laboratory tests are currently not accessible in the Indonesian public health sector. Further research is needed to identify other markers that would assist in a more timely diagnosis of impending HELLP syndrome, particularly in early-onset preeclampsia patients managed conservatively.

Background: Nuclear Magnetic Resonance (NMR) spectroscopy is a powerful analytical tool in metabolomics, but it is often hindered by the high cost and technical complexity of the machines, limiting its clinical and point-of-care applications. Recent advances in benchtop NMR technology have sought to overcome these barriers by providing more compact, affordable, and user-friendly instruments. This systematic review aims to assess the potential of benchtop NMR in clinical metabolomics, highlighting its practical advantages, current applications, and technological challenges relative to high-field systems. Methods: For this systematic review we searched Web of Science and PubMed databases to identify studies employing benchtop NMR spectroscopy in clinical and biomedical applications. The review focuses on works that evaluated metabolic profiling in human and animal disease contexts, compared benchtop and high-field performance, and utilized advanced data analysis methods, including multivariate and machine learning approaches. Results: Among the 74 records identified, 15 research articles were eligible, including 11 studies involving human biospecimens and 4 studies concerning animal samples. The selected works were published between 2018 and 2025. These studies demonstrated the potential clinical utility of low-field NMR in differentiating disease states such as tuberculosis, type 2 diabetes, neonatal sepsis, and chronic kidney disease, achieving diagnostic accuracies comparable to high-field instruments. Conclusions: Although limited by lower sensitivity and spectral resolution, benchtop NMR represents a significant step toward the democratization of NMR-based metabolomics. Continued hardware development, improved pulse sequences, and the integration of artificial intelligence for spectral processing and modeling are expected to enhance its analytical power and accelerate its clinical adoption.