Sex-specific Neonatal Medicine: Do We Teach More Than We Practice?

Abstract

Sex-based differences in neonatal outcomes have been consistently reported in neonatal literature, with male infants demonstrating higher morbidity and mortality than females at comparable gestational ages. Delayed pulmonary maturation, increased vulnerability to hypoxic–ischemic brain injury, altered immune responses, and higher susceptibility to sepsis contribute to this well-recognized “male disadvantage.” Despite these established biological differences, neonatal intensive care unit practices remain largely sex-neutral. Clinical guidelines, risk prediction tools, and management algorithms rarely incorporate sex as a biologically meaningful variable, resulting in a disconnect between neonatal pathophysiology and bedside care. Treating sex solely as a demographic characteristic rather than a determinant of vulnerability may lead to under-recognition of risk, particularly among male preterm infants. Bridging this gap by integrating sex-aware risk assessment into neonatal care represents a translational opportunity rather than a conceptual innovation. Incorporation of sex-specific considerations into research design, guideline development, and clinical decision-making may support more individualized neonatal care and improve outcomes without increasing resource burden.