Inhaled nitric oxide (iNO) is an effective but costly therapy for infants with hypoxemic respiratory failure. The approved and solidly evidence-based indication is for treatment of late preterm and term infants with persistent pulmonary hypertension of the newborn (PPHN); however, off-label use of iNO has become widespread. Although iNO treatment of infants with congenital diaphragmatic hernia constitutes one of the approved indications, available evidence from randomized trials suggests marginal if any efficacy. Rescue therapy in preterm infants with severe respiratory failure has been studied extensively and is not supported by data from a number of controlled trials. Such use is widespread, but should be discouraged. There may be a subgroup of such infants with pulmonary hypoplasia and documented PPHN who may benefit from this treatment, but the data are limited. Several studies have examined the use of iNO for prevention of chronic lung disease with inconsistent results. This promising application requires more study before it can be recommended. There may be a role of iNO in treating infants with pulmonary hypertension complicating severe bronchopulmonary dysplasia, but there are limited data on long term outcomes. Alternate therapies such as sildenafil may be beneficial in this specific population as well as in other causes of pulmonary hypertension. Rational use of this expensive treatment will maximize cost:benefit and avoid potential exposure to unknown adverse effects not balanced by documentable benefits.

Objective: To study the bacterial pathogens causing neonatal sepsis and their sensitivity pattern so that guidelines can be prepared for empirical antibiotic therapy. Materials and Methods: We conducted a prospective analysis of all the cases admitted to the neonatal intensive care unit (NICU) of a tertiary care hospital and studied the culture and sensitivity pattern of organisms isolated. The neonates who presented with signs and symptoms of septicemia, with/without pneumonia and/or meningitis were studied and a detailed record of the maturity, age at onset, sex, birth weight (weight on admission for home deliveries), symptoms and signs along with the maternal risk factors was made. The cases with suspect sepsis were screened using various screening markers. Blood culture was done in all the cases, while cerebrospinal fluid was analysed only in those indicated. Sensitivity of the isolated organism was tested by Kirby Bauer disc diffusion techniques and various drug resistance mechanisms were studied. Result: Out of the 190 neonates (M:F=1.22:1) admitted to the NICU, 60 (31.57%) shows blood culture positive. Ninety-five percent cases were due to early onset septicemia. Thirty one neonates had Gram negative, twenty seven had Gram positive septicemia and two had candidial infection. Seventy percent Gram-positive isolates were resistant to penicillin. Ninety percent Gram negative isolates were resistant to gentamycin and ampicillin. Carbapenem resistance mechanisms such as ESBL. Conclusion: There is an increasing trend of antibiotic resistance to the commonly used and available drugs. Continuous surveillance for antibiotic susceptibility should be done to look for resistance pattern.

Background: Retinopathy of prematurity (ROP) is a serious complication of prematurity treatment and can lead to blindness unless recognized and treated early. Objective: To estimate the incidence of ROP in preterm infants in our NICU, to identify the risk factors which predispose to ROP, and to assess the outcome of these cases. Materials and Methods: ROP prospective screening survey was performed enrolling all prematures admitted to the NICU from January 2009 to December 2010, with a gestational age of 32 weeks or less at birth and a birth weight of 1500 g or less. Infants whom gestational age was >32 weeks or birth weight was >1500 g were included if they exposed to oxygen therapy for more than 7 days. Also infants who were born between 32 and 34 weeks gestational age were examined if they had a course of instability (like sepsis, asphyxia or ventilation). A total of 172 infants (88 females) had retinal evaluation by indirect ophthalmoscopy from the 4 ^th postnatal week and followed up periodically. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Infants who progressed to stage 3 ROP with plus disease were given laser therapy. Results: Out of the studied 172 infants, 33 infants (19.2%) developed ROP in one or both eyes; 18 (54.5%) cases stage 1, 9 (27.3%) cases stage 2 and 6 (18.2%) cases stage 3 with plus disease. None of the studied neonates presented ROP at stages 4 or 5. The six cases diagnosed as ROP stage 3 with plus disease underwent laser ablative therapy. Laser was effective in treatment and decreasing the progression of ROP. Univariate analysis showed that there was a significant relationship between the occurrence of ROP and gestational age (P=0.000), sepsis (P=0.004), oxygen therapy (P=0.018), and frequency of blood transfusions (P=0.030). However, nonsignificant relationship was found between the occurrence of ROP and sex, mode of delivery, birth weight, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, hypotension, phototherapy, duration of oxygen therapy, mechanical ventilation, and CPAP (all P>0.05). Gestational age, sepsis, oxygen therapy and frequency of blood transfusions remained significant variables after logistic regression analysis. Conclusion: The incidence of ROP in this study was 19.2%; low gestational age, sepsis, oxygen therapy and frequent blood transfusions were significant risk factors for ROP. Laser was effective in treatment and decreasing the progression of ROP. As this is a unit-based study, a comprehensive countrywide survey on ROP in Egypt is recommended to determine any regional differences in disease incidence.

Purpose: A hemodynamically significant Patent ductus arteriosus (HsPDA) in premature infants is known to be associated with significant morbidity. Recently brain natriuretic peptides and superior mesenteric artery (SMA)-resistive indices have been used to effectively diagnose HsPDA. Objective: To assess the sensitivity and specificity of N-terminal proBNP (NT-proBNP) in predicting an HsPDA diagnosed by clinical and echocardiographic criteria including pulsatility index (PI) of SMA. Materials and Methods: All preterm neonates <1500 g were evaluated with echocardiograms and NT-proBNP levels on the 3 ^rd to 5 ^th day of life and then every week until the echo showed either a closed PDA or non-HsPDA. Results: Sixty-nine babies with mean gestational age of 27 weeks were included in the study. NT-proBNP levels were significantly higher in the HsPDA group (n=22) with a mean±SEM of 24420±3190 compared to 3072±332 in the non-HsPDA group (n=47) (P<0.001). NT-pro BNP level of 5900 pg/ml had 96% sensitivity and 90% specificity of predicting HsPDA. Conclusions: With frequently changing hemodynamics in low-birth weight infants, including NT-proBNP and PI of SMA improve the ability of assessing the effects of a HsPDA and will help timing of intervention.

Disseminated neonatal herpes simplex virus (HSV) infection is characterized by progressive multiple organ failure and high mortality rates up to 85% for untreated neonates. It can result from infection with either HSV-1 or HSV-2. We report the first known case of disseminated neonatal herpes associated with fulminant liver failure caused by HSV-2 who survived without liver transplant.

Chylothorax, a known complication of surgery for Congenital Diaphragmatic hernia, can sometimes be resistant to treat. Octeriotide (Somatostatin analogue) can be useful in this situation. However, the dose and schedule of Octeriotide therapy in neonates is not well established. We report two cases of resistant chylothorax following surgery for congenital diaphragmatic hernia which were successfully managed by using an escalating infusion of octeriotide. The literature on the subject is also reviewed.

Congenital toxoplasmosis may be subclinical, or may present with multisystem involvement. Most of the symptomatic cases have either ocular or neurological manifestations. A case of congenital toxoplasmosis presenting as isolated hepatitis is reported.

Primary ciliary dyskinesia (PCD) is a genetic disorder that manifests clinically with chronic sinopulmonary and otologic disease. Despite the majority of patients presenting with respiratory symptoms in the neonatal period, the diagnosis is often delayed until several years of age. We report the case of a 5-day-old male who was diagnosed with PCD by electron microscopic evaluation of cilia obtained from nasal brush biopsy. This case also demonstrated the successful treatment of persistent hypoxemia with frequent nasal suctioning.