Administration of liquid surfactant through an endotracheal tube for the treatment of respiratory distress syndrome has been the standard of care for decades. Surfactant administration through laryngeal or supraglottic airways (SALSA) is a simplified procedure for delivery of surfactant that is less invasive and better tolerated. The Al Bashir Maternity and Children’s Hospital NICU in Amman, Jordan, implemented SALSA as a potentially better practice in 2019 with the objective to effectively and efficiently deliver surfactant in a minimally invasive way and to decrease the adverse events associated with intubation–surfactant–extubation (InSurE) and laryngoscopy. The quality improvement initiative was conducted from March 2019 to December 2019. All infants who weighed 750 g or more who required surfactant were eligible. As physicians were trained in the technique and use expanded, we were able to use plan–do–study–act cycles to observe differences between SALSA and InSurE. The primary aim was the optimization of non-invasive ventilation by the effective and efficient delivery of surfactant. Balancing measures included episodes of bradycardia while receiving surfactant or the need for a second dose of surfactant. We evaluated 220 infants who received surfactant by SALSA or InSurE with a mean gestational age of 32 weeks and a mean birth weight of 1.8 kg. The Respiratory Severity Score (RSS) prior to surfactant administration was 2.7 in the SALSA group compared to 2.9 in the InSurE group (p = 0.024). Those in the InSurE group had a lower mean heart rate during the procedure (p =< 0.0001) and were more likely to need a second dose of surfactant (p = 0.026) or require intubation for mechanical ventilation (p = 0.022). Both groups were effectively delivered surfactant as evidenced by improvement in their RSS over an 8 h period. SALSA was a more time efficient surfactant delivery method (93 vs. 111 secs, p =< 0.0001). Implementation of SALSA into the Al Bashir NICU was successful. We found that it was equally effective to InSurE, but was a more efficient method of delivery. Infants who received surfactant by this method tolerated it well.

Background/Objectives: Critical congenital heart disease (CCHD) is among the major causes of global neonatal morbidity and mortality. While the incidence of CCHD appears to vary across populations, much of this variation may stem from differences in detection and reporting capabilities rather than true prevalence. In Jordan, recent data revealed a congenital cardiac disease incidence of 17.8/1000 live births, much higher than international averages. Diagnosis is largely dependent upon echocardiography, which is difficult to obtain in low-resource settings where prenatal screening modalities are limited. Screening for CCHD with pulse oximetry offers a potential method to identify patients earlier and contribute to improved outcomes. Methods: This prospective cohort study evaluated 20,482 neonates screened using pulse oximetry at Al-Bashir Hospital between January 2022 and May 2024. Demographic data, pulse oximetry measurements, and echocardiogram findings were collected during the screening process after obtaining ethical approval from the Jordanian Ministry of Health. Results: Pulse oximetry screening identified 752 neonates (3.7%) requiring further evaluation by echocardiography. An abnormality was detected in 240 neonates (31.9%), which included cardiac anomalies and pulmonary hypertension. Screening led to the identification of 138 infants with CCHD, including 80 with a previously unknown diagnosis, and an additional 247 infants with conditions requiring increased monitoring or treatment. Among those with CCHD, hypoplastic left heart syndrome and Tetralogy of Fallot were the most common conditions, 3.1%, and 2.4%, respectively. The overall false positive rate was 1.8% and was higher among those screened at less than 24 h of life compared to those screened at or after 24 h of life (2.3% [95%CI 2.1–2.6] vs. 0.8% [95%CI 0.6–1.0], p < 0.001). Conclusions: Pulse oximetry screening successfully led to the early detection of CCHD among Jordanian neonates. There was a high prevalence of CCHD compared to other reported cohorts. This highlights the importance of implementing national screening protocols to improve early diagnosis and intervention. Future studies will inform the feasibility and cost-effectiveness of national implementation in this setting.

Beta-thalassemia is a prevalent autosomal recessive hematological disorder characterized by defective β-globin chain production. Splenectomy is commonly performed in severe cases to alleviate transfusion dependency, but persistent post-splenectomy thrombocytosis poses significant clinical challenges. This Strengthening the Reporting of Observational Studies in Epidemiology-compliant retrospective cohort study included β-thalassemia major patients who underwent splenectomy at Al-Bashir Hospital between 2018 and 2024. Hematologic and biochemical parameters before and 1 year after surgery were compared using paired t tests after verifying data normality with the Shapiro–Wilk test ( P > .05). A P value < .05 was considered statistically significant. Persistent thrombocytosis was observed in all patients, with mean platelet counts of 965.36 ± 413.50 × 10 ⁹ /L immediately after surgery, decreasing slightly to 843.23 ± 320.08 × 10 ⁹ /L at the 1-year follow-up. Hemoglobin levels significantly increased from 8.91 ± 0.96 g/dL pre-splenectomy to 9.65 ± 1.49 g/dL post-splenectomy. Blood transfusion requirements decreased by 42.49%, and transfusion intervals lengthened significantly, confirming the procedure’s effectiveness in reducing transfusion burden. Ferritin levels declined, reflecting improved iron overload management. Nevertheless, adherence to postoperative medications, including aspirin and hydroxyurea, was suboptimal, potentially elevating thrombotic risk. Splenectomy in β-thalassemia major is associated with sustained hematologic improvement but persistent thrombocytosis. These findings underscore the importance of long-term platelet monitoring and strict adherence to antithrombotic prophylaxis to ensure optimal safety and clinical outcomes. Further multicenter studies are warranted to establish standardized monitoring and management protocols for this population.