ENSTN is the first database to collect incidents and medical errors in NICU in Egypt. To ensure confidential and anonymous reporting system, identify the nature of medical errors and grade of harm as well as the risk factors. To promote patient safety culture and aid to decrease mortality and morbidity due to medical errors in NICU. Data reported by one University hospital and 12 non-University hospitals were collected through internet-based system on our webpage. Incident reporting icon in English and Arabic languages with standard structured data entry format was developed during the ENSTN project life time (www.egyneosafety.net).The system provides confidential and anonymous reporting. The number and types of reported events and factors that contributed to the events were verified and validated. In total, 2724 incidents were verified. The majority of incidents were from the English versions 2699 while Arabic version 25 incidents. English first version 866 incidents, second 155 and third final versions 1678 incidents. The most frequent events categories were equipment/devices in 29.94%, and treatment/medication errors in 29.68%. Incident classification showed that 43.20% of incidents were adverse events, 5.928% were sentinel, 50.166% near miss and 0.222% intentionally unsafe act, while 0.481% of incidents were not determined by reporters. The most frequent contributory factors were related to medication errors (28.34%), education/training (28.26%), and communication problems (27.82%). Serious patient harm was reported in 2.945%, death in 4.528% and minor harm in 25.259% of reported incidents. The ENSTN incidents reporting system successfully demonstrated the most common types and causes of medical errors in NICUs and underlying contributing factors. These findings suggest need multidisciplinary collaborative training. The ENSTN educational forum may play a role in reducing medical errors.

Background/Objectives: Precision medicine is a state-of-the-art medicine tactic that tailors information about people’s genes, environment, and lifestyle to aid the prevention, diagnosis, and treatment of various diseases to provide an overview of the currently available knowledge and applicability of precision medicine in the diagnosis of different cases admitted to the NICU, such as encephalopathies, respiratory distress syndrome of prematurity, hemodynamic instability, acute kidney injury, sepsis, and hyperbilirubinemia. Methods: The authors searched databases, such as PubMed and PubMed Central, for the terms neonatal “precision medicine”, “personalized medicine”, “genomics”, and “metabolomics”, all related to precision medicine in the diagnosis of neonatal illness. The related studies were collected. Results: The review highlights the diagnostic approach that serves to implement precision medicine in the NICU and provide precision diagnosis, monitoring, and treatment. Conclusions: In this review, we projected several diagnostic approaches that provide precision identification of health problems among sick neonates with complex illnesses in the NICU; some are noninvasive and available in ordinary healthcare settings, while others are invasive or not feasible or still in ongoing research as machine learning algorithms. Future studies are needed for the wide implementation of artificial intelligence tools in the diagnosis of neonatal illnesses.

The present study investigates the immunoregulation of hepatic fibrosis in experimental murine schistosomiasis. Disease parameters measured were portal pressure, hepatic granuloma area, hepatic interstitial collagen, and glycosaminoglycans. C57BL/6 mice were infected with 25 Schistosoma mansoni cercariae and administered splenocytes or serum derived from uninfected mice or chronically infect syngeneic mice at 6 and 7 wk of infection. Immunologically mediated modulation was noted in animals receiving splenocytes derived from chronically infected mice. Both a reduction in portal pressure and hepatic granuloma areas were noted. Hepatic collagen content but not glycosaminoglycan content was reduced by the administration of either lymphoid cells or serum from chronically infected mice. The isotypic profile of hepatic interstitial collagens was modulated by both the administration of serum or lymphoid cells. Augmented levels of type III collagen was noted on administration of serum derived from chronically infected mice, whereas type I collagen levels were relatively elevated on administration of splenocytes. The data indicate that immunomodulation of inflammation and hepatic fibrosis can occur in murine schistosomiasis but that fibrotic events and inflammatory processes are independently modulated.

"To the Editor." Neonatal sepsis is major cause of death or disability in neonatal age population, even with suitable therapy and optimal care. 1) Early recognition and diagnosis of neonatal

Patient safety is fundamental to upholding the quality of health care. Health-care workers in neonatal intensive care units (NICUs) face daily challenges to sustain safe care for their patients and to counteract medical errors. The objectives were to develop the Egyptian Neonatal Safety Training Network (ENSTN) to promote safe health care practices in NICUs through training of Health-care workers on PtS and dissemination of a culture for patient safety. The ENSTN project accomplishments were completed through 8 work packages. The first package activities were intended to establish standards of knowledge and skills for safe practices in the NICU, develop the course specifications for PtS and develop standards. The remaining packages included: a professional patient safety reporting system and database; cohesive shared education and training in patient safety leadership and research; development of protocols and guidelines to enhance and ensure sustainability of safe practice; dissemination of ENSTN messages; confirmation of quality measures and adequate performance; sustainability of patient safety practices in the NICU; and structuring the management plan and facilitating project activities. Project outputs included: patient safety standards for NICUs in Arabic and English; 3 patient safety courses for physicians, nurses and other health-care workers the ENSTN electronic reporting system for medical errors and guidelines; and a parent's booklet. Continuous organized training for health-care workers on patient safety and implementation of ENSTN standards to reduce medical errors in the NICU are needed. We implemented the first confidential patient safety reporting system for NICU.

Objective: Apelin is a proinflammatory adipocyte-derived factor. The aim of this study was to evaluate the role and significance of serum apelin as a new sepsis marker in the identification of full-term and preterm new-born infants with early-onset sepsis. Material and Methods: This was a case-control study. We included 80 neonates. The cases were divided into 2 groups; neonates with early-onset sepsis and control group with neonates non-sepsis. Apelin was quantified by enzyme-linked immunosorbent assay. Results: There was a significant elevation in the mean values of serum apelin in the early-onset sepsis group (1214.7 ± 273.06 pg/mmol) than in the non-septic neonates 116.27 ± 21.96 pg/mmol (P < .0001). Apelin values were correlated to clinical sepsis and hematological scores as well as C-reactive protein. Serum apelin concentration was significantly higher among culturepositive cases than the culture-negative cases (mean ± SD was 1239.52 ± 268.47 and 929.42 ± 136.97 pg/mmol, respectively, P < .0001). Moreover, the apelin level was higher in non-survivor neonates than in the survivors in the early-onset sepsis group. No significant difference was found between preterm and full-term new-born infants with regard to the apelin values. The best cut-off estimate of apelin to diagnose early sepsis was >178.33 pg/mmol. Conclusion: Apelin may be useful in the diagnosis and prognostic prediction of neonates with early-onset sepsis. Cite this article as: ELMeneza SAEN, Mohamed Said El Bagoury IMS, El Sayed Mohamed K. Role of serum apelin in the diagnosis of early-onset neonatal sepsis. Turk Arch Pediatr. 2021; 56(6): 563-568.