Healthcare-associated conjunctivitis (HAC) has been associated with serious ophthalmological complications in neonates, including blindness. This three-year retrospective, descriptive study was conducted between 2019 and 2021 to determine the most common bacteria associated with neonatal HAC at a tertiary-care hospital in Saudi Arabia. The inclusion criteria were defined based on the centers for disease control and prevention (CDC) guidelines for the diagnosis of neonatal HAC. When HAC was clinically suspected, conjunctival swabs were obtained from neonates and sent to the microbiology lab following standard protocols. A univariate analysis was conducted on the included samples. A total of 79 cases met our inclusion criteria and were retrospectively studied. A descriptive analysis showed that Pseudomonas aeruginosa was the leading cause of HAC, with 25% (20 cases), followed by Escherichia coli and Klebsiella pneumonia (11.5% for each). About 9% of the analyzed cases were positive for Staphylococcus aureus. Orogastric feeding was the most commonly (94%) associated factor with HAC, followed by respiratory distress syndrome (RDS) and preterm birth, which were found in 70% and 64% of the cases, respectively. To conclude, HAC is an alarming healthcare problem, and bacteria, including Gram-negative bacteria, are common causes. Thus, physician awareness, effective communication with microbiologists, and the implementation of infection control recommendations, including hand hygiene, could minimize this problem and avoid the serious complications of HAC.

Background and objectives: Congenital hypothyroidism (CH) is a critical condition that can lead to severe neurodevelopmental impairments if not diagnosed and treated promptly. Early detection through neonatal screening is essential. This study evaluated the efficacy of cord blood free thyroxin 4 (CBFT4) screening for detecting CH in comparison to serum sample testing and newborn metabolic screening (NBS). The aim was to determine the efficacy of current cord blood screening for congenital hypothyroidism in the presence of metabolic screening and to establish the prevalence of CH in a single tertiary center in Saudi Arabia. Methods: This retrospective cohort study was conducted at Johns Hopkins Aramco Healthcare Center and included all newborns born between January 2021 and December 2023. Both cord blood and heel-prick T4 and thyroid-stimulating hormone (TSH) results were collected from the medical records of 3328 newborns. Diagnostic accuracy parameters were calculated for cord blood and serum findings. Demographic and clinical data were analyzed, including maternal risk factors. Results: The CH prevalence was 0.8%, which was confirmed by NBS, and there was a higher initial detection rate of 3.4% based on cord blood screening. The average level of cord blood total thyroxin 4 (CBTT4) was 6.48 ± 0.78 µg/dL, and the cord blood TSH was 5.9 ± 6.4 µIU/mL. Serum FT4 levels were 1.3 ± 0.5 ng/dL, and serum TSH levels were 8.7 ± 24.5 µIU/mL. The sensitivity and specificity of cord blood diagnosis were 50% and 97%, respectively, while serum sample diagnosis had a sensitivity of 62.5% and a specificity of 98.6%. Significant associations were found between lower birth weight (2.146 ± 0.771 kg vs. 2.801 ± 0.662 kg; p = 0.006), lower gestational age (35 ± 3 weeks vs. 37 ± 3 weeks; p = 0.008), and CH. Cord blood TSH levels were significantly higher in CH cases (32.9 ± 55.2 µIU/mL vs. 5.7 ± 3.7 µIU/mL; p < 0.001). Conclusion: Cord blood screening for congenital hypothyroidism demonstrates moderate sensitivity and high specificity, indicating that it is reliable for ruling out the condition but necessitates confirmatory serum testing due to the risk of false positives. The prevalence of CH in this cohort aligns with global estimates. Lower birth weight, lower gestational age, and maternal thyroid disease are significant risk factors for CH. A two-tiered screening approach with follow-up serum testing is recommended to improve diagnostic accuracy and ensure timely intervention.

Background: Neonatal bladder perforation is a rare but life-threatening condition associated with significant morbidity if not promptly recognized. Case presentation: We report the case of an extremely preterm male infant born at 26 weeks of gestation who developed bladder perforation on day 15 of life, presenting with abdominal distension, decreased urine output, and respiratory distress. The diagnosis was confirmed by fluoroscopic voiding cystourethrogram demonstrating contrast extravasation into the peritoneal cavity. The etiology was multifactorial, involving extreme prematurity, umbilical arterial catheterization, repeated urinary catheter insertions, and heavy sedation. Initial conservative management with urinary catheterization and broad-spectrum antibiotics was followed by successful surgical repair via exploratory laparotomy on day 23 of life. Conclusion: This case highlights the importance of maintaining a high index of suspicion for bladder perforation in extremely preterm neonates presenting with ascites and sepsis-like features, particularly in the presence of multiple iatrogenic risk factors. Early diagnosis and timely intervention are critical for optimizing outcomes.

Objectives: To describe morbidity and mortality among preterm neonates (<37 weeks' gestation) admitted to the neonatal intensive care unit (NICU) at Johns Hopkins Aramco Healthcare (JHAH), to evaluate survival by gestational age (GA), and to identify factors associated with mortality. Methods: This single-center retrospective cohort study reviewed the electronic medical records of all preterm neonates born at JHAH, Dhahran, Saudi Arabia, and admitted to the NICU between January 2019 and December 2023. Maternal, perinatal, and neonatal variables were compared between survivors and non-survivors. Survival to discharge by GA was compared using the log-rank test, and factors associated with mortality were assessed using Firth penalized logistic regression. Results: Of 587 neonates, 22 (3.7%) died before discharge. Survival was 63.4% at 22-27 weeks, 95.2% at 28-31 weeks, and 99.4% at 32-36 weeks (p < 0.001). The most common complications were bronchopulmonary dysplasia (12.8%), patent ductus arteriosus (9.7%), and intraventricular hemorrhage (3.4%), all more frequent among non-survivors. After adjustment, higher GA was associated with lower mortality (28-31 weeks: adjusted odds ratio (aOR): 0.11, 95% CI: 0.03-0.33; 32-36 weeks: aOR: 0.015, 95% CI: 0.003-0.046), and small-for-gestational-age status with higher mortality (aOR: 3.82, 95% CI: 1.11-12.61). Conclusion: Mortality among preterm neonates was low overall but concentrated among those born before 28 weeks. GA was the strongest predictor of survival, and growth restriction independently increased mortality risk.

Background and objectives: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is highly prevalent in the Middle East and is a recognized risk factor for neonatal hyperbilirubinemia. However, the clinical impact of specific G6PD gene variants on hyperbilirubinemia severity remains unclear. This study aimed to determine the prevalence of G6PD gene variants among neonates at Johns Hopkins Aramco Healthcare and to evaluate their association with hyperbilirubinemia severity and phototherapy requirements. Methods: We conducted a retrospective cohort study of neonates diagnosed with G6PD deficiency between January 2021 and December 2023. Demographic, clinical, laboratory, and genetic data were collected from electronic medical records. G6PD variants were identified using newborn DNA screening. Associations with phototherapy requirement were assessed using chi-square and Mann-Whitney U tests. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of phototherapy. Results: Among 5,375 neonatal admissions, 572 (10.6%) neonates were diagnosed with G6PD deficiency, with a male predominance (66.6%). The c.563C>T (Mediterranean) variant was the most prevalent (93.5%). Phototherapy was required in 193 neonates (33.7%). In multivariate analysis, female sex was independently protective against phototherapy (adjusted odds ratio (AOR) = 0.239; p = 0.003), while a positive Coombs test (AOR = 8.668; p < 0.001) and the presence of two mutant G6PD gene copies (AOR = 3.890; p = 0.007) were significant independent predictors of phototherapy requirement. No significant association was observed between specific G6PD variants and the need for phototherapy. Conclusion: G6PD deficiency was common in this cohort and was mainly associated with the c.563C>T mutation. A positive Coombs test and multiple gene copies were independent predictors of phototherapy, whereas specific G6PD variants were not associated with hyperbilirubinemia severity. These findings support the importance of early G6PD screening and vigilant monitoring to prevent severe neonatal hyperbilirubinemia.