To identify the risk factors, laboratory profile, microbial profile, mortality and complications, mortality causing organisms and antimicrobial susceptibility patterns of neonatal sepsis at a tertiary care hospital. A retrospective study was conducted using the neonatal intensive care unit (NICU) database in King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. All neonates born in KFMC with clinically diagnosed sepsis in the NICU were included in this study. During the study period, a total of 245 neonates with a culture-proven diagnosis of neonatal sepsis were included in this study and 298 episodes of sepsis were observed. Out of the 298 episodes, EOS occurred 33 (11.1%) times, and LOS occurred 265 (88.9%) times. For both neonates with EOS and LOS prematurity was the major neonatal risk factors for sepsis 16 (48.5%), 214 (80.8%); respectively. Multiparty and delivery by caesarean section were the top maternal risk factors of both EOS and LOS. Nneonates with LOS had high CRP, Total WBC count and thrombocytopenia compared to EOS neonates. Our results showed that in the EOS neonates, GBS was the most common pathogen followed by Escherichia Coli. In LOS neonates, the common organisms were Staphylococcus spp., Klebsiella and Pseudomonas aeruginosa. Mortality rate of neonatal sepsis is higher in EOS 5 (15.2%) from total EOS compared to LOS 24 (11.3%) from total LOS. All Gram-negative bacteria were sensitive to Amikacin. Gram-negative non-fermenting bacteria, such as P. aeruginosa and Acinetobacter were sensitive to amikacin and gentamycin. All Gram-positive bacteria were sensitive to gentamycin. Among thirteen Candida albicans isolates, 85% were sensitive to fluconazole. Concerted efforts are needed to determine the spectrum of risk factors and the clinical characteristics of EOS and LOS in order to implement appropriate treatment strategies as sepsis remains to be a serious danger to neonatal wellbeing. Moreover, our study emphasizes that use of aminoglycosides is much agreeable as compared to the broad spectrum antibiotics which are more rampantly used nowadays.

To this end, the influence of COVID-19 on pregnant women and their neonates is not completely clear. Therefore, the main aim of this study is to investigate maternal and neonatal clinical outcomes with confirmed COVID-19 infection. Besides, it investigates the likelihood of vertical transmission of COVID-19 infection from pregnant women to their neonates. A retrospective descriptive study was conducted in three medical centers during the period from March to November 2020. Data were collected from the available medical records in the respective hospitals using a standardized questionnaire on maternal and neonatal clinical outcomes. All pregnant women with confirmed COVID-19 infection across the three hospitals and their neonates were eligible to participate in this study. Descriptive statistics were presented as a median and interquartile range (IQR) or frequencies and percentages as appropriate using SPSS 24.0 software. This study has identified a total of 288 pregnant women with confirmed COVID-19 infection over the study period of a median age of 30 years and median GA at diagnosis 38 weeks (IQR: 39 -33) as well as 27% of them were obese (n = 78). The majority of pregnant women were symptomatic with cough (n = 92, 31.9%) being the most frequent COVID-19 symptom followed by fever and dyspnea (n = 36, 12.5%). Two-hundred and four pregnant delivered (70.84%) and caesarean sections were prevalent among 35.8% of them. The most common adverse pregnancy outcome was premature (n = 31, 15.5%), followed by fetal distress (n = 13, 6.5%), preeclampsia (n = 4, 2.0%), and one pregnant woman died. The laboratory results exhibit that temperature higher than 38 (n = 27), leukopenia (n = 19), neutropenia (n = 54), ALT (n = 12), AST (n = 31), and thrombocytopenia (n = 35) were less frequent among pregnant women while lymphopenia (n = 126), hemoglobin levels lower than 13.0 (n = 218), deceased albumin levels (n = 195) were most frequent among them. However, a small proportion of pregnant women were admitted to the ICU (3.8%). The most frequent maternal treatments were antibiotics (n = 81), antiviral (n = 49), and corticosteroid (n = 24). Of 204 neonates, four had died and all the remaining neonates were alive. The median gestational age at delivery was 39 weeks (IQR: 35–40). Most neonates had normal laboratory results. However, 14 had lymphopenia (7.0%), 22 had neutropenia (11.0%), and 11 had thrombocytopenia (5.5%). Four infants had low hemoglobin levels of less than 13.0 (2.0%) and 81 had hyperbilirubinemia (e.g., total bilirubin of higher than 23; 40.5%). Approximately less than one-half of neonates required admission to the NICU (n = 86, 43%), 7% of them required respiratory support of mechanical ventilation, and none of them get infected with COVID-19 disease. This multicenter study suggests that the majority of pregnant women had mild or moderate disease symptoms. Nevertheless, this study did not find any evidence of possible vertical transmission of COVID-19 infection from mothers to their babies. This study may provide a baseline for further studies focusing on investigating long-term maternal and neonate's outcomes and possible vertical transmission of COVID-19 from mothers to their newborn babies.

Introduction: Neonatal Acute kidney injury (AKI) is an underestimated morbidity in the neonatal intensive care unit (ICU). However, there is a paucity of information about risk factors, outcomes, and possible preventive measures to limit its occurrence. Aim: This study aimed to determine the prevalence of neonatal AKI in a neonatal ICU. Data obtained from this study will help to better understand current local practices and investigate possible preventive strategies. Materials and methods: Charts from January 2011 to December 2018 were reviewed. Neonates less than 2 weeks old who depended on intravenous fluid as a nutrition source for at least two days were included. Results: Overall, the eight-year prevalence of neonatal AKI in the neonatal ICU was 19.6%, and severity was distributed as follows: stage 1 (46.2%), stage 2 (26.5%), and stage 3 (27.3%). Caffeine administration before 29 weeks’ gestational age significantly decreased the incidence of neonatal AKI. The incidence of neonatal AKI was independently associated with death (odds ratios (OR) = 7.11, P < 0.001) and extended length of hospital stay (OR = 2.47, P < 0.001). In the multivariate regression model, vancomycin (AOR = 1.637, P < 0.004), loop diuretics (AOR = 2.203, P < 0.001), intraventricular hemorrhage (AOR = 2.605, P < 0.001), surgical intervention (AOR = 1.566, P < 0.008), mechanical ventilation (AOR = 1.463, P < 0.015), and dopamine administration (AOR = 2.399, P < 0.001) were independently associated with neonatal AKI. Conclusion: Neonatal AKI occurred in one-fifth of the study population in a neonatal ICU. Outcomes can be improved by identifying high-risk infants and cautiously monitoring kidney function.

Sepsis is a life-threatening condition that requires aggressive and rapid intervention. However, data on the association between antibiotic administration timing in neonatal sepsis and neonatal outcomes is limited, particularly in the gulf area. This study aimed to evaluate the association between the timing of antibiotic administration and the outcome of neonatal sepsis. This retrospective comparative study was conducted through data collection from medical records of patients with neonatal sepsis. The patients were categorized into two groups based on the time interval between antibiotic prescription and drug administration: non-delayed group consisted of patients who received antibiotics within 3 h and the delayed group consisted of those who received antibiotics after 3 h. A total of 237 neonates diagnosed with sepsis were included, of which 9.3% had necrotizing enterocolitis, 35% had bronchopulmonary dysplasia, and 6.3% had maternal chorioamnionitis. Additionally, 18.6% of the neonates' mothers were prescribed with antibiotics during labor, and 5.5% had maternal fever. Staphylococcus epidermidis was the most commonly isolated strain (24.1%). Of the total neonates, 87.3% received antibiotics within the first 3 h from the prescription. Survival rate was significantly higher and the risk of complications such as necrotizing enterocolitis, and bronchopulmonary dysplasia was significantly lower in the non-delayed group. Moreover, the length of hospital stay was significantly shorter in the non-delayed group. Early antibiotic administration in patients with neonatal sepsis can improve the survival rate and reduce the incidence of complications.

Background: Prophylactic indomethacin has been widely used as an effective intervention for reducing mortalities and morbidities in preterm infants including the cardiopulmonary and neurodevelopmental morbidities such as intraventricular hemorrhage (IVH), but many studies have reported contradictory outcomes regarding its significance. Therefore, we aim to systematically review and meta-analyze the data of prophylactic indomethacin on preterm infants.Methods: Our systematic search included the following databases: Pubmed, Google Scholar, Scopus, Web of Science, The New York Academy of Medicine (NYAM), Virtual health library (VHL), and the System for Information on Grey Literature in Europe (SIGLE) to include studies that assessed the use of prophylactic indomethacin in preterm infants until 12 August 2021.Results: The final list of our included studies is comprised of 23 randomized trials and cohort studies. Among all the studies outcomes, significant favorable outcome was lowering the rate of PDA, surgical PDA ligation (P < 0.001) and severe IVH (P = 0.008) while no significance was recorded with BPD, pulmonary hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, intestinal perforation, mortality, and length of hospital stay.Conclusion: Since the meta-analysis results regarding effectiveness of prophylactic indomethacin varied based on the study design particularly with regard to outcomes such as surgical PDA ligation and severe IVH, this warrants the need for more evidence regarding the effectiveness of prophylactic indomethacin in very low birth weight infants.

Background: Neonatal purpura fulminans (PF) is a rare but frequently fatal disorder associated with high morbidity and mortality. It may be congenital, as a result of protein C and S deficiency, or acquired due to severe infection. Gram-negative orga...