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INTRODUCTION: For neonatal sepsis, several clinical and laboratory parameters have been proposed for its diagnosis but with variable sensitivity and specificity. The bacterial products in sepsis, including endotoxin, induce the production of proinflammatory cytokines that evoke the expression of tissue factor (TF) on monocytes and endothelial cells. OBJECTIVE: Our goal was to estimate the percentage of monocytes that express TF (TF%) by flow cytometry in patients with neonatal sepsis and to delineate its significance in diagnosing neonatal sepsis. METHODS: Twenty-seven neonates with neonatal sepsis and positive blood-culture results were recruited and evaluated clinically for their risk factors. Laboratory investigations including obtaining complete blood count and C-reactive protein level and estimation of the monocytes' TF expression by flow cytometry were performed. Twenty-four normal newborns were included as controls for the laboratory data. RESULTS: The monocytes that expressed TF% of the studied patients was significantly higher than that of the controls (P = .0001). The level of TF% was significantly influenced positively by premature rupture of membranes, multiplicity, white blood cell (WBC) count, staff/segment ratio, and C-reactive protein level and negatively by gestational age, body weight, and platelet count. The sensitivity and overall accuracy of the TF% were higher than those of the staff/segment ratio and the WBC count for diagnosing neonatal sepsis. The areas under the receiver operating characteristic curve of TF%, staff/segment ratio, and WBC count were 0.84, 0.79, and 0.60, respectively. CONCLUSIONS: The monocytes expressing TF% is a promising diagnostic and prognostic marker of infection in neonatal sepsis with high sensitivity and overall accuracy. Adding the estimation of monocytes expressing TF% to the sepsis screen may improve the diagnosis of neonatal sepsis.

Purpose: Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. Methods: The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. Results: A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0-4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development.

Background: Applying mechanical ventilation (MV) to premature lungs carries many risks, up to lung injury and bronchopulmonary dysplasia. Stabilization with continuous positive airway pressure (CPAP) avoids intubation and invasiveness. Aim of work:To evaluate the predictors of outcome of nasal CPAP on preterms with respiratory distress syndrome (RDS). Material and Methods: This prospective observational study included all preterms with RDS that necessitated CPAP introduction (according to the European Consensus Guidelines on the Management of RDS), who were admitted to the Neonatal Intensive Care Unit (NICU) of Department of Pediatrics, Cairo University Hospitals, from February to July 2019. CPAP was initiated in the first 2 hours of life. Respiratory compromise was assessed using Silverman score. Hematological scoring system (HSS) was studied as a predictor of outcome. Those who did not need subsequent intubation were labeled CPAP success group and were compared to the group where CPAP failed. Results: Over 6-months, 508 preterm with gestational age (GA) 27-33 weeks with RDS were admitted to our NICU, of them 61 (mean GA± SD of 32.08 ± 1.98 weeks) were included in the study. Of them 35 (57.4%) were males and 26 (42.6 %) females. CPAP was successful in 37 (60.7%) and Silverman score improved 2 hours after CPAP. Their initial median (IQR) of Silverman score was 5 (range 3-6) and improved to 1 (range 1-2) 2 hours after CPAP, while in the failure group, it was 6 (range 5-7) initially and worsened to 8 (range 7.5-9) (p=0.026). Antenatal steroids administration was highly protective (p= 0.000) but not GA p=0.086) or gender (p=0.521). Initial severe RDS in chest X-ray at birth was present in 1 (2.7 %) preterm in the CPAP success group and 10 (41.7 %) in the failure group (p=0.000). The systolic blood pressure ≤ 66, HSS, chest X-ray before CPAP, non-improvement of chest X-ray after CPAP and apnea were the important predictors for CPAP failure (p= 0.023), (p= 0.090), (p= 0.025), (p= 0.011) and (p= 0.049) respectively. Conclusion: Trials of CPAP for preterms with severe RDS with hemodynamic stability are effective in obviating the need for more invasive MV. Factors including hypercarbia, apnea, poor respiratory efforts, systemic hypotension, higher Silverman score and HSS ≥5 were the most significant associations of failed CPAP.