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Introduction: Necrotizing enterocolitis (NEC) is a major cause of mortality among premature babies. It has no definitive pathogenesis and no specific treatment. Its prevention remains the most important intervention till now. Aim of the work:To detect the impact of using mother's own milk to feed preterm babies (< 37 weeks) on necrotizing enterocolitis, occurrence of signs of feeding intolerance, sepsis and mortality. Methods: This prospective cohort study enrolled 250 preterm babies (< 37 weeks) whose gestational ages ranged from 27-36 weeks who were admitted to the neonatal intensive care unit (NICU) of Kasr Al-Ainy Hospital, Cairo University soon after birth. Mothers with no contraindication to breast feeding were included in the "case" group and the others were included in "control" group. Results: The mean± SD gestational age of the case group (120 preterm) was 33.12 ± 1.63 weeks and of the control group (130 preterm) was 32.17 ± 1.95 weeks. The mean birth weights of the case and control groups were 1.86 ± 0.49 and 1.55 ± 0.32 kgs, respectively (p= 0.000). The case group showed significant decrease in the incidence of NEC (5% in the case group versus 13% in the control group (p= 0.027). Sepsis incidence also decreased among patients in the case group (37.5% in the case group versus 60% in the control group (p= 0.00). There was no significant difference between the two groups regarding time at which trophic feeding was started but the study group showed significantly shorter duration to reach both minimal enteral nutrition (20cc /kg) (6.85 ± 3.16 days versus 11.20 ± 7.05 days in the control group) (p= 0.000) and full feeds (10.60 ± 3.94 days versus 15.47 ± 8.85 in the control group) (p= 0.000). The mean duration of total parenteral nutrition was significantly shorter in the case group (p= 0.020). The difference between the need for antibiotics in both groups was insignificant (p= 0.353). However, the duration of antibiotic therapy was significantly shorter in the case group (p= 0.000). Conclusion: Preterm mother's own milk feeding (not necessarily exclusively) proved to be protective against NEC, sepsis and poor outcome.

Background: Prompt management of respiratory distress (RD) among neonates is lifesaving. Electric cardiometry (EC) is not suitable for diagnosis, but its value in monitoring changes in cardiac parameters over time is in need of verification. Aim of the Work:To study EC hemodynamic parameters predictive ability of outcome in fullterm newborns with RD. Materials and Methods: using electric cardiometry (EC) hemodynamic parameters were studied among 30 full term neonates with RD within the first 10 minutes of life and 2 hours later compared to another 30 without RD. The studied parameters were heart rate variability (HRV), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), thoracic fluid content (TFC), stroke volume variation (SVV), index of contractility (ICON), left ventricular (LV) pre-ejection period (PEP), ejection time (ET), and systemic vascular resistance (SVR). Results: The mean ± SD gestational age of the studied group was 38.20 ± 1.19 weeks, weight was 3.03 ± 0.51 kilogram, females were 15 (50%), and males were 15 (50%) which was comparable to the control group (p=0.584), (p=0.284) and (p=0.436) respectively. The mean Apgar score was less among the RD group; at one minute it was 6 and at 5 minutes was 8 (p=0.0001) and (p=0.002). Initial HRV, CO, CI, SV, SI, TFC, SVV, ICON, LV, PEP, ET, and SVR were not different among both groups but there was a significant decrease in CI (p=0.033), HRV (p=0.030), SI (p = 0.017), and SV (p= 0.016) in the RD group after 2 hours. Those with RD, 20 (66.6%) improved and 10 (33.3%) were admitted to the neonatal intensive unit. Both groups with RD had comparable HRV, CI, CO, SV, SI, TFC, SVV, PEP, ICON, LVET, or SVR in initial and the 2 hour of life assessment (p= 0.860), (p= 0.071), (p= 0.932), (p= 0.260), (p= 0.548), (p= 0.338), (p= 0.744), (p= 0.488), (p= 0.392), (p= 0.983), (p= 0.066) respectively. Conclusion: Hemodynamic parameters assessed by electric cardiometry of full term neonates within 10 minutes of birth was not different among those with RD and those without. Electric cardiometry at 2 hours of life of those with RD was not predictive of outcome.

Background The risk of kernicterus and BIND may be in part determined by total serum bilirubin (TSB) and by the level of non-albumin bound free bilirubin, which can easily pass the blood–brain barrier. Free bilirubin (Bf) seems a more reliable predictor for bilirubin neurotoxicity. Bilirubin/albumin ratio (B/A) is considered a surrogate parameter for Bf and has been more useful than TSB. The aim of the study is to determine whether B/A ratio correlates with BIND in newborns with severe hyperbilirubinemia and if it can predict poor neurologic outcome at 3 months follow up. Results This prospective study included one hundred seventeen outborn neonates ≥ 35 weeks admitted in a tertiary care neonatal intensive care unit, between May and December 2012, with TSB ≥ 20 mg/dl or necessitating exchange transfusion. Total serum bilirubin and serum albumin were done on admission and bilirubin/albumin ratio was calculated. BIND score was calculated. At the age of 3 months, 112 neonates were followed up with a detailed neurological assessment. Babies who depicted any abnormal motor examination were subjected to brain stem auditory evoked response and MRI examination. Seven infants (6.2%) presented with kernicterus on follow up. BIND scores on admission, mean TSB, and bilirubin/albumin ratio was significantly higher in kernicteric infants compared with those having normal neurological outcome at 3 months of age (P 0.001). The lowest TSB level at which kernicterus occurred in our study was 31 mg/dl. Receiver operation characteristics analysis identified B/A ratio cut off value for predicting kernicterus of 9.6 with sensitivity of 100% and specificity of 91.4%, whereas TSB cut off value of 30 mg/dl showed sensitivity of 100% and specificity of 83%. Conclusion B/A ratio is a strong indicator for the risk of kernicterus. B/A is more specific than TSB and should be used in the early management of neonatal hyperbilirubinemia.

Background: Bilirubin induced neurological dysfunction (BIND) remains an important cause of disability in developing countries. Although high total serum bilirubin (TSB) is the main instigator for BIND, different babies may have different neurological outcomes at the same TSB level. This reflects the need for a more specific predictive factor for the neurological outcome, which would allow prompt intervention and prevention of kernicterus. Aim of the Work:To assess the value of serum activin A as a predictor for acute bilirubin neurotoxicity and adverse neurodevelopmental outcomes at one year of life. Materials and Methods:The study enrolled 84 term/near-term infants admitted with indirect hyperbilirubinemia requiring intervention to the Neonatal Intensive Care Unit of Cairo University Children's Hospital. Clinical examination, BIND score and laboratory tests including activin A were performed. Neurodevelopmental outcome was assessed at 3, 6 and 12 months using the Bayley scale of Infant Development II. Correlations between serum activin A, TSB, BIND scores and Bayley scores were studied. Results: Mean TSB level at admission was 25.92±7.14 mg/dL. BIND score at admission ranged from 0-7, and mean serum activin A level was 109.92±55 pg/ml. Activin A did not show significant correlations with TSB or BIND scores. A negative correlation between activin A level and psychomotor developmental index (PDI) at 3 months was detected however all other neurodevelopmental outcomes showed no significant correlation with activin A. Conclusion:In cases of neonatal hyperbilirubinemia, activin A is not a reliable biomarker for predicting acute or chronic bilirubin induced neurotoxicity.