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Background Necrotizing pneumonia is rare in children and is one of the most serious complications of a lung infection caused by antibiotic failure. We present a 12-year-old leukopenic child with a long-lasting lung infection, presenting as having a lung hydatid cyst, but diagnosing with necrotizing pneumonia in the right bilobed lung. Failure to medical treatment and ongoing leukopenia justified surgical intervention with positive results. Case presentation The patient was referred to our teaching hospital’s pediatric surgery department. He had previously been diagnosed with intestinal tuberculosis (TB) and received anti-TB treatment. On referral to our hospital, the patient was suffering from restlessness, frequent coughing, fever, vomiting, and diarrhea. Following the completion of the clinical work-up, a blood test revealed leukopenia (white blood cell count of 2100/microliter), a normal platelet count, and a lesion in the right lung. Computerized tomography scanning (CT-Scan) image reported a lung hydatid cyst. In the pediatrics ward, a broad-spectrum antibiotics regimen with triple-antibiotic therapy (linezolid, vancomycin, and metronidazole) was instituted and continued for a week with no response, but worsening of the condition. In the pediatric surgery ward, our decision for surgical intervention was due to the failure of medical treatment because of a pulmonary lesion. Our team performed right lung upper lobe anterior segment wedge resection due to necrotizing pneumonia and followed the patient 45 days post-operation with a reasonable result. Conclusion Living in remote rural areas with low resources and inaccessibility to proper and specialized diagnostic and treatment centers will all contribute to an improper diagnosis and treatment of lung infection. In total, all of these will increase the morbidity and mortality due to lung necrosis in the pediatric population, regardless of their age. In low-resource facilities, high-risk patients can benefit from surgical intervention to control the ongoing infection process.

Background: Prematurity is prevalent worldwide and accounts as the leading cause of neonatal death. Slow weight gain, feeding intolerance, prolong hospital stay, recurrent infection and high mortality are significant issues for preterm neonates. Dual strain probiotic can manage such complication of prematurity. Objective: To evaluate the effectiveness of dual strain probiotic on weight gaining and feeding intolerance of preterm neonates in Kabul city.Method: This randomized controlled trial conducted at Neonatal units of Malalai and Maiwand Hospitals in Kabul city. Finally, 84 preterm neonates assessed for the effect of dual strain probiotic. The clinical parameters were daily weight gain and the risk of feeding intolerance and neonatal mortality. Statically analysis was performed by SPSS 20. Results: Forty-two premature neonates in dual strain probiotic group and another forty-two preterm babies in control group were investigated. The preterm neonates in probiotic versus control group had mean age (7.2±6.3 vs 6.8±3.3 day; P=0.63), weight (1495.5±273 vs 1476.2±273 g; P=0.75) and gestational age (33.6±2.1 vs 32.9±2.4 week; p=0.14). Sex distribution in probiotic group was (boys 54.4%, girl 45.2%) and in control group was (boys 50%, girl 50%). Both groups were observed for mean days of (17.6±6.4 vs 18.8±6.3; P=0.45). The premature newborns in probiotic versus control group had mean daily weight gain (15.4±9.4 vs 10±7.9g; CI=1.75-9.31, P=0.005), risk of feeding intolerance (RR=0.65, CI=0.1-4.1, P=0.6) and risk of mortality during hospital stay (RR=0.65, CI=0.1-0.41, P=0.8).Conclusion: Preterm neonates in our country had slow growth than high-income countries. Dual strain probiotic significantly improved the daily weight gain of premature neonates. However, probiotic also decreased the risk of feeding intolerance and death during hospital stay but these findings were not statistically significant.Clinical trial registration number: This RCT was registered in the Australian New Zealand Clinical Trials Registry with the number of ACTRN12620000538943. Date of Registration is first May 2020. https://www.anzctr.org.au/ACTRN12620000538943.aspx

Introduction: Prematurity is one of the leading causes of neonatal death in Afghanistan and complicates many serious problems including apnea. Although recurrent and prolong apnea of prematurity (AOP) may be directly or indirectly associated with significant adverse outcomes, there isn’t enough scientific information regarding the prevalence and risk factors of this problem in Afghanistan, therefore, this study is performed to obtain such information. Objective: To determine the prevalence rate and risk factors for apnea of prematurity in neonates admitted to the Neonatal Intensive Care Unit of the French Medical Institute for Mothers and Children Hospital, Kabul City. Patients and Methods: This analytic cross-sectional study was conducted at the Neonatal Intensive Care Unit of the French Medical Institute for Mothers and Children Hospital in Kabul City, Afghanistan. The study participants were preterm neonates. Statistical analysis was performed by SPSS 24. Results: 75 preterm newborns were enrolled in this study and the apnea of prematurity were developed in 48% of them. Extremely low birth weight preterm neonates had a 71.4% prevalence rate of such apnea, while in very low birth weight and low birth weight the rates were 47.4% and 36.4% respectively. Based on gestational age, the prevalence rates of apnea in the early and moderate preterm neonates were 55.6% and 52.8% respectively, whilst also in late preterm neonates it was 42.8%. The apnea of prematurity appeared more prevalent in boys (54.3%) than girls (45.7%). The preterm neonates in the apnea group versus the non-apnea group had the mean birth weight of (1233.33 ± 235.25g vs 1333.46 ± 274.44g, 90%CI= -198 _ -1.4), mean maternal age of (24.78 ± 3.68y vs 26.62 ± 4.58y, 90%CI= -3.44_-0.23) and RR of anemia (2.2, P=0.05). Conclusion: The overall prevalence rate of AOP in preterm neonates was 48% and the highest rates were seen within extremely low birth weight and early preterm neonates. The lower neonatal birth weight, neonatal anemia and younger maternal age were found to be the risk factors for apnea of prematurity.

Background Congenital right-side diaphragmatic eventration with atrial septal defect and cleft palate is a rare congenital anomaly. Case presentation We present a rare case of congenital right-sided diaphragmatic eventration along with atrial septal defect, cleft palate, pneumonia, and undernutrition in a 3-month-old Asian and Afghan girl. The clinical features were observed in the third month of life, and the diagnosis of these anomalies was established by the patient’s history, physical examination, chest X-ray, thoracic computed tomography, and echocardiography. Her condition was good after supportive treatment. Since the index case of diaphragmatic eventration was associated with congenital heart disease, cleft palate, and parental consanguinity, a genetic basis may have played an important role in the pathogenesis of this anomaly. Conclusion Eventration of the diaphragm may be diagnosed in early infancy, and genetic factors may contribute to its pathogenesis.