Objective: The purpose of this study was to investigate the clinical significance of the platelet to lymphocyte ratio (PLR) and the neutrophil to lymphocyte ratio (NLR) in term neonates and its impact on management of Early-Onset Neonatal Sepsis (EOS).Materials and Methods: This prospective cross-sectional observational study was conducted with 40 term neonates diagnosed with EOS compared with 40 healthy controls. Exclusion criteria were prematurity, post- maturity, small or large for gestational age according to week of pregnancy, preeclampsia, gestational diabetes mellitus, chorioamnionitis, congenital major anomalies, and cyanotic congenital heart disease. Results: A total of 80 term neonates were included in the study. Of these, 40 were diagnosed with EOS and 40 were healthy controls. NLR and PLR as predictors of early-onset neonatal sepsis, sensitivity of NLR was 67% and PLR was 70% and specificity of NLR was 99% and PLR was 73% and PPV of NLR was 98%, PLR was 72%. There is a significant weak positive correlation between platelets and sepsis, significant fair positive correlation between WBCs and PLR with sepsis, significant moderate positive correlation between immature neutrophils, I.T and NLR with sepsis, finally a significant negative fair correlation between lymphocytes and sepsis.Conclusions: NLRs and PLRs were positively correlated with EOS in term neonates, and these ratios can be used as diagnostic adjunct tests for neonate EOS workups.

Background: This study aimed to evaluate the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as diagnostic adjunct tests for early-onset neonatal sepsis (EOS). Methods: This prospective cross-sectional study included 80 full-term neonates with confirmed EOS and 80 healthy newborns. All examinations were done 24 hours after birth. Neonatal sepsis (NS) was characterized as a positive blood culture with symptoms of infection. Positive diagnostic indicators, including I/T ratio > 0.2, total leukocytes [WBCs] of either 5109/L or > 15109/L, thrombocytopenia [150,000/mm3], CRP > 1 mg/dL, and procalcitonin >0.5 ng/mL were considered as NS. Results: As the predictors of EOS, the sensitivity of NLR and PLR was 67% and 70%, and their specificity was 99% and 73%, respectively. Also, positive predictive value (PPV) of NLR and PLR was 98% and 72%, respectively. We found a weak correlation between platelets and sepsis, Strong correlation between WBCs and PLR with sepsis, and a moderate correlation among the ratio of immature to total neutrophil counts (I/T ratio), all of which were significant. Besides, concerning NLR with sepsis, we found an inverse correlation between lymphocytes and sepsis. Conclusions: PLR and NLR are important predictive markers for EOS (PPV of NLR and PLR was 98% and 72%, respectively). Moreover, leukocytosis, thrombocytopenia, high c-reactive protein (CRP), high procalcitonin, and positive blood culture were correlated with the risk of NS. NLR and PLR showed more specificity than CRP and procalcitonin.

Background: Sepsis still causes morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Sepsis induces myocardial dysfunction and causes a reversible decline in ejection fraction (EF) of ventricles. Many biomarkers have been described for diagnosing sepsis, including serum ferritin and C-reactive protein (CRP). Objectives: This study was conducted to assess the relationship of cardiac dysfunction evaluated using echocardiogram, ferritin, and CRP with negative outcomes of sepsis in the PICU. Methods: A cross-sectional study was conducted on 80 patients aged between one month and six years who fulfilled the following criteria: (1) confirmed diagnosis of sepsis according to the American College of Critical Care Medicine; (2) receiving ventilation for 48 h and/or vasoactive medicines. The CRP and ferritin levels were recorded on the first day (D1) and third day (D3) of hospitalization in the PICU. Participants underwent an echocardiography study to investigate the ejection fraction on D1 and D3. All outcomes were evaluated. Results: Our results showed a highly statistically significant difference between D1 and D3 in ejection fraction (P = 0.001). The serum ferritin level and CRP enhanced significantly from D1 to D3 (P < 0.001). Low left ventricular ejection fraction, and high serum ferritin were associated with unfavorable outcomes (P values < 0.001 and 0.021, respectively), but there was no significant difference in the outcomes regarding CRP. Conclusions: Cardiac dysfunction and high serum ferritin were associated with unfavorable outcomes in children with sepsis admitted to the PICU.

Background Since December 2019, Covid-19 has resulted in high morbidity and mortality worldwide. MIS-C associated with SARS-CoV-2 infection led to serious and life-threatening illness in children causing severe multisystem inflammation. It presented with new neurological symptoms involving both the central and peripheral nervous systems. The aim is to evaluate the neurological manifestations in pediatric patients with MIS-C associated to COVID-19. Aim To evaluate the neurological manifestations in Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) associated to COVID-19. Methods This cross section study included patients who were admitted to Pediatric Intensive Care Unit (PICU) isolation unit at Minia University Hospital during the period from December 2020 to April 2022. The study included a total of 303 patients who were classified in to 3 groups; Group (I) (MIS-C, PCR positive), Group (II) (MIS-C, PCR negative), and Group (III) (Non-MIS-C, PCR positive). Results The respiratory, cardiovascular, hematologic and gastrointestinal symptoms were significantly greater among Group (II). Convulsions, DCL, Headache, and Weakness were significantly more demonstrated in Group (I) (19 (31.7%), 17 (28.3%), 17 (28.3%), and 15 (25.0%), respectively). While, drowsiness was significantly more demonstrated in Group (II) (41 (21.9%)). Lymphocytes (%) showed significant lower values in Group (I) and Group (II) (Mean ± SD is 18.9 ± 1.8(, compared to Group (III) (Mean ± SD is 21.4 ± 1.8), p-value < 0.01. D-dimer, CRP and S. Ferritin levels were significantly increased among Group (I) while albumin levels were significantly decreased in Group (I). Troponin levels were significantly increased in patients of Group (II). The majority of patients in the three studied groups showed abnormal Chest CT findings in the form of ground glass opacities (CO-RADS III). The percentage of non-survived patients was significantly increased in Group (I). Conclusion Pediatric patients with MIS-C and associated to COVID-19 presenting with neurological, respiratory, cardiovascular, gastrointestinal, and hematologic symptoms. The neurological manifestations could include convulsions, DCL, headache, and weakness.

Background: Extubation readiness is assessed by spontaneous breathing trials (SBTs); however, there is a lack of universally agreed protocols for their accurate performance and reporting in pediatric intensive care units (PICUs). Objectives: We aimed to evaluate extubating bundles, including modified SBT, in predicting successful extubation in critically-ill children with planned extubation. Method: This prospective cross-sectional study was based on the collection of data from 150 critically-ill children admitted to the PICU at Minia University Hospital. From January 2019 to June 2020, those children admitted to the PCIU and subjected to mechanical ventilation (MV), and extubation were enrolled. When the clinical team decided a child was ready for extubation based on the extubating bundle, a modified SBT (10 min) was used. It was started with switching to the CPAP\PS mode, followed by PS zero, and maintaining the original PEEP for 3 min. Finally, PS was kept at 5 - 8 cm H2O, and the original PEEP was maintained for the remaining 7 min (total period of 10 min). Results: The extubation bundle with modified SBT could predict extubation success with 89% sensitivity and 89.9% positive predictive value (PPV). There were no significant differences in age, weight, gender, and length of intubation between children with failed SBT and those who were successfully extubated. In 41 cases, SBT failure occurred in 3 ‐ 5 min, while nine cases showed failure in 6 ‐ 10 min. Conclusions: Extubation bundle with modified SBT before elective extubation is indicated for children. Guidelines for extubation among critically-ill children are needed to reduce unnecessary exposure to mechanical ventilation's adverse effects. Further multicenter research is required to enhance outcomes and decline the burden of these patients.