Background; Lead enters drinking water by leaching from pipes and solder joints in household plumbing.
Aim of the work is to evaluate the lead pollution of potable water and its impact on blood lead levels of infants fed either milk or artificial formula.
Methods; This study was done on ninety potable tap water samples collected from different districts and ninety blood samples taken from infants who attended in some of different hospitals. All samples were analyzed for lead by graphite furnace atomic absorption Spectrophotometer. All samples and standards were read to the same accuracy and at the same time.
Results; Mean lead level in groundwater showed higher level than in surface water. An elevation of blood lead level of bottle feeders using groundwater was noticed higher compared with that of their counterparts using surface water. Also, an elevation of blood lead level of breast feeders where mothers drink groundwater was noticed higher when compared with that of their counterparts born to mothers drinking surface water. There was a positive relationship between blood lead levels and potable water lead levels.
Conclusion; bottle feeding was a strong predictor of elevated blood lead levels among infants.

Objective
Thermal control following delivery is an essential of neonatal care. We decided to learn more about it in our unit. The goal of this study was to determine the temperature at the time of admission to our (NICUs) and how it relates to death and other morbidity.
Methods
Prospective cohort study using chart review data for babies admitted to NICU at King Fahd central hospital in Jazan from April 2021 to March 2022. Hypothermia was classified according to WHO definition. We used a multivariable logistic regression analysis to investigate the adjusted effect of hypothermia.
Results
Half of infants (49.3%) had abnormal temperature, 20.7%, 11.3%, and 17.3% had mild, moderate, and severe hypothermia respectively. Around 20% of newborns were given a bath 2 hours after birth, 36% their head covered with hats, and 21.7% had skin-to-skin contact. The adjusted model found newborns with severe hypothermia were 0.53 (OR = 0.53; [95% CI: 0.15-1.83]) times likely to die and 2.04 (OR = 2.04; [95% CI: 0.76-5.46]) times likely to develop any complication when compared to newborns without hypothermia. Newborns with low birth weight (OR = 16.5; [95% CI: 1.47-185.7]) and without skin-to-skin contact (OR = 3.27; [95% CI: 1.33-8.04]) were more likely to develop any complication when compared to those with skin-to-skin contact.
Conclusion
Hypothermia, low birth weight, abnormal CBC, and absence of skin-to-skin contact all raise the risk of neonatal morbidity. Thermal regulation techniques such as head coverings, skin-to-skin contact, and delayed bathing are not widespread in Saudi Arabian hospitals.

Introduction: Human milk donation is an alternative for infants who cannot access their mother's milk. This study assessed the knowledge, attitude and practice of pregnant and lactating mothers regarding milk donation.
Methods: A descriptive cross-sectional study was conducted with 410 mothers who visited health centers for any reason. A questionnaire with four sections was used to collect data. Data were analyzed using independent t-tests and analysis of variance with SPSS version 16 software.
Results: The mothers had low knowledge but positive attitudes towards milk donation. Their practice of donating milk was moderate. Only 22.7% of the mothers were willing to donate their excess milk to others. Knowledge, attitude and practice were influenced by education, occupation, economic status, milk donation experience and donated milk use experience. Attitude and practice were also influenced by the number of pregnancies and the husband's opinion on the mother's decision to donate milk.
Conclusion: The mothers had low knowledge but positive attitudes towards milk donation. However, their practice of donating milk was only average. Factors such as education, economic status, occupation, milk donation experience, donated milk use experience and husband's opinion affected the mothers' knowledge, attitude and practice regarding milk donation. Extensive education by the media and the internet, as well as nurses' education to mothers about milk donation, its banking process and its benefits, can promote milk donation.
Keywords: Human milk bank, milk donation, Newborn

Background:
Despite the overwhelming benefits of vaccination some choose not to vaccinate due to safety concerns, resulting at least in part to a rise in the vaccine preventable diseases such as measles. Interactions between Health Care Professionals (HCPs) and parents help alleviate vaccination concerns and potentially increase vaccine confidence and uptake.

Objectives:
• What is the prevalence of vaccine concerns in antenatal mothers in a District General Hospital over one-month?
• Can information sessions for families and HCPs improve confidence in vaccine safety?

Methods: Following parental consent, data from 147 questionnaires by antenatal mothers was analysed and informed the structure of education sessions. 11 Bespoke ‘vaccine safety’ sessions for both HCP and families were undertaken. Vaccine confidence pre & post sessions were analysed.

Results: Majority of mothers had no concerns about vaccination (n=126, 86%) with commonest concerns being ‘fever and allergic response’ and ‘link between Measles, Mumps and Rubella (MMR) vaccine and autism’. 3 ‘Vaccine safety’ sessions for families significantly increased their confidence in vaccine safety (p=0.0004). 8 ‘Vaccine safety & having conversation’ sessions attended by 113 multidisciplinary HCPs significantly increased their confidence (p<0.0001) with greatest increase in post score confidence in Nursing & Medical students.

Conclusions
Majority of families are confident about vaccine safety. Educational sessions for families and HCPs facilitate increase confidence in vaccine safety and improve conversations with parents who express hesitancy around routine childhood vaccinations. Self-reflection on vaccine safety awareness offers opportunity for staff to seek education and enhancement to improve care delivery and parental interaction.

Neonatal infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are increasing worldwide and
creating therapeutic challenges.
Case 1:
Premature male, eutocic delivery and uneventful pregnancy. Apgar score 7/9/10. Mother with negative CRE screenings. Ampicillin and gentamicin were started due to infectious risk and then changed to amikacin and vancomycin because of late-onset sepsis with meningitis. Blood culture and CRE screening became positive for CRE Klebsiella oxytoca and ceftazidime/avibactam was associated. Malleolus’ cellulitis and signs of ventriculitis on cranial ultrasound developed later and the antibiogram was changed, showing resistance to all betalactams and amikacin. Sensitivity to colistin and fosfomycin was demonstrated, antibiotic therapy was switched accordingly and he completed four weeks of treatment with clinical and analytical improvement. Neurological examination at discharge and brain MRI were normal.
Case 2:
Full-term male, mother with positive CRE screening. Cesarean delivery due to acute chorioamnionitis. Apgar score 5/8/8. Resuscitation and invasive mechanical ventilation were required and hypothermia criteria were met. Ampicillin and gentamicin and induced hypothermia were started. Blood culture and CRE screening were positive for CRE Klebsiela pneumonia. Meropenem in high dose was added. Ceftazidime/avibactam and fosfomycin were started because of clinical and analytical unimprovement, with further clinical response, and maintained for 21 days. Microbiological examination of the CSF was negative. Neurological examination at discharge and brain MRI were normal.
Neonatal sepsis remains one of the main causes of mortality and morbidity. The emergence of multidrug-resistant bacterial strains urges the need to adapt current therapeutic regimens. The use of old bactericides is a possible solution.

Background and Aims: This is a clinical case review that aims to state the evidence-based effect of surgical PDA ligation on the neonatal course in extremely low birth weight neonates & the strategies for choosing the best management. Methods: A male Preterm (+28wks), EVLBW (690g) infant who was delivered&transferred to NICU because of ELBW, severe IUGR, RDS & need for respiratory support, presenting with large PDA with huge volume overload not responding to medical treatment, then developed multisystem complications of NEC, multiply perforated gut, periventricular leukomalacia, bacterial&fungal neonatal sepsis, metabolic acidosis, abnormal hematological&coagulation profile. Baby deteriorated
clinically, so, explorative surgery with intestinal resections&end-to-end anastomosis was done&PDA ligated surgically. Baby then improved significantly&early feedings was started&gradually increased up to full feedings with significant clinical improvement. Discussion: We present an evidence-based treatment, with surgical PDA ligation and a stormy neonatal course with perforated gut&multisystem complications in ELBW neonates&the strategies for choosing the best management for such cases, as surgical PDA ligation is the best choice in the management of PDA with big volume overload in EVLBW neonates with multiple complications during medical management with significant clinical, laboratory&radiological improvement of such cases. Conclusions: 1) Prematurity is the single greatest risk factor for multisystem complications&avoidance of premature birth is the best way to prevent such problems. 2) The role of surgical PDA ligation&its preference rather than medical management with its significant effect on a stormy neonatal course.

Background: Meconium obstruction of prematurity (MOP) usually manifests as feeding intolerance in early postnatal days, and being small for gestational age (SGA) is a risk factor for MOP. The timely diagnosis and treatment of MOP are critical, but the pathogenesis is still obscure.

Objective: The objective of this study was to compare superior mesenteric artery Doppler ultrasound characteristics in SGA infants with and without MOP.

Methods: We prospectively enrolled 37 preterm infants (<34 gestational weeks) who were SGA (birth weight<3P). The superior mesenteric artery blood flow characteristics of each neonate were measured with Doppler ultrasound during the first 48 hours of life (T1) and between the fifth and seventh day of life (T2) sequentially. Demographics, comorbidities, and outcomes were recorded and analyzed.

Results: Among the 37 SGA infants, MOP occurred in 8 infants. The peak systolic velocity (PSV) was significantly lower in the infants with MOP than without MOP at T1 (40.24±7.67 vs. 52.95±18.35, P=0.007) and T2 (39.35 ±17.93 vs. 60.94 ±22.12, P=0.016). In the logistic regression analysis, including birth weight z-score at birth, PSV at T2 was significantly associated with MOP occurrence (OR 1.066, 95% CI 1.006-1.129, P=0.031).

Conclusion: The intestinal blood flow may be associated with MOP in preterm SGA infants.

Background: Infants in the neonatal intensive care unit (NICU) often show cardiorespiratory deterioration during gavage feeding. We aimed to see whether slow infusion intermittent feeding (SIIF) can reduce respiratory deterioration during gavage feeding in preterm infants in the NICU.
Methods: Preterm infants, whose gavage feeding method was changed to SIIF (1-hour infusion with an infusion pump and 2-hour rest with a 3-hour interval) from bolus feeding (using gravity with a 2-or 3-hour interval) due to feeding-associated cardiorespiratory deterioration were retrospectively reviewed. Significant cardiorespiratory event was defined as desaturation below 80% or a bradycardia below 80bpm. Feeding related cardiorespiratory event is defined as cardiorespiratory event that occurs during or within 30 minutes after feeding. We compared the frequency of cardiorespiratory events and the level of respiratory supports 24-hours before and after the application of SIIF.
Results: A total of 34 infants were enrolled and analyzed. Total frequency of desaturation or bradycardia was significantly decreased after the application of SIIF (8.94 vs 5.03, p=0.001). The frequency of feeding related bradycardia and desaturation was also significantly decreased (4.15 vs 1.68, p=0.008). 11 out of 34 subjects (32.4%) decreased in ventilatory support, 16 (47%) had same ventilator support, 7 (20.6%) increased the level of respiratory support within 1 day after initiation of SIIF.
Conclusions: SIIF significantly decreased gavage feeding-associated cardiorespiratory events and enabled level down of respiratory supports in about one-third of subjects. SIIF can be a therapeutic option for gavage feeding-associated respiratory deterioration in preterm infants in the NICU.

Background : Hypernatremic dehydration is a rare & potentially serious issue in newborn, if not treated timely. This is mainly attributed to inadequate breastfeeding resulting from various factors and processes involved in development of breastfeeding and its transition from mother to newborn.
Incidence of hypernatremic dehydration,
Objective : Clinical profile of newborns with hypernatremic dehydration and seasonal variation was studied. Also, any correlation with hyperbilirubinemia & other clinical features were studied.
Methods : Study was conducted between September 2020 to August 2021 on inborn babies with GA > 35 weeks with weight loss >10 % or with signs of dehydration and hypernatremia (serum sodium > 145mEq/L). The presenting symptoms, daily weight, clinical signs, birth & feeding history and laboratory investigations of the subjects were noted and evaluated.
Results : 987 babies delivered, 934 eligible newborns were included in study, 57 (6.1 %) babies were found to having hypernatremic dehydration Females were more affected than males with 34 (7.62 %) and 23 (4.71%) respectively. Babies born to primigravida mothers (41, 8.49 %) were significantly more affected (P value – 0.0029) than multipara mothers. Maximum percentage (9.3%) of cases were reported in summer months. On evaluation with Pearman’s correlation co-efficient analysis, significant relation was found between the hypernatremic dehydration with age of presentation (p value- 0.003), weight loss (P value- 0.019) and serum BUN at admission (P value- 0.004).
Conclusions : it is observed that dehydration, hypernatremia, and other related problems could be due to decreased breastfeeding & hot weather conditions.

Background:Palivizumab (P) provides passive immunity against RSV and therefore reduces hospital admission and reduces RSV hospital days in high-risk infants.
The Government has made available funding to support to delivery of P to eligible infants to reduce the risk of RSV infection.
High-cost medication use is renumerated if occurring in compliance with guidelines.
Aim: 1) To Identify whether P protects against RSV bronchiolitis; 2) to check whether infants receiving P have documented reasons in line with NICE guidance; 3) to check compliance with regular IM injections for a total of 5 months over the winter period; 4) too see if any babies are admitted to hospital with clinical or swab confirmation of RSV; and to check the degree of medical treatment needed in those admitted to hospital with bronchiolitis.
Sample: 35 Babies received P from October 2022-Feburary 2023.
Methods: Retrospective analysis data of Badger net, Clinical Web Portal, ICE and prescription charts.
-Excel Sheet.
Results: In general, CLD accounts for the majority of indications.
14 babies were admitted with bronchiolitis, 2 of them were RSV positive.
Conclusion: Overall, there is a good adherence to government guidance.
All babies who received P were eligible for immunoprophylaxis.
Furthermore, infants receiving palivizumab prophylaxis had fewer RSV hospital days, fewer days with increased supplemental oxygen and fewer days with a moderate or severe LRTI.
Most babies requiring admission only needed supplemental oxygen +/-antibiotic except one who needed CPAP. There were no ICU admissions needed.

Background
Neonatal sepsis is a major contributor to neonatal deaths in India and worldwide. Antibiotics are mainstay of treatment in neonatal sepsis. Antimicrobial resistance to antibiotics is a fast rising major concern. There is a need to generate location specific data to identify bacterial profile, susceptibility to antimicrobials and antimicrobial resistance pattern for rational antibiotic usage. Molecular techniques are rapid, less laborious, and more sensitive, specific and efficient compared to the conventional methods of bacteriological profiling and maybe useful in surveillance.

Objectives
Profiling of the bacteria isolated from culture proven neonatal sepsis blood samples and understand carbapenem resistant determinants among the gram negative isolates

Methods
This was multi-site hospital based study from Assam, India. Culture positive blood samples from neonates were studied.

Results
A total of 1711 neonates were recruited. Klebsiella pneumoniae (146/437,33.4%) was the predominant gram negative organism detected whereas staphylococcus aureus was the predominant 17.6%(77/437) amongst gram positive organisms. A subset of the Klebsiella pneumoniae isolates were analyzed for carbapenem resistance and 54% of this subset were found to be carbapenem-resistant. bla NDM  is the predominant gene causing cabapenem resistance in several parts of India and hence we wanted to see whether this gene is present in these carbapenem-resistant K. pneumoniae isolates. The presence of bla NDM  genes was detected among 38% of these isolates which showed carbapenem resistance.

Conclusions
This shows that in isolates collected from the different districts of Assam, carbapenem resistance is due to metallo-beta lactamase as is also noted in other parts of India.

BACKGROUND :Perinatal Asphyxia affects every organ of the body of which HIE is most pronounced.
OBJECTIVE: To determine frequency of HIE and different organ dysfunction and its severity in neonates requiring resuscitation ,also to determine association of different organ dysfunction with severity of HIE.
METHODS:
Newborn >34 weeks delivered at tertiary center receiving resuscitation were studied over a period of 1 year. Clinical and biochemical parameters were recorded to determine the effect on multiple organ system. Sarnat staging was used to label HIE . Several clinical and biochemical markers were used to monitor different organ dysfunction
RESULTS:
The incidence of perinatal asphyxia was 3.4% (118/3400) and HIE was 1.94%.(164/3400) in our study. HIE developed in 66(40%){HIE I 14(8.5%) HIE II 18(11%) HIE III 34(20%) }out of 164 babies who received resuscitation. Metabolic derangement was most commonly present in those who received resuscitation at birth followed by renal followed by respiratory system followed by hematological.54.9%(28) were expired having CVS dysfunction followed by hematological 35.7%(25) followed by renal system 35.1%(32).

CONCLUSION: Nearly 1/3rd neonates who required resuscitation developed HIE. Metabolic derangements were most common in neonates requiring resuscitation while Renal derangement were most common among HIE . This study found multiple organ dysfunction is common in babies with HIE, severity increased as the stage of HIE increased. Cardiovascular involvement and respiratory involvement are associated with poor outcomes. Hence monitoring of following clinical and biochemical parameters in neonates with good obstetric care and rapid resuscitation is essential for decreasing morbidity and mortality.