Objective: To compare the need of mechanical ventilation between LISA (less invasive surfactant administration) method and conventional INSURE method (INtubation SURfactant administration and Extubation) in spontaneously breathing preterm infants with respiratory distress syndrome (RDS).

McKusick-Kaufman Syndrome (MKKS) is one of rare syndromes which presents as polydactyly, hydrometrocolpos (HMC) and cardiac anomalies. This autosomal recessive disorder occurs due to mutations in MKKS gene. It is characterised predominantly by genitourinary and digit abnormalities. The diagnosis can be made on clinical findings; however, it is important to rule out Bardet-Biedl syndrome before making the definitive diagnosis. Treatment of MKKS revolves around treatment of its manifestations and complications. We hereby report a case of neonate with features of MKKS.

Background: Malnutrition in under five children is prevalent in our country.  It makes them prone to infections and increases child mortality. This can be controlled by identifying and modifying the predisposing factors. Objective: To assess nutritional status and to analyze the influence of various demographic factors on nutritional status of under five children. Methodology: This cross-sectional study was conducted in Shifa Falahi and Community Health center in Islamabad. Children under five years of age were included. Information was collected from mothers on a self-designed questionnaire. Weight and height of children was recorded and classified according to WHO Z score. Data was evaluated on SPSS 20. Univariate analysis was done to determine independent effect of each predictor on outcome. Results: Total of 280 patients were enrolled. 162 (57. 9%) of them were malnourished. Stunting was seen in 24.6% cases, while 26.1% were underweight. Wasting was seen in 19.6% cases. More males were stunted (27.9%) and underweight (27.27%) as compared to females (21.2%) and (24.8%) respectively. Low household income (p value 0.014), poor maternal education (p value 0.018), joint family system (0.002), unboiled drinking water (0.008) and repeated diarrheas (0.02) were found significantly associated with malnutrition. Most of the mothers (>75%) had adequate knowledge of breast feeding, vaccination, seeking medical advice for their babies. Conclusion: All forms of childhood malnutrition are prevalent. Poor socioeconomic status and maternal illiteracy are strong contributors towards malnutrition. Unboiled drinking water and diarrheas are further aggravating the nutritional status of children.

Neonatal sepsis is the significant reason of neonatal mortality and morbidity and mostly results in extended hospitalization of infants in the neonatal intensive care unit. The sepsis was confirmed by a positive blood culture and a condition is considered clinical sepsis when the blood culture is negative. It is practically not possible to clinically differentiate sepsis from neonatal meningitis. However, a positive CSF for pathogenic bacteria indicates meningitis. Aim: The purpose of this study was to evaluate the frequency of late-onset sepsis in neonates with meningitis and to determine whether CSF analysis and lumbar puncture is mandatory in all cases of late-onset sepsis. Methods: This study was conducted in the Paediatrics department of CMH Abbottabad, and Sharif Medical City Hospital Lahore, and Pathology department of Women Medical and Dental College, Abbottabad for the duration from January 2022 to June 2022 among neonates with late neonatal sepsis. All neonates underwent clinical examination, history, routine tests (blood culture, C-reactive protein, complete blood count) and analysis and culture of cerebrospinal fluid for clinical evaluation of sepsis. Results: All 80 neonates tested positive for clinical sepsis: hematological sepsis was seen in 59 patients and 21 were CSF culture positive for sepsis; 8 (38.9%) of the 21 have positive CSF culture and 13 cases have negative blood culture. The most common clinical symptom was poor suction 70(87.5%), followed by weak moor 61(76.3%), and lethargy 46(57.5%). The Klebsiella spp was common organism seen in 15 children in the blood culture and the most communal organism in the cerebrospinal fluid culture was Staphylococcus aureus in 6 cases. Conclusions: The incidence of neonatal meningitis is high in new-borns with late-onset sepsis. Meningitis in neonates often transpires in the absence of bacteraemia. Therefore, the CSF examination and lumbar puncture are compulsory in all children with late onset sepsis. Keywords: Lumbar puncture, Meningitis, Neonatal sepsis

Background: Ventilator associated pneumonia (VAP) is a relatively common and sometimes deadly complication of mechanical ventilation seen in neonatal ICUs around the globe. Objective: The study aimed to analyze the effect of three different infant positions on the rate of ventilator associated pneumonia in newborns in NICU. And compare the bacterial growth on tracheal aspirates in all three groups. Study design: It was randomized controlled trial study conducted for the duration of six months from 1st January 2021 to 30th June 2021 at Neonatal ICU department of Children Hospital PIMS, Islamabad. Material and Methods: The sample size was calculated by WHO sample size calculator, with power of test 80% and level of confidence 05%. Population proportion for group 1 was 67% (rate of bacterial colonization in supine group). Population proportion for group 2 was 47% (rate of bacterial colonization in lateral group). Sample size was turned out to be 50 in each group and a total of 150 patients were included in the study. The patients were randomized to one of the three groups using lottery method. The ethical and review board committee of the hospital approved the study. Results: First group patients were in supine position after the procedure of endotracheal intubation on the ventilator. The second group was the one in which infants were put in prone position by following protocol. And the third group contained patients in lateral positions. The goal of the study was to study the effect of these three positions on the incidence of ventilator associated pneumonia in case of infants admitted in hospital. The other goal was to do a comparison on the bacterial growth produced on tracheal aspirates in case of all these groups. Infants were kept in these positions and there was no information collected for 10 minutes as there could be any potential instability in respiration. After the patients were stable data was collected. Conclusion: There was no difference found in the incidence of VAP in case of all three positions and the bacterial colonization was found to be increased in case of supine position as compared to other groups. Keywords: Ventilator associated pneumonia (VAP), Neonatal ICUs, Respiratory tract.