Background: From a forensic pathologist's perspective, there are several aspects of the perinatal postmortem that are particularly important if the baby was born alive or dead. In cases of litigation for perinatal morbidities occurring in hospitals, access to the obstetric and neonatal notes if the baby is born alive and dies a few hours or days later is essential to reach a correct interpretation and conclusion. Hypoxic ischemic encephalopathy (HIE) after prenatal asphyxia is an important cause of neonatal morbidity and long-term neurological disability. It has many causes including intrauterine strangulation by umbilical cord (nuchal cord). Failure of early diagnosis of neonatal asphyxia and its treatment is considered a medicolegal negligence against the doctors. Aim: The present study aimed to use cord blood lactate & S100 protein levels as early markers of neonatal hypoxia caused by nuchal cord to minimize the risk of medicolegal liabilities against the doctors and hospitals. Methods: This is a comparative cross-sectional study conducted on 30 hypoxic neonates due to intrauterine cord strangulation. Lactate & S100 protein levels in the cord blood were measured. These were compared to 30 apparently healthy neonates matched in age, sex and body weight as a control group. Results: Lactate & S100 protein levels in cord blood were a higher significant difference in HIE neonates than control group. In conclusion: lactate & S100 protein levels in cord blood could be used as an early marker for diagnosis of neonatal HIE.

Background:The most frequent disorders of admission in neonatal intensive care unit is respiratory distress syndrome. Continuous positive airway pressure (CPAP) is essential to maintains functional residual capacity. Many predictors of CPAP failure have been reported in studies Aim of Study: This study aimed to evaluate the early predictors of the failed continuous positive airway pressure (CPAP) in preterm babies with respiratory distress syndrome (RDS).Patients and Methods: All born preterm neonates with gestational age (GA) 36 weeks or less from December 2020 to October 2022, in whom CPAP was initiated within the first 72 hours after birth and FIO2 level was determined in the first 2 hours of life, were enrolled in the study.Results: Of the 207 neonates 36 weeks gestation or less in the study, 7 neonates were excluded from the analysis, so 200 neonates were included. In the vast majority of neonates with CPAP failure, the following factors were highly significant explaining CPAP failure as birth weight and FiO2 level at the first & second hours of life compared to CPAP success patients. In ROC analysis, FiO2 -1 st hr. at cut off point >0.38 and FiO2 -2nd hr. at cut off point >0.33 achieved significance for predicting CPAP failure with sensitivity of (72%, 87%) and specificity of (66.7%, 70.2%), with PPV (68%, 79%) and NPV (70%, 82%), respectively. Conclusion:FiO2 -1 st hr> 0.38 and FiO2 -2nd hr. >0.33 predict CPAP failure in preterm neonates.

The aim of this study was to compare the effects of delayed cord clamping (DCC) and early cord clamping (ECC) on venous hematocrit (htc) and clinical outcomes in infants of diabetic mothers (IDMs). This prospective randomized study included 157 term IDMs. The umbilical cords of these infants were clamped at least 60 seconds in group I (DCC group, n = 79) and as soon as possible after birth in group II (ECC group, n = 78). The two groups were compared regarding neonatal venous htc levels, hypoglycemia rates, jaundice requiring phototherapy, respiratory distress, and admission to the neonatal intensive care unit (NICU). Hematocrit levels were significantly higher in the DCC group, both at 6 and 24 hours postnatally (p = 0.039 and 0.01), respectively. Polycythemia frequency was higher in DCC than the ECC group, but no patient in either group needed partial exchange transfusion (PET). Rates of jaundice were significantly higher in the DCC group (p = 0.028), but there was no significant difference between the two groups regarding jaundice requiring phototherapy (p = 0.681). There were no differences between the groups regarding hypoglycemia rates, need for glucose infusion, or respiratory distress. The incidence of admission to NICU was lower in the DCC group (p = 0.005). Early clamping was a significant predictor for increased risk of NICU admission. DCC increased polycythemia and jaundice rates but did not increase the need for PET or phototherapy. Also, DCC reduced the severity of respiratory distress and the subsequent need for NICU admission.