Therapeutic hypothermia (TH) either by selective head cooling or whole-body cooling decreases brain damage and provide neuroprotection and reduced mortality rate in cases of moderate-to-severe hypoxia-ischemia encephalopathy (HIE) of newborns, especially if started at first 6 hours after birth. Also, management with adjuvant therapies like magnesium sulfate (MS) provides more neuroprotection. The interventional randomized controlled research aimed to assess short-term actions of TH as sole therapy and in combination with MS as a neuroprotective agent for the treatment of HIE newborn infants. A total of 36 full-terms and near-term infants delivered at Assiut University Children's Hospital and fulfilled HIE criteria were enrolled. They were divided equally into three groups; Group 1 (n = 12) received whole body cooling during first 6 hours of life as a sole therapy; Group 2 (n = 12) received whole body cooling in addition to MS as adjuvant therapy; Group 3 (n = 12) received supportive intensive care measures as a control. TH plus MS group (group 2) had a significantly good short-term outcomes as short period of respiratory support and mechanical ventilation (p-value =0.001), less in incidence of convulsion (p-value = 0.001) and early in feeding initiation (p-value = 0.009), compared with other groups managed by TH (group 1) or by supportive treatment (group 3). In conclusion, whole body cooling in addition to MS as adjunctive therapy for the treatment of HIE neonates is safe therapy that improves short-term outcome both clinically and radiologically.

TO THE EDITOR: Once-daily use of aminoglycosides has been shown to be safe and effective in adults; however, there has been limited experience in children. 1 Also, the Bayesian pharmacokinetic approach for individualizing dosage of aminoglycosides is poorly documented in pediatric patients. 2 We determined the amikacin plasma concentrations achieved and the pharmacokinetics (estimated by the Bayesian approach) in pediatric patients with bronchopneumonia with once-or twice-daily dosing.Methods. Twenty-one patients (mean ± SD age 1.45 ± 1.34; mean ± SD body weight 8.4 ± 4.0 kg) diagnosed with bronchopneumonia were empirically treated with ampicillin 100 mg/kg/d and amikacin given either once daily (n = 10; 15 mg/kg/d) or twice daily (n = 11; 7.5 mg/kg q12h). Intravenous amikacin was infused over 30 minutes and all patients had good renal function (serum creatinine ≤1 mg/dL). Exclusion criteria included serum creatinine >1.4 mg/dL, granulocytopenia, proven otitis media or hearing loss, or history of aminoglycoside administration, including amikacin, within at least seven days of entry into the study. Two amikacin plasma concentrations were determined in every patient using TDxFLx (a peak value 30 minutes after the end of infusion and a trough value just before the next infusion). The clearance (Cl) and apparent volume of distribution (V d ) for amikacin were calculated based on characteristics (e.g., age, weight) of individual patients and measured plasma concentrations of the drug. A pharmacokinetics software package (Abbott Diagnostica, Wiesbaden, Germany) was used to analyze serum concentration data. The mean prediction error (me) for estimation of bias and root mean 2 error (rm 2 ) for estimation of precision, in addition to their corresponding CIs as defined by Sheiner and Beal, 3 were used to evaluate predictive performance of these methods.

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Background: Sedation is a necessary component in the care of all critically ill patients, especially those requiring mechanical ventilation to prevent asynchronous ventilation, improve oxygenation, and prevent inadvertent extubation.Patients and Methods: Data of 100 children (1m-18y) age receiving mechanical ventilation in pediatric intensive care unit of Assiut University Children Hospital during period of six months from April 2016 to October 2016 is collected and analyzed and is compared with the standard guidelines according to American Association of Critical Care (2012) as a reference standard in sedation in mechanically ventilated child.Results: Midazolam is the most common drug used by (70%) of cases. Monitoring of sedation by sedation assessment scale (simplified COMFORT scale) done only for (30%) of cases. Conclusion:We need to stick with the international guidelines as a reference standard to facilitate the correct selection of drugs, their appropriate administration and careful monitoring, improve the quality of sedation and avoid their adverse effects.