Objective: To compare the outcome of plasma exchange versus intravenous immunoglobulin among children with Guillain Barre Syndrome. Methods: A comparative experimental study was conducted at department of Pediatrics, National Institute of Child Health, Karachi from August 2016 to February 2017. All patients of age ranged from 2-15 years of either gender having duration of Guillain Barre Syndrome not more than 14 days were included. The children were divided into plasma exchange or intravenous immunoglobulin group. Intravenous immunoglobulin was administered for five days in a dose of 0.4 g/kg/day/ while a daily one-volume plasma exchange was given to patients in the plasma exchange group for five days. Duration of mechanical ventilation and the pediatric intensive care unit stay in days were noted. Results: Of 78 children, the mean age was 6.64 ±3.06 years. There were 47 (60.3%) males and 31 (39.7%) females. A significantly higher length of intensive care unit stay was noted among children who received plasma exchange (9.45 ±4.59 days) as compared to the children who received intravenous immunoglobin (4.97 ±2.84 days) (p-value <0.001, 95% CI -6.23 to -2.73). Similarly, the mean duration of ventilator stay was significantly higher among children who received plasma exchange (7.33 ±3.44 days) as compared to the children who received intravenous immunoglobin (2.01 ±0.01 days) (p-value <0.001, -7.91 to -2.74). Conclusion:The outcome of intravenous immunoglobin founds better than that of plasma exchange in treating children with Guillain Barre syndrome.

Background: Congenital heart disease (CHD) is one of the frequent congenital health issues in neonates. Early diagnosis is a key factor to combat this problem. This study aims to assess the frequency and common types of CHD among neonates presenting to a tertiary care hospital, Karachi. Patients and methods: This descriptive cross-sectional study was conducted in a Neonatal Intensive Care Unit (NICU) of National Institute of Child Health (NICH), Karachi from March to September 2017. All neonates of gestational age ≥37 weeks with suspected CHD (presence of blue-tinged skin, i.e. cyanosis on routine clinical examination) were included. Information regarding presence of CHD and its types were collected along with the demographic characteristics and history of the patients. Results: Of 134, frequency of CHD was observed in 126 (94%) patients. Out of these 126 CHD patients, Ventricular septal defect (VSD) was observed in 49 (38.9%), patent ductal arteriosus (PDA) in 29 (23%), atrial septal defect (ASD) was observed in 19 (15.1%), Transposition of great arteries (TGA) in 18 (14.3%), and tetralogy of Fallot (TOF) in 14 (11.1%) patients. A significant association of VSD was observed with neonatal age (p = <0.001), ASD with neonatal age (p = 0.037) and maternal age (p = 0.025), while TGA was found significantly associated with neonatal age (p<0.001). Conclusion: CHD was observed in majority of the suspected patients with VSD as commonest type of congenital heart diseases among neonates.

Vitamin D is a fat soluble vitamin, most commonly recognized for its importance in regulating serum electrolyte levels, particularly calcium and phosphate, along with its role in muscle development and bone 1 growth in children, specifically. Its insufficiency has emerged as common problem across many age 2 groups. Multiple sources in literature have shown that Vitamin D deficiency has a high prevalence in the , pediatric population.³ ⁴ Vitamin D insufficiency remains a stringent cause of concern in pediatric patients diagnosed with Cystic Fibrosis. Exocrine pancreatic insufficiency is well known for causing malabsorption of fat soluble. It is commonly seen in cystic fibrosis patients, therefore putting this patient population at risk of developing deficiencies of 5,6 fat soluble vitamins including Vitamin D. Vitamin D deficiency has been seen to be proportional to an increase in morbidity and mortality, due to a higher risk of decline in pulmonary function, increased occurr-

Objective: To determine the outcome of Bubble Continuous Positive Airway Pressure (bCPAP) Therapy use in preterm neonates with respiratory distress admitted in large public sector children hospital. Methods: This prospective observational study was conducted at National Institute of Child Health (NICH) from March 2016 to February 2017. All preterm neonates with respiratory distress diagnosed within 24 hours treated with bCPAP were consecutively included. Respiratory distress was defined on the basis of presence of any of the three following symptoms (i) tachypnea (ii) chest indrawing (iii) grunting (iv) nasal flaring (v) hypoxemia. Outcome was measured in terms of survival, median for duration to achieve 21% O , apnea, hyperemia of nose, 2 abdominal distention, median for hospital stay, and median weight gain. Results: Of 70 preterm neonates, the median birth weight was 2700 (2300 -3000) gm, duration to achieve 21% O2 was 3 (2 -72) hours, and hospital stay was 8 (6-10) days. The complications of bubble CPAP showed that abdominal distension was found higher followed by hyperemia of nose and apnea i.e., 18 (25.7%), 17 (24.3%), and 4 (5.7%) respectively. Survival was found significantly associated with birth weight (p-value 0.049) and in neonates with no complications (p-value <0.001). Whereas apnea was found significantly higher in female preterm neonates (p-value 0.017), low birth weight (p-value 0.012) and in neonate who reported no survival (p-value <0.001). Conclusion:The administration of bCPAP is an effective modality for managing respiratory illness in preterm Neonates due to fewer complications and shorter hospital stay.

Neonatal sepsis is one of the significant life-threatening condition encountered by almost all neonates affected due to any communicable or non-communicable 1 diseases particularly during hospitalization. Various studies have reported that neonatal sepsis is a significant cause of morbidity and mortality 1-4 worldwide. Though, it is reported that sepsis is highly preventable, still, an estimate given by World Health Organization (WHO) revealed that on average, 1 million mortality among neonates was observed due to sepsis 5 every year. In Pakistan, situation is also unsatisfactory. According to a study, 25-50% of all neonatal mortality 6 are attributable to infections. While, appropriate therapeutic options are now available, still, the neonatal sepsis problem is on the rise not only in early onset but in late onset neonatal sepsis as well. Literature has identified many causes for the