Paracetamol is as effective as indomethacin and ibuprofen in closure of PDA in preterm neonates and has less side effects mainly on renal function, platelet count, and GIT bleeding. What is Known: • Hemodynamically significant patent ductus arteriosus has many complications for preterm and low birth weight neonates and better to be closed. Many drugs were used for medical closure of PDA e.g. indomethacin, ibuprofen and recently paracetamol. Many studies compare safety and efficacy of paracetamol with either indomethacin or ibuprofen. What is New: • It is the first large study that compares the efficacy and side effects of the three drugs in one study.

Background/Aim:Vitamin D deficiency is common in irritable bowel syndrome (IBS). There is growing interest in the role of vitamin D in pediatric IBS. We aimed to evaluate the effect of vitamin D supplementation in adolescents with IBS and vitamin D deficiency.Patients and Methods:One hundred and twelve adolescents with IBS and vitamin D deficiency were randomly divided into two groups of matched age and sex. The first group received oral vitamin D3 2000IU/day for 6 months and the second group received placebo for 6 months. Vitamin D status as well as different IBS score systems (IBS-SSS, IBS-QoL, and total score) were evaluated before and 6 months after treatment.Results:IBS patients who received vitamin D supplementation for 6 months showed significant improvement in IBS-SSS (P < 0.001), IBS-QoL (P < 0.001), and total score (P = 0.02) compared to IBS placebo group. IBS patients treated with vitamin D showed two folds increase in their serum vitamin D levels (from 17.2 ± 1.3 to 39 ± 3.3) ng/ml with P < 0.001. While in the placebo group, their serum vitamin D levels were not significantly changed (P = 0.66). Vitamin D was tolerated well without any recorded adverse effects during the study period.Conclusion:Vitamin D supplementation can be effective in treating adolescents with IBS and vitamin D deficiency.

Laryngeal air column width difference measurement may serve as a simple reliable noninvasive method for predicting postextubation stridor in children.

BackgroundPostoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery.Methods and ResultsA prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P<0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P<0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P>0.005).ConclusionProphylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.

Background Invasive mechanical ventilation (MV) is lifesaving for critically ill neonates. Limiting the duration of MV support is crucial. Lung ultrasonography is a bedside technique useful to predict weaning success in adults, but few data are available about its use in neonates. Our aim was to assess the value of lung ultrasonography to predict weaning success of the ventilated neonates. Methods This study included 80 neonates on MV suffering from different pulmonary diseases. All patients had lung ultrasound just before extubation and 6 hours after extubation. Lung ultrasound score (LUS) was calculated for all neonate. Blood gases and chest x‐ray were performed just before extubation as well. All neonates were followed up for 48 hours after extubation for extubation failure (EF). Results Eighteen neonates (22.5%) experienced EF. Neonates with EF had significantly lower gestational age, lower weight but significantly prolonged duration of MV, prolonged NICU stay, and higher mortality. LUS before and after extubation was significantly higher in neonates with EF than those with weaning success. Pre‐extubation LUS had a sensitivity of 83% and a specificity of 88% to predict weaning success in neonates at a cutoff value ≤4. While, post‐extubation LUS had a sensitivity of 89%, and a specificity of 90% to predict weaning success in neonates at a cutoff point ≤6. Conclusion Lung ultrasound is a rapid, noninvasive, repetitive, and reliable tool for predicting the weaning success of ventilated neonates.