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Objective Successful extubation and prevention of reintubation remain primary goals in neonatal ventilation. Our aim was to compare three modalities of postextubation respiratory support—noninvasive positive pressure ventilation (NIPPV), nasal bilevel positive airway pressure (N-BiPAP), and nasal continuous positive airway pressure (NCPAP)—using the RAM cannula in preterm neonates with respiratory distress syndrome (RDS). Our secondary aim was to define the predictors of successful extubation. Study Design A total of 120 preterm neonates (gestational age ≤35 weeks) with RDS who had undergone primary invasive ventilation were randomized to receive either NIPPV, N-BiPAP, or NCPAP. The incidence of respiratory failure in the first 48 hours postextubation, total days of invasive and noninvasive ventilation, duration of hospitalization, and mortality were measured and compared among the three different noninvasive support modalities. Results There were no significant differences in the postextubation respiratory failure rates and the number of days of invasive as well as noninvasive ventilation among the three different support modalities (p ˃ 0.05). The total number of days of mechanical ventilation and the duration of hospitalization were significantly higher in the N-BiPAP group than those in the NCPAP or NIPPV groups (p < 0.05). A gestational age of at least 29 weeks and a birth weight of at least 1.4 kg were predictive of successful extubation with a sensitivity of 98.2% and 85.3% and a specificity of 63.6% and 90.9%, respectively. Conclusion Longer durations of mechanical ventilation and hospitalization were observed with N-BiPAP as a noninvasive mode of ventilation, but there was no significant difference in the extubation failure rates among the three modalities. Gestational age and birth weight were shown to be independent predictors of successful extubation of preterm neonates with RDS. Key Points

Background: Autism spectrum disorder (ASD) is a biologically based neurodevelopmental disorder without a known cause. However, some autistic children experience immune malfunction and numerous studies noted that probands with autism and their mothers had higher HLA-DR4 frequencies than their fathers did. Probably, the mother's HLA-DR4 activity contributes to the phenotype of autism in her fetus. The purpose of this work was to investigate any potential link between the HLA-DR4 gene and autism. Methods: We conducted a controlled cross-sectional study on 100 subjects enrolled from the Children's Hospital of Ain Shams University. They comprised four groups: 25 autistic children, 25 mothers of the autistic children, 25 healthy children as a control group, and 25 mothers of the healthy children. All children underwent a detailed history taking, general and neurological examination, and IQ assessment using the Stanford Binet scale. Molecular HLA-DR typing was assessed in all subjects. The diagnosis of ASD was established using the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Severity was assessed using the childhood autism rating scale (CARS). Results: 45.5% of the autistic patients demonstrated the HLA DR4 allele compared to 36% of the control children. Up to 9.1% of cases of ASD had a double DR4 allele compared to 4% of the controls but with no significant statistical difference in-between. Also, 48 % of the autistic children's' mothers had the HLA DR4 allele compared to 24% of the control mothers but the difference did not reach a significant difference. On the other hand, the HLA DR3 haplotype was present in only 6.8 % of the patients' alleles compared to 24% of controls (p<0.05). Conclusion: The link of some HLA alleles to autism indicates the possible contributing role of these alleles to autoimmunity in some autistic children. Wider scale studies are needed to validate our findings.

Background Type 1 diabetes is a common childhood disease that is affected by and affects every aspect in the life of the child or adolescent with diabetes. Data on attention-deficit hyperkinetic disorder (ADHD) among children and adolescents with type 1 diabetes is limited. The aim of this study was to assess the prevalence of ADHD among a cross-sectional sample of 70 children and adolescents with type 1 diabetes as compared to 70 matched controls and to assess the glycemic control of included patients. For a comprehensive evaluation, assessment was done using Pediatric Symptom Checklist (PSC, the 35 item), Diagnostic and Statistical Manual of Mental Disorders—the fifth edition (DSM-5) criteria, and Conners comprehensive behavior rating scale—revised for parents/caregivers. Glycemic control of all included patients was also evaluated by HbA1c %. Results A screening PSC score was significantly higher for children and adolescents with type 1 diabetes than controls (p < 0.001). Significantly larger number of cases with type 1 diabetes fulfilled DSM-5 criteria for inattentive or hyperactive or mixed type ADHD (14.3%, 17.1% and 18.6%, respectively) as compared to controls (4.3%, 5.7%, and 7.1% respectively, p < 0.05). Also, a significantly larger number (more than half, 57.14%) had a Conners score above 70, and the mean scores on Conners parent rating scale were also significantly higher for children with type 1 diabetes than controls (p < 0.001). Most of the included patients did not achieve adequate glycemic control (47.14% of patients were in poor control and only about one fifth achieved a HbA1c < 7.5%). Conclusion ADHD is more common among children and adolescents with type 1 diabetes than in healthy controls. It is important to perform psychiatric evaluation of children and adolescents with type 1 diabetes especially those in poor metabolic control to assess for associated neuro-behavioral disorders such as ADHD. This is crucial to be able to properly design insulin therapy for such a group of patients who may suffer hypo- or hyper-glycemia due to inattention, forgetfulness, or hyperactivity and to properly select educational material that take the easy distractibility of ADHD patients into account as well as to be able to properly manage such cases given the extra stresses entailed in having a diagnosis of diabetes.