Gentamicin has proven to be a very successful treatment for bacterial infection, but it also can cause adverse effects, especially ototoxicity, which is irreversible. Therapeutic drug monitoring (TDM) in saliva is a more convenient non-invasive alternative compared to plasma. A physiologically-based pharmacokinetic (PBPK) model of gentamicin was built and validated using previously-published plasma and saliva data. The validated model was then used to predict experimentally-observed plasma and saliva gentamicin TDM data in Jordanian pediatric preterm infant patients measured using sensitive LCMS/MS method. A correlation was established between plasma and saliva exposures. The developed PBPK model predicted previously reported gentamicin levels in plasma, saliva and those observed in the current study. A good correlation was found between plasma and saliva exposures. The PBPK model predicted that gentamicin in saliva is 5–7 times that in plasma, which is in agreement with observed results. Saliva can be used as an alternative for TDM of gentamicin in preterm infant patients. Exposure to gentamicin in plasma and saliva can reliably be predicted using the developed PBPK model in patients.

Introduction:Respiratory distress syndrome (RDS) is defined as acute respiratory distress caused by surfactant deficiency that disturbs gas exchange in preterm infants. It is one of the most common neonatal problems and has been considered to be the most common cause of mortality and morbidity in preterm babies.Aim:In this study, different variables were studied to predict factors for INSURE failure that might help in choosing infants for this procedure early.Methods:Sixty three (63) patients were enrolled in this study as they met the inclusion criteria. All neonates were intubated briefly less than 2 hours, given natural surfactant in the dose of 3 ml/kg. As soon as it was appropriate and the neonate was stable in the form of normal heart rate and oxygenation, extubation was done and the baby connected to NCPAP at a pressure of 6 cmH2O. INSURE failure was considered if the patient needed mechanical ventilation for more than 72 hours while INSURE success was considered if we were able to wean the patient from CPAP or if the patient didn’t need mechanical ventilation in the first 72 hours after surfactant administration. The indications for mechanical ventilation after INSURE procedure were respiratory distress with desaturation (02 sat less than 90%), recurrent apnea, Pco2 more than 60 mmHg.Results:Since INSURE procedure is being largely applied in the neonatal intensive care units, it is important to determine the candidate neonate for this procedure with the minimum failure rate. Although the sample of our study is small, but we can suggest that neonate with gestational age less than 28, birth weight less than 1000 gm, umbilical PH of less than 7, low Apgar score and anemic patients are at high risk for INSURE failure.Conclusion:Early diagnosis of PDA and IVH is essential to avoid INSURE method in these patients.

The aim of this study is to evaluate some biochemical parameters including serum creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) in newborns with birth asphyxia. Methods: This retrospective study was conducted in King Hussein medical center over two year period. Fifty seven patients were enrolled in this study who fulfills the inclusion criteria (group A), another sixty patients were enrolled as control (group B). Biochemical parameters as CPK and LDH were measured in both groups. Results: Forty seven patients out of fifty (82%) showed liver involvement indicated by the elevation of LDH and CPK, done in the first three days of life. Most of the patients were in the grade one of HIE according to sarnat and sarnat classification. Statistical analysis was done for the available data and showed significant elevation of both CPK and LDH in asphyxiated babies. Conclusion: Measurement of both CPK and LDH in babies with high risk and who are suspected to have birth asphyxia, can help in predicting those who are candidate for neuroprotective measures as hypothermia, which might lead to significant improvement In neurodevelopment abilities of neonate later on.

Sacral agenesis, known also as caudal regression syndrome, is a rare congenital abnormality characterized by absence of a variable amount of sacrum, lumbar spine and associated neural elements. It is mostly seen in infants of diabetic mothers. Nearly all patients have genitourinary anomalies, neurogenic bladder being the most common. Other associated anomalies include cardiac, gastrointestinal and orthopedic. Here, we present a rare type of lumbosacral agenesis in an infant of a diabetic mother. It was diagnosed antenatally at 26 weeks of gestation.