A 9-day old male neonate was admitted for fever. He was born at term with normal antenatal records and a smooth transition from in utero to ex utero. He was febrile and had a left-sided pre auricular hot, tender, erythematous swelling and oral purulent discharge from Stensen’s duct. The septic profile was suggestive of sepsis. Ultrasonography revealed parotid gland enlargement with pus collection. Empirical antibiotics started, and parotid swelling pus drained. Culture of Pus from parotid swelling and Stensen’s duct yielded growth of Staphylococcus Aureus. According to the sensitivity report, antibiotics continued for ten days, and the patient was discharged after complete resolution of signs and symptoms.

Objective: To explore different barriers to the implementation of continuous positive airway pressure ventilation in neonates at the birthplace. Study Design: Mixed method study. Place and Duration of Study: Combined Military Hospital and Pak-Emirates Military Hospital Rawalpindi Pakistan, from Jan to Jun 2021. Methodology: Health care professionals involved in neonatal care at these two hospitals were included. The sample size was predetermined (60 in total). Participants' written response was obtained on an open-ended self-administered questionnaire distributed in person. All enrolled participants responded. Thematic analysis of data was carried out. Results: The participants were predominantly female (66.66%), aged 20-30 (66.66%). Eight (13.33%) had received CPAP training. The majority (83.33%) think that CPAP is useful, but only 10 (33.33%) have CPAP experience at the delivery suite. The first theme category was "Health professional related". Participants reported lack of awareness, motivation and training, understaffing, communication gap, responsibility conflict and rapid turnover of health professionals as a barricade. The second theme category was "organization/system related". Nonexistence of CPAP written guidelines, Obstetrics/ Gynaecology health professionals' unawareness about CPAP, CPAP implementation inferiority/ subservience/ subordinationand multi-discipline hierarchy were deterrents. The third emerged theme category was "logistics/resources". Shortage, failed continuous equipment supply, and poor infrastructure is major hurdles. Conclusion: This study has identified weak areas/glitches on which efforts should be focused and suggested recommenddations to overcome hurdles and implement CPAP use at birthplaces.

A male neonate was admitted for jaundice on the third day of life. On examination, baby was active, jaundiced, systemic examination revealed no abnormality except pulse oximetry difference of more than eight between pre and post ductal oxygen saturation. Later on, echocardiography revealed the diagnosis of hypo plastic left heart syndrome. The second case was a term female delivered by elective lower segment caesarean section. The first neonatal examination showed oxygen saturation of 70% with pre and post ductal difference of seven on routine pulse oximetry. Later on, pulmonary atresia, tricuspid atresia and patent duct us arteriosus were diagnosed on echocardiography. The patient was managed with prostaglandin to keep the duct open, followed by duct stenting.