Background The health benefits of breastfeeding are well known. However, some ill babies including those admitted to the neonatal intensive care unit (NICU) cannot be directly breastfed. In this situation, expressed breast milk (EBM) can be used. However, breast milk is not always sterile and may be contaminated by many microorganisms. EBM contamination is probably attributed to improper technical and hygienic factors and may pose significant threats to the newborn baby. The present study aimed to document the prevalence of EBM contamination in NICU and to uncover the relevant risk factors. Subjects and Methods The study included 118 mothers who could express breast milk for their own neonates admitted to the NICU. A checklist was used to document the steps the mothers followed during expression of milk and all steps of handling until the EBM reached the NICU. A 1 mL sample of EBM was obtained and sent to the microbiology laboratory within 20 minutes. Data obtained from the present study are expressed as number and percentage or mean ± standard deviation (SD). Statistical calculations were computed using SPSS 25. Results In the present study, 106 (89.8%) out of the assessed 118 EBM samples were contaminated. Hygienic factors related to EBM contamination included hand only wash, possible recontamination of hands during turning taps off, lack of using cotton pads or cloth piece on nipple and breast cleaning by water only. Other factors related to EBM contamination included container cleaning by water only, fresh milk refrigeration after > 4 hours, adding freshly expressed warm breast milk to refrigerated milk expressed earlier in the same day, milk transport in plastic bags with ice packs and longer transportation time. In the contaminated samples, the most commonly isolated organisms included Staphylococcus aureus (55.7%), Staphylococcus epidermidis (21.7%) and Enterobacter (11.6%). Conclusion The present study identified bacterial contamination in about 90% of EBM samples delivered to NICU infants. Factors related to EBM contamination include hygienic, storage and transport factors.

OBJECTIVE: The study aimed to determine the prevalence of acute kidney injury (AKI) in term neonates with persistent pulmonary hypertension of the newborn (PPHN), to identify the probable risk factors, and to find its relation to mortality. METHODS: The study recruited 758 term neonates admitted to the neonatal ICU (NICU). Diagnosis of PPHN was established on the basis of clinical and echocardiographic criteria. For diagnosis of AKI, we adopted the modified Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition. This definition has three grades of AKI severity depending on degree of serum creatinine rise and urinary output. Patients were followed until they died or discharged from NICU. RESULTS: Among the 758 term neonates included in the study, there were 47 babies (6.2 %) fulfilling the criteria of PPHN. AKI was reported in 16 patients (34.0 %) and the reported mortality rate was 31.9 %. Neonates with AKI had significantly higher mortality rate when compared with patients without AKI (75.0 % versus 9.7 %; p = 0.0001). A significant association was noted between severe grades of PPHN and AKI. CONCLUSIONS: AKI is prevalent in neonates with PPHN. It is significantly associated with mortality. There is suggested link between AKI and severity of PPHN.

Meconium aspiration syndrome (MAS) is a serious neonatal condition. Prediction of MAS is challenging particularly in low-resource setting. Neutrophil to lymphocyte ratio (NLR) is a new simple index used for diagnosis of many inflammatory conditions. The present study was an attempt to determine whether NLR can predict the occurrence of MAS. The present study included 101 children with meconium-stained amniotic fluid. They comprised 22 patients who developed MAS and 79 neonates who didn't have the condition. All neonates were subjected to careful analysis of maternal and perinatal history in addition to thorough clinical assessment and radiological and laboratory evaluation. Blood samples from the umbilical cord were collected at birth and were used to obtain complete blood counts and C-reactive protein (CRP) assay. Univariate analysis revealed that elevated CRP levels, increased NLR, and 5-minute Apgar score of <7 were significant risk factors for the occurrence of MAS. Multivariate analysis revealed that low 5-minute Apgar score and increased NLR remained as significant risk factors of MAS. Receiver operating characteristic curve analysis showed good performance of NLR in prediction of MAS. NLR is useful in prediction of MAS in term neonates with meconium-stained amniotic fluid.

Background and Aim Patient safety in the neonatal intensive care unit (NICU) is one of the highest priority issues on the health care quality agenda worldwide. Efforts are needed to improve neonatal safety in NICU. The present study evaluated the effect of educational intervention on neonatal safety. Materials and Methods Quasi-experimental study was conducted in three major hospitals, including the health care workers in their NICU during the period of study from May 2016 to May 2018. Neonatal safety standards were evaluated using an observational checklist after its validation by a pilot study. An intervention educational program was conducted in the three hospitals, followed by a reevaluation of the standards. All staff members (58 physicians and 69 nurses) participated in the three stages of the study. Results The interventional program resulted in significant improvement of the health care workers implementation of the general (90.6 ± 15.1 vs. 127.6 ± 7.02, p = 0.016) and specific (50.6 ± 17.1 vs. 96.1 ± 13.2, p = 0.04) Egyptian Neonatal Safety Standards. Conclusion Training and increasing the awareness of health care workers of the neonatal safety standards can significantly increase the fulfilment of these standards in both secondary and tertiary care neonatal units.