Background: Infantile spasms (IS) are a unique form of seizure disorder that their occurrence is almost entirely limited to infancy (the first year of life) and they are refractory to conventional anticonvulsant drugs. IS usually are associated with developmental retardation or deterioration and a characteristic electroencephalographic (EEG) pattern (hypsarrhythmia) that together form a syndrome. IS involves a sudden, generally bilateral and symmetric contractions of muscles of the neck, trunk, and extremities. Patients with IS can be classified into focal IS and diffuse groups. Objective: Our main objective in this study is to evaluate the clinical profile, laboratory data, and outcome of children having infantile spasms in Sohag University Hospital. Methods: This retrospective study was conducted on 540 patient (mean age 8.4 ± 6.9 months.:) from December 2015 to November 2016 in neuropediatric outpatient Clinic, Pediatric department at Sohag University Hospital. Detailed clinical data of the patient, Investigation done for the patient including the neuroimaging (MRI or CT) , EEG pattern, basic metabolic studies , serum enzymes and Karyotyping were retrospectively collected from files and records. Results: In this study ; (66.1%) of cases were males.(33,9%) of cases were females ,mean age of presentation (8.4± 6.9 months). Positive consanguinity was found in (7.6%) of cases. (79.2%)of cases presented with flexor spasms, (8.9%) with extensor spasms and (11.9%) with mixed spasms. (8%) of cases were idiopathic, (13.5%) of cases were cryptogenic and (78.5%) of cases were symptomatic,(15.2%) of cases showed favorable outcome, and (84.8%) cases showed unfavorable outcome, of them (11.5%) of cases developed other type of seizures, (54.3%) of cases had mental retardation, (28.8%) of cases died and (5.2%) of cases had autistic features. In univeriate analysis (symptomatic) etiology (P= <0.001, OR= 4.7) and absence of primary control of infantile spasm (P= <0.001, OR= 18.3), and frequency of spasm (P= <0.017, OR= 1.8) were significantly related to unfavorable outcome. In Multiple variable analysis primary response to treatment(odd ratio=16.9,P-value=<0.001), etiology(symptomatic)(odd ratio=3.2,P-value=0.002) significantly associated with unfavorable outcome. Conclusion:. Infantile spasms was common. it occured in males more than females with ratio of 1.9:1; the majority of cases were in the age range 1-12 months. flexor spasms was more common than extensor, mixed type of spasms. Symptomatic type was most common than cryptogenic, idiopathic. long-term neurodevelopment outcomes for children with IS had several factors, including symptomatic etiology, abnormal development at the time of diagnosis, poor response to initial treatment. .

Background:A systematic ultrasound has been used across a wide span of ages depending on both chest anatomic structures (ie, the ribs or the pleural line)and artifact images, such as the B-lines. The presence of multiple bilateral B-lines is suggestive of an interstitial syndrome(eg, pulmonary edema, interstitial pneumonia, diffuse parenchymal lung disease). In the neonate, the aerated dry lung, which appears as a uniform hypoechogenic pattern, sliding with respiration and showing horizontal reverberations of the pleural image (the A-lines), can be easily differentiated from the hyperechogenic "white" pattern of the "wet" or inflamed organ. Objective To study the value of chest ultrasound in neonates with respiratory distress and to study the value of chest ultrasonography in comparison with chest x -rays. Methods: This prospective hospital-based study was conducted on 74 neonates

Acute kidney injury is common in critically ill children admitted to intensive care unit. Sepsis remains a significant risk factor and it is the leading cause of acute kidney injury in critically ill children. The aim of the study is to evaluate the outcome of AKI in critically ill septic children. Sixty eight patients, who met criteria of sepsis and related syndromes, were classified into two groups (AKI and non-AKI groups). Patients with AKI are much younger than those without AKI. Hypervolemia is present in about 28% of patients with AKI and the pulmonary oedema is pesent in about 6% of those patients. Patients with AKI need more support as regard to inotropes, mechanical ventilation and the need for RRT [P value< 0.05] than patients without AKI. Patients with AKI have a higher PRISM score [20 vs.9] and a higher mortality rate [62% vs.8%] than patients without AKI. In conclusion, AKI is common among critically ill children and early diagnosis is vital to prevent and decrease associated morbidity and mortality.

thy objective of this study was to evaluate the use of central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Sohag University Hospital . We reviewed the records of all children that had CVCs and were hospitalized between 1 st of January 2016 to the end of December 2016. Patients were evaluated with respect to their age, gender, catheter type, indication for CVC insertion, site and side of the body of CVC insertion. The duration of catheter use and eventual complications were also taken into consideration. A total of 115 CVCs were inserted in 100 children. Patient age ranged from 1 month to 16 years. The average catheter insertion time was 12 days. We noted 80 (80%) CVC-related complications. Complications related to CVCs insertion were infection(40%),occlusion(10%),local edema(8%),hematoma(5%), pneumothorax(4%),catheter displacement(4%),hemothorax(4%),thrombosis(3%),air embolism(2%) were complications associated with lenght of CVCs use. We conclude that central venous catheterization is a safe and efficient procedure with many complications in pediatric patients.

Neutrophil gelatinase-associated lipocalin (NGAL) is a rapidly emerging biomarker for early detection of acute kidney injury (AKI). The aim of the study is to evaluate the impact of sepsis on serum NGAL in critically ill children, and to investigate whether the presence of sepsis affects the ability of serum NGAL to predict AKI. Sixty eight patients, who met criteria of sepsis and related syndromes, were classified into two groups (septic shock and severe sepsis). They were reclassified regarding who developed AKI into AKI and non-AKI groups. Twenty sex and age matched healthy subjects served as a control group. Serum NGAL was assayed using Enzymelinked Immunosorbent Assay (ELISA), and serum creatinine was measured using kinetic spectrophotometric method. Serum NGAL levels were significantly high in critically ill septic patients compared to healthy controls (median: 100.4ng/ml vs. 47.1 ng/ml, P>0.0001), and were significantly higher in septic shock (median 105.1ng/ml) than in severe sepsis (median 96ng/ml) with P values of 0.005. However, there was no significant difference in the levels of serum NGAL between AKI patients and non-AKI patients (P=0.3). Receiver operating characteristic (ROC) curve analysis of serum NGAL for prediction of AKI in critically ill septic children showed an area under the curve (AUC) was 0.56 (95% C.I. =0.42-0.70) with an optimal cutoff value of 102.5ng/ml, sensitivity=56.2%, specificity 55.6%, PPV =52.9%, NPV =58.8%, and accuracy=55.9%. For serum creatinine, the AUC was 0.97 (95% C.I. =0.94-1.00) with an optimal cutoff value of 0.6 mg/dl, sensitivity= 90.6%, specificity 91.7%, PPV=90.6%, NPV=91.7% and accuracy=91.2%. In conclusion, serum NGAL is raised in critically ill septic children and is a marker of bacterial infection and systemic inflammation. However, in AKI associated with sepsis, serum NGAL is not a specific biomarker for the prediction of AKI and it loses its early predictive property. In such patients, serum creatinine is more specific than serum NGAL.