Objective: To determine the risk of retinopathy of prematurity (ROP) among preterm with and without sepsis admitted in a neonatal intensive care unit of a tertiary care hospital of Karachi, Pakistan. Methodology: In this prospective cross-sectional study conducted at Aga Khan University Hospital from October 2021 to March 2022. All the preterm born at gestation <32 weeks with birth weight of <1.5kg and were <28 days old of either gender was included. Examination for ROP was performed. Information about maternal and neonatal confirmed sepsis, risk factors predisposing to sepsis, ROP status were noted. Babies were followed in the outpatient clinics. The first examination was performed at 28th days and was subsequently followed at one or two week’s interval as per the Ophthalmologist. Results: Of 125 neonates, the mean age was 4.34 ±0.79 weeks. There were 72 (57.6%) males and 53 (42.4%) females. Stage 0 and 1 were most common stages reported as 49 (39.2%) and 55 (44%) neonates respectively. Zone 1 disease was observed in 15 (12.0%) whereas ROP plus disease in 7 (5.6%) neonates. Neonates with ROP stage <2 had significant association with maternal risk factors for sepsis (p-value 0.026), neonatal risk factors for sepsis (p-value 0.047), and neonatal culture proven sepsis (p-value 0.010). Similarly, zone 1 disease had a significant association with presence of maternal risk factors for sepsis (p-value 0.033), neonatal risk factors for sepsis (p-value 0.045), and antibiotics taken >48 hours (p-value 0.027). Conclusion: A considerably higher risk of ROP was observed among hospitalized neonates with neonatal sepsis. Keywords: Neonates, sepsis, retinopathy of prematurity, Preterm

Background: To assess the risk factors associated with early onset group B streptococcal disease and newborn outcomes in a tertiary care center in Pakistan. Methods: A prospective cohort study design was implemented in the postnatal wards and neonatal intensive care unit of Aga Khan Hospital between 15 December 2021 – 15 June 2022. The exposed group included all pregnancies with risk of GBS infection, the un-exposed group included all pregnancies with no risk factors for GBS. All births were followed for outcomes during admission and after discharge for 28 days of life. Information about the mother and baby dyad was retrieved from the medical records. A second proforma was filled out at the time of discharge (2 to 5 days of life for healthy babies and at 10 to 15 days of life for babies admitted for NICU). These were the average length of stay of healthy and ill newborns at our facility.) The final follow up was at 28 days of life which was at the clinic or telephonic. Data on morbidities such as sepsis, use of antibiotics and hospitalization breast feeding practices was captured at the day 28 follow up. Results: A total of 78 patients were included, with a mean maternal age of 30.82 ± 4.65 years and gestational age of 37.26 ± 2.1 weeks. GBS colonization was positive in high vaginal swab in 23 (29.5%) patients, in urine culture in 16 (20.2%) patients, and 1 (1.3%) patient who delivered a previous baby with GBS infection. Two patients suffered from pneumonia among them one patient also had sepsis and 77 patients were stable at 28 days. In 16 (41%) cases of GBS colonization, high vaginal swab yielded a negative result. Similarly, in 23 (59%) patients with GBS colonization, urine culture was also negative. Only one patient with GBS colonization had a history of a previous infant with GBS infection. Approximately 70% of GBS positive had PROM. Maternal Leukocytosis and tachycardia were significantly higher in patients with GBS (p<0.0001). Uterine tenderness was found in 14 (35.9%) mothers with GBS colonization (p<0.0001). Intrapartum fever was significantly more common in mothers with GBS colonization (p=0.011). Tachycardia was significantly higher in neonates of mothers with GBS colonization (p=0.01). Need of oxygen was significantly higher in neonates with mothers having GBS colonization (p=0.002). Conclusion: In hindsight, GBS colonization and the early onset of Group B streptococcus infection is a public health issue in Pakistan that requires attention. Recommended antenatal screening measures should be implemented, as well as the necessary steps, such as an antibiotics treatment regimen following a positive GBS colonization report, to protect newborns from this disease. Keywords: colonization, maternal risk factors, group B streptococcal, early onset group B streptococcal disease, GBS, PROM

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Objective: To determine the outcome of Bubble Continuous Positive Airway Pressure (bCPAP) Therapy use in preterm neonates with respiratory distress admitted in large public sector children hospital. Methods: This prospective observational study was conducted at National Institute of Child Health (NICH) from March 2016 to February 2017. All preterm neonates with respiratory distress diagnosed within 24 hours treated with bCPAP were consecutively included. Respiratory distress was defined on the basis of presence of any of the three following symptoms (i) tachypnea (ii) chest indrawing (iii) grunting (iv) nasal flaring (v) hypoxemia. Outcome was measured in terms of survival, median for duration to achieve 21% O , apnea, hyperemia of nose, 2 abdominal distention, median for hospital stay, and median weight gain. Results: Of 70 preterm neonates, the median birth weight was 2700 (2300 -3000) gm, duration to achieve 21% O2 was 3 (2 -72) hours, and hospital stay was 8 (6-10) days. The complications of bubble CPAP showed that abdominal distension was found higher followed by hyperemia of nose and apnea i.e., 18 (25.7%), 17 (24.3%), and 4 (5.7%) respectively. Survival was found significantly associated with birth weight (p-value 0.049) and in neonates with no complications (p-value <0.001). Whereas apnea was found significantly higher in female preterm neonates (p-value 0.017), low birth weight (p-value 0.012) and in neonate who reported no survival (p-value <0.001). Conclusion:The administration of bCPAP is an effective modality for managing respiratory illness in preterm Neonates due to fewer complications and shorter hospital stay.