Noise in our NICU exceeded the international permissible levels. Noisy events are numerous, which altered the neonates' physiologic stability especially preterm infants. Staff education is mandatory in ameliorating noise pollution with its deleterious effects on neonatal physiologic homeostasis.

Lung ultrasound (LUS) has become one of the most exciting applications in neonatal point-of-care ultrasound (POCUS), yet still lacks routine clinical use. This study assesses the utility of LUS for neonatal respiratory disorders (NRDs) diagnosis and follow-up compared to chest X-ray (CXR). A prospective cross-sectional study was conducted on 100 neonates having NRDs with a gestational age ≥28 weeks, excluding those having multiple congenital anomalies, chromosomal aberrations, hydrops fetalis and/or heart failure. CXR and LUS were done on admission for diagnosis and were repeated after 7 days, or if needed earlier within the 7 days. The diagnosis of NRDs by CXR and LUS on admission and after 7 days was comparable (p > 0.05). LUS diagnosis sensitivity and specificity for respiratory distress syndrome, pneumonia, meconium aspiration syndrome, pneumothorax and pulmonary atelectasis were 94.7/100%, 97.5/95%, 92.3/100%, 90.9/98.9% and 100/97.8%, respectively. The total agreement between LUS and CXR was 98.5% with 95% CI (0.88 to 0.92). LUS and CXR had considerable agreement in the diagnosis of NRDs. Being a reliable bedside modality of diagnosis and safer than CXR, LUS may be considered an alternative method for the diagnosis of neonates with NRDs.

Background: Vascular endothelial growth factor (VEGF), a known mediator of angiogenesis, stimulates the survival of endothelial cells in newly formed blood vessels. VEGF exerts its effects by binding to two receptors; VEGFR-1 and VEGFR-2. Soluble VEGFR-1 is a potent inhibitor of vascular endothelial growth factor and placental growth factor. Objective: to test the hypothesis that serum concentration of the soluble receptor sVEGF-R1 is increased in infants with intrauterine growth restriction (IUGR) regardless of the underlying cause of IUGR. Study design: Serum samples of 30 IUGR and 20 appropriate for gestational age (AGA) neonates were obtained within the first 24 h of life and kept frozen at −80 • C degrees until the time of assays. Concentrations of sVEGFR-1 were measured by the enzyme-linked immunosorbent assay double sandwich method. Regression analysis was performed to test the association of IUGR with sVEGFR-1 after controlling for confounding variables. Results: sVEGFR-1 concentrations in IUGR patients were increased when compared to control. Patients with preeclamptic mothers had increased sVEGFR-1 when compared to patients with non-preeclamptic mothers. The latter had increased concentrations of sVEGFR-1 than control. sVEGFR-1 correlated negatively with birth weight, length and head circumference of the studied neonates. Conclusion: Concentrations of sVEGFR-1 are increased in the serum of IUGR neonates when compared to AGA controls. IUGR and preeclampsia are independently associated with increased sVEGFR-1 concentrations. This phenomenon presumably reflects a predominance of anti-angiogenic mechanisms present in IUGR.

lung ultrasound (LUS) was used traditionally in the assessment of pleural effusions and masses but LUS has moved towards the imaging of the pulmonary parenchyma, mainly as a point-of-care technique. Objective To assess the agreement between LUS and CXR for the diagnosis of RD in neonates. Methods This prospective cross sectional study was conducted on 100 neonates presents with RD in the first 24 hours of life in the neonatal intensive care unit (NICU) of the Ain Shams University. All enrolled neonates underwent LUS and CXR initially and on day 7. Neonatologists were blind to the LUS diagnosis and the clinical decisions were driven by CXR findings. Lung score was applied to describe lung aeration, interstitial, alveolar, or consolidation patterns for each lung area. Results 125 different diagnoses were reported in 100 patients. The total agreement between LUS and CXR diagnosis was 96% (95% CI 88–98%) with a κ statistic of 0.94 (95% CI 0.86– 1.00). The agreement for RDS, Pneumonia, TTN, MAS, CDH, PE, Pnumothorax and atelectasis were 99%, 96%,98%, 99%,100%,100%,98% and 98% consequently. Conclusion LUS is a safe, low coast, easy to operate and has high agreement with CXR for the diagnosis of RD in neonates in the first week of life. Key words Neonatal intensive care, Point-of-care ultrasound, Chest X-ray Abbreviations: NICU: Neonatal Intensive Care Unit, LUS: Lung ultrasound, CXR: Chest X ray, RDS: respiratory distress syndrome, TTN: Transient Tachypnea of Newborn, MAS: Meconium Aspiration, PE: pleural effusion, CDH: cong. diaphragmatic hernia.

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