Introduction: Elevated sound levels in neonatal intensive care units may cause undesirable effects and influence the stability of vital signs in moderately sick newborn infants.Objective: To evaluate the effect of using earmuffs on the seven most common vital signs in newborns in NICUs.Methods: This is a prospective controlled study. All term and pre-term infants admitted to the NICU were randomized to either an "earmuffs" or a "no earmuffs" area and underwent hourly measurements and recording of vital signs during routine NICU activity for three consecutive days. Data were collected by sampling data from the routine continuous monitoring of heart rate (HR), respiratory rate (RR), oxygen saturation (OSAT), blood pressure (BP), FIO2 requirement, pain score (PS), and temperature (T). Exclusion criteria included neonates on high frequency ventilation, sedation and congenital anomalies with possible auditory system involvement.Results: The study included 182 infants; of them 100 infants completed the 72-hour measurements. Vital signs of fifty newborn infants in each group were recorded for a period of 72 hours. During this time, the observed linear increase in heart rate was significantly reduced within the earmuffs group (139 versus 146 beat per minute) with p value <0.001, which also exhibited a similar significant decrease in systolic BP, although there was no evidence of significant difference between-group effect for diastolic BP and mean blood pressure. The average RR in the EM group was significantly lower than the NEM group for the entire 72-hour period (0.001), while temperature showed no significant difference between the two groups across the same time-period. Earmuffs also conferred a small but significant improvement in the gradual increase of the average O 2 saturation (p value = 0.01). Similar improvement due to earmuffs could also be seen in the infants' requirement for oxygen (days); the average oxygen requirement was 1.8 days versus 2.5 days with p value of <0.001.Conclusion: Wearing earmuffs inside the NICU had a positive effect on the infants' vital signs.

Background Bronchopulmonary dysplasia (BPD) is the need for oxygen therapy at 36 weeks postmenstrual age (PMA). Sildenafil has been shown to enhance the lung alveolarization and vascularization in newborn animal models after lung injury and has possible therapeutic potential for the prevention of BPD. Objective To perform a proof-of-concept, Phase II, pilot randomized, double-blind, clinical trial to study the efficacy of sildenafil in preventing BPD, in postnatal (< 24 h), extremely and very preterm infants. Methods This Phase II, pilot randomized, double-blind, clinical trial was conducted in the Neonatal Intensive Care Unit of Women's Wellness and Research Center, Doha, Qatar during 2012-2014. Infants of 24 0/7-29 6/7 weeks' gestation were eligible if they needed respiratory or oxygen support ≥ 25% at randomization, and if they were at a postnatal age of < 24 h at randomization. Forty preterm infants were randomly assigned to receive off-label oral sildenafil (0.5 mg/kg every 6 h) or a placebo solution, for one week. The primary endpoints were the incidence of BPD and death at 36 weeks PMA, and the side effects. Secondary outcomes included the incidence of BPD and the respiratory support at day 28 of life, duration of oxygen use, fraction of inspired oxygen use at 36 weeks and 28 days of life, duration of hospitalization, and the incidence of significant retinopathy of prematurity, severe intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, and late sepsis. Results No significant differences were observed between the sildenafil and placebo study groups in mortality at 36 weeks PMA (10% vs 20%, p = 1), respiratory support at 36 weeks (30% vs 25%, p = 0.57), and side effects (0% vs 0%). For all other secondary outcomes, no significant differences were detected. Conclusions While not associated with side effects, off-label oral sildenafil did not demonstrate benefits in the prevention of BPD or death in the extreme and very preterm infants. Future studies of dosing and efficacy that target different regimens of sildenafil are warranted before sildenafil is recommended for the prevention of BPD.

Myofibroma tumors are uncommon benign neoplasms, affecting mainly the early pediatric age group. Infantile myofibromas consist of benign nodules in the skin, muscle, or bone .Less often, they can occur in the lung, heart, gastrointestinal tract, or orbit. Infantile myofibromas exhibit growth in the immediate perinatal period that may continue for the first few months of life, reaching a size approaching several centimeters in diameter. Because this tumor grows rapidly during infancy, capillary hemangioma of the scalp or malignant neoplasia is often suspected. We examine a case of solitary infantile myofibroma in a newborn's scalp, which presented a diagnostic challenge.

Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED [MIM 240300]), also known as autoimmune polyglandular syndrome type I (APS I), is a rare, debilitating autosomal recessive disease caused by mutations in the autoimmune regulator (AIRE) gene. The clinical spectrum of the disease is variable and includes several autoimmune endocrine and non-endocrine manifestations, which may lead to acute metabolic alterations and eventually life-threatening events. The clinical diagnosis requires the presence of two out of three major criteria; chronic mucocutaneous candidiasis, autoimmune hypoparathyroidism, and autoimmune adrenal failure. Brain calcifications secondary to hypoparathyroidism have been reported in many patients with APECED. These tend to be extensive, bilateral and symmetrical and have characteristic predilection to the basal ganglia. The calcifications may extend to affect the cerebellum and subcortical white matter. The aim of this work is to describe intracranial calcifications in APECED and to report a new feature of pontine calcification expanding the phenotype of this rare condition.

infliximab, respectively, were necessary in order to achieve similar levels of cost-effectiveness as secukinumab, whereas discounts as high as 90% for etanercept, 60% for ustekinumab, 55% for adalimumab and 50% for infliximab were necessary to reach similar levels of cost-effectiveness as ixekizumab and brodalumab. Conclusion According to this economic model, modern anti-IL-17s are highly cost-effective compared to anti-TNFs and anti-IL-12/23. Though discounts may be a way of making anti-TNFs and anti-IL-12/23 more cost-effective, this study indicates that very high levels of discounts would be necessary to achieve this.