Sepsis in newborns is a serious medical condition having a high mortality. Pakistan and other developing countries have a high burden of neonatal sepsis. Objectives: To determine the bacterial spectrum and antibiotic activity pattern in neonatal sepsis. Methods: This retrospective cross-sectional research was performed at the Pediatrics Unit of Ziauddin University Hospital Karachi from 1st June 2022 till 1st December 2022. A total of 120 medical records of neonates admitted with the clinical suspicion of sepsis were reviewed. Non-probability convenience sampling technique was used. Data regarding clinical characteristics of neonates, type of bacteria isolated and antibiotic susceptibility results were recorded. SPSS version 20 was used for statistical analysis. The results were written as frequencies / percentages.  Results: Neonatal sepsis was suspected in 120 newborns but blood culture-proven infection was present in 32 (13.3%) neonates with 23(71.8%) having early -onset sepsis. The mean age on admission was 7.61±3.61 days. Acinetobacter was the commonest bacteria implicated in sepsis followed by Klebsiella ,Burkholderia and Serratia. The mortality rate in study population was 8.3%. Mortality was highest in Klebsiella sepsis. None of the bacterial species were sensitive to ampicillin while Acinetobacter and Burkholderia species responded to colistin, polymyxin and meropenem but showed resistance to imipenem. Conclusion: Early-onset neonatal sepsis has a high prevalence especially with gram -negative bacteria. Antimicrobial resistance to first line empiric therapy is common

Necrotizing Enterocolitis (NEC) contributes significantly to a high neonatal death rate in Pakistan and other developing countries. A number of elements related to its development are modifiable and can be addressed. Objectives: To evaluate the frequency of NEC, its associated factors and outcome in preterm babies. Methods: This retrospective, cross-sectional study was conducted at Ziauddin University Hospital, Karachi. Medical records of admitted preterm newborns from 1st December 2020 till 1st December 2022 were reviewed and neonates meeting the modified Bell’s diagnostic criteria ,with NEC stage II and III were included. Data pertaining to antenatal period, delivery and postnatal course of the disease were recorded . Data analysis were done using SPSS version-20 and results expressed as frequencies and percentages. Chi square test was applied with p-value statistical significance set at <0.05. Results: The prevalence of NEC was observed to be 7.1%. Male to female ratio was 1.6:1 with 84.5% of the neonates being low birth weight and culture-proven sepsis present in 44.8%. The mortality rate was 32.7%. Thrombocytopenia, hypotension, formula feeds, a positive blood culture and invasive ventilation were significant risk factors for mortality (p-value 0.01) Conclusions: Necrotizing enterocolitis has a high prevalence and mortality in preemies. Sepsis, formula feeding and a low birth weight adversely affect outcome. Early diagnosis and timely intervention can improve survival