Objective The study aimed to compare the efficacy and safety of two different nasal high-flow rates for primary respiratory support in preterm neonates Study Design In this single-center, double-blinded randomized controlled trial, preterm neonates ≥28 weeks of gestation with respiratory distress from birth were randomized to treatment with either increased nasal flow therapy (8–10 L/min) or standard nasal flow therapy (5–7 L/min). The primary outcome of nasal high-flow therapy failure was a composite outcome defined as the need for higher respiratory support (continuous positive airway pressure [CPAP] or mechanical ventilation) or surfactant therapy. Results A total of 212 neonates were enrolled. Nasal high-flow failure rate in the increased flow group was similar to the standard flow group (22 vs. 29%, relative risk = 0.81 [95% confidence interval: 0.57–1.15]). However, nasal flow rate escalation was significantly more common in the standard flow group (64 vs. 43%, p = 0.004). None of the infants in the increased flow group developed air leak syndromes. Conclusion Higher nasal flow rate (8–10 L/min) when compared with lower nasal flow rate of 5 to 7 L/min did not reduce the need for higher respiratory support (CPAP/mechanical ventilation) or surfactant therapy in moderately and late preterm neonates. However, initial flow rates of 5 L/min were not optimal for most preterm infants receiving primary nasal flow therapy. Key Points

Since the coronavirus disease (COVID-19) pandemic hit the globe in early 2020, we have steadily gained insight into its pathogenesis; thereby improving surveillance and preventive measures. In contrast to other respiratory viruses, neonates and young children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have a milder clinical presentation, with only a small proportion needing hospitalization and intensive care support. With the emergence of novel variants and improved testing services, there has been a higher incidence of COVID-19 disease reported among children and neonates. Despite this, the proportion of young children with severe disease has not increased. Key mechanisms that protect young children from severe COVID-19 disease include the placental barrier, differential expression of angiotensin-converting enzyme 2 (ACE-2) receptors, immature immune response, and passive transfer of antibodies via placenta and human milk. Implementing mass vaccination programs has been a major milestone in reducing the global disease burden. However, considering the lower risk of severe COVID-19 illness in young children and the limited evidence about long-term vaccine safety, the risk–benefit balance in children under five years of age is more complex. In this review, we do not support or undermine vaccination of young children but outline current evidence and guidelines, and highlight controversies, knowledge gaps, and ethical issues related to COVID-19 vaccination in young children. Regulatory bodies should consider the individual and community benefits of vaccinating younger children in their local epidemiological setting while planning regional immunization policies.

y would reach full feeds of 180 mL/kg/d by the 6th day of life. Thus, how do we get a lower bound of IQR as 0 d?Table 2 provides outcomes on continuous scale as mean ± SD or median (range/IQR); additional information of mean/median difference between the two study groups with its 95% CI would have been helpful to reader.

Etiology of coma and clinical status at the time of presentation are likely predictors of outcome in cases of non-traumatic coma. The present study included of clinical profile, etiology of non-traumatic coma and immediate outcome in terms of survival and death in pediatric patients. This was prospective hospital based cohort study undertaken over a period of one year. A detailed history of all patients were taken and entered in case proforma. A complete clinical examination of patients was done. The etiology of coma was determined and the diagnosis of tuberculous meningitis was done. The data was analyzed using statistical software SPSS version 16. The clinical data was analyzed for the etiology of non-traumatic coma. Thirty one children survived and 19 died with mortality rate of 38%. Among survivors 20 (64%) were normal, 11(36%) had some disability (23%) mild disability, 10% moderately and 3% severely disabled. From the study, we got infections as the important cause of non-traumatic coma.

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