Objectives To investigate the effectiveness of nebulized magnesium sulfate in treating persistent pulmonary hypertension of newborn (PPHN). Methods Twenty-eight mechanically ventilated term neonates with severe PPHN were randomized into two groups: NebMag group (n = 14), who receiving nebulized isotonic magnesium (1024 mg/h), and IVMag group (n = 14), who received intravenous magnesium (200 mg/kg over 30 min, followed by 50 mg/kg/h). The study time frame was 24 h. Outcome measures were the changes in oxygenation index (OI), mean arterial blood pressure (MABP), vasoactive inotropic score (VIS), and serum magnesium level. Results Baseline demographic, ventilatory, and hemodynamic characteristics were comparable between the two groups. At the end of the study, the OI decreased by 44.3% in the NebMag group compared with 35.3% in the IVMag group (mean difference −3.14; 95%CI −5.08, −1.19; p 0.003). The NebMag group had a higher MABP (mean difference 2.29 mmHg; 95% CI 1.80, 2.77; p 0.000) and lower VIS (mean difference −14.64; 95% CI −16.52, −12.77; p 0.000) at the 24-h study time point. The increase in serum magnesium level, measured at 12-h study time point, was lower in the NebMag group (mean difference −2.26 mmol/L; 95% CI −2.58, −1.96; p 0.000). Conclusion Nebulized magnesium sulfate may be an effective therapeutic modality for neonates with severe PPHN on mechanical ventilation, but this should be confirmed by larger studies. Retrospectively registered at www.clinicaltrials.gov (identifier: NCT04328636).

Background: The potential for ondansetron to cause ECG changes as QT prolongation is well-reported. Objectives: The aim of this study was to evaluate the effect of parenteral ondansetron on the PR interval, QRS duration and QTc interval of ECG at peak effect and at post peak effect in pediatric patients with vomiting in PED. Patients and methods:The study was conducted in the Pediatric Emergency Department, Sohag University Hospital. ECG was done for 110 patients before and after injection of ondansetron 0.15 mg/ kg for vomiting. 60 Patients received ondansetron by intravenous injection and 50 patients received ondansetron by intramuscular injection. Results: IV ondansetron administration resulted in a significant increase in QTc interval after 15 minutes and 45 minutes p= 0.03 and p= 0.0003 respectively, significant decrease in PR interval after 15 minutes p= 0.02 and there was a significant decrease in QRS duration at 15 minutes after injection of ondansetron p= 0.02. IM ondansetron administration resulted in a significant increase in QTc interval after 30 minutes and 60 minutes p= 0.04, p= 0.0001 respectively, significant decrease in PR interval after 30 minutes and 60 minutes p<0.0001, p= 0.04 respectively and a statistically significant decrease between QRS duration before and after 30 minutes of ondansetron injection p<0.0001. Conclusion:It could be concluded that significant ECG changes occurred in children receiving a single dose of parenteral Ondansetron 0.15 mg/ kg. None of the patients had an ondansetron related cardiac adverse events.

Red blood cell transfusions are a common therapy in critically ill anemic children ,a packed cell product is the component of choice for replacement therapy during RBC loss and sporadic transfusion therapy. The decision to transfuse must be based on an assessment of the risks of anemia versus the risks of transfusion. In addition to the individual assessment of any symptomatic anemic child, the duration of anemia must be taken into consideration as well as the extent of trauma or surgery and the probability of blood loss and coexisting conditions such as impaired pulmonary function and inadequate cardiac output. (1-3) This study was a prospective observational study conducted for one year in Pediatric Intensive Care Unit (PICU) of SohagUniversity Hospital ,a tertiary health center which provide specialized care to critically ill infants and children with about 400 admissions. Patients was divided to two groups according to arterial blood pressure. yearly standard 2 not hypotensive (mean arterial pressure not less than : Stable critically ill deviations below the mean for age), or no cardiovascular support for at least two hours prior to enrollment. standard 2 hypotensive (mean arterial pressure less than : Unstable critically ill deviations below the mean for age), or there is cardiovascular support for at least two hours prior to enrollment, this includes patients with heart failure. was used. estrictive blood transfusion strategy r Packed RBCS transfusion following a received blood transfusion only if hemoglobin : le critically ill patients Stab concentration falls below 7 gm/dl. received blood transfusion according to clinical Unstable critically ill patients: judgment. (1,4) Short term outcome till discharge including (mortality or improvement) and duration of ICU stay was observed and recorded. Our study showed that respiratory diseases were the main risk factor that increase the duration of PICU stay (p value 0.001),while suffering from hemodynamic unstablity was the main risk factor for death in our PICU (P value 0.02) .a restrictive blood transfusion strategy was safe in pediatric patients whose condition was stable in PICU, with no effect on mortality or duration of admission in PICU andthe studywas not able to highlight a cause-effect relationship between RBC transfusions and outcomes in critically ill children.

Background:Echocardiography is a valuable component of the clinical service in the pediatric intensive and intermediate care units. It is an important bedside imaging modality and an accurate diagnostic tool that provides a clear image of the heart. Objectives: Our objective in this study was to detect the role of echocardiography in pediatric intensive and intermediate care units at Sohag University Hospital, Egypt. Method:It was a prospective hospital-based study conducted in pediatric intensive & intermediate care units from 1 August 2016 to 31 July 2017.These intensive care units receive critically ill children from emergency pediatric department or directly from the outpatient clinic. Data of these patients was collected; including clinical history, clinical examination, clinical indications for echocardiography, echocardiographic findings and management alterations after echocardiography. Results:During the study period, 495 patients were admitted to intensive and intermediate care units and 182 echocardiograms were performed for 170 patients.Congenital heart disease was the most common indication and finding of echocardiography.In this study 61% of echocardiograms done produced new findings that lead to additional clinical management steps especially medical interventions (30% of interventions). Conclusion:Echocardiography is a very valuable tool in ICUs. More than half of echocardiograms done produced new findings that changed management plans for these critical patients, so its use should be encouraged on a wide base in these units.