Objectives. Relationships of mechanical ventilation to pneumothorax in neonates and care procedures in particular are rarely studied. We aimed to evaluate the relationship of selected ventilator variables and risk events to pneumothorax. Methods. Pneumothorax was defined as accumulation of air in pleural cavity as confirmed by chest radiograph. Relationship of ventilator mode, selected settings, and risk procedures prior to detection of pneumothorax was studied using matched controls. Results. Of 540 neonates receiving mechanical ventilation, 10 (1.85%) were found to have pneumothorax. Respiratory distress syndrome, meconium aspiration syndrome, and pneumonia were the underlying lung pathology. Pneumothorax mostly (80%) occurred within 48 hours of life. Among ventilated neonates, significantly higher percentage with pneumothorax received mandatory ventilation than controls (70% versus 20%; P < 0.01). Peak inspiratory pressure >20 cm H2O and overventilation were not significantly associated with pneumothorax. More cases than controls underwent care procedures in the preceding 3 hours of pneumothorax event. Mean airway pressure change (P = 0.052) and endotracheal suctioning (P = 0.05) were not significantly associated with pneumothorax. Reintubation (P = 0.003), and bagging (P = 0.015) were significantly associated with pneumothorax. Conclusion. Pneumothorax among ventilated neonates occurred at low frequency. Mandatory ventilation and selected care procedures in the preceding 3 hours had significant association.

There is limited data regarding the vertical transmission (VT) of severe acute respiratory syndrome-coronavirus-2 infection. We report the first case of VT in preterm triplet pregnancy, with all triplets positive for severe acute respiratory syndrome-coronavirus-2 at 20 hours and day 5 of life. This report reiterates the need for an expedited formulation of a simple, standardized, and reproducible international case definition and classification for VT.

Background The overuse of antimicrobials in neonates is not uncommon and has resulted in a global health crisis of antibiotic resistance. Objectives To evaluate changes associated with a neonatologist-driven antibiotic stewardship program (ASP) in antibiotics usage. Study design We conducted a pre-post retrospective cohort study in a tertiary care hospital in Oman. Neonates admitted in 2014-2015 were considered as the pre-ASP cohort. In 2016, a neonatologist-driven ASP was launched in the unit. The program included the optimization and standardization of antibiotics use for early and late-onset sepsis using the CDC's "broad principles," an advanced antimicrobial decision-support system to resolve contentious issues, and greater emphasis on education and behavior modification. Data from the years 2016-2019 were compared with previous data. The outcome of interest included days of therapy (DOT) for antimicrobials. Baseline characteristics and outcomes were compared using standard statistical measures. Results The study included 2098 neonates in the pre-ASP period and 5464 neonates in the post-ASP period. There was no difference in baseline characteristics. The antibiotic use decreased from 752 DOT per 1000 patient-days (PD) in the pre-ASP period to 264 DOT in the post-ASP period (64.8% reduction, P < 0.001). The proportion of neonates who received any antibiotics declined by 46% (pre-ASP = 1161/2098, post-ASP = 1676/5464). The most statistically significant reduction in DOT per 1000 PD was observed in the use of cefotaxime (82%), meropenem (74%), and piperacillin-tazobactam (74%). There was no change in mortality, culture-positive microbial profile, or MDRO incidence in the post-ASP period. Conclusions: Empowering frontline neonatologists to drive ASP was associated with a sustained reduction in antibiotics utilization.