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Objective: To compare the need of mechanical ventilation between LISA (less invasive surfactant administration) method and conventional INSURE method (INtubation SURfactant administration and Extubation) in spontaneously breathing preterm infants with respiratory distress syndrome (RDS)., Study Design: An experimental study., Place and Duration of Study: Department of Neonatology, PIMS, Islamabad, from April to December 2017., Methodology: A total of 100 preterm infants <34 weeks gestation, on nasal CPAP requiring fraction of inspire oxygen (FiO2) >0.4, with respiratory distress syndrome (RDS) were included in the study and divided randomly into two groups, 50 each., Results: There were 28 (56%) males in LISA and 31 (62%) in the INSURE group. Median birth weight was 1300 grams (IQR 600) in LISA, while 1400 grams (IQR 400) in INSURE infants. C-section rate was 52% (n=26) and 48% (n=24) in LISA and INSURE, respectively. Pre-natal steroids were given to 38 patients (76%) in LISA and 30 patients (60%) in INSURE group. LISA patients had significantly less need of mechanical ventilation with p-value <0.05 {30% (n=15) vs. 60% (n=30)}. The median duration of mechanical ventilation was 40 hours (IQR 75) and 71 hours (IQR 62) in LISA and INSURE, respectively. Similarly, median FiO2 reduction was 30 (IQR 30) in LISA group and it was 25 (IQR 10) in INSURE group, with p-value <0.05. There was no significant difference in mortality, hospital stay and complications., Conclusion: LISA technique was safe, non-invasive approach of surfactant administration, with reduced need of mechanical ventilation rate and duration.

Objective: To measure the frequency of ophthalmia neonatorum among all babies born in MCH Center, PIMS (Pakistan Institute of Medical Sciences), Islamabad, in one month's time and to determine their causative organisms., Study Design: An observational study., Place and Duration of Study: The MCH Center, PIMS, during the month of November 2008., Methodology: All babies born from 1st to 30th November, 2008 in the MCH Center, PIMS, Islamabad, Pakistan were included in the study. All babies were examined for signs of conjunctivitis on days 1, 3, 7, 14, 21 and 28 of life. Conjunctival swabs were taken for gram staining and culture from those with clinical diagnosis of conjunctivitis. Frequency of known maternal and neonatal risk factors for the disease were assessed. Proportions were compared using chi-square test with significance at p < 0.05., Results: Seventeen percent of the 1010 babies developed conjunctivitis. Staphylococcus aureus (65% of all positive cultures) was the most common causative organism. No case of gonococcus was isolated. Meconium stain liquor (p=0.004) and caesarain section (p < 0.001) were found to be the most frequent associated conditions in conjunctivitis., Conclusion: There was a high frequency of neonatal conjunctivitis, with Staphylococcus aureus as the most common causative agent. Poor hygienic conditions and practices could be an important risk factor in Pakistan.

Objective: To describe the presentations, complications and to look at the subtypes of children with osteopetrosis., Design: A case series., Place and Duration of Study: This study was conducted at the National Institute of Child Health (NICH) from July 2002 to December 2003., Subjects and Methods: All children presenting as outpatients or inpatients with anemia, thrombocytopenia, and hepatosplenomegaly were evaluated. Those suspected of the disorder (n=126) were screened by X-rays of long bones., Results: Eighteen children including 10 girls and 8 boys in 16 families were diagnosed as having osteopetrosis over a period of 18 months. Fifteen had isolated autosomal recessive osteopetrosis. The mean age at diagnosis was 33 months. Parental consanguinity was high (83.3%). Anemia, hepatosplenomegaly, failure to thrive, recurrent infections and neurological manifestations were common. A high mortality (33.3%) owing to infection was noted., Conclusion: Osteopetrosis should be considered in children presenting with unexplained anemia and hepatosplenomegaly. Once diagnosed, these children should then be monitored for the complications that occur with high frequency in the disorder. Early diagnosis and treatment of the disorder improves the outcome.