Antibiotics are a very important group of drugs for the sick neonate and have undoubtedly played a role in their improved survival. But they come with a set of risks which must be carefully considered and weighed against the benefits in any decision to commence antibiotics. For the neonatologist this is not an easy task. This article intends to discuss the potential risks of antibiotics to the sick newborn in the hope that it will aid clinicians to better balance the benefits and harms and use antibiotics in a rational way.

Pharmacological closure of patent ductus arteriosus in pre-term infants with indomethacin has been applied since the late 1970s. However, because of complications, a search for a safer and efficacious alternative continues. In this review, we look at the available evidence in the literature for and against closure of the patent ductus arteriosus with non-steroidal anti-inflammatory medications, and we present the results of our own pilot study looking at the safety and efficacy of orally administered ibuprofen on premature infants with clinically significant patent ductus arteriosus.

Gastrointestinal dysmotility is a common condition in preterm infants due to immature development of gastrointestinal peristalsis. Erythromycin, with its motilinomimetric effect, has been used to facilitate enteral feeding in preterm infants. Various regimens, including prophylaxis versus rescue treatment and low dose versus high dose therapy have been investigated. The results suggest that intermediate or high doses oral erythromycin used as rescue treatment is associated with a shorter time to attain full enteral feeding, a decrease in the duration of parenteral nutrition requirement, a reduction of parenteral nutrition-associated cholestasis and a decrease in catheter-associated recurrent septicemia. Although none of the studies reported any sinister adverse effects, neonatologists should use this class of drug cautiously and selectively in preterm infants with refractory functional gastrointestinal dysmotility.

Evidence-based medicine has become increasingly important over the years. Getting research evidence into practice is a necessity in current practice. It has to be kept in mind that every patient population has its own special characteristics and this may make the best available research evidence sometimes not the best option for that particular population. Some examples of how the characteristics of a population may influence important evidence-based treatment decisions are discussed.

Neonatal jaundice is very common in newborn infants. Although it is often a natural and transitional condition, some infants develop severe hyperbilirubinemia, in which unconjugated bilirubin in the serum may cross the blood-brain-barrier and cause bilirubin encephalopathy (acute bilirubin intoxication) or kernicterus (chronic bilirubin intoxication). To avoid these hazardous conditions, it is important to identify the infants at risk for developing severe hyperbilirubinemia. There are many genetic diseases that can cause or aggravate neonatal jaundice. Thus, the knowledge of the genetic diseases associated with neonatal jaundice may be essential for identification of the infants at highest risk. Here, we review neonatal jaundice and describe some genetic disorders associated with neonatal jaundice, such as bilirubin metabolism disorders, hemolytic disorders, bilirubin transport disorders, and others. It is desirable that rapid and accurate screening systems of genetic disorders should be developed for the proper management of neonatal hyperbilirubinemia.

The benefits of human milk for both infants and mothers have been well established. Especially preterm infants benefit from breast milk. However barriers to breast milk expression in mothers with preterm babies result in a relatively low availability of human milk for these particularly vulnerable infants. To overcome this problem, human milk banks have been established in many parts of the world. The Muslim countries have been not participating in these milk sharing activities for preterm babies because of inherent religious cultural issues. This article addresses these issues and discusses potential ways to overcome these issues.

Although survival of very preterm neonates has improved in the surfactant era necrotizing enterocolitis (NEC) continues to be major cause of mortality and morbidity. Despite decades of research the pathogenesis of NEC is poorly understood. Historically, apart from antenatal glucocorticoids and postnatal preference to early feeding with human milk, neonatologists have had not many options to minimize the risk of NEC in preterm neonates. Probiotics supplementation has given a fresh outlook for prevention of NEC in preterm neonates. Evidence from many recent randomized controlled trials have shown that probiotics can significantly reduce the risk of NEC, all cause mortality and time to full feeds in preterm VLBW neonates. Some important issues need to be addressed (e.g. optimal strains, dose, and duration, combination of probiotic organisms) before this therapy becomes a safe routine in high-risk preterm neonates. This brief review covers the current evidence, and future for probiotic supplementation in preterm neonates.

Jaundice is the most common reason for doing blood tests and starting therapy in newborn infants. In some neonates serum bilirubin levels may become excessively high, and in rare instances this may lead to brain damage (kernicterus). In such cases it is important to start treatment quickly. Herein we will discuss various approaches through which serum bilirubin levels may be reduced, thus potentially preventing brain damage. This paper is based on relevant publications found through a Medline search, from which a selection was made based on the authors’ prior knowledge of and experience in the field. Case histories are used to illustrate the important points. Neonatal jaundice always has a foundation in normal physiology. However, the degree of jaundice may be accentuated by a number of pathological processes. These include hematomas and other occult hemorrhage, AB0- and Rhesus incompatibility, and increased enterohepatic circulation of bilirubin. In addition, genetic conditions such as galactosemia, hemolytic anemias, and Gilbert and Crigler-Najjar syndromes can significantly increase jaundice in newborn infants. Neonatal jaundice can be treated in several ways, including phototherapy, exchange transfusion, breast milk substitutes, and drugs (e.g. intravenous immune globulin and phenobarbital). By employing such therapies individually or in combination, it is possible to achieve rapid reductions of dangerously high bilirubin levels, and thus reduce the risk of sequelae. It is important to keep in mind that factors which may be unknown at the time of discharge from hospital or birthing unit can contribute to significant increases in total serum bilirubin levels after discharge. It is therefore important to evaluate an infant’s risk status prior to discharge. Written therapeutic guidelines for professionals are useful adjuncts in management, and oral and/or written orientation in terms and language which the parents can understand will help them as far as the post-discharge management. A written orientation in the form of a brief handout may also be a useful tool for educating parents prior to discharge.