Ibrahim Qattea

Purpose of Review: Despite advances in diabetes management, recurrent diabetic ketoacidosis (DKA) remains a common and largely preventable complication in paediatric patients with type 1 diabetes mellitus (T1DM). This systematic review and meta-analysis aimed to synthesise available evidence on risk factors associated with recurrent DKA in children and adolescents. Recent Findings: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception to October 2025. Observational studies involving children and adolescents (< 21 years) with established type 1 diabetes mellitus and biochemically confirmed DKA were included. Random-effects meta-analyses were performed for predefined predictors, reporting pooled odds ratios (ORs) with 95% confidence intervals (CI). Twelve observational studies comprising 58,911 paediatric patients were included. A prior episode of DKA was the strongest predictor of recurrence, conferring an almost eightfold increased risk (OR = 7.97, 95% CI 4.33–14.67). Longer diabetes duration of 12–15 years was also associated with increased recurrence risk (OR = 1.94, 95% CI 1.21–3.11), whereas duration of 5–11 years was not (OR = 1.13, 95% CI 0.76–1.69). Female sex was not significantly associated with recurrence in the primary analysis. Overall risk of bias was moderate across studies. Summary: Prior DKA episodes and longer disease duration are key predictors of recurrent DKA in paediatric T1DM. Targeted prevention strategies following an initial DKA episode are urgently needed, supported by future prospective research.

Accurate confirmation of endotracheal tube (ETT) placement is critical in neonatal resuscitation. This systematic review and meta-analysis assessed the diagnostic accuracy of point-of-care ultrasound (POCUS) for confirming ETT placement in neonates. We searched PubMed, Scopus, Web of Science, and Cochrane Library through May 2025. Eligible studies included neonates (<28 days) and compared POCUS with gold-standard confirmation (capnography, chest radiography, or direct laryngoscopy). Diagnostic performance was pooled using a bivariate random-effects model. Thirteen studies (930 neonates) met inclusion criteria. POCUS showed pooled sensitivity of 93% and specificity of 59%, with an area under the SROC curve of 92%. tracheal placement was confirmed in 99%, and esophageal misplacement detected in 4%. Subgroup analysis indicated higher accuracy by neonatologists and with linear transducers. POCUS offers a rapid, radiation-free method for confirming neonatal ETT placement. Broader implementation requires standardized techniques and operator training.

Background: Infants with congenital heart disease (CHD) may have an increased risk of seizures. Methods: We analyzed the US National Inpatient Sample Database (2016–2020). We included infants with CHD who developed seizures. We excluded premature infants P P <0.001). Conclusions: Infants with CHD have higher odds of experiencing seizure. Cyanotic CHD had the lowest incidence of seizure, while patients with single ventricle experienced the highest risk. Having seizures was associated with longer hospital stay and higher odds of mortality. This information may help in counseling families about the neurologic outcomes of infants with CHD.

Background: Reports on the survival of infants born at periviable gestation (GA of ≤24 weeks and birth weight of <500 gm) vary significantly. We aimed to determine hospital factors associated with their survival and to assess the trend for the timing of postnatal mortality in these periviable infants. Methods: We utilized the de-identified National Inpatient Sample (NIS) dataset of the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ). National data were analyzed for the years 2010–2018. Hospitals were categorized according to delivery volume, USA regions, and teaching status. Results: We identified 33,998,014 infants born during the study period; 76,231 infants were ≤24 weeks. Survival at birth and first 2 days of life was greatest in urban teaching hospitals in infants <24 weeks and those who completed 24 weeks, respectively. The Northeast region has the lowest survival rate. There was a significant delay in the postnatal day of mortality in periviable infants. Conclusions: Hospital factors are associated with increased survival rates. Improved survival in large teaching hospitals supports the need for the regionalization of care in infants born at the limits of viability. There was a significant delay in the postnatal mortality day.

Introduction Preterm birth is a leading cause for prolonged length of stay (LOS) in the hospital. In the USA, the rate of preterm birth is around 10.5%, thereby contributing substantially to the burden of hospitalization. The interaction of demographic, financial, and hospital factors with LOS of preterm infants has not been studied. Objective To assess the effect of demographic, financial, and hospital factors on LOS of surviving preterm infants born at 23 0/7–36 6/7 weeks of gestational age (GA). Methods We utilized de-identified patient information from the Healthcare Cost and Utilization Project (HCUP) from 2016–2020. All infants with GA between 23 0/7 and 36 6/7 weeks were identified. ANOVA test was used to assess LOS differences at different GA. Cochran-Armitage test was used for trend analyses. Results A total of 1,359,280 surviving premature infants were included in the study. LOS was significantly (p < 0.001) impacted by GA, ethnic group, hospital size and type, and US geographic region. LOS was not affected by sex or type of health insurance. Conclusion LOS of preterm infants is significantly affected by multiple demographic factors that are potentially modifiable. These findings can remarkably help policymakers and stakeholders optimize interventions and resource allocations for preterm infants.

Objective: We aimed to look for the mortality of Black and White Neonates and compare the Black and White neonates’ mortalities after stratifying the population by many significant epidemiologic and hospital factors. Design/Method: We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Neonatal characteristics used in the analysis included ethnicity, sex, household income, and type of healthcare insurance. Hospital characteristics were urban teaching, urban non-teaching, and rural. Hospital location was classified according to the nine U.S. Census Division regions. Results: Neonatal mortality continues to be higher in Black populations: 21,975 (0.63%) than in White populations: 35,495 (0.28%). Government-supported health insurance was significantly more among Black populations when compared to White (68.8% vs. 35.3% p < 0.001). Household income differed significantly; almost half (49.8%) of the Black population has income ≤ 25th percentile vs. 22.1% in White. There was a significant variation in mortality in different U.S. locations. In the Black population, the highest mortality was in the West North Central division (0.72%), and the lower mortality was in the New England division (0.51%), whereas in the White population, the highest mortality was in the East South-Central division (0.36%), and the lowest mortality was in the New England division (0.21%). Trend analysis showed a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by sex, type of insurance, household income, and type of hospital, the mortality was consistently higher in Black groups throughout the study years. Conclusions: Disparities in neonatal mortality continue to be higher in Black populations; there was a significant variation in mortality in different U.S. locations. In the Black population, the highest mortality was in the West North Central division, and the lower mortality was in the New England division, whereas in the White population, the highest mortality was in the East South Central division, and the lowest mortality was in the New England division. There has been a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by many significant epidemiologic and hospital factors, the mortality was consistently higher in Black groups throughout the study years.

Objective: We aimed to look for the mortality of Black and White Neonates and compare the Black and White neonates' mortalities after stratifying the population by many significant epidemiologic and hospital factors. We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Design/Method: We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Neonatal characteristics used in the analysis included ethnicity, sex, household income, and type of healthcare insurance. Hospital characteristics were urban teaching, urban non-teaching, and rural. Hospital location was classified according to the 9 U.S. Census Division regions. Results: Neonatal mortality continues to be higher in Black: 21,975 (0.63%) and in White was: 35495 (0.28%), Government-supported health insurance was significantly more among Black populations when compared to White (68.8% vs. 35.3% p<0.001). Household income differed significantly; almost half (49.8%) of the Black population has income ≤ 25th percentile vs. 22.1% in White. There was a significant variation in mortality in different U.S. locations. In the Black population, the highest mortality was in the West North Central division (0.72%), and the lower mortality was in the New England division (0.51%), whereas in the White population, the highest mortality was in the East South-Central division (0.36%), and the lowest mortality was in the New England division (0.21%). Trend analysis showed a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by sex, types of insurance, the household income, the type of hospitals, the mortality was consistently higher in Black groups throughout the study years, Conclusions: Disparities in neonatal mortality continue to be higher in Black; There was a significant variation in mortality in different U.S. locations. In the Black population, the highest mortality was in the West North Central division, and the lower mortality was in the New England division, whereas in the White population, the highest mortality was in the East South-Central division, and the lowest mortality was in the New England division. There has been a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by many significant epidemiologic and hospital factors, the mortality was consistently higher in Black groups throughout the study years.

Background Reports on survival of infants born at periviable gestation (GA ≤ 24 weeks and birth weight < 500gm) vary significantly. We aimed to determine hospital factors associated with their survival and to assess the trend for the timing of postnatal mortality in these periviable infants.Methods We utilized the de-identified National Inpatient Sample (NIS) dataset from the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ). National data were analyzed for the years 2010–2018. Hospitals were categorized according to delivery volume, USA regions, and teaching status.Results We identified 33,998,014 infants born during the study period; 76,231 infants were ≤ 24 weeks. Survival was greatest in urban teaching hospitals in infants < 24 weeks and completed 24 weeks, respectively. The Northeast region has the lowest survival rate. There was a significant delay in the postnatal day of mortality in periviable infants.Conclusions Hospital factors are associated with increased survival rates. Improved survival in large teaching hospitals supports the need for regionalization of care in infants born at the limits of viability. There was a significant delay in the postnatal mortality day.

Purpose of review: to evaluate the accessibility, success rate, and attributable complications and to describe the maneuver for PICC line insertion via proximal basilic or axillary veins in neonates. Recent findings: This study demonstrated a total of 78 PICCs inserted successfully 91.7% and fewer complications. The median postnatal age of patients was eight days (2 days - 92days), and the median weight of patients at the procedure was 2600g (590g - 3900g). The median corrected gestational age of patients at the procedure was 36weeks (23weeks - 46weeks). Summary: This study demonstrated a high success rate and fewer complications of proximal basilic and axillary veins central lines in neonates with difficulties getting intravenous vascular access. This procedure is also safe for Very low birth and extremely low birth Preterm and can be used as central intravenous access for a long time.

Objectives: to evaluate the accessibility, success rate, and attributable complications and to describe the maneuver for central line insertion via proximal basilic or axillary veins in neonates. Methods: This retrospective study included all infants admitted to the neonatal intensive care unit and had an axillary central line inserted or attempted. Success rate, complications, and outcomes were reviewed. Results: Axillary central line was attempted in 85 infants and was successful in 78 infants with a success rate of 91.7%. The median postnatal age of patients was 8 days (2 days–92 days), and the median weight of patients at the procedure was 2600 g (590 g–3900 g). The median corrected gestational age of patients at the procedure was 36 weeks (23 weeks–46 weeks). No serious complication was observed in any of the 85 infants. Conclusion: This study demonstrated a high success rate for insertion of proximal basilic and axillary veins central lines in neonates with difficult vascular access. This procedure was feasible in very low birth and extremely low birth preterm infants, especially in those who failed previous central line attempts.