The intervention group will receive Montelukast Sodium for 10 days in addition to the conventional antibiotic therapy regimen and other supportive measures according to the policy of neonatal units and patients' needs. Montelukast sodium will be given at a dose according to body weight (1.5 kg to 2 kg, will be given 1.5 mg; greater than 2 kg, 2 mg will be given) this dose was calculated according to ( Kim et al. (2015). Four mg of the drug will be dissolved in four ml milk and 1.5 - 2 ml milk only will be given once daily at 9 pm via an orogastric tube or by oral administration for 10 days and patients of this group will be closely observed for development of Montelukast side effects as "diarrhea, colic, vomiting, fever and cough" (Adelsberg et al. 2005).

The control group will receive antibiotics and other supportive measures according to the policy of neonatal units and patients' needs.

Neonatal Sepsis

Montelukast sodium (Singulair) will be given at a dose according to body weight. Four mg of the drug will be dissolved in four ml milk and the dose will be given once daily at 9 pm for 10 days.

Montelukast Sodium

Mansoura University Childran Hospital

Role of Montelukast in Modulation of Response to Sepsis in Preterm Infants

Change in serum level of TNF alpha is assessed by the difference between the admission level and its level at 10 days after receiving the therapy.

Serum C-reactive protein (CRP) level will be measured on admission and compare its level with the level at 10 days after receiving therapy. It will be measured in both groups

Patients are considered 1.improved when manifested clinically by no respiratory distress, normal temperature, no oxygen support, no inotropes, alert, not lethargic, tolerate feeding, increasing in body weight and laboratory by normal CBC , normal CRP, Culture negative. 2. Partially improved if patient still on intravenous fluid therapy, still on oxygen support, still on inotropes, CRP decreasing but still positive, and CBC still abnormal. 3. Deteriorated if developed complication as coagulopathy, septic shock or MODS.

use of positive pressure ventilation (receiving mechanical ventilation or CPAP) and the duration

duration of inotropes (dopamine, epinephrine, norepinephrine)

Hanan El-Halaby

Principal investigator

Mansoura University Children Hospital

Ampicillin 2 gm IV every 6 hours followed by amoxicillin 500 mg PO every 8 hours with Azithromycin 1 gm PO once at randomization.

Ampicillin 2 gm IV every 6 hours followed by amoxicillin 250 mg PO every 8 hours for 5 days with erythromycin 250 mg IV every 6 hours for 48 hours followed by 500 mg PO every 8 hours for 5 days.

Preterm Premature Rupture of Membranes (PPROM)

Study is to be carried out on pregnant patients with diagnosis of PPROM.

Azithromycin

Erythromycin 250 mg IV every 6 hours for 48 hours followed by 500 mg PO every 8 hours for 5 days.

Erythromycin

Ampicillin 2 gm IV every 6 hours for 2 days

Ampicillin

Amoxicillin 500 mg PO every 8 hours for 5 days

Amoxicillin

University of Mississippi Medical Center

St. David's North Austin Medical Center

University of Texas Medical Branch

Treatment of ppROM With Erythromycin vs. Azithromycin Trial

TREAT: Treatment of ppROM With Erythromycin vs. Azithromycin Trial

Proportion of women still pregnant by day 7 after the diagnosis of PPROM is made. The investigators' working hypothesis is that there is no measurable difference in the primary outcome between the group randomized to the azithromycin regimen versus the group randomized to the erythromycin regimen

Number of days from diagnosis of PPROM to delivery

The University of Texas Medical Branch, Galveston

Allocation: Randomized Intervention model: Parallel Assignment

200 women will receive IV ceftriaxone (2g) 60 minutes before skin incision

200 women will receive IV ceftriaxone (2g) immediately with skin incision

200 women will receive IV ceftriaxone (2g) immediately after umbilical cord clamping

Endometritis

IV ceftriaxone (2g) will be given to all participants

ceftriaxone

The Optimal Time for Intravenous Antibiotic Prophylaxis in Elective Cesarean Section

The Optimal Time for Intravenous Antibiotic Prophylaxis in Elective Cesarean Section: Randomized Comparative Study

maternal axillary temperature ≥ 38°C for at least 48 hours, uterine tenderness, infected lochia & leukocytosis.

clinical signs, leukocytosis, CRP & positive blood culture

induration, redness, hematoma, seroma or purulent discharge at the incision site

neonatal sepsis/diarrhea

Role of Montelukast in Modulation of Response to Sepsis in Preterm Infants

Treatment of ppROM With Erythromycin vs. Azithromycin Trial

The Optimal Time for Intravenous Antibiotic Prophylaxis in Elective Cesarean Section

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