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Ammar K Alomran, Dalal A Bubshait, Ibrahim A Albrahim, Jaffar Saleh M Alsayigh, Ammar J Abusultan, Abdulraheem Altalib, Zaid A Alzaid, Mohammad M Alzahrani Department of Orthopaedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Mohammad M Alzahrani, Imam Abdulrahman Bin Faisal University, King Faisal Road, Dammam, 34212, Saudi Arabia, Tel +966 138966666 Ext 1647, Email mmalzahrani@iau.edu.saObjective: Supracondylar humeral fractures are among the most common pediatric fractures that require surgical intervention when displaced. Recent attention has been directed towards the utilization of serial radiographs in the post-operative period and their effect on decision-making. This study aimed to determine the usefulness of postoperative radiographs early post-operatively, with the goal of determining the optimal frequency for these radiographs.Methods: Pediatric patients who sustained a supracondylar humeral fracture and underwent operative intervention over a 15-year period were included in this study. Data were collected, including the baseline characteristics of the patients, fractures, and operative interventions. In addition, the time until healing, the total number of X-rays before K-wire removal, and postoperative function were evaluated.Results: A total of 122 pediatric patients were included, with a mean age of 5.33 ± 2.93 years. Most fractures were Gartland Type III (74.6%). Most fractures healed at 4 (36.1%) and 3 weeks (35.2%) after surgery. Of the cohort, 94.3% underwent four different x-rays before wire removal, with 4.9% requiring revision surgery. All revision cases were Gartland type 3, and for all cases, the decision to revise was made within three weeks of surgery.Conclusion: Routine post-fixation radiography should not be performed for surgically treated supracondylar humeral fractures before healing. An exception is the Gartland type 3 fracture, for which earlier imaging may be indicated.Keywords: supracondylar, pediatric humerus, closed reduction, fixation, post-operative x-ray

Rayyan Suqaty,1 Ammar K Alomran,2 Mohammed K Alkhalifah,3 Saad S Aldughaythir,4 Abdulrahman M Albeshry,5 Yousif Aldilaijan,6 Mohammed T Alzahrani,1 Thamer Alhussainan1 1Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; 2Department of Orthopedics, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 3Department of Family Medicine & Polyclinics King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 4Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 5Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; 6Primary Health Care Centers, Eastern Health Cluster, Khobar, Saudi ArabiaCorrespondence: Thamer Alhussainan, Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Al Mathar Ash Shamali, Riyadh, 11564, Saudi Arabia, Tel +966504181881, Fax +96614414839, Email alhussainan.t@gmail.comBackground: Developmental dysplasia of the hip (DDH) is one of the most common hip pathologies in pediatric age group and late diagnosis remains a major concern in Saudi Arabia.Objective: The aim of this study is to examine the ability of Saudi Arabian pediatricians and family physicians to conduct clinical screening for (DDH) by estimating their clinical knowledge and skills and analyzing the gaps therein to determine whether there is potential to launch a national screening protocol for DDH in Saudi Arabia.Methods: This is a multicenter cross-sectional study from three major regions in Saudi Arabia (Central, Eastern and Western provinces). The assessed aspects are risk factors, age of screening, incidence in Saudi Arabia, physical signs and diagnostic markers, and treatment, along with their ‘clinical knowledge and skills’ score.Results: Half of the participants were pediatricians, while the rest were family physicians. More than a third of the participants were considered to have adequate knowledge, ie, above the mean score. Dimensions with the most significant knowledge gaps included the incidence of DDH in Saudi Arabia, adverse effects of swaddling, and the management of a high-risk infants presenting with a negative physical examination. Additionally, there were relatively low rates of awareness regarding positive risk factors as well as a generally poor ability to identify physical signs. Clinical knowledge and skill levels were significantly lower among family physicians.Conclusion: Pediatricians and family physicians in Saudi Arabia still need further training to improve their clinical skills for DDH screening. The proper administration of training programs could eventually enable the gradual implementation of a national systematic screening program.Keywords: orthopedic, pediatrics, observational study, pediatricians, family physicians, developmental dysplasia of the hip

Ammar K Alomran,1 Hadeel Almulhim,2 Shahad Alabdulqader,2 Danah S Almutairi,2 Danah F Alrusayyis,2 Sarah A Althwaiqb,2 Arwa Alumran3 1Orthopedics Department, Imam Abdulrahman bin Faisal University, College of Medicine, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 3Health Information Management and Technology Department, Imam Abdulrahman bin Faisal University, College of Public Health, Dammam, Saudi ArabiaCorrespondence: Hadeel Almulhim, Tel +966501407070, Email 2170006025@iau.edu.saBackground: Hip spica tables are widely used among pediatric orthopedic surgeons to maintain the hip position during cast application and drying processes for a better outcome. Locally customized spica tables can be a significant concern if their limitations significantly interfere with the quality of care.Objective: This study aims to explore the current practice of pediatric hip spica table application among hospitals in the GCC countries and report comprehensive data that help surgeons enhance their practice.Methods: This is a cross-sectional study on pediatric orthopedic surgeons using a self-administered Online Questionnaire. The respondents were grouped as those using locally customized tables, where further information about the material and characteristics were collected, and those using company manufactured tables. Both groups answered analytical questions related to their current practice of hip spica tables.Results: Sixty-three surgeons completed the survey. More than half the physicians in this study are using locally customized spica tables (n= 41, 65%). Compared to company-manufactured tables, locally customized tables were associated with a higher rate of difficulties when taking an X-ray, when the patient weighs more than 50.0 kg, and with anesthesia, although not statistically significant.Conclusion: Obtaining a good quality spica table at a suitable price is a primary obstacle pediatric orthopedic surgeons face. This study shows no statistically significant difference between locally customized and company-manufactured tables regarding the outcomes and that spica tables have room for development to optimize their utilization.Keywords: spica tables, pediatric orthopedics, spica cast, developmental dysplasia of the Hip, DDH, fractures

Afnan Aljaffary,1 Fatimah AlAnsari,1 Abdulaleem Alatassi,2 Mohammed AlSuhaibani,3 Ammar Alomran4 1Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Preoperative Quality and Patient Safety Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 3Operating Room Services Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 4Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Afnan Aljaffary, Tel +9661333, Email aaljaffari@iau.edu.saBackground and Objectives: The operating room (OR) is considered the highest source of cost and earnings. Therefore, measuring OR efficiency, which means how time and resources are allocated precisely for their intended purposes in the operating room is crucial. Both overestimation and underestimation negatively impact OR efficiency Therefore, hospitals defined metrics to Measuring OR Effeciency. Many studies have discussed OR efficiency and how surgery scheduling accuracy plays a vital role in increasing OR efficiency. This study aims to evaluate OR efficiency using surgery duration accuracy.Methods: This retrospective, quantitative study was conducted at King Abdulaziz Medical City. We extracted data on 97,397 surgeries from 2017 to 2021 from the OR database. The accuracy of surgery duration was identified by calculating the duration of each surgery in minutes by subtracting the time of leaving the OR from the time of entering the OR. Based on the scheduled duration, the calculated durations were categorized as either underestimation or overestimation. Descriptive and bivariate analyses (Chi-square test) were performed using the Statistical Package for the Social Sciences (SPSS) software.Results: Sixty percent out of the 97,397 surgeries performed were overestimated compared to the time scheduled by the surgeons. Patient characteristics, surgical division, and anesthesia type showed statistically significant differences (p < 0.05) in their OR estimation.Conclusion: Significant proportion of procedures have overestimated. This finding provides insight into the need for improvement.Recommendations: It is recommended to enhance the surgical scheduling method using machine learning (ML) models to include patient characteristics, department, anesthesia type, and even the performing surgeon increases the accuracy of duration estimation. Then, evaluate the performance of an ML model in future studies.Keywords: efficiency, operating room, overestimation, underestimation, Saudi Arabia

Mir Sadat-Ali,1,&ast; Hussain K Al-Omar,2,&ast; Khalid W AlTabash,1,&ast; Ammar K AlOmran,1,&ast; Dakheel A AlDakheel,1,&ast; Hasan N AlSayed1,&ast; 1The Department of Orthopedic Surgery, King Fahd Hospital of the University, Imam AbdulRahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Orthopedic Surgery, King Fahd Military Medical City, Dhahran, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Mir Sadat-Ali, King Fahd Hospital of the University, POBOX 40071, AlKhobar, 31952, Saudi Arabia, Tel +966505848281, Fax +966138820887, Email drsadat@hotmail.com; smali@iau.edu.saPurpose: Nonunion of fractures occurs in about 15% of all fractures causing repeated surgical interference and prolonged morbidity. We performed this systematic review to assess genes and polymorphisms influencing fractures’ nonunion (FNU).Methods: We searched between 2000 and July 2022 in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Genome Wide Association Studies (GWAS) Catalog, and the Science Citation Index, with the keywords nonunion of fractures, genetic influence, and GWAS. The exclusion criteria were review articles and correspondence. The data were retrieved to determine the number of studies, genes, and polymorphisms and the total number of subjects screened.Results: A total of 79 studies were reported on nonunion of fractures and genetic influence. After the inclusion and exclusion criteria, ten studies with 4402 patients’ data were analyzed. Nine studies were case-controlled, and 1 GWAS. It was identified that patients with polymorphisms in the genes ANXA3, BMP2, CALY, CYR61, FGFR1, IL1β, NOG, NOS2, PDGF gene, and TACR1 are prone to develop a nonunion of fractures.Conclusion: We believe that for patients who develop an early nonunion of fractures, a genetic study should be conducted for single nucleotide polymorphism (SNP) and genes so that alternative and more aggressive treatment can be performed to heal fractures without prolonged morbidity.Keywords: nonunion, fractures, genome wide association study, genes, influence, morbidity

Amal Alomran,1,2,&ast; Nada Alyousefi1,2,&ast; 1Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Amal Alomran, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia, Tel +966114670836, Email amal9alomran@gmail.comObjective: The interaction between physicians and patients is essential in clinical practice. Patient-centered care (PCC) is becoming popular in healthcare and provides an approach to deliver high-quality healthcare to yield positive clinical outcomes. This study explores family medicine residents’ attitudes toward the physician–patient relationship and patient-centered care and the possible influence of demographic characteristics, level of training, school of graduation, and previous training.Methods: A cross-sectional study was conducted among family medicine residents in Riyadh. They were invited to enroll in a web-based survey that includes demographic data, training details, and the “Patient Practitioner Orientation Scale (PPOS).”.Results: A total of 114 family medicine residents completed the survey. There were 68 (59.6%) males and 46 (40.4%) female residents. The overall PPOS was 4.23 ± 0.53. The mean score for sharing domain was 3.97 ± 0.66. The caring domain scored 4.49 ± 0.57. No correlations were found between the residents’ demographic data and other included variables, and the means of sharing domain, caring domain, and overall score.Conclusion: Family medicine residents were found to have positive attitudes toward patient-centeredness. Integrating patient-centered training early in the curriculum can improve healthcare students’ and trainees’ attitudes toward patient-centered care. Future research can explore the possible interventions in systematic assessment and training programs that can improve PCP.Keywords: physician–patient relations, medical residency, patient-centered care, Saudi Arabia

Saud A Alanazi,1 Abdullah A Alomran,1 Ali Abusharha,1 Raied Fagehi,1 Naji J Al-Johani,2 Gamal A El-Hiti,1 Ali M Masmali11Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; 2Comprehensive Cancer Center, Department of Endocrinology and Thyroid Oncology, King Fahad Medical City, Riyadh, Saudi ArabiaObjective: To investigate the ocular tear film in patients with thyroid disorders using various tests.Methods: The study involved the assessment of the ocular tear film in 20 patients with thyroid disorders (6 men and 14 women) aged 18–43 years (mean±standard deviation=34.3±3.2 years). An age-matched control group consisting of 20 subjects (8 males and 12 females) ranging in age from 18 to 43 years (31.3±2.9 years) was also examined under similar conditions. All patients completed the Ocular Surface Disease Index questionnaire, followed by the tear ferning test within the right eye. A phenol red thread test was carried out 10 mins later followed by the fluorescein tear break-up test with a 10-min gap between the tests being implemented.Results: The median score for the Ocular Surface Disease Index (P

Abstract The rice weevil Sitophilus oryzae is one of the primary insects that infest stored grains, causing both quantitative and qualitative losses. The use of synthetic pesticides to control it has led to the emergence of several problems related to human health and the environment, which has prompted the search for safer alternatives for their control. In this study, the effectiveness of two essential oils, cumin (Cuminum cyminum) and basil (Ocimum basilicum), was evaluated as insecticides for controlling the rice weevil at three different times intervals and various concentrations. (GC-MS) analysis revealed that both oils contain several key compounds, such as procanal (26.07%), ˠ- terpinene (15.78%), for C. cyminum and linalool (56.7%), cadinol, epi-α (11.4%) for O. basilicum, in addition to some secondary components. The results showed that, the lethal concentration (LC50) of cumin was 49%, 45%, and 33% lower than that of basil at the 24, 48, and 72-h assessment periods, respectively demonstrating the superiority of cumin over basil. Regarding the effects on the levels of certain enzymes activity, the results indicated that both oils had a significant impact on the activity of both enzymes ALP and GOT, while there was no significant effect on (GOT), α-amylase, and acetylcholinesterase (AChE) compared to control. Based on the obtained results, it can be concluded that tested essential oils could be developed as a safe and effective alternatives for controlling rice weevil.

In the digital age, "kidfluencers," or child influencers, have emerged as significant figures in shaping the online experiences of children. This study explores their impact on the cultural identity of Kuwaiti middle school students, as perceived by their parents. Employing a quantitative research design, the researchers collected data via questionnaire from a random sample of 383 parents. The findings reveal the substantial perceived impact which kidfluencers have on various aspects of cultural identity for Kuwaiti middle school students. Notably, they have a significant effect on language acquisition, leading students to adopt non-Kuwaiti vocabulary and slang prevalent in online kidfluencer content. Additionally, kidfluencers affect moderate influences over cultural values, moral beliefs, national identity, and traditions amongst students. This study underscores the need for a nuanced understanding of the multifaceted powers which kidfluencers can wield, thus helping inform educational strategies and parental guidance for the online era.

Nodular lymphangitis, also known as lymphocutaneous syndrome or sporotrichoid lymphangitis, presents with inflammatory nodules along the lymphatic vessels, typically involving the upper or lower extremities. Although the most common cause of nodular lymphangitis is infection due to Sporothrix schenckii, Nocardia brasiliensis, Mycobacterium marinum, or Leishmania braziliensis, it is important for clinicians to be aware of methicillin-resistant Staphylococcus aureus as a rare cause of nodular lymphangitis and perform gram stain, bacterial culture, and antibiotic sensitivity profiles when appropriate. History of recent travel or exposures, incubation time, presence of systemic symptoms, and presence of ulceration, suppuration, or drainage can serve as diagnostic clues, but microbiological tissue cultures and histopathologic studies confirm the diagnosis. Herein, we present a case of nodular lymphangitis caused by methicillin-resistant Staphylococcus aureus (MRSA); tissue culture and antibiotic sensitivities were used to guide treatment.

PPHN is a common cause of neonatal respiratory failure and is still a serious condition that is associated with high mortality. Objectives: To analyze the clinical characteristics and outcomes of SARS-CoV-2 infection in neonates with PPHN to identify neonatal cases at risk to develop severe illness. Methods: For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, Embase, CINAHL, and PubMed for studies on the development of COVID-19 in neonates with PPHN, published from 1 December 2019 to 29 February 2024, with an English language restriction. Results: Of the 2406 papers that were identified, 21 articles were included in the systematic review. Studies involving thirty-six neonates with PPHN and infected with SARS-CoV-2 were analyzed (twenty-nine survived, six died, and one is still hospitalized). The main causes of PPHN in neonates who had COVID-19 were neonatal respiratory distress syndrome (NRDS) (41.7%), meconium-stained amniotic fluid (MSAF) (16.7%), preterm premature rupture of membranes (PPROM) (11.1%), hypoxic ischemic encephalopathy (HIE) (5.5%), pneumonia (5.5%), and idiopathic (2.8%). Most of those neonates were male (33.3%), belonged to Indian ethnicity (50%), and were delivered via caesarean section (44.4%). COVID-19 in cases with PPHN commonly occurred in neonates born with a pregnancy range from 32 to p = 0.026]. Neonates with PPHN and COVID-19 had a higher relative risk of death if they received more antibiotics (RR 4.14, 95% CI 0.64–6.88) and if their COVID-19 was defined as critical (RR 2.84, 95% CI 0.86–9.39). Male neonates with PPHN and COVID-19 (RR 2.60, 95% CI 0.30–1.17) and those requiring prolonged invasive positive pressure ventilation (RR 2.22, 95% CI 0.64–7.73) also showed an increased relative risk for death. Conclusions: COVID-19 in neonates with PPHN is challenging and may be associated with increased mortality, severity, ICU admission, ARDS, MIS-N, and MV usage. The results should be interpreted with caution owing to the small number of studies and substantial heterogeneity and indicate a need for future research in this area. Due to its benefits, testing for SARS-CoV-2 should be encouraged for newborns with symptoms consistent with COVID-19, especially in neonates with a history of SARS-CoV-2 exposure. Effective protection measures should be implemented during delivery and post-delivery care as necessary.

RETRACTION NOTICE (6 th October 2023): The article by AlOmran A. ‘The effect of obesity on the outcome of total knee replacement (TKR)’ [version 1; peer review: 1 approved with reservations]. F1000Research 2022, 11:1406 ( https://doi.org/10.12688/f1000research.126901.1) has been retracted from F1000Research by the F1000 Editorial Team. After publication, concerns were raised to the F1000 Editorial Team by a potential peer reviewer about the integrity of the data presented in the article. Investigation into the content of the article was performed by the F1000 Editorial Team, which revealed that the article had been published without the raw underlying data. The Editorial Team requested the raw underlying data for the research from the author, including a request for the ethical approval document, on 22 nd March, 24 th March, 19 th April and 24 th April 2023. The author did not respond to the requests to provide the underlying data, however, they did provide an ethical approval document. On review of the ethical approval document, its authenticity could not be validated. The author's institution was contacted on 22nd June, 24 th July and 11 th August 2023 to request further information about the underlying data and verify the ethical approval document. The author's institution has not responded to these requests. Therefore, the decision was made by the F1000 Editorial Team to retract this article, due to the inability to verify the ethical approval for this study and concerns over the integrity of the data. As per F1000Research policies, ethical approval for this type of study must be sought prior to the study start and all articles that report original results should provide access to all data underlying the results, unless there is good justification. The author has seen a copy of this retraction notice and has not responded.

RETRACTION NOTICE (3rd October 2023): The article by Khotimah H, Dewi Lestari Ismail D, Widasmara D et al. ‘Ameliorative effect of gel combination of Centella asiatica extract transfersomes and rosemary essential oil nanoemulsion against UVB-induced skin aging in Balb/c mice’[version 1; peer review: 3 approved with reservations] ( https://doi.org/10.12688/f1000research.109318.1) has been retracted from F1000Research by the F1000 Editorial Team. During prepublication checks of a new article by these authors, the F1000 Editorial Team noticed that the dataset and methodology of the new article were very similar to this published article. Investigation into the content of these two articles was performed by the F1000 Editorial Team, which revealed discrepancies in the ethical approval (approval document mentioned rats when the study was in mice; new article mentioned consent when study in animals) and methodology (wrong description of mouse model used); and concerns over the treatment of the mice (wellbeing concerns during shaving procedure and euthanasia) and authenticity of the data. The new article was rejected. For this published article, the F1000 Editorial Team requested an explanation from the authors regarding the above issues, including a request for a copy of the ethical approval document, on 22 nd March and 29 th March 2023. The authors’ institution was contacted on 24th April and 21 st June 2023. The authors were unable to respond adequately to our queries; the institution has not responded to our requests. The decision was made by the F1000 Editorial Team to retract this article, due to the inability to verify the ethical approval for this study, and concerns over data integrity and the study design, including the treatment of the mice. The authors have seen a copy of this retraction notice. Husnul Khotimah and Dina Dewi Lestari Ismail agree with the retraction of the article. No responses were received from the other authors.

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare dermatosis initially described as ‘comedo nevus’ and renamed ‘PEODDN’; it has also been referred to as linear eccrine nevus with comedones, porokeratotic eccrine ostial and hair follicle nevus, and porokeratotic adnexal ostial nevus. PEODDN is usually present at birth or develops early in life. Rarely, PEODDN can develop in adults. The treatment of this puzzling condition is not standardized. We report herein a new case of adultonset PEODDN with dermatoscopic images. Our patient responded favorably to topical tazarotene.

PPHN is a common cause of neonatal respiratory failure and is still a serious condition that is associated with high mortality. Objectives: To analyze the clinical characteristics and outcomes of SARS-CoV-2 infection in neonates with PPHN to identify neonatal cases at risk to develop severe illness. Methods: For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, Embase, CINAHL, and PubMed for studies on the development of COVID-19 in neonates with PPHN, published from 1 December 2019 to 29 February 2024, with an English language restriction. Results: Of the 2406 papers that were identified, 21 articles were included in the systematic review. Studies involving thirty-six neonates with PPHN and infected with SARS-CoV-2 were analyzed (twenty-nine survived, six died, and one is still hospitalized). The main causes of PPHN in neonates who had COVID-19 were neonatal respiratory distress syndrome (NRDS) (41.7%), meconium-stained amniotic fluid (MSAF) (16.7%), preterm premature rupture of membranes (PPROM) (11.1%), hypoxic ischemic encephalopathy (HIE) (5.5%), pneumonia (5.5%), and idiopathic (2.8%). Most of those neonates were male (33.3%), belonged to Indian ethnicity (50%), and were delivered via caesarean section (44.4%). COVID-19 in cases with PPHN commonly occurred in neonates born with a pregnancy range from 32 to <37 weeks (moderate to late preterm) (36.1%). The maternal severity of COVID-19 was reported to be severe in three cases only (8.3%); however, SARS-CoV-2 infection in neonates with PPHN was either severe (44.4%) or critical (22.2%). Most of these neonates experienced acute respiratory distress syndrome (ARDS) (58.3%). Early and late multisystem inflammatory syndrome in neonates (MIS-N) were reported in 50% and 11.1%, respectively. A high proportion of neonates were admitted to the intensive care unit (ICU) (58.3%) or needed mechanical ventilation (MV) (47.2%). Neonates with concurrent PPHN and SARS-CoV-2 infection who died had worse severity of COVID-19 [i.e., severity of COVID-19 was critical in 10% (neonates with PPHN who survived group) vs. 83.3% (neonates with PPHN who died group); p = 0.026]. Neonates with PPHN and COVID-19 had a higher relative risk of death if they received more antibiotics (RR 4.14, 95% CI 0.64–6.88) and if their COVID-19 was defined as critical (RR 2.84, 95% CI 0.86–9.39). Male neonates with PPHN and COVID-19 (RR 2.60, 95% CI 0.30–1.17) and those requiring prolonged invasive positive pressure ventilation (RR 2.22, 95% CI 0.64–7.73) also showed an increased relative risk for death. Conclusions: COVID-19 in neonates with PPHN is challenging and may be associated with increased mortality, severity, ICU admission, ARDS, MIS-N, and MV usage. The results should be interpreted with caution owing to the small number of studies and substantial heterogeneity and indicate a need for future research in this area. Due to its benefits, testing for SARS-CoV-2 should be encouraged for newborns with symptoms consistent with COVID-19, especially in neonates with a history of SARS-CoV-2 exposure. Effective protection measures should be implemented during delivery and post-delivery care as necessary. [ABSTRACT FROM AUTHOR]