9^th International Conference on Neonatology and Perinatology November 28-30, 2016 Valencia, Spain

Lidija Banjac is a specialist in the field of pediatrics and neonatology. She has completed her PhD at Montenegro University School of Medicine. She is head of the Department of neonatology and Assistant professor at the Medical faculty in Podgorica. She has published more than 40 papers in journals in the field of pediatrics and neonatology.

Neonatal cerebral sinovenous thrombosis (CSVT) is a life-threatening neurological disorder. Neonates represent up to 50% of all reported pediatric cases. CSVT is increasingly recognized in neonatal practice. This study presents two newborns with CSVT from our neonatal center and analyzes their clinical findings. The first newborn (female) admitted in the 6th day of life because of deterioration of consciousness and the occurrence of recurrent seizures. Magnetic resonance venography demonstrating thrombosis of the right transverse sinus and the left transverse and sigmoid sinus, hemorrhagic infarcts and parenchymal haemorrhage. The patient had difficult clinical course and received anticoagulation therapy. She had neurological deficits at discharge from the hospital (periventricular leukomalacia, epilepsy). Second newborn (male) was admitted in a 3-day because of motor weakness, an episode of seizures and the central facial paresis. There was no disturbance of consciousness. Magnetic resonance venography showed thrombosis of the left transverse and sigmoid sinus. There were no signs of intracranial hemorrhage. The patient had mild clinical course and was not treated with anticoagulation therapy. He had a discrete neurological deficit at discharge from the hospital. In both patients, the diagnosis of hypercoagulable diseases were set (first newborn - protein S deficiency, the second - thrombophilia). They have a positive family history of hypercoagulable disease. CSVT presents with wide spectrum of neurological sings. Hypercoagulable state was the most common predisposing factor for CSVT. Newborns with neurological sings and positive family history of hypercoagulable disease should be tested on CSVT.

Guadalupe Cordero Gonzalez is a Neonatologist attending at the Neonatal Intensive Care Unit in the Instituto Nacional de Perinatologia at Mexico City. She has completed her Post-graduate studies from Instituto Nacional de Pediatria and Instituto Nacional de Perinatologia in Mexico City, and completed a Master’s in Medical Education from Interamerican University in Mexico. She is the NICU Chief at INPer and has published more than 20 papers in reputed journals.

Introduction: 95% of monochorionic-monoamniotic twins have veno-arterial placental anastomoses allowing blood transfusion from one to another. Without treatment, both babies are affected. Material and methods: a retrospective analysis of the outcomes of 55 monochorionic-monoamniotic pregnancies treated at Instituto Nacional de Perinatología (INPer) in México City, from January 1999 to July 2014 was performed. Data were obtained from clinical charts; percentages, means and standard deviations were calculated for descriptive analysis and t Student test was applied to compare quantitative variables and chi square for qualitative ones, with SPSS v. 20. Results: 48 babies were alive, 38 died before birth and 20 continued their treatment outside of INPer. Survival correlated with Quintero stage at the diagnostic and treatment time: stage 1(83%), 2 (35%), 3 (67.5%), 4 (50%). Mean gestational age at lasser coagulation was 23.3 weeks. 93.7% born by cesarean section, at 31.2 weeks (56 days after coagulation); mean birth weight: 1399.8 g. Statistical difference in hematocrit values between donors (47.2 ±10) vs receptors (48.9 ±11.2) was observed (p=0.000); frequent complications were: hydrops (4%), necrotizing enterocolitis (4%) and thrombosis (2%) and main morbidities were retinopathy (14%), bronchopulmonary dysplasia (10%) and neurodevelopmental disability (10%). Conclusions: survival and outcomes of twin to twin transfusion syndrome patients are related to Quintero stage and gestational age at birth, so that, best chance of living without sequel are correct and early detection and treatment when is needed. Key words: Transfusion, twin to twin syndrome, lasser coagulation

Barbaria Wiem has completed her medical studies at the age of 24 years from faculty of medicine of Tunis. She chose pediatrics as specialty. She accomplished many trainings in different pediatric departments and neonatal center. She participated in national and international conferences as speaker. She have published papers in reputed journals

Gastric or esophageal perforation in the preterm newborn is a rare affection. The search for a cause is still involved before concluding the spontaneous or idiopathic nature. Observations We report three premature infants with respective gestational ages of 28, 30 and 31 weeks of amenorrhea, each derived from a twin pregnancy. They presented at birth neonatal respiratory distress treated with nasal continuous positive airway pressure. Between the second and the forth days of life, they developed abdominal bloating. Thoraco-abdominal radiography showed pneumoperitoneum. In the first case, surgical exploration confirmed the presence of pus and perforation of the abdominal esophagus and stomach related to prenatal septic enterocolitis origin. In the second case, the surgical exploration confirmed gastric perforation in the antrum and the greater curvature. No cause was found and it was concluded as a spontaneous perforation. In the third case, two gastric perforations were found intraoperatively, with bilious effusion. Bacteriological samples and blood cultures were positive for streptococcus B. Ventilatory and hemodynamic support as well as appropriate antibiotic therapy after surger ywere needed to save this child. The evolution was fatal for the first two newborns.

Lana Gagin, MD, MPH, IBCLC, FAAP attended Bashkirian State University Medical School. She completed her Pediatric Residency at the Michigan State University’s College of Human Medicine GRMEP in 2007. She earned her Master’s degree in Public Health at the University of Michigan in 2010 while also working as a pediatrician in the Outpatient General Pediatric Clinic. She joined the staff of the Helen DeVos Children’s Hospital’s Academic General Pediatrics in 2010. In 2011, she joined the staff of Spectrum Health Medical Group and became a Medical Director of Newborn Services in Grand Rapids Campus. As a Medical Director she led the team of physicians in establishing new practices for breastfeeding support which resulted in a successful Baby-Friendly Hospital designation in 2014. She serves as a core faculty at the Pediatric Residency Program at Spectrum Health. She is a co-founder and a Director of Quality Improvement and Patient Safety Rotation, and has been leading multiple quality improvement initiatives. She completed her Lean Healthcare Certification at the University of Michigan in 2014. In 2015, she became an International Board Certified Lactation Consultant.

Transient neonatal hypoglycemia is a common problem affecting many newborns. Up to 15% of healthy newborns and up to 50% of babies in at risk groups are affected. Independent risk factors for hypoglycemia include prematurity, high or low for gestational age birth weight as well as infants born to mothers with diabetes. Correcting critically low blood glucose concentration is important to avoid more serious complications and adverse outcomes. Hypoglycemia can put newborns at risk for potentially life threatening consequences including seizures, brain damage, coma and death. Traditional approach in management of neonatal hypoglycemia included intense feeding interventions as well as close blood glucose monitoring. Intravenous dextrose was reserved to babies in whom the initial conservative approach failed. Despite varying protocols, many babies still struggle with low blood glucose and require more frequent monitoring which causes more lab draws, disruption of bonding between a mother and a baby, interruption of breastfeeding, and at times need for transfer to the neonatal intensive care unit (NICU). More recently, oral dextrose gel use has been shown to be beneficial as an adjunct therapy in management of neonatal hypoglycemia. This study explores the effect of oral dextrose gel on correcting low blood glucose levels in neonates based on specific risk factors.

Ines Semi has completed her medical studies at the age of 24 years from faculty of medicine of Tunis. She chose pediatrics as specialty. She accomplished many trainings in different pediatric departments and neonatal center. She participated in national and international conferences as speaker. She have published papers in reputed journals.

INTRODUCTION : Neonatal and infant cholestasis have a relatively high incidence. Their particularity is the high variability of their etiologies and the severity of the prognosis of some of them. OBJECTIVE : The aim of this study is to discribe the epidemiological, clinical, therapeutic and evolving aspects of this pathology RESULTS : The Hospital incidence was 3,7 new cases per year. The mean age was 3 months and 14 days. 60% wereunder the age of 45 days . The sex ratio was 1,8 . Surgical pathologies werefoundin 17 cases ( 29,8 % ). The most frequent surgical cause was biliary atresia ( 16 cases ). Only one newborn had lithiasis of the common bile duct. Cholestasis were caused by medical pathologies in 24 cases (42,2%). It wascaused by idiopathic neonatal hepatites (15 cases), Alagille’s syndrom (3 cases), Bylerdisease (2 cases), urinary infection (3 cases), and pituitary stalk interruption syndrome (1 case). The etiology were unknown in 16 patients (28%). The meanage of jaundice onset in biliary atresia was 10 days. Surgical treatment was performed at a meanage of 3 months and 13 days. 13 patients devolopped cirrhosis of the liver. 6 of them died at a meanage of 4,3 years. Liver transplantation was successfully performed in only one patient.

Jin Sook Yuk, M.P.H., OTR earned a Bachelor of Science in Occupational Therapy from Yonsei University, Master in Health Policy & Management from Yonsei University. I am licensed as an occupational therapist in Korea. She has been primarily in the area of pediatric occupational therapy. Her research interests are on occupational therapy interventions with infants and young children in the hospital.

Background: Computerized cognitive training becomes most popular and accessible form of cognitive training (CT). Evidences suggest CT facilitates cognitive function, while most of the studies targeted on children older than 6 years age. Touch screen technology can promote motivation and apply to very young children or children with lower cognitive level. Aim: This study evaluated the applicability and efficacy of the tablet PC-based CT program for children with cognitive impairment of cognitive ages between 18 and 36 months. Method: 28 subjects between cognitive ages 18 and 36 months were recruited and randomly assigned to a training group (n=14) and a control group (n=14). Training group received tablet PC-based CT program (Injini) for 30 minutes a day, twice a week, for 12 weeks, by experienced occupational therapist. The control group received traditional rehabilitation program only. Cognitive function was assessed by psycho-developmental measurement scales which include Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), Laboratory Temperament Assessment Battery (Lab-TAB) and Goal Attainment Scale (GAS) at baseline and after the completion of 12 weeks intervention. Result: There was no significant difference between the training and control groups in the scores of psycho-developmental tests at baseline. After 12 weeks of training, training group showed significant improvements in all domains. Control group also showed improvements in almost domains except manipulation domain of Lab-TAB. Comparing the two groups, training group had greater increments in BSID II, social function domain of PEDI, observation and manipulation domains of Lab-TAB, and GAS, than control group. Conclusion: Tablet PC-based CT was feasible and showed promising results in children with cognitive impairment of cognitive ages between 18 and 36 months. More works are needed to study lasting effects and real-world application of CT.

Barbaria W has completed her Medical studies from Mongi Slim Hospital-Tunisia. She chose Pediatrics as specialty. She accomplished training in different pediatric departments and neonatal centers. She participated in national and international conferences as speaker. She has published papers in reputed journals.

Introduction: Congenital heart diseases are common in children. The ductal-dependent heart disease group includes defects with major right or left obstacles. Maintaining patency of the ductus arteriosus in this group is vital to ensure the systemic circulation. The purpose of our study was to clarify the clinical and developmental profile of these conditions. Material & Methods: We conducted a retrospective study of cases of ductal-dependent heart diseases collected in the neonatal unit of the pediatric department of Mongi Slim Hospital La Marsa over a period of 4 years (January 2012-July 2016). Results: We collected 21 cases of ductal-dependent heart disease during the study period. Average age at diagnosis was 2.1 days with extremes of first hour of live and eighteen days. Sex ratio (M/F) was 2. Inbreeding was present in 2 cases. Only one case had history of cardiac disease among siblings. The pregnancies were complicated by gestational diabetes in 4 cases. Antenatal ultrasound has not been performed in 5 newborns. Antenatal diagnosis of heart disease has been established in only 2 cases. The birth was vaginal in 12 cases. The Apgar at one minute and 5 minutes was respectively 7.4 and 9.1. Mean birth weight was 3070 grams. Neonatal resuscitation in the delivery room with use of mechanical ventilation was necessary in 2 cases. Ten (10) newborns were cyanotic at birth. The most common reason for admission was neonatal respiratory distress (12 cases). This respiratory distress was secondary in 8 newborns. A heart murmur was objectified in 10 cases. Two (2) newborns had developed heart failure. Femoral pulse were little or not perceived in 15 cases. Average saturation at ambient air was 78.4% and 89.7% within oxygen. Genetic studies have been performed in only 6 cases of which one (1) Di George syndrome, one (1) Cornelia Delange syndrome, two (2) Down syndrome and two with normal genetic profile. Eight (8) newborns received a first-line treatment based on prostaglandin. Seven (7) cases have urgently received an atrioseptotomy (Rashkind maneuver) and were operated abroad successfully. A fatal outcome was observed in 6 patients with heart disease in question as critical valvular abnormalities, single ventricle and atrioventricular discordance. Eight (8) infants were lost to view. Mean follow survivors were estimated at 20 months. Their evolution was marked by susceptibility to viral and bacterial infections without heart failure episodes. Conclusion: Ductal-dependent heart diseases are potentially serious pathologies. Collaboration between gynecologists, pediatricians and pediatric cardiologists is essential to ensure optimal care.

Emily Brockbank is currently a Foundation Year 2 Doctor in Wales Deanery. She has worked in Pediatrics for more than a decade and presented numerous papers in international conferences. Her clinical interest is in Neonatology and is very keen on advocating evidence based neonatology and providing child and family centered care.

Background: Although prolonged jaundice can be a sign of serious underlying pathology and warrants further evaluation, there is not yet agreement as to the appropriate screening investigations, especially in otherwise well children. Prolonged jaundice screen vary in complexity and the additional diagnostic yield from screening has not been assessed. Aim: The aim of this retrospective study was to ascertain the causes of PJ in well infants and to analyze the extent and consistency of investigations performed. Methods: We performed a retrospective study of all PJ screening in our children’s assessment unit in a District General Hospital during 2013-15. Nurse-led PJ screening, included history and examination with investigations including urine culture as per the proforma. All the clinical notes and results were analyzed. Results: A total 115 infants aged 14-73 days were referred for screening by midwives, GP and A&E. All the infants were examined by a doctor and had all essential documentations including stool color. Neutropenia was common finding on blood-film persisting for 3-4 weeks. All had unconjugated hyperbilirubinemia and most common cause was breast milk jaundice. Two (2) infants were treated as UTI and no other pathological causes of PJ were identified. Additional tests (TFTs, LFTs and G6PD in high-risk population) did not identify any pathological causes. Conclusion: Our study demonstrated still delay in referrals and varied practice of requesting the additional investigations. Additional blood tests did not identify any pathological causes. Hence the PJ screening investigations may safely be reduced to: A FBC and split bilirubin in addition to clinical evaluation.

Pasqua (Mary) Betta is a Neonatologist and Anesthesiology and Intensive Care Consultant. She is Vicar Chief Of NICU of the University of Catania. She is also specialist in Bronchopneumology . She has published More than 50 Papers in indexed reputed Journals.

Introduction: Gastroschisis is a frequent cause of intestinal dysmotility and dependence on parenteral nutrition. It is associated with the slowdown of intestinal transit which depends on the delayed intrauterine maturation of myenteric plexus and interstitial cells of Cajal and on the short bowel syndrome caused by recurring surgical resection. Despite the lack of randomized clinical trials addressing the use of Domperidone in newborns operated for gastroschisis, the use of it for treating gastroparesis syndrome and gastroesophageal reflux disease has proven its efficacy with low risk of side effects. Thus, Domperidone was successfully used for treating our patient in order to improve the intestinal motility. Case Report: The baby, first son of a seventeen year old mother, was born at 37 weeks gestation by elective cesarean section, because of prenatal diagnosis of fetal gastroschisis. Immediately after birth, the newborn underwent surgical correction of gastroschisis and was placed on central venous catheter. Four laparotomy surgeries were necessary due to channeling intestinal failure, the marked abdominal distention and the continued incidents of postoperative biliary stagnation. During such operations, surgeons performed multiple lysing adhesions, resection of the last ileal loop with pack-to-end anastomosis, appendectomy, excision of a stenotic segment sigmoid, multiple intestinal biopsies and ileostomy; ileostomy will be closed during a further surgery after assessment of the patency of colon downstream through colostogram. At 4 months of age, due to the persistence of symptoms and the radiological evidence of severe slowdown of intestinal transit, we used the sub-continuous enteral nutrition with milk formula aminoacid plus medium chain triglycerides, parenteral nutrition with high energy quotient and, to improve the intestinal motility, we decided to start Domperidone in off label. Conclusion: We observed a gradual improvement of food tolerance, followed by weaning from the total parenteral nutritional support. Domperidone was administered successfully and without side effects. The patient was finally discharged in good condition at 6 months of age weighting 4500 grams. So in our patient Domperidone has shown to be safety and useful.