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

Biography:

Claire Kendal Wright has completed her PhD from The Open University, UK in Neuropathology and Post-doctoral studies from Imperial College London and The University of Hawaii in Neuroscience and Reproductive Biology, respectively. She is now an Assistant Professor at Chaminade University of Honolulu, and the John A Burns School of Medicine where her research program focuses on understanding the normal and pathological mechanisms of human fetal membrane weakening.

Abstract:

Infection accounts for over 40% of preterm premature rupture of the fetal membranes (PPROM), a major cause of preterm birth. Toll-like receptors (TLR) play key roles in pathogen surveillance in many tissues but their expression and function in amnion mesenchymal cells (AMC) is unknown. The aims of this study were to determine the expression of all TLR isoforms and the effect of macrophage-activating lipoprotein-2 (MALP-2) on human AMC. AMC were isolated from normal, term, amnion at repeat caesarean section. Semi-quantitative RT-PCR, immunocytochemistry, immunohistochemistry and western blotting were used to detect TLR isoform expression. Immunocytochemistry of NF-κB p65, pro-inflammatory cytokine secretion (ELISA), MTT assay, LDH assay, immunoblotting of cytosolic cytochrome c and cleaved caspase-3, and expression of 84 microRNAs by Qiagen miRNA PCR array were used to determine the functional effect of MALP-2 on AMC. TLR1-10 was detected in AMC, and protein expression of TLR2, 4 and 6 were confirmed. MALP-2 induced nuclear translocation of p65, reaching significance after 45 minutes (ANOVA, P<0.05). MALP-2 did not cause apoptosis but did lead to significant secretion of IL-4, IL-6 and IL-8 (P<0.05, 0.01, 0.001, respectively) and significant changes in miRNA-320a and miRNA-18a (P<0.05). These results suggest that AMC elicit a pro-inflammatory response following stimulation with the known TLR2/6 ligand MALP-2. This data supports the idea that AMC express the innate immune system receptors that could help with immune surveillance during infection and contribute to inflammatory responses that lead to PPROM.

Biography:

Shalea Piteau is a Consultant Pediatrician at Quinte Health Care in Belleville Ontario and an Assistant Professor at Queen’s University. She went to Queen’s University and graduated with a Bachelor of Science Honors Degree, and then she did a Master of Science in Physiology at the University of British Columbia. She went to Medical School at UBC and then she completed a Residency in Pediatrics at Queen’s University. During her residency, she was awarded the Physicians Services Incorporated Resident Research Award ($2000) and the Best Resident Research in the Department of Pediatrics in 2010.

Abstract:

Background: Cap myopathy is a rare congenital myopathy characterized by cap structures located at the periphery of the muscle fiber. Cap structures consist of disarranged thin filaments with enlarged Z discs. The clinical presentation and natural history of cap myopathy is variable and overlaps with other congenital myopathies.

 Methods: We describe a case of cap myopathy in a 10 year old boy and contrast it with 20 other cases reported in the literature.

Results: Our patient presented at birth with hypotonia and weakness, and subsequently developed respiratory failure in infancy. He is ambulatory but has increasing fatigue requiring a wheelchair by mid-afternoon. His muscle biopsy at 3 months showed a nemaline myopathy and secondary fiber type disproportion with Type 1 hypotrophy and predominance. A repeat muscle biopsy at 6 years showed numerous peripherally located cap-like structures containing nemaline rods and exhibited a spectrum of Z-disk and myofibrillary abnormalities. Molecular genetic testing was performed for NEB, TPM2, TPM3, ACTA1, TNNT1, SEPN1, SMN1, DMPK, FSHMD1A, and mtDNA. A known pathogenic mutation, c.1152+1G>A, and a previously unreported variant, c.1782+4_1782+5delAG, were detected in NEB.

Conclusion: Our patient has a more severe phenotype than the majority of reported cases in the literature and is the first patient with cap myopathy to have a mutation in NEB. Our case supports the identification of cap myopathy as a congenital myopathy with significant overlapping features with nemaline myopathies and further elucidates the phenotype of this disease.

Biography:

Patrick Pladys, MD-PhD, is Head of Pediatrics Department of Rennes University Hospital in France; and is Neonatologist, Expert in signal analysis, neonatal physiology and clinical studies. He is the Leader of the GCS HUGO (Hugoperen) Organization on Health Technology in Pediatrics (HUGOPEREN) in the western part of France. He is also In-charge of the pediatric team of the Research Center for Clinical Investigation of the Rennes University Hospital. He is now In-charge of the Scientific Coordination of the Digi-NewB Project which has received funding from the European Union's Horizon 2020 Research and Innovation Program under Grant Agreement N°689260.

Abstract:

In the EU, more than 200 000 infants are hospitalized each year in a European neonatal care unit during a critical developmental period. During this period, the risk of sepsis is high with a high risk of mortality and many environmental exposures have been shown to impact long-term neurobehavioral outcomes. These observations justify the development new methods to monitor the risk of sepsis, the comfort and the evaluation of cardio-respiratory and sleep/neuro-behavioral development. These methods have to be as non-invasive as possible to preserve the environment of the developing brain. They have also to be useful and usable to make health care more efficient and safer by helping the clinicians and nurses in their decisions. There is an increasing amount of available clinical scores and complex physiologic variables that can be monitored for which the bedside interpretation and integration is not always easy and sometime contributes to the exposition of the nurses to alarm fatigue. A new generation of multi-modal noninvasive monitoring begins to be available based on the creation of composite indices integrating targeted clinical data together with physiological signals (heart rate and respiratory rate variability, movement and sound analysis, oxygen saturation and perfusionindices). These indices have started to be tested in clinical studies with promising results in the fields of late onset sepsis (decrease in late onset sepsis related mortality) with interesting perspectives in evaluation of cardio-respiratory maturation, risk of severe cardiorespiratory events or sleep-wake cycle maturation.

Biography:

Silja T.Griffiths completed her PhD in ‘Functional MRI, structural MRI and school performance in children born extremely preterm’ at the University of Bergen, Norway. She is a paediatrician currently working as a consultant at the paediatric section of neurology, Haukeland University Hospital. As a senior researcher in the Research Group for Paediatric follow-up studies, Bergen, Norway (http://www.uib.no/en/rg/paediatrics) she has been following several cohorts of very preterm and extremely preterm children, and children with prenatal drug exposure.

Eivind Sirnes is a pediatrician. As a PhD-student in the Research Group for Paediatric follow-up studies, Bergen, Norway, he is currently involved in a project investigating possible neurodevelopmetal consequences of prenatal drug exposure.

Abstract:

During the last three decades, treatment and care for babies born extremely preterm has gone through major positive improvements. As a result of this, preterm children without major sequelae now grow up, go to school and face theirworking career. Being born right in the middle of the brain folding process, myelination and nerve cell network development is bound to influence the developing nervous system. Can we see the changes in cerebral ultrasound or magnetic resonance imaging (MRI) examinations? Functional MRI? School performance? Our research group, The Research Group for Paediatric follow-up studies, is following several cohorts, both national and regional, with focus on short- and long-term outcome of exposures related to fetal and neonatal life. In cohorts of children born very preterm and extremely preterm we have looked at motor development, structural MRI and functional MRI, how preterm children cope with pain, how they cope in school, and how their sleep patterns differ compared to term born control children. Prenatal exposure to maternal substance abuse can also be detrimental to the developing fetal brain. Over the past few decades brain imaging studies have helped improve our understanding on how prenatal drug exposure can impact normal brain development, especially by elucidating the teratogenic effects of alcohol. However, possible long term effects of prenatal opioid exposure remains poorly understood. In a hospital based population of school-aged children with prenatal drug exposure we have investigated associations between prenatalopioid exposure and brain changes detectable by structural and functional MRI.

Biography:

Sean Seeho is an Obstetrician and Post-doctoral Fellow at the University of Sydney. He obtained his PhD from the University of Sydney in 2011. He is currently Co-Head of the Discipline of Obstetrics, Gynecology and Neonatology at the University of Sydney and is active in clinical research.

Abstract:

Background: Early-onset preeclampsia is associated with adverse maternal and perinatal outcomes. For women who consider another pregnancy after one complicated by early-onset preeclampsia, the likelihood of recurrence and the subsequent pregnancy outcome for themselves and their babies are pertinent considerations.

Objectives: To determine the subsequent pregnancy rate after a nulliparous pregnancy complicated by early-onset preeclampsia, and among those who have a subsequent pregnancy, the risk of recurrence by gestational week and adverse pregnancy outcomes.

Study Design: Population-based record linkage cohort study was done. The study population included nulliparous women with a singleton pregnancy and early-onset preeclampsia (<34 weeks) giving birth in New South Wales, Australia, 2001 through 2010 (theindex birth), with follow-up for a subsequent birth through 2012. Early-onset in the index birth was further categorised as <28 weeks versus 28-33 weeks. Subsequent pregnancy outcomes assessed included the pregnancy rate, preeclampsia recurrence, and maternal and perinatal morbidity and mortality. The risk of preeclampsia necessitating delivery at each gestational week for women at risk was plotted and the net gain or loss of gestational age when comparing the index with the subsequent pregnancy was calculated.

Results: Among 361,031 nulliparous women with singleton pregnancies, 1473 (0.4%) had early-onset preeclampsia. Women with early-onset preeclampsia in their first pregnancy had a lower subsequent pregnancy rate (59.7%) than women without preeclampsia (67.7%). Of the 758 women with a subsequent singleton birth, 256 (33.8%) developed preeclampsia in the next pregnancy including 57 (7.5%) with recurrent early-onset preeclampsia. Cumulative rates of preeclampsia in the subsequent pregnancy were higher at every gestation from 23 weeks when the index birth was <28 weeks compared with 28-33 weeks. The cumulative rate and gestationspecific risk of recurrent preeclampsia rose most steeply between 32 and 38 weeks. Most women (94.6%) progressed to a later gestational age in their subsequent pregnancy: The median overall increase in gestational age at delivery was 6 weeks (interquartile range 4 to 8), and among women with recurrent preeclampsia the median increase was 5 weeks (interquartile range 2 to 7). Women with index birth <28 weeks compared with 28-33 weeks were more likely to deliver preterm (38.8% versus 28.7%: Relative risk 1.35; 95% confidence interval 1.04-1.75) and have a perinatal death (4.3% versus 1.2%: Relative risk 3.46; 95% confidence interval 1.15-10.39) at the subsequent birth, but liveborn infants had similar rates of severe morbidity (17.1% versus 15.0%: Relative risk 1.14; 95%confidence interval 0.73-1.79).

Conclusion: Women with early-onset preeclampsia in a first pregnancy appear less likely than women without preeclampsia to have a subsequent pregnancy. Maternal and perinatal outcomes in the subsequent pregnancy are generally better than in the first: Most women will not have recurrent preeclampsia and those who do will usually give birth at a greater gestational age compared to their index birth.

Biography:

Shalini Tripathi has completed her MD Pediatrics from King George’s Medical University, India and Senior Residency in Neonatology from the same institute. She is Assistant Professor in Department of Pediatrics, KGMU, working as a Consultant in Neonatal Intensive Care Unit. She has published more than 15 papers in reputed journals and is also serving as Reviewer of the same.

Abstract:

In order to determine the profile, incidence of acute bilirubin encephalopathy (ABE), risk factors of ABE and outcome of neonates with severe hyperbilirubinemia (a serum bilirubin >20 mg% in first 72 h of life or >25 mg% later), a cohort study was done on 64 neonates (>35 weeks gestation). The primary objective was to find outcome (mortality and development of bilirubin encephalopathyboth acute and chronic), secondary objective was to find risk factors for the development of ABE. Neonates were treated withphototherapy and exchange transfusion as required (AAP2004). Neonates were followed at 1, 3 and 6 months for chronic bilirubin encephalopathy (CBE). Out of the 64 neonates enrolled, causes of jaundice were ABO incompatibility in 41.6%, Rh incompatibility in 25%, cephalhematoma in 3.3% and unknown in 26.6%. Of the 64 neonates, 28 (44%) had ABE on admission itself. Four of these left against medical advice. Of 60 neonates left, 5 (8.3%) expired. A total of 17 (89.5%) neonates of ABE group and 25% of all neonates developed CBE on follow-up. A lower weight on admission (2254.68+417 g vs. 2481.75+369 g; p=0.0195), ABO/Rh incompatibility (odds ratio 4.00; 95% CI: 1.13–14, p=0.030), a positive Coomb's test (odds ratio 5.7; 95% CI: 1.53–21.4, p=0.0096), culture-proven sepsis (odds ratio 16; 95% CI: 0.82–312, p=0.067), normal vaginal delivery (odds ratio 5.5; 95% CI: 1.1–27.4, p=0.037) were significant risk factors for development of ABE. Nearly half of the neonates admitted in a tertiary care NICU with severe hyperbilirubinemia had features of ABE on admission. The risk was more if they had had a lower weight on admission, sepsis, blood group incompatibility with positive Coomb's test and born vaginally.

Biography:

Sue Lamburne has completed her Registered General Nurse Training in 1988. In 1990, she obtained her Special and Intensive Care of the Newborn qualification and has since worked within Neonatal Units in England and Bermuda. She has been a Research Nurse to two multicenter randomized controlled trails, DRIFT and TOBY. She is currently Sister/Team Leader in the NICU at Southmead Hospital, Bristol, UK. She has published articles in peer reviewed journals relating to the care of the newborn.

Abstract:

Nasal CPAP and high flow devices have the potential to cause tissue break down if used incorrectly. In an effort to prevent nasal excoriation/scaring and tissue break down, an assessment tool was implemented within the Neonatal Intensive Care Unit at Southmead Hospital, Bristol, UK. On an hourly basis the infants’ nares are scored and the score is documented on the Infants’ intensive care record chart. This unique visual assessment tool is a simple staging system that when used together with the nCPAP and high flow competency serves as a strategy for prevention and treatment to this iatrogenic and cutaneous event. Following an extensive and scrutinized literature search involving Pub Med and CINHAL this assessment tool has been published in peer reviewed journals relating to the care of the neonate. The author is currently assisting other managed neonatal networks in the England in implementing this tool through presentations at conferences and attending individual neonatal units to support senior nurses in implementing this work. The author has recently presented this assessment tool at an international conference in the Philadelphia, USA.

Biography:

Dipali Shah is a Consultant Pediatrician at West Middlesex University Hospital, UK. She is a Pediatric Assessment Unit Lead. Her interest is Under-graduate and Postgraduate education, training and teaching. She is working as a Consultant since November 2013. She has also worked as a Quality Improvement Fellow. She has done four poster presentations.

Abstract:

Background: Legius syndrome is autosomal dominant and caused by mutations in the SPRED1 gene. Clinical manifestations include multiple cafe-au-lait spots, axillary/inguinal freckling and a degree of macrocephaly, without the non-pigmentary signs of neurofibromatosis type 1 (NF1). Learning disabilities, developmental delay and ADHD are known. It is a rare disorder (fewer than200 individuals with a confirmed diagnosis), and difficult to differentiate from NF1 in early childhood. This is important in terms of prognosis and monitoring. We describe a case in a 13 month old boy.

Case: A 13 month old boy was referred by the GP with a one day history of a dilated right pupil on a background of a viral URTI for which parents were giving nasal decongestant spray. His neonatal, developmental and past medical history was unremarkable. His head circumference was on 99.6th centile. The eye signs resolved spontaneously, thought to be due to the nasal spray. On assessment he was noted to have multiple cafe-au-lait spots >5 mm in diameter. Cafe-au-lait spots were also noted on his mother and brother. The rest of his clinical examination was unremarkable. Baseline bloods including metabolic screen as well as MRI brain were normal. His initial neurofibromatosis type 1 analysis was negative. He went on to have further genetic screening which revealed ‘heterozygous for SPRED1 c.229A>T’, confirming a diagnosis of Legius syndrome.

Conclusion: This is a rare disorder and difficult to differentiate from NF1, highlighting the importance of  identifying more affected individuals to better delineate the clinical picture and course.

Biography:

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

Abstract:

Background: Prolonged jaundice (PJ) is a common presentation in pediatric units. The National Institute of Health and Care Excellence (NICE) recommend routine urine culture for infants with prolonged jaundice. However, research suggests that screening for UTI’s is unnecessary due to the low incidence of cases. We aimed to assess the need for urine culture in well infants with prolonged jaundice.

Method: We performed a retrospective study of all PJ screening in our Children’s assessment Unit in a District General Hospital from 2011-15. Nurse-led prolonged jaundice screening (PJS) was introduced in 2011. The screening included history and examination with investigations including urine culture as per the proforma. Urine samples were obtained through clean-catch and UTI was defined as the presence of >5×106/l white cells and growth >106/ml of a single organism in the urine.

Results: A total of 191 infants aged 14 days to 73 days had PJS screening. All these infants were thriving and clinically well. The urine culture in 110 infants out of 191 (57.6%) had normal microscopy and showed no growth. Fifty-five (55) infants (28.8%) had mixed growth but no growth on repeat culture. Twenty-six (26) infants (7.8%) had growth of single organism, most commonly E. coli (10) followed by Enterococcus (5) but only two infants had positive microscopy. Two (2) infants showed positive microscopy and grew E.coli on repeat testing and were treated as UTI (1% of all PJ screen). The remaining 24 infants did not present with any further episodes of UTI during the study period. All of the infants were clinically well and no other pathological causes of PJ were identified.

Conclusion: Our study of 191 infants presenting with PJ shows only 1% had positive urine culture.We recommend that testing for UTI should be reconsidered when screening well infants with prolonged jaundice in the UK.

Biography:

Shivendra Kishore holds Bachelor’s and Master’s degree in Biochemical Engineering from IIT Delhi. He obtained his PhD from University of Erlangen, Germany in noncoding RNAs involved in genetic abnormalities. Post-PhD, he worked in USA, Germany and Switzerland where he further worked on alternative splicing, transcription, RNA binding proteins, small RNAs and cancer-specific recombination hot spots utilizing single gene models and also high-throughput transcriptome-wide analysis. He subsequently forayed into healthcare consulting where he worked in Basel with a focus on Market Access and Pricing. Since 2013, He heads the Department of New Technologies at Centogene that constitutes the core of R&D activities.

Abstract:

Whole exome and whole genome sequencing allows to probe for multiple genetic conditions in a single step, reducing the time and cost to reach a diagnostic decision. These technologies have also entered the critical care units (including neonatal) where time to diagnosis is extremely important not only to guide treatment decisions and treatment efficacy but also to assess utility ofprocedures like surgery or transplantation. While it is not uncommon to use karyotyping, FISH, aCGH and single gene sequencing in these critical units, the emergence of NGS promises to detect both sequence variants with copy number variants within a single test, making the whole procedure significantly more effective in a clinical setting. The majority of the genetic disorders- especially autosomal recessive metabolic diseases or de novo cases- typically appear in the ICU without prior indication. Genetic testing is thus targeting a larger group of patients in the ICU where clinical features of the diseases will be more prominent than before birth or start the first time after delivery. This is particularly of importance, when one is screening for complex neuromuscular disorders or metabolic abnormalities where more than one gene can be involved. CentoICUTM offers a targeted panel based solution for early and fast diagnosis of critically ill newborns and children under 24 months. In thecurrent format, this panel screens for several hundreds of diseases in less than 4-7 days.

Biography:

Andre Ricardo Araujo da Silva has completed his PhD from FIOCRUZ-National Institute of Infectology, Brazil. He is the Coordinator of Scientific Program of Medicine Course-Federal Fluminense University (UFF), Brazil and leads the Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections. He has published more than 15 papers in reputed journals and is a Member of International Federation of Infection Control.

Abstract:

There are many formal guidelines about infection prevention and control (IPC) published by national policy committees,professional societies and expert groups, focusing mainly on hand hygiene and the prevention of device-related healthcareassociated infections (HAIs). Although guidelines as stand-alone are insufficient to prevent healthcare-associated infections (HAI), such documents are useful to inform local implementation of evidence-based measures. Guidelines should incorporate up-to-date evidence from a systematic review including assessing the quality of the identified studies, and recommendations by an expert committee taking into account the levels of evidence and applicability. However, many guidelines suffer from lack of transparency and inconsistent application of strengths of evidence. International infection prevention (IPC) guidelines provide standardized recommendations for healthcare-associated infection (HAI) prevention in adults, but often lack specific information about neonates and children. We reviewed 10 international IPC/HAI guidelines to identify pediatric-specific recommendations for HAI prevention. Hand hygiene, bloodstream infection, ventilator-associated pneumonia, environmental control and outbreak management were frequently reported with recommendations applicable to children and newborns, but documents on catheter-associated urinary tract infection, surgical site infection and antibiotic stewardship were lacking.

Biography:

Prachi Shah is currently working as Associate Professor of Pediatrics in University of Michigan, USA. She has published several papers in reputed journals. Her research interests focus on the development of emotional regulation in infants born in the late preterm period.

Abstract:

Objective: To examine the association of gestational age with poor school readiness in kindergarten reading and math skills. We hypothesized that compared to infants born at 39-41 weeks; infants born at lower gestational ages would have poorer school readiness.

Study Design: Sample included 5250 children from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), assessed with specialized reading and math assessments at kindergarten. Poor school readiness was characterized by reading and math theta scores ≥1.5 SD below the sample mean. The adjusted odds ratios (aOR) and 95% confidence intervals (CI) of poor school readiness were estimated using multivariate logistic regression, examining gestational age continuously and categorically (very preterm (VPT), moderate/late preterm (M/LPT), early term (ET) and term). Pairwise comparisons tested for differences by gestational age categories.

Results: There was an association between gestational age and poor school readiness for reading and math with suggestion of a threshold effect in children born ≥32 weeks gestation. In adjusted models, the odds of poor school readiness in VPT reading and math were aOR=2.58, 95% CI [1.29-5.15] and aOR=3.38, 95% CI [1.66-6.91], respectively. However, for infants born M/LPT and ET, the odds of poor school readiness in reading did not differ from children born full-term.

Conclusions: Compared with term infants, the highest odds of poor school readiness in reading and math were seen in VPT infants, with lower odds of poor school readiness in children born ≥32 weeks gestation. Ongoing developmental surveillance prior to kindergarten is indicated for very preterm infants.

Biography:

Yair Sadaka is a Pediatric Neurologist, Pediatrician with a PhD in Neurosciences and background in Behavioral Sciences, Computers and Electronics. He is currently working as a Pediatric Neurologist and Pediatrician at Soroka Medical Center and Lecturer at Ben Gurion University. He is an Entrepreneur since 2012 and CEO of LinkCaring Ltd. He was involved in several research fields in the past few years, namely: McDonald criteria for diagnosing pediatric multiple sclerosis at the Hospital for Sick Children, Toronto working on the Canadian Multiple Sclerosis Database; evaluating actigraph in children with epilepsy at the Hospital for sick Children Toronto and Avi Sadeh Tel Aviv University; building and analyzing the epilepsy and sleep database at the Hospital For Sick children. He is working on a web system with a vision of a better communication between the patient, the patient's parents and the health care provider at Soroka Medical Center.

Abstract:

Objective: The new diagnostic statistical manual (DSM) requires the presence of fewer symptoms to make a diagnosis of adult ADHD while the criteria for diagnosis in childhood are unchanged as compared to previous editions. This study examines the prevalence of adults meeting the revised DSM-5 symptoms cutoff as compared to the previous DSM-IV symptoms cutoff.

Method: This study is part of a larger nationwide study that evaluated the use of, and the attitudes toward, ADHD medications by university students. 445 students from four major university faculties were surveyed and filled out questionnaires for our study.

Results: The proportion of participants that met the minimum threshold of six out of nine current symptoms in either of the two DSM-IV symptom domains (inattentive presentation and hyperactive/impulsive presentation) for ADHD was 12.7% while the proportion that met the minimum threshold of five symptoms in either of the DSM-5 symptom domains was 21%.

Conclusion: Since the new DSM requires fewer current symptoms for a diagnosis of ADHD, a significant increase (65%) was observed in the number of participants meeting the new cutoff as compared to the old DSM-IV symptoms cutoff. This increase in the number of adults meeting symptoms cutoff may affect the rates of adults diagnosed with ADHD. Using the new criteria may identify more adults with ADHD and fewer diagnoses will be missed. However, meeting the new symptoms cutoff should be considered within the overall clinical context to prevent over-diagnosis.

Biography:

Cristina Alomar Dominguez has completed her Medical studies from Universitat Autonoma de Barcelona. Currently, she is working at the Department of Anesthesiology and Intensive Care at Innsbruck Medical University. In both, clinical and research fields, she managed to cooperate with the departments of Neonatology, Gynecology, Psychiatry and Anesthesiology for this pluridisciplinary project.

Abstract:

During pregnancy, birth and lactation various interactions occur between structural alterations of the maternal brain and placental metabolism. Functional and structural synaptic plasticity and dendritic remodeling occur in different regions of the maternal brain to maintain physiologic conditions and proper fetal and neonatal development during pregnancy. Cerebrospinal fluid concentrations of tau, phospho-tau-181 and amyloid ß42 proteins, as well as brain-derived neurotrophic factors, glial cellline- derived neurotrophic factors and vascular endothelial growth factors were investigated. We evaluated whether biomarkers vary during normal pregnancy and in women with preeclampsia and HELLP syndrome. Biomarkers in the cerebrospinal fluid of 90 pregnant women electively assigned for regional anesthesia during pregnancy or for cesarean section were measured using enzymelinkedimmunosorbent assays. Blood pressure, liver function, clotting activity and kidney function were significantly different in 11 women with preeclampsia and HELLP syndrome. The weight of the newly born, the weight of the placenta and concentrations for phospho-tau-181 correlated significantly with the disease. Phospho-tau-181 protein concentrations correlated with placental function supporting the hypothesis that altered expression of neuronal factors during pregnancy may affect development of the placenta. Levels of amyloid ß42 were significantly increased in 62 healthy pregnant women at term compared to 7 healthy women in the second trimester. Although not significant, the cerebrospinal fluid levels of growth factors, tau and phospho-tau-181increased during pregnancy. This may indicate a physiological adaptive response of the brain function to the growing metabolism of the fetus.

Biography:

M C Jaramillo Mejia is a Full Time Faculty Member from 2007 and Coordinator of MA Health Management from 1998 at the Icesi University. He pursued PhD at Universidad de Granada with major in Clinic Medicine and Public Health. He completed MS at Niversidad de Granada in 2009 with major in Preventive Medicine and Public Health and MA at Instituto de Ciencias de la Salud-CES in 1992 with major in Management of Public Health. He also did MA at Universidad EAFIT in 1990 with major in Hospital Management. He received BS degree at Universidad de Antioquia in 1984 with major in Medicine and Surgery.

Abstract:

Objective: The goal of this study was to inform public health policy which can reduce Colombia’s estimated infant mortality rate (IMR) by lowering preventable first day mortality (PFDM).

Methods: We combined a time series analysis, using a linear regression method, for examining the trends for 2001–2012 in Colombia’s infant mortality rate per 1000, and in the relative significance of PFDM by cause, with a cross-sectional analysis, using odds ratios and bivariate methods for the year 2012 to study first day mortality (FDM) and PFDM classified by biological, socioeconomic and medical correlates. Then, the study established the major causes of PFDM within major risk categories and groups.

Results: Between 2001 and 2012, the average annual rate of FDM declined by 6.30%, while overall infant mortality only declined by 4.20%. Yet, in 2012, 37.04% of FDM was preventable by using proper pregnancy control (7.00% of total preventable), proper care during childbirth (37.20%) and handling causes associated with late diagnosis and treatment (55.80%).PFDM is primarilysocio-economic phenomenon, even among normal weight and gestational age newborns, which account for 32.73% of PFDM due to improper management of pregnancy and delivery among lower socio-economic and outlying populations, specifically in rural areas and the inferior subsidized social insurance regime.

Conclusion: From efficacy and probable cost effectiveness perspectives, intervention priority should be given to handling babies with normal gestation age and birth-weight, and then to babies with very low gestation age and birth-weight. The use of fetal monitoring and echography methods by all general practitioners should be considered.Objective: The goal of this study was to inform public health policy which can reduce Colombia’s estimated infant mortality rate (IMR) by lowering preventable first day mortality (PFDM).

Biography:

Rigler Tohar has completed his MD from UMF Iasi. He is a Resident of Pediatric in Soroka University Medical Center. He is a part of a research group that practices mainly on ADHD.

Abstract:

Background: In recent years, there has been an increase in the use of ADHD medications among students who do not have a diagnosis of ADHD in an effort to improve their academic performance. This includes medications that have been obtained through a legitimate prescription and through other means. How healthcare trainees perceive and use these medications deserves a special focus as their current attitudes and choices may influence their future practice in managing the care of children with ADHD.

Methods: Students were asked about symptoms of ADHD according to the 18 criteria in the DSM 5 and were also surveyed about their attitudes towards the use of methylphenidate (MPH) and their personal use (both with and without prescription). A sample of 312 students was taken from a cohort of pediatric residents, and medical and psychology students. An additional 133 engineeringstudents were sampled for the sake of comparison.

Results: Overall, 22% of all healthcare trainees reported some MPH use. Healthcare trainees were far less likely to carry a formal diagnosis of ADHD than engineering students (9% vs. 23%), although they tended to meet diagnostic criteria to the same level (20% vs. 21%). Healthcare trainees were also more likely to use these medications without a formal ADHD diagnosis (only 37% of health care MPH users had a formal diagnosis vs. 60% among engineering trainees) and they were far more likely to believe that MPH has an effect on people without ADHD (71% vs. 55%).

Conclusions: High rates of health care trainees who do not have a diagnosis of ADHD report using MPH and may not be educated enough about the subject of ADHD. Healthcare trainees should be educated about the importance of appropriate diagnosis of ADHD and the responsible use of methylphenidate.

Biography:

Tatiana Papazian is a Clinical Dietitian and Nutrition Lecturer at the St. Joseph University (USJ), Faculty of Pharmacy since 1997. Her main academic interests are the medical nutrition therapy in pathologies. Currently, in her second year of Doctoral studies at USJ, she is working in the assessment of the nutritional status of pregnant females and the genetic polymorphisms regarding PgP transporters in the placenta, together with the inflammatory markers and its association to the Mediterranean diet and the aflatoxin exposure of both the mother and the child.

Abstract:

Accurate dietary assessment tools are required to ensure that maternal diet supplies all the nutrients needed for fetal development. However, no dietary method could accurately estimate food intake, especially during gestation, where physiological changes affecting nutritional status are frequent. Food Frequency Questionnaires (FFQ) are tools frequently used in epidemiological studies, because they can estimate long term nutritional status of the target population. However, it is recommended to create and validate a FFQ compatible with the dietary habits of the studied population, to avoid cultural and social discrepancies. Hence, this study aimed to develop and test the reproducibility and the validity of a semi-quantitative FFQ compatible with the diet of Mediterranean and Middle-Eastern population, in a sample of Lebanese pregnant women. 128 women participated in the validation study, while 38 took part in the reproducibility phase, which was repeated in a time frame of 21 days. The FFQ was validated against a 24 hr. dietary recall (DR). The intra class correlation coefficient (ICC) ranged from 0.935 for calcium to 0.984 for vitamin D (value<0.001), indicating an excellent reproducibility. Spearman’s and Pearson’s correlations coefficients varied between 0.294 for iron to 0.762 for caloric intake (p value<0.01) implying a satisfactory agreement between the two tools. Bland-Altman plot showed good agreement between these two dietary tools. In conclusion, the newly developed FFQ englobing Mediterranean food items was culture specific and assessed the nutrient intake of our population. Administering this tool in future researches will help us monitor the nutritional status of pregnant women, aiming at implementing more effective strategies for improving maternal and newborn health.

Biography:

Umesh Joshi is Post-graduate specialty resident in Pediatrics Department at the V S General Hospital, Ahmedabad. He received his MBBS from Smt. NHL Municipal Medical College and is currently pursuing MD from V S General Hospital. He completed his schooling from prestigious Sacred Heart Convent School and Delhi Public School, New Delhi. He had attended numerous seminars on autistic spectrum disorders and presented same in national conferences. He was given AAP certified Neonatal Resuscitation Program Certificate in 2015. He had been currently working under renowned Epileptologist Dr. Nitish Vora for 1 year. Apart from medicine, he had special interests in music and tennis.

Abstract:

Introduction: Epilepsy is one of the most urgent problems in pediatric neurology. Asserting the causes and types of seizure is important for diagnostic purposes and for evaluating therapy. Objectives: To identify the clinical & etiological profile of children and the characteristics of seizures in them along with therapeutic responses.

Methods: All patients who attended the epilepsy clinic & fulfilled the selection criteria were enrolled in study. This is a descriptive study of 12 months (June’15–June’16) & involved analysis of records of the patients who came to specialty OPD. Three groups were formed accordingly–focal, generalized & unknown onset with further etiological sub-divisions-Genetic, Structural/Metabolic, Immune, Infectious & Unknown.

Results: In all, 417 patients were studied. The distribution as per clinical presentation was- group I (generalized) 215 (58.5%)–group II (focal) 154 (36.9%), and group III (unknown) 48 (4.6%). The main etiologies were perinatal asphyxia (28.3%), NHBI (11.4%) in (structural–metabolic) sub group. In Genetic & Infectious, Channelopathies (10.5%) & Post Meningitis Sequelae (4.7%). 56.3% of the patient in group II were on more than 3 AEDs. 14.3% in group I were weaned of AEDs. 61.4% patients in group II were having neuro-developmental sequelae. EEG revealed abnormal activity in 30 (6.2%) in group I & 31 (19.3%) in group II. Maximum patient with refractory epilepsy were seen in group III.

Conclusion: To have a good management of epilepsy, we need to have multi-dimensional classification of epilepsy based on both clinical & etiological spectrum. Perinatal asphyxia & NHBI are one of the most common yet avertible etiologies.

Biography:

Fasih Zareen is a Consultant, a Pediatrician and Neonatologist at Gulf Medical College Ajman, UAE from 2014 till date. She is Consultant Neonatologist and Pediatrician at Al–Zahra Hospital, Sharjah, UAE. She is Chairperson and Professor of Pediatrics at United Medical and Dental College, Karachi, Pakistan from 2013. Also, she is Head of Department, Professor of Pediatrics and Neonatologist at Ziauddin Medical University Hospital since 1999 till date. She is a Gold Medalist and topped Karachi University, holding First Class First position in final year in MBBS, Examination and won President's Award, Pakistan. She has published 7 papers.

Abstract:

Objective: To study risk factors for Enterobacter sepsis and sensitivity pattern of the organism.

Method: Prospective hospital based study was conducted at tertiary neonatal intensive care unit of Ziauddin University Hospital from January 2011 to December 2014. Blood specimens for culture from 2166 babies were sent. Repeat cultures were done when the neonate did not show improvement or deteriorated on first line antibiotics. Risk factors were looked for. Antibiotic resistance of the isolate was studied by the disk diffusion technique.

Results: There were 540 (24.93%) cases of culture proven sepsis. Enterobacter was grown in 84 (15.55%) cases. Among the gram negative organism Enterobacter was the commonest organism n=84 (15.5%) followed by pseudomonas n=54 (10%). Among the gram positive organism, Staphylococcus lugdunensis was seen in 150 (27.77%) cases followed by Staphylococcus aureus n=54 (10%). Increased incidence of late onset sepsis (4.6/1000 live births) was observed during this period. Univariate analysis of risk factorsrevealed a significant association between LBW 54 (P value 0.001),prematurity 78 (P value 0.001) and prolong stay 66 (P value 0.001) and Enterobacter sepsis. Resistance to the first line antibiotics (Cefotaxime sodium, Aminoglycoside) was seen in 72% of cases.

Conclusion: Prolonged stay in the nursery due to prematurity/LBW is important risk factor of Enterobacter sepsis. Prolonged use of antibiotics results in emergence of multidrug resistance. Further studies are needed to establish the role of antibiotics in the emergence of multidrug resistant microorganism.

Biography:

Tuna Sahin has completed her Medicine from Erciyes University, Faculty of Medicine. She has completed her Post-doctoral studies from Cukurova University, Faculty of Medicine. She is presently working in Adana Numune Training and Research Hospital, as an MD, and Specialist in Anesthesiology and Reanimation at Clinic in Adana, Turkey.

Abstract:

Objective: Preoperative anxiety can be associated with poor postoperative clinical outcomes. We aimed to assess whether preoperative maternal anxiety level of obstetric patients scheduled for elective cesarean surgery has an effect on clinical outcome of the newborn.

Methods: Sixty (60) pregnant women with ASA physical status 1-2 scheduled for elective cesarean surgery were enrolled. All patients received spinal anesthesia with hyperbaric bupivacaine 12.5 mg. We performed a State-Trait Anxiety Inventory questionnaire to evaluate preoperative maternal anxiety. We used the Apgar scoring system to assess the physical condition of the newborn. Hemodynamic measurements (heart rate, systolic and diastolic blood pressure) were recorded at baseline, skin incision, childbirth, and 10, 15 and 30 minutes after skin incision.

Results: Average preoperative maternal state anxiety score was 41.1±4.6 and trait anxiety score was 50.9±5.7. Average Apgar scores of newborns were 7.6±0.8 and 9.2 ±0.6, at first minute and fifth minute, respectively. We found no significant relationship between the anxiety scores and Apgar scores at first and fifth minute.

Conclusions: We concluded that there was no relationship between preoperative maternal anxiety scores and Apgar scores at the first and fifth minute.

Biography:

Maja Tomicic is serving as the Head of Department for Platelet and Leukocyte Diagnostics and Hemostaseology, and Education Department at Croatian Institute of Transfusion Medicine (CITM) from 1992. She is Scientific Assistant at University of Zagreb Medical School from 2012. As a Head of Department her responsibilities include development and introduction of methods for platelet and leukocyte immunogenetic and haemostasis testing for outpatients, blood products quality control hemostasis testing, and investigation of transfusion associated acute lung injury, post transfusion purpura, fetal and neonatal alloimmune thrombocytopenia and neutropenia. Her MS thesis was on the topic “Frequency and Significance of Anti-Platelet Antibodies in Pregnant Women and Hematology Patients” and PhD thesis on the topic “Serological,Molecular and Clinic Characteristics of Alloimmune Neonatal Neutropenia”. She has published 27 papers; 18/24 cities in CC, 59 congress abstracts, 22/59 in CC Journals, and 37/59 in “Index Medicus” Journals.

Abstract:

Background: Alloimmune neonatal neutropenia (ANN) is the result of maternal alloimmunization during pregnancy to fetal neutrophil antigens inherited from the father. In most cases, ANN develops consequently to alloimmunization to the specific human neutrophil antigens HNA-1a and HNA-1b, less frequently HNA-2a, and to the neutrophil Fc gamma receptor IIIB (CD16). The clinical course of the disease is self-limiting, with a mean duration of 7 weeks. Generally, only mild bacterial infections are recorded, however, lethal outcome may occur in the severe forms of the disease associated with sepsis. The treatment usually includes antibiotics, intravenous (IV) gamma globulins, and recombinant human granulocyte colony-stimulating factor (hr G-CSF); however,with variable success.

Aim: The aim of this study was to analyze laboratory and clinical data of 36 newborns undergoing serologic testing for alloimmune neonatal neutropenia (ANN) during the 1998-2015 period in Croatian Institute of Transfusion Medicine (CITM).

Results: The average absolute neutrophil count in newborn blood at birth was 750/mm3 (min.115 and max.1470) and duration of neutropenia 6.5 weeks. Eleven (11) of 25 neonates did not receive any treatment and there were no signs of bacterial infection. Other were treated with antibiotics only and antibiotics and intravenous gamma globulins or granulocyte growth factor. Seven (7) of 25 newborns had mild bacterial infection (omphalitis) and 6 had severe respiratory infection and threatening sepsis. All of them reached full recovery. There was no fatal disease.

Conclusion: ANN is a rare but potentially life-threatening disorder. Serologic testing for ANN in case of isolated neutropenia in the newborn contributed considerably to timely detection of ANN.

Biography:

Pasqua (Mary) Betta is a Neonatologist, Anesthesiologist 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.

Abstract:

The retinopathy of prematurity (ROP) is an ischemic-vascular disease that affects preterm infants. Several studies show that the incidence of the disease is closely related to low gestational age (GE) and low birth weight (BW). The influence of being twins in the occurrence of ROP is not entirely clear yet. To date, the studies carried out so far on this matter have not showed unanimous
results. The aim of our study was to show the role of being twins in the development of ROP and to evaluate whether assisted reproductive techniques can be an additional risk factor for the disease development. So we performed a retrospective study upon 253 preterm infants (131 males and 122 females) born between January 2011 and March 2015, whose GE was between 24 and 34weeks of gestation (31.2; +/-2.4) and BW was between 450 and 2960 g (1619.2 +/-512.2). Of the 253 studied infants, 123 were twins (48.6%), including 23 babies born from triplet pregnancies (18.6%), and 59 (47.9%) were born after artificial insemination. Of the 253 infants, 83 (32.8%) developed ROP; 54 of them (65%) were twins. In particular, 38 infants (45.8%) developed stage I ROP (50% in twins, 31% in single children), 24 (28.9%) stage II ROP (27.7% in twins, 31% in single children) and 22 (26.5%) stage III ROP (22.2% in twins, 34% in single children). 32 patients (38.5%) have also developed signs of PLUS (35.9% in twins, 44% in single children). Of the 83 infants affected by ROP, 46 (55.4%) were treated with laser therapy; among them, 24 (52.17%) were twins. The 253 infants were divided into two groups: Group 1 (twins) and Group 2 (single children). The twins were also divided into 2 groups: Group A (twins born after artificial insemination techniques), Group B (the remaining ones). The populations were compared by performing the χ2statistical test. Our results have showed a significantly higher chance of developing ROP in Group 1 than in Group 2 (p=0.000256) but they have not showed a significant difference in the severity of the disease (p>0.05). Furthermore, we didn’t find any statistically significant difference by comparing Groups A and B (p>0.05). In conclusion, our data show that being twins is significantly related to the development of ROP. On the other hand, artificial insemination techniques do not seem to be an additional risk factor for ROP development.

Biography:

Abstract:

Neonatal convulsions (NC) are the most distinctive sign of disturbance of the central nervous system with incidence 2-3/1000 in term and 10-15/1000 in preterm infants. NC may cause irreversible changes to the immature brain and progress to epilepsy.The outcome is, to a large extent, dependent on the cause of the convulsions, while some other clinical and electrophysiologicalparameters are also predictive. Our study of 61 newborns with NC, born between 1989 -1995 found epilepsy in 18%. The group of causes with perinatal hypoxia was significantly associated with subsequent epilepsy. Predictive factors for outcome were neurological examination, the number of days with seizures and EEG findings. Considering the high incidence of neurological sequelae after NC our retrospective study of 176 newborns, born between 1999-2009, aimed to construct risk score for postnatal epilepsy. The incidence of epilepsy in this group was 18.1%; moderately to severely abnormal EEG background activity and aetiology were predictive for epilepsy. The duration of seizures had a different effect on the development of epilepsy with respect to the gestational age, which turned out to determine the association between the two predictors. Our results support the evidence that recurrent and prolonged NC may act on an epileptogenic substrate, causing further damage, which is responsible for the subsequent clinical expression of epilepsy. We conclude that the construction of a simple scoring system, based on independent predictors, as a universal useful tool for prognosis of epilepsy after NC is not reasonable due to connection and interaction between variables.

Biography:

Antonia Hargadon Lowe has completed her primary medical qualification, BMBS, at Nottingham University in 2006 and then became a Member of the Royal College of Pediatrics and Child Health in 2011 after completing membership exams (MRCPCH). She has just completed a Master’s at Imperial College London in Pediatrics and Child Health, and is currently a PICU Trainee at Evelina Children’s Hospital, London.

Abstract:

Accepted best practice for neonatal intubations now involves the use of medications beforehand (pre-medications); for both patient comfort and to increase chances of success. Time taken to prepare these medications is a barrier to their use. We implemented quality improvement strategies to reduce this time, and re-audited (following previous audits between 2009 and 2015). We instigated prescribing of pre-medications on admission to NICU, which was disseminated by consultants and reinforced regularly in order to change habit. Every nurse was questioned on what they felt caused delays. Unfortunately, staffing restraints prevented planned ‘Intubation’ simulations. Advanced emails, posters and regular reminders following intubations increased awareness. Data was collected from 1/5/15-1/8/15. Criteria measured were: %of patients with medications pre-prescribed; %of eligible patients receiving pre-medications; %of cases with drugs prepared in under 16 minutes (considered best practice). 19 intubations were recorded (6/19;emergencies). 79% of patients had medications pre-prescribed, 100% (vs. 95% last time) received pre-medications, and 53% (vs. 27%) took under 16 minutes, with a mean time of 19.4 (vs. 36) minutes. Nurses felt that the primary issue was lack of drug-checkers and suggested doctors being available for this. Increased awareness could have impacted on the demonstrable improvement, however the pre-prescribing will likely have contributed significantly; this was a successful quality improvement intervention. Therefore, we recommend the continued practice of prescribing on admission, along with doctors being drug-checkers if available. Future planning for new drug charts with specific pre-printed designated boxes is underway. With a full rota, real-time multi-disciplinary intubation simulations should occur repeatedly to have the widest impact.

Biography:

Alvarado Socarras Jorge Luis is a Neonatologist Pediatrician. He is Director of the unit Neonatal of the Fundacion Cardiovascular de Colombia. He is also a University Professor at Universidad Industrial de Santander and Universidad de Santander.

Abstract:

Aim: To evaluate hospital mortality of infants transported to a tertiary hospital based on clinical factors and type of transport.

Methods: Observational study of seriously ill neonates transported via air or ground, which required medical care at a center providing highly complex services, was done. A 6 month observational study was conducted to obtain clinical variables for intrahospital mortality among patients requiring inter-facility transport. Data on sociodemographic, clinical, the transport risk index of physiologic stability (TRIPS) and mode of transport were collected.

Results: A total of 176 neonates were transported by ambulance (10.22% by air) over 6 months. Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple models. Increased mortality was associated with the transport risk index of physiologic stability (TRIPS).

Conclusions: Weight<1500 g, renal failure, congenital defects (except congenital cardiopathies) and high TRIPS were associated with a higher risk of intra-hospital mortality. Mode of transport was not associated with the outcome.

Biography:

Ni Hong has completed his PhD from Zhejiang University and Post-doctoral studies from Peking University School of Medicine. He is the Director of Neurology Laboratory of Children's Hospital Affiliated to Soochow University and Deputy Director of the Institute for Pediatric Research, Soochow University.

Abstract:

Because leptin was affecting expression of brain energy metabolism-related genes and because zinc/lipid metabolism signals and its associated autophagy stress were also found to be involved in energy depletion, we hypothesized that leptin might exert its neuroprotective action via zinc/lipid and autophagic metabolism signaling. Here, we tested this hypothesis by examining the long-term expression of zinc transporter ZnT1 and ZIP7, lipid membrane injury-related cPLA2, its downstream autophagy marker Beclin-1, LC3, bcl2 and Cathepsin-E, as well as its execution molecule CaMK II following neonatal seizures and chronic leptin treatment. On postnatal day 6 (P6), 40 Sprague-Dawley rats were randomly assigned to two groups: Flurothyl-induced recurrent seizures group and control group. On P13, they were further randomly divided into the seizure group without leptin (RS), seizure plus leptin (RS+Leptin, 2 mg/kg/day, consecutive 10 days), the control group without leptin (Control), and the control plus leptin (Leptin, 2 mg/kg/day, consecutive 10 days). Neurological behavioral parameters of brain damage (negative geotaxis reaction reflex, plane righting reflex, cliff avoidance reflex, forelimb suspension reflex and open field test) were observed from P23 to P30. Morris water maze test was performed during P27-P32. Then hippocampal mossy fiber sprouting and the protein levels were detected by Timm staining and Western blot analysis, respectively. Flurothyl-induced RS rats show a long-term lower amount of CaMK II alpha, and higher amount of ZnT1, ZIP7, cPLA2, Beclin-1/bcl2, LC3II/LC3I and Cathepsin-E which are in parallel with hippocampal mossy fiber sprouting and neurobehavioral and cognitive deficits. Furthermore, chronic leptin treatment (RS+Leptin) is effective in restoring these molecular, neuropathological and cognitive changes. The results imply that a zinc/lipid metabolism-associated membrane peroxidation and autophagy pathway is involved in the aberrant hippocampal mossy fiber sprouting and neurobehavioral deficits following neonatal seizures, which might be a potential target of leptin for the treatment of neonatal seizure-induced brain damage.

Biography:

Mahdi Mashaiekhi has completed MD at Isfahan University, Pediatrics in 2009 at Tehran University of Medical Sciences and Neonatology in 2016 at Iran University of Medical Sciences. He has published 5 papers in medical journals.

Abstract:

Introduction: The diagnosis of acute kidney injury is based on calculating glomerular filtration rate rely on serum creatinine, however this method seems to be unreliable due to potential effects of underlying confounding parameters. Thus, recent efforts have been focused on new diagnostic specific markers with high sensitivity and accuracy for early prediction of acute kidney injury. Recentresults identified NGAL as a widespread and sensitive response to established AKI in humans. However, the role of this marker to early predict acute kidney injury in children remains uncertain. The present study aimed to assess and compare the level of urinary NGAL in neonates with acute kidney injury and those without kidney injury admitted to neonatal intensive care unit.

Methods: This cross-sectional study was performed on 75 consecutive neonates who were hospitalized because of acute kidney injury. Among neonates admitted to hospital due to causes unrelated to kidney disease (with normal serum creatinine level) were randomly selected as the control (n=81). In both groups and on admission, the urine levels of creatinine and NGAL were measured. The level of creatinine was assessed by enzymatic method and the level of NGAL was measured using ELISA method. The level of urine creatinine was measured at two time points.

Results: The mean level of NGAL was 825.81±175.08 ng/ml in case group and 292.20±322.03 ng/ml in control group with a significant difference. NGAL had a sensitivity of 100%, s specificity of 55.6%, a positive predictive value of 67.6%, a negative predictive value of 100%, and an accuracy of 76.9% to predict acute kidney injury. Assessing the area under the ROC curve showed that the measurement of NGAL could effectively discriminate acute kidney injury from normal condition (AUC=0.899). The best cutoff value for NGAL to predict acute kidney disease among neonates was estimated to be 427 ng/ml yielding a sensitivity of 100% and a specificity of 67.9%. The Pearson’s correlation test showed a strong linear association between the level of NGAL and the changed level of creatinine (r=0.395, p<0.001).

Conclusion: The measurement of NGAL has a high sensitivity and proper specificity compared to creatinine level in predicting acute kidney injury among neonates.

Biography:

Pawel Galecki has completed his PhD at the age of 25 years from Medical University of Warsaw. He is working at Neuonatal Unit of Plonsk Hospital. He also cooperate with Neonatal Pathology Unit of second degree referenced hospital in Ciechanow, Poland. He usually deals with issues in the field of care of infant from physiological pregnancy and childbirth. As the the result of the cooperation with the Clinic of Pathology and Intensive Care of the Newborn of Medical University of Warsaw was exsistance of work on ultrasound in neonatal care of physiological infant.

Abstract:

Ultrasonography of newborns born long before term and newborns with extremely low birth weight or other significant pathology has become a gold standard on the neonatal pathology units and NICU. It is rather simple method, non-invasive; they aren't bringing the increased risk for the newborns, and are providing much information about the condition of the patient, the course ofdisease, the effectiveness of the treatment and further predictions. However, only 10-15 % of children are born below 35-th week of pregnancy and, is being hospitalized on the II and III degree of neonatal care units. It will leave the majority of children left without ultrasound diagnostics, because of very few centers of first degree of neonatal care is conducting that kind of diagnostics apart from very rigorous recommendations, acknowledging that these children are "from the assumption" healthy. Perhaps such an assumption isn't fully correct and many children from so-called physiology of pregnancy are burdened with certain diseases, which could be to recognize and possibly healed, if all children were examined. In this paper, we have studied ultrasound examinations of the central nervous system and the abdominal cavity carried out at children born after 35th week of pregnancy at the Neonatal Unit of theHospital in Plonsk (first level of neonatal care) in the time period from 01.01.2014 to 02.12.2014. However, examinations didn't have screening character but readings for carrying them out were significantly widened, what had allowed providing with examinations with much larger group of children than average. A 49.1% of children were examined and in 14.63% cases abnormalities of different degree were stated through the ultrasound scan. Counted each abnormality individually changes within CNS slightly predominated over changes in the abdominal cavity (53.8%/45.2%). The majority of changes were requiring only a clinic control (63.89 %); however,serious changes requiring specialist diagnostics and treatment amounted to 36.11%.

Biography:

Biniam Ayele has completed his graduation from University of Gondar as a Medical Doctor in 2012. Currently, he is working as a Physician and Lecturer at Felegehiwot Referral Hospital and Bahir Dar University respectively. He is also a year 3 surgical resident at Bahir Dar University

Abstract:

Intussusception refers to telescoping of one portion of proximal gut to another distal part with further motion of the intussusception into the intussuscipiens by ongoing peristalsis; the commonest being ileocolic in about 85 to 90%. Rarely caecocaceo-colic, jejunojejunal or even ileo-ileo-colic occurs in a double or three-fold manner. Colo-colic is found more often in parasitic diseases. As far as aetiology is concerned, a mobile ascending colon, malrotation or non-rotation facilitates intussusception. Here, the author presents a case report of double intussusception in 20 days old male neonate after he presented with abdominal distension and vomiting of ingested matter of three days, the neonate has also intermittent crying since birth especially after breastfeeding. For this, the neonate was admitted and diagnosis is made by abdominal ultrasound and for that the neonate was prepared and explored. The intraoperative finding was, the baby was having gangrenous ileocolocolic intussusception with transverse colon perforation and about 5 cm of distalileum, the lumen was extremely narrow when compared with the proximal one with the leading point. And the cecum and ascending colon was mobile. For this the author had done end to end ileoascending anastomosis with end to end colocolic anastomosis of the transverse colon was done and biopsy sent for histopathology. The patient followed in the neonatal ICU for a week and discharged improved. So that, details of double intussusception and details of the intraoperative finding will be discussed.

Biography:

Lakshmi D Katikaneni has been a Neonatologist and NICU Graduate follow up Clinic Director for the past 30+ years and has a number of national and international presentations and publications related to nutrition, body composition and body fat measurements of preterm infants, brain and neuroinflammation markers, fetal drug exposure and hair analysis for cocain metabolites, retinopathy of prematurity and Avastin therapy, and sleep apnea issues in preterm infants. She is a Member of Pediatric Research Society, American Academy of Pediatrics, Brighton collaboration for vaccination issues as well as harmonized safety monitoring of immunization in pregnancyorganized through GAIA project.

Abstract:

Introduction: Chorioamnionitis is associated with white matter injury (WMI) in animal models. MRI diffusion metrics (MRIDM) may serve as early biomarkers of neonatal WMI in chorioamnionitis. Additionally, MR spectroscopy (MRS), used to quantify metabolites in specific neural regions, has been shown to be predictive of long-term developmental testing.

Objective: The purpose of the study was to determine the utility of MRS and MRI-DM markers arising from different brain regions as indicators of global brain injury in term newborns exposed to chorioamnionitis and confirmed funisitis.

Design/Methods: MRI-DM was performed on 25 term infants at 39-42 weeks GA at time of MR imaging with confirmed funisitis at birth. The ROI in OR (optic radiation) was quantitatively assessed for fractional anisotropy (FA) and mean diffusivity (MD) using MRICRON software. MRS metabolites were quantified at TE 30 & 270 in the basal ganglia (BG) and frontal white matter. Sixteen (16) infants had useable MRI-DM and MRS, which were correlated with a Pearson test.

Results: Left OR FA was found to be negatively correlated with lactate/NAA (R=-0.65, p=0.0066) and Lactate/Creatine (R=-0.64, p=0.008) in the basal ganglia.

Conclusions: Lactate/NAA has previously demonstrated better diagnostic accuracy than conventional MRI as in neonates with high lactate/NAA values predicting lower motor scores. The correlation of this ratio to the optic radiations, which undergo myelination shortly after birth, present two clinically applicable biomarkers for global WMI while, also, allowing insight into how chorioamnionitis affects and acts to delay development. Thus, early brain injury is detected by brain scans and early intervention is possible in those with abnormal brain biomarkers as noted in the current study.

Biography:

Jacquelyn R Evans attended Dalhousie University School of Medicine and completed her Pediatric Residency at the University of Cincinnati and the University of Minnesota. Her Neonatology Fellowship was completed at the IWK Hospital for Children and the Grace Maternity Hospital, Halifax, Canada. She is the Associate Division Chief of Neonatology at The Children’s Hospital of Philadelphia and a Clinical Professor of Pediatrics at The Perelman School of Medicine, University of Pennsylvania. She is the Director of Patient Safety and Quality in Neonatology at CHOP and the CHOP Newborn Care Network. She is the Chair of the US News and World Report Best Children’s Hospitals Survey Neonatal Advisory Group and is the Chair of the Children’s Hospitals Neonatal Consortium.

Abstract:

Excellent, longitudinal, worldwide benchmarking data have previously been available for infants cared for primarily in NICUs with delivery services. These databases primarily focus on preterm infants and their relatively small number of common associated morbidities, many of which can be used as outcome measures. Infant patient population that requires quaternary NICU care oftendiffers substantially from those previously well characterized. Launched in 2010, and with 32 participating sites in Canada and the US, The Children’s Hospitals Neonatal Database (CHND) was developed to allow quality benchmarking for infants with uncommon neonatal disease. In the CHND, the majority of patients are born >37 weeks’ gestation; there is a high prevalence of rare to uncommon diagnoses and surgical care is remarkably frequent. In addition, the population of preterm infants in the CHND differs from mostsystematically studied preterm populations because the timing of referral of preterm infants to these quaternary NICUs is usually well after birth, and frequently after a significant proportion has acquired severe prematurity-associated morbidities, which indeed are often existing at the time of or even the very reason for referral. Thus, these traditional outcome measures are inappropriate for benchmarking the care and outcomes in large regional NICUs and perhaps serve more appropriately as to highlight the severity of illness in the very preterm infants who were referred. However, the rarity of the diagnoses managed as well as the historical absence of a large, multicenter collaboration has precluded both the development of appropriate benchmarks for expected outcomes, as well as disease- or intervention-specific quality improvement efforts. Likely due to this lack of systematic multicenter data collection around these uncommon diseases, few standards of care for these infants have existed and data on the inter-center variation in care, resourceutilization and outcomes in the CHND sites have been striking. This presentation will highlight the findings of 6 years of quaternary NICU benchmarking in North America and the opportunities to improve care for infants with uncommon neonatal disease by collaborative efforts across many sites.