20th International Conference on Neonatology and Perinatology December 04-06, 2017 Madrid, Spain

Catherine is currently a Clinical Nurse Educator in the Neonatal Intensive Care Unit at St Michael’s Hospital.

The Family Support Program (FSP) at St. Michael’s Hospital (SMH) utilizes trained volunteers to cuddle hospitalized infants in the absence of parental or guardian presence in the Neonatal Intensive Care Unit (NICU). The program aims to provide universally recognized physiological benefits of cuddling to infants, as well as to alleviate stress for families associated with hospitalization and illness through companionship and the fostering of a welcoming environment. Opioid exposure during pregnancy can result in neonatal withdrawal after birth, also known as Neonatal Abstinence Syndrome (NAS). As an inner city hospital with a diverse patient population, specific focus was given to creating a program at SMH that would meet the needs of marginalized families, including those struggling with substance use and addiction. The FSP was initially launched to optimally address the needs of infants experiencing NAS; however, many families encounter barriers to spending time with their hospitalized infants. Barriers could include, but are not limited to: single parent families or those with limited social support; continued employment after birth; parents with multiples; no or limited access to childcare for siblings; transportation; parental illness; need for parental self-care; and child protection involvement (restricting access or mandating outside program participation). Recognizing the benefits of a cuddling program for all infants and their families the FSP was extended as a standard of care for all infants admitted to the NICU. While volunteer cuddling programs are gaining momentum in NICUs in Canada; the FSP is unique in that the need for support for the whole family, and not just the hospitalized infant, is recognized as an integral program component. The creation, development and ongoing coordination of this program is led by social work and nursing and highlights how innovative programs can improve the quality of care provided to clients and their families. The impact of the Family Support Program on infants with NAS is currently being examined in a mixed-methods research project entitled The Infant Cuddler Study, with the aim to provide evidence that can lead to practice. The poster presentation will highlight how social work and nursing can take the lead in the development and coordination of a family support program in a Neonatal Intensive Care Unit. Summary: The Family Support Program utilizes trained volunteers to cuddle hospitalized infants in the NICU. This social work/nursing led program aims to provide universally recognized benefits of cuddling, as well as to alleviate stress for families associated with hospitalization and illness.

Dr. Laxmi S Hadalagi, after completing MBBS in the year 2002 at my hometown, she perceived paediatrics as she was very much interested in this field and completed my postgraduation in reputed medical college of Karnataka i.e Bapuji and Chigateri Government Hospital, Davangere, Karnataka. Seeing many neonates suffering from birth asphyxia, she always questioned herself, Is there no treatment available to prevent damage of these growing brains???This zeal took her towards doing Fellowship in Neonatal and Perinatal Medicine and started working at a Tertiary Care Unit catering to peripheries, started Therapeutic Hypothermia with Cerebral Function Monitoring and Erythropoietin to reduce neuronal damage. This has given them satisfactory results interms of mortality and neurodevelopmental outcome. She had been to Georgetown University Hospital, Washington DC,2015, as GIANI Scholar Awardee(By AAP and NNF), appreciating her research work and community level works. She is now working as Unit Incharge, examiner for Fellowshipexam for Doctors and Nurses in Neonatology, also Board of Advisor for Public-Private Partnership(VIJINAP 2016) to upgrade our government hospitals to meeting health demands of our society. Conduct regular workshops/CME for doctors and nurses to keep them updated.

Introduction: Pageon et al coined the term ‘CHARGE’ an acronym to 5 major features. Restricted criteria of Pageon and Blake et al, dichotomously divided, made diagnosis of this entity rare, giving rise to ‘possibly’ CHARGE or ‘Near’ CHARGE like terms. Major Signs of CHARGE Syndrome are (3C): Coloboma(iris/choroid, with or without microphthalmia, Atresia of choanae, Hypoplastic semi-circular Canals. The Minor Signs of CHARGE Syndrome are, Rhombencephalic dysfunction(brainstem dysfunctions, cranial nerve VIIto XII palsies and neurosensory deafness), Hypothalamo-hypophyseal dysfunction(including GH and gonadotrophin deficiencies), Abnormal middle or external ear, Malformation of mediastinal organs(heart,esophagus) and Mental retardation. Case Discussion: Term, AGA, Male baby, 4th order birth to Non-consanguinously married couple, delivered by normal vaginal route, through meconium stained amniotic fluid, birth weight being 3.2 kgs. Mild respiratory distress since birth required supplemental oxygen and referred to us on D4. On admission, baby had significant respiratory distress, Downe’s score being 6/10, taken on conventional mechanical ventilation for 48 hours, weaned to hood. Dysmorphic features observed were bilateral nanophthalmos, high and narrow arched palate, Lt.choanal atresia. Chest Xray showed fluffy opacities in bilateral lungs, Echo screening showed 2 ASDs, 1 VSD, USG abdomen revealed Rt Renal agenesis, MRI Brain being normal, OAE b/l ear-Refer. Ophthalmologist opined very guarded prognosis of vision. Discussion: CHARGE is characterized by very specific developmental anomalies of optic vesicle, otic capsule, midline CNS structures and upper pharynx. Updated definition of CHARGE reinforces very specific embryological defects avoiding inclusion of nonspecific or secondary anomalies and dismiss sex-dependent criteria. 3 Major criteriae refer to 3 non-overlapping embryonic territories, 5 Minor criteriae to topographically distinct areas. Hence 3 major criteria fulfilled in our case study, defines the syndrome. Definition of Typical, Atypical and Partial CHARGE Syndrome Typical CHARGE • 3 major signs • 2/3 major sings + 2/5 minor signs Partial/Incomplete CHARGE • 2/3 major + 1/5 minor Atypical CHARGE • 2/3 major + 0/5 minor • 1/3 major + 3/5 minor Conclusions: CHARGE syndrome is basically a midline structural defect. Updated diagnostic Criteriae for CHARGE make many unlabelled entities given the diagnosis.

V Vitkova graduated from Faculty of Medicine Charles University, Prague in 2012 and started her PhD studies in 2016 at Charles University, Department of Pathological Physiology. Currently, she works as a Pediatrician/Neonatologist in Department of Neonatology, Thomayer Hospital, Prague, Czech Republic

Introduction & Aim: Inflammatory response influences mortality and morbidity. Processes leading to a systemic inflammation are associated with endothelial injury. Endothelial cells release microvesicles and several other biomarkers which can be used as diagnostic tools for detection and treatment of inflammatory response. There is limited information regarding endothelial dysfunction in newborns. Aim of our study was to explore microvesicles in critically ill newborns. Methods: Microvesicles were measured in newborns on extracorporeal membrane oxygenation (ECMO) and compared to samples of healthy term newborns. The total microvesicle count and number of surface antigen-specific microvesicles was determined by flow cytometry (BD FACS CantoII). The plasma concentration of cell-derived microvesicles (MV) was measured using annexin V labeling of the microvesicles and the endothelial origin of microvesicles were determined using lineage specific antigen labelling of endothelial cell/microvesicle markers (CD105, CD31, CD309, MadCAM). Results: 13 newborns on extracorporeal membrane oxygenation (ECMO group) and 13 healthy term newborns (Term group) were included. There were no significant differences in gestational age, birthweight and gender between groups. The concentration of markers shows Table1. Conclusion: Soluble markers of inflammation and concentration of microvesicles were significantly increased in ECMO group. We did not detect significant differences in the concentration of endothelial specific microvesicles between the groups, with the exception of mucosal endothelium marker MadCAM. The understanding of endothelial cell response during inflammation may help to find biomarkers of early detection of neonatal diseases.

Jamie Grech completed undergraduate medical education at the University of Malta in 2016, before completing a Postgraduate Certificate in Child Welfare and Wellbeing from Oxford Brookes University. He is currently reading for a Master of Science degree in Neonatal Medicine at Cardiff University while undergoing Foundation Programme training at Mater Dei Hospital, Malta.

Cow’s Milk Protein Allergy (CMPA) represents the majority of food allergies in children, especially in early childhood, with an incidence of up to 3% in the first year of life. Indeed, 90% of patients develop CMPA before they reach three months of age and often within a week of introducing cow’s milk protein into their diet. Classical presentation may involve variable gastrointestinal symptomatology, inclusively regurgitation, vomiting, diarrhoea or constipation, among other non-gastrointestinal signs and symptoms. We report an unusual presentation of CMPA in a previously healthy eight day old formula fed baby girl, who was admitted due to multiple episodes of vomiting followed by a single instance of bile-stained vomiting associated with maroon-coloured blood stained stools on the first day of admission. Physical examination was non-remarkable. Initial diagnostic investigation included a water-contrast upper gastrointestinal tract study with follow-through and delayed films, to exclude mid-gut malrotation as sinister surgical pathology. Elimination of ominous pathologies from the differential diagnosis and cessation of symptoms with interruption of formula feeds led to a working diagnosis of CMPA. Reintroduction of hypo-allergic formula feeds elicited no relapse of symptoms, and the patient improved dramatically, further supporting this diagnosis. High index of suspicion is mandatory in management of such challenging cases.