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

Biography:

Jeffrey Karsdon completed his medical education at the Free University of Brussels, Belgium. After completing his pediatric residency in New York and his neonatology fellowship in San Francisco he worked at the University of Leiden, the Netherlands for 7 years before returning back to the united states. He is a clinical neonatologist and scientist with a passion for preventing preterm birth. His innovative approach to inhibiting the uterine contractions of a preterm birth with an electrical pacemaker is a paradigm shift in preventing preterm birth. It allows for a very localized and rapid inhibitory effect with no systemic side-effects. He is pioneering the way to an electroceutical tocolytic and into a new era of interventional uterine electrophysiology. His unique method of inhibiting smooth muscle contractions and tone paves the way for treating other pathologies caused by increased smooth muscle tone

Abstract:

Background: Uterine smooth muscle electrical activity precedes and controls the preterm uterine mechanical contractions. This is monitored with electromyogram (EMG), electrohysterogram (EHG) and tocodynamometry (TOCO). EHG is a more objective measure of contraction force than the TOCO.

Objective: EI of preterm uterine EMG and subsequent inhibition of mechanical activity (frequency and force) . Study Design: Women in preterm labor at 24-34 weeks gestation had standard monitoring of TOCO and fetal heart rate (FHR) with simultaneous external monitoring (OBMedical, Gainsville, FL) of EHG and fetal electrocardiogram (fECG). An electrical pacemaker gave EI to an electrode catheter placed into the vaginal posterior fornix next to the cervix. EI was a bipolar constant current square wave pulse: 0-10mA, 0-28ms/pulse, 0-30Hz. There were 3 groups of EI: 20, 40 or 80 minutes. EI was a 10-second burst only during a monitored contraction. Each group had 20 minutes of pre-EI sham control (C1) and post-EI sham control (C2). Outcome measures were TOCO and EHG contraction frequency or peak-to- peak (P-P) interval and EMG power spectral density (PSD). Differences in the estimated means of P-P and PSD for the C1, EI, and C2 periods used a mixed-model analysis of variance and a paired t-test with a 0.05 two-sided significance level.

Results: Electrical PSD and mechanical TOCO and EHG P- P all decreased during EI compared to C1 and C2. FHR and fECG were unchanged. Also, EI decreased uterine resting tone.

Conclusions: This is the first EI study of human preterm uterine electrical and mechanical activity i.e. contraction frequency and force. EI is an electroceutical tocolytic with no systemic side- effects on mother or baby. The EI mechanism is unknown, but may produce membrane hyperpolarization. EI decreased preterm uterine resting tone that may increase placental blood flow. EI may decrease the resting tone of other smooth muscles in certain neonatal pathologies e.g. persistent pulmonary hypertension of the newborn.

Biography:

Ann Quinlan-Colwell has completed her PhD at The University of North Carolina at Greensboro.  She works as a Clinical Nurse Specialist and Chair of the Nurse Research Committee at New Hanover Regional Medical Center which is a regional trauma center in Wilmington, NC, USA. She has published in and reviews for  reputed peer review journals, has published book chapters and a book on pain management. She is current president of the Nu Omega chapter of Sigma Theta Tau International; president-elect of the Southern Pain Society and serves on the board of the American Society for Pain Management Nurses.

Abstract:

The Pasero Opioid-Induced Sedation Scale (POSS) is a valid, reliable tool used to assess sedation when administering opioid medications to manage pain. POSS is endorsed by The Joint Commission and the American Society for Pain Management Nursing to help prevent adverse opioid-related respiratory events. Although POSS is used to assess sedation in pediatric patients at some hospitals, it was not formally evaluated in the pediatric population. This study used a quasi-experimental design with a convenience sample of pediatric patients admitted to a large regional medical center. POSS was evaluated from three perspectives. First the study was designed to compare documentation of sedation when opioids were administered before (n = 25) and after (n = 27) implementation of POSS to assess sedation. Second, occurrence of respiratory adverse events before and after implementation was compared. Third, appropriateness of using  POSS in pediatric population was evaluated. When POSS was used, there was an increase in both clarity and frequency of documentation when sedation was assessed. There was no incidence of opioid-related adverse respiratory events after implementation of POSS. Finally, POSS was found to be appropriate and safe to use in pediatric population. Through survey, the majority of registered nurses who cared for the research subjects evaluated POSS as easy, appropriate and safe to use with pediatric patients. The nurses also noted using POSS provided standardized communication among staff regarding patients’ levels of sedation. No adverse effects, concerns, or objections were reported. Coincidentally, frequency of documentation of assessment of pain also improved with POSS.

Biography:

Lily Wang completed her medical degree at the age of 22 from University of New South Wales, Sydney, Australia and has a Masters in Public Health from University of Sydney, Australia. She is a neuroradiologist at University of Cincinnati Medical Center and director of medical student radiology education at College of Medicine, University of Cincinnati

Abstract:

Congenital anomalies of the spinal cord can pose a diagnostic dilemma to the radiologist, neonatologist and neurosurgeons. Several classification systems of these anomalies exist. Antenatal ultrasound and fetal magnetic resonance imaging is playing an increasingly important role in the early diagnosis and management of patients. Understanding the underlying anatomy as well as embryology of these disorders is vital in diagnosing the type of spinal cord dysraphic defect. Common and uncommon malformations will be discussed, with focus on differentiating these entities using MRI

Biography:

Anne-Catherine ROLLAND is the chair of child psychiatrist at the University of Reims and the head of the child psychiatry ward at the University Hospital of Reims since 2012. After her medical studies in Reims Medical School, with a specialization in psychiatry and child psychiatry, she has completed her PhD from Paris VII Descartes University in 2010. She did a research year at Melbourne University next to Jeannette Migrom and Anne Buist in 2007-2008. She is specialized in mother infant interactions, and works preferentially on all the mothers’ feelings around the pregnancy and the maternity.

Abstract:

Introduction. – Postnatal depression (PND) affects 10 to 15 % of the women who gave birth. The “postnatal depression group” is a group therapy set up in the parents-infant unit of the child psychiatry department of the university hospital of Reims city in France. The purpose of this communication is to present how the women who suffered from postnatal depression feel about this group therapy in order to improve its quality and broaden its use.

Method. – It is a qualitative study based on a semi-directed interview with a survey. The study sample is a population of 9 mothers who participated in the PND group in the last six years.

Results. – All the mothers we interviewed were very satisfied with the PND group and considered their experience as “very positive”. They felt that the group therapy helped free them of their guilt, to resocialize and to improve their self-image (renarcissization). The results show that talking with their husbands improved the couple’s relationship, which is an important part of the process. Group therapy enabled patients to speak about their feelings in a space where they feel safe and supported.

Conclusion. – We are aware that this study is based on a limited number of women and that some interviews were conducted several years after their participation in the PND group, but the results are so encouraging that we think this method should be broadened.

Keywords: Postnatal depression; Postpartum; Group therapy; Perinatology; Qualitative Study

Biography:

Tieyuan Zhang has completed his PhD from Yonsei University, South Korea, in 2001. He did Post-doctoral studies from McGill University, Canada (2002). He is
an Assistant Professor in the Department of Psychiatry, McGill University, Canada. He has published papers in reputed journals including Jneurosci and PNAS.

Abstract:

The quality of parent-child interactions in humans predicts multiple mental health outcomes. We have little understanding of the neurobiological responses to the demands of reproduction in females. We found that high licking/grooming (LG) lactating rats had increased levels of phosphorylated CREB (pCREB) in the medial preoptic area (MPOA) and they displayed a reduced population of greater dendritic complexity index (DCI) neurons compared to Low LG mothers. High LG mothers show increased Rem2 and BDNF in the MPOA. There were no differences in Rem2 and BDNF expression in virgin high and Low LG female rats. CREB overexpression in the MPOA of lactating rats increased maternal LG. CREB overexpression in MPOA neuronal cultures associated with a decrease in dendritic complexity. We suggest that CREB activity in the MPOA associates with maternal behavior and changes in dendritic complexity in the MPOA possibly mediated by CREB induced regulation of Rem2 and BDNF. These results provide a novel neuroendocrine basis for individual differences in maternal behavior.

Biography:

Caroline Fraser is a Paediatric Trainee in the West Yorkshire region of England. She is an ST3 and hopes to pursue a career in Neonatal Medicine. She graduated
from the University of Bristol in 2012 and has been working in West Yorkshire since.

Abstract:

A term, DCDA infant had an unexpected cardiovascular collapse on day 3 of life on the postnatal ward. The pregnancy had been uneventful and the parents were non-consanguineous. There had been 11% weight loss noted on the day of the collapse, she was breast fed. After resuscitation she was admitted to the neonatal unit (NNU) and found to be in ventricular tachycardia (VT). Her electrolytes were deranged with a glucose of 0.8 an ionised calcium of 0.45 and a potassium of 7.23. She was treated with IV calcium gluconate, IV dextrose and sodium bicarbonate, and she converted back to sinus rhythm. The VT returned so magnesium sulphate was given, which terminated the VT. VT in neonates is uncommon and mostly seen in patients with congenital heart disease, and cardiac channelopathies. A metabolic screen taken at the time of the collapse revealed raised octanoylcarnitines and a diagnosis of MCADD was made. There are few case reports of babies with MCADD presenting with arrhythmias. They are a recognized feature of longer change fatty acid disorders and there is evidence demonstrating cardiac myocyte ion channel dysfunction in these conditions. This case adds to the small number of patients with MCASS who present with VT. It serves as a reminder to consider metabolic diseases in the setting of multiple electrolyte abnormalities and arrhythmia. It also highlights the importance of correcting any metabolite disturbance in patients with arrhythmias before considering anti-arrythmic agents, as they can be pro-arrythmogenic and may worsen the situation.

Biography:

Cristina Rossi was born in 1974 and got her medical degree in 1998 and Residency in Obs/Gyn in 2003. She is both author and reviewer of peer-reviewed journals. She is mainly interested in prenatal diagnosis and twin pregnancy. She is actually consultant in Obs/Gyn at Ospedale della Murgia (Bari, Italy).

Abstract:

Objective: The objective of this study was to review literature about the correlation between fetal autopsy and ultrasound findings of fetal malformations.
Methods: Search in PubMed, Medline, EMBASE, Clinicl trials.org, reference list was performed. Inclusion criteria for studies selection were: fetal autopsy performed after termination of pregnancy (TOP) or stillbirth, TOP for fetal anomalies, prenatal diagnosis of malformations, data reported as proportional rates, case reports, non-English language and data reported in graphs or percentage. From each article: sample size, type of malformation, indication for TOP, autopsy findings was collected. Fetal anomalies were grouped in central nervous system (CNS), genitourinary (GU), congenital heart defects (CHD),
gastrointestinal (GI), thorax, limbs, skeleton, genetics (TOP for abnormal karyotype) and multiples (TOP for multiple severe malformations for which a single indication for TOP/stillbirth could not be identified). Correspondence between autopsy and ultrasound was defined as agreement (same diagnosis), additional (additional findings undetected by ultrasound) and unconfirmed (false positive and false negative ultrasound). PRISMA guidelines were followed.
Results: From 19 articles, 3534 fetuses underwent autopsy, which confirmed prenatal ultrasound in 2401 (68.0%) fetuses, provided additional information in 794 (22.5%) fetuses, and unconfirmed prenatal ultrasound in 329 (9.2%) fetuses. The latter group consisted of 3.2% false positive and 2.8% false negative cases. The additional findings changed the final diagnosis in 3.8%
of cases. The most frequent indication for TOP/stillbirth was CNS anomalies (36.3%), whereas thorax anomalies represented the less frequent indication (1.7%). The highest agreement between autopsy and prenatal ultrasound was observed in CNS (79.4%) and genetics (79.2%), followed by GU anomalies (76.6%), skeleton (76.6%), CHD (75.5%), thorax (69.7%); GI (62.6%),
multiple (37.0%), limbs (23.3%).
Conclusion: In spite of the high agreement between prenatal ultrasound and autopsy, fetal examination is mandatory because in a minority of cases it discloses additional findings or changes the final diagnosis and genetic counseling.

Biography:

Dr. Hadalgi has 10 years of experience in Pediatrics, with 5 years of experience in Advanced Neonatology. She is NICU Incharge, Tertiary Care Centre.  She is Faculty for DNB Postgraduation, Fellowship in Neonatal and Perinatal Medicine for Doctors/Nurses, NRP Instructor. She is Board member for public-private  partnership in Vijayapur District(VIJINAP-2016). GIANI Scholar Awardee by AAP(2016)

Abstract:

INTRODUCTION:

Surgical emergencies in neonates are usually congenital malformations. Their smaller size, immature organ system and differing volume capacities, pose challenge during perioperative period.

AIMS AND OBJECTIVES

1. To study the  incidence and etiology of acute abdomen in neonates.
2. To Study the outcome of  above newborns.

MATERIALS AND METHODES

This is a 1 year prospective observational study.  Patient’s profile, symptoms,  etiology of acute abdomen, surgical intervention and their outcomes were analyzed.

RESULTS:

Total admissions to NICU were 1206. A total of 27 neonates(2.2%) were admitted with acute abdomen. 5 babies had underlying medical condition -3 had Septic ileus, 1 had meconium ileus, 1 had portal vein thrombosis . Out of all surgical cases(22),  majority were males 17(77%). 10 babies (45%)were born at term, 12 were preterms of gestational age 30-37wks. 6 babies were >2500 gms, 4 babies were LBW, 2 babies were VLBW.  9 babies(40%) presented with in 1^st  week of life majority diagnosed to have ARM and intestinal obstruction. Mean age of  NEC presenting as acute abdomen was 2^nd  week. Malrotation and colonic perforation presenting as intestinal obstruction were encountered in  3^rd week. Most common clinical presentation was abdominal distension with bilious vomiting. 22 babies  required surgical correction. 7(32%) were diagnosed with Anorectal malformations, 2(9%) had hirschsprung disease, 6(27%) had stage III necrotizing enterocolitis ,5(23%) diagnosed with malrotation ,1(4.5%) for Gastroschisis and 1(4.5%) with Ruptured omphalocoele. 7 postop cases died, mortality being  32%,  mainly attributed to infection, multiple atretic gut.

DISCUSSION

Most common surgical conditions in the newborn involve gastrointestinal tract.  Most of our patients were male(77%). 40% of cases presented in first week of life, as ARM or intestinal obstruction, second most common cause being intestinal atresia. This pattern of etiology agrees with Deshmukh SN et al. Corrective surgeries done in most of our cases.  Overall mortality rate in our study was 32%,  nearing other studies. Highest mortality observed due to  NEC, septicaemia, multiple atretic gut. No mortality observed in Hirschsprungs disease,ARM.

CONCLUSION

Early presentation observed  in Anorectal malformations, intestinal atresias, meconium ileus.Hirschsprung and Malrotation presented later. Hence sick newborns borns with congenital malformations are salvageable if given proper NICU care,specialist surgeon and anaesthetist and ideal postoperative care.

Biography:

Maja Tomicic is the Head of Department for platelet and leukocyte diagnostics and haemostaseology, and Education Department, specialist of transfusion medicine, from 1992. Scientific assistant, University of Zagreb Medical School from 2012.
CITM is National Blood Transfusion Center that collects and test donor’s blood, produces blood products and performs pretransfusion testing patients and pregnant women.
As a head of Department, I have responsibilities for development and introduction of methods for platelet and leukocyte immunogenetic and hemostasis testing for outpatients, blood products quality control hemostasis testing, and investigation of transfusion associated acute lung injury(TRALI), post transfusion purpura (PTP), fetal and neonatal alloimmune thrombocytopenia (FNATP) and neutropenia (ANN).

Abstract:

Background:

Alloimmune fetal and neonatal thrombocytopenia (FNATP) is the result of maternal alloimmunization during pregnancy to fetal platelet antigens (HPA) inherited from the father.

In most cases develops consequently to alloimmunization to the specific platelet antigens (HPA)-1a and-5b, less frequently HPA-3a and -15a/b. FNATP has an incidence of 1:1000 to 1:2000 births in white populations. It is self-limiting and transient disorder with an excellent prognosis in absence of intracerebral bleeding (ICH). Current guidelines recommended transfusion of HPA compatibile platelets to prevent ICH.

Aim:

The aim of this study was to established an algorithm of laboratory testing for FNATP and to analyze laboratory and clinical data on platelet transfusions in anti-HPA-1a cases.

Methods:

 An algorithm of laboratory testing for FNATP included serologic screening of maternal and neonatal sera/plasma and platelets by immunofluorescence (IF) method; direct and indirect test. The monoclonal antibody immobilization of platelet antigens (MAIPA) and PAK 12-KIT (Lifecodes/Immucor, USA) were employed to determine anti-HPA antibody specificity. Results of serologic anti-HPA testing were confirmed by maternal and neonatal/paternal HPA-1, -2, -3, -5 and -15 genotyping by PCR-SSP method.

Results:

Serology screening for FNATP yielded positive results in of 56 of investigated cases. Anti-HPA antibodies were detected in 34 of 56 (61%) cases of serologically positive NATP, i.e. 19 anti-HPA-1a, 11 anti-HPA-5b, 1 antiHPA-1b, 1 antiHPA-3a, 1 antiHPA-5a and 1 anti-HPA-15a. In 6 of 56 (11%) pan-reactive (anti GP IIb-IIIa) autoantibodies in mothers with ITP were detected. In another 16 of 56 (28%) cases, anti-HPA specificity could not be demonstrated.

The average lowest platelet count in newborn blood was 60x 10⁹/L (min.11 and max.104) and duration of thrombocytopenia 1,5 weeks (min. 0,5 and max. 3). 14 of 16 (87%) neonates did not receive any treatment and there were no signs of hemorrhage. One newborn received platelet transfusions, intravenous gamma globulins and corticoids, and another tree transfusions and intravenous gamma globulins. All of them reached full recovery. There was no fatal disease.

Conclusion:

FNATP is rare but potentially life-threatening disorder. Serologic testing for FNATP in case of isolated thrombocytopenia in the newborn contributed considerably to timely detection of this disease. Platelet transfusions are needed in severe cases of FNATP to prevent ICH

In the absence of HPA compatibile platelets random donor transfusion is an acceptable approach in urgent situations.

Biography:

Abstract:

Introduction: Persistent ductus arteriosus (PDA) constitutes 5-20% of all inborn heart defects. In preterms born with body weight <1000g is present even in 80%.

Fast diagnosis and treatment of hemodynamically significant PDA (hsPDA) allows avoiding many complications. In pharmacological treatment of hsPDA conventionally inhibitors of cyclooxygenase (COX) are used but they may cause many side effects. That is why alternative methods are investigated. One of them is the use of paracetamol.

Aim of the study: The aim of our study was the assessment of effectiveness of paracetamol treatment of hsPDA in preterm neonates.

Material and methods: The study was performed in 10 preterm neonates, with hsPDA confirmed by echocardiography. 2 neonates were exclude from the study. In diagnosis we considered the width of arterial duct and clinical status of the patient. Paracetamol treatment was started after the cardiological confirmation of hsPDA, intravenously in dose of 15 mg/kg every 6 hours during 5 days +/- 2 days. In none of the patients included in our study side effects were observed.

Results: The effectiveness of the treatment was verified by controlled echocardiography. Effective treatment with paracetamol was observed in 62% studied neonates. In two of the remaining neonates treatment with ibuprofen was initiated but the therapy failed. In one contraindications of COX inhibitors treatment were present. Eventually surgical ligation was performed in 3 of them.

Conclusions: Paracetamol can be considered as an effective alternative method of treatment of hsPDA to ibuprofen.

Biography:

Dr. Sood has completed Pediatrics Residency training and fellowship training in Neonatal-Perinatal Medicine at Children’s Hospital of Michigan and Wayne State University. She also completed a Masters Masters course in Clinical Research Design and Biostatistics at the University of Michigan. She has been appointed as Assistant and later Associate and then Full Professor on the Research Educator track at Wayne State University and the affiliated Detroit Medical Center since 2001. She has published over 50 papers in reputed journals. In 2014, she recieved federal funding to conduct clinical trials to evaluate delivery of aersolized surfactant in preterm infants

Abstract:

Purpose: Respiratory distress syndrome (RDS) is the leading cause of mortality and morbidity in preterm infants (PTI). Intratracheal instillation, the only approved means of surfactant delivery, requires endotracheal intubation and mechanical ventilation with their attendant risks. Widespread use of non-invasive ventilation (NIV) for initial respiratory support of PTI not only averts the need for intubation and MV but also delays surfactant instillation. We hypothesized that treatment of RDS with aerosolized surfactant (AS) in PTI undergoing NIV is safe and feasible.   

Methods: We initiated a Phase I study of AS in PTI<37 weeks GA with RDS undergoing NIV. Sequentially enrolled infants received increasing doses and dilutions of surfactant using a MiniHeart jet nebulizer. Infants were monitored during AS and for 72 hours after AS. 

Results: Of 17 patients enrolled, two extremely PTI exited the study for worsening respiratory distress. Fifteen infants completed study intervention; two were weaned to room air after the 1^st dose of AS and 13 received 2 doses. The mean age (SD) at receipt of 1^st and 2^nd dose of AS was 7.2 (5.7) and 11.8 (6.4) hours respectively. Infants tolerated the aerosol treatment well. No significant adverse events were identified. Of 15 infants that completed the study, one required medical treatment for a patent ductus arteriosus; one received vasopressors, two were treated medically for necrotizing enterocolitis (NEC) and one was intubated at 19 days of age following a diagnosis of NEC. Majority of the 17 enrolled infants were discharged to home (n=15) without respiratory support (n=14) at a mean corrected GA of 35^5/7 weeks. Conclusion: We have demonstrated the feasibility of administering AS to PTI; AS was well tolerated by infants. A Phase II clinical trial of aerosolized survanta duirng NIV in PTI comparing two doses and two nebulizer devices is currently ongoing.

Biography:

Tieyuan Zhang  has completed his PhD from Yonsei University, South Korea,  in 2001. He did postdoctoral studies from McGill University, Canada from 2002. He is an assistant professor in the Department of Psychiatry, McGill University, Canada. He has published  papers in reputed journals including JNeurosci, PNAS

Abstract:

The quality of parent-child interactions in humans predicts multiple mental health outcomes. We have little understanding of the neurobiological responses to the demands of reproduction in females.  We found that high licking/grooming (LG) lactating rats had increased levels of phosphorylated CREB (pCREB) in the medial preoptic area (MPOA) and they displayed a reduced population of greater dendritic complexity index (DCI) neurons compared to Low LG mothers. High LG mothers show increased Rem2 and BDNF in the MPOA. There were no differences in Rem2 and BDNF expression in virgin high and Low LG female rats. CREB overexpression in the MPOA of lactating rats increased maternal LG. CREB overexpression in MPOA neuronal cultures associated with a decrease in dendritic complexity. We suggest that CREB activity in the MPOA associates with maternal behavior and changes in dendritic complexity in the MPOA possibly mediated by CREB induced regulation of Rem2 and BDNF. These results provide a novel neuroendocrine basis for individual differences in maternal behavior

Biography:

Abstract:

Early onset sepsis (EOS) is a significant cause of morbidity and mortality in neonates, typically presenting within the first 72hours of birth. The management of infants at risk of EOS varies between units. The introduction of the UK NICE guideline: Antibiotics for prevention and treatment of early onset neonatal infection in 2012 aimed to provide clarity and consistency in the management of such infants. Since publication by NICE the impact of this guideline has prompted debate with several units reporting negative consequences including increased length of stay and number of laboratory investigations performed. We implemented the NICE EOS guideline in two tertiary perinatal centres in Glasgow in 2014 and 2015 after undertaking a robust education programme for all staff members who would be involved in utilizing the guideline. The new guideline came with significant changes in practice. We also introduced a neonatal early warning score chart (NEWS booklet) to be used simultaneously. Following implementation, serial interval audits were undertaken to assess impact on patient care and guideline adherence. In contrast to other published reports we have observed a positive impact on patient care with a reduction in length of stay and no increase in laboratory investigations performed. Furthermore no baby became unwell
following the changes in practice.

Biography:

Xin Ding，MD. PhD, ever as an visiting scholar at Boston Children’s Hospital of Harvard University. Her director is Xing Feng, the secretary-general and permanent member of committee of Pediatrics Branch of Chinese Medical Association. She has published nearly ten papers in reputed journals on circadian rhythm disturbance.    

Abstract:

Circadian rhythm disorder is a common neurological deficit caused by neonatal hypoxic-ischemic brain damage (HIBD). However, little is known about its underlying mechanisms. Our previous studies revealed a significant elevation of clock genes at the protein, but not mRNA, levels in the pineal gland after neonatal HIBD. To investigate the mechanisms of post-transcriptional regulation on clock genes, we screened changes of miRNA levels in the pineal gland after neonatal HIBD using high-throughput arrays. Within the miRNAs whose expression was significantly down-regulated, we identified one miRNA (miR182) that targeted the 3’-untranslated region (3’-UTR) of CLOCK, a key component of clock genes, and played a crucial role in regulating CLOCK expression after oxygen–glucose deprivation in primarily cultured pinealocytes. Our findings therefore provide new insight on studies of therapeutic targets for circadian rhythm disturbance after neonatal HIBD.

Biography:

Abstract:

A global reduction in cerebral blood flow in infants and neonates results in reduced oxygen and glucose supply to the brain which induces brain damage. This results in hypoxic-ischemic encephalopathy in the affected infants. The cerebral manifestations of HIE depend on the period during which ischemic insult occurs, the duration and severity of ischemia. Therefore in preterm infants the peri ventricular white matter ,which happens to be the vascular water shed zone in the developing fetus and is the region of high metabolic demand due to ongoing myelination, is extremely susceptible to ischemic injury.

When ischemia occurs in the term infants on the other hand, cortical and sub cortical injury is more common with lesser degree of hypoxia; while severe hypoxias involves the deep gray matter of thalamus and basal ganglia.

MR imaging is the best modality available today to evaluate infants and neonates of suspected cerebral ischemic injury. Conventional MRI sequences have an established role in detecting both acute and chronic changes of cerebral ischemia. Of late, diffusion MR has shown high sensitivity in detecting acute ischemic changes in the brain parenchyma.

MR imaging diagnoses the extent of damage in the brain, the site of involvement, differentiates between acute and chronic changes in the brain, thereby assisting in prognosticating the clinical course in patients of Hypoxic ischemic encephalopathy. I shall be discussing the spectrum of changes of hypoxic ischemia in pediatric neonatal population on MR imaging.

Biography:

Abstract:

Statement of the problem: (292 words)

The importance of Early Intervention programs' effectiveness acknowledged worldwide. Based on its effectiveness Neonatal Early Intervention (EI) Physical Therapy (PT) Program was established one year ago, in King Abdullah Specialized Children's Hospital in Riyadh. The program starts by screening, evaluating and treating Neonates during admission and continued after hospitalization discharge following in the Early Intervention Clinic in Outpatient Physical Therapy Department.

The purpose of the study:

To determine the effectiveness of implementing the EI Program starting from Neonatal Intensive Care Unit (NICU) admission until 12-18 months, Post Conceptual age, on the Sensory-Motor performance after hospitalization discharge, until following the Early Intervention Clinic in Outpatient PT Department in one year duration.

Methodology and theoretical orientation:

Retrospectively all Medical charts were reviewed for all patients and data were collected and statistically analyzed by SPSS, for all patients included in the EI - PT Program ranging from birth until 12-18 months of age. Therefore, patients not included in the EI - PT program since NICU admission will be excluded from the study.  Many factors, Information and Investigations were considered such as; Diagnosis, Respiratory support modalities, Gestational Age, Post Conceptual age, Radiology outcomes, Postural Alignment, Length of Stay in hospital and the developmental milestone level. Objective measures used are; Osteopathic approach assessment and evaluation, General Movements (GM), Alberta Infant Motor Scale (AIMS). The treatment approaches utilized are; NE-O Osteopathic approach, Bobath concept, family education.

Findings:

The results of Neonatal Early Intervention Physical Therapy Program outcomes will be finalized in 4 months' time. 

Conclusion and significance:

Some considerations as the co-relations between all factors and the collected data besides, the efficacy of Physical Therapy at the early age of intervention.

Biography:

Dr. Olaya-C is pediatric pathologist and PhD from Pontificia Universidad Javeriana. She is the director of Pathology Department and associated professor at the same University and its Hospital Universitario San Ignacio. She has published more than 25 papers and has worked for fetuses’ health for 20 yerars.

Abstract:

Introduction: Preeclampsia is an important syndrome associated with gestation that causes mortality and morbidity not only for fetuses but also for mothers. The rest of the Hypertensive Disorders of Pregnancy (HDP) (including chronic hypertension -from any cause-,chronic hypertension with superimposed preeclamp sia, and gestational hypertension) also cause an important impact. Likewise, umbilical cord complications have been recognized as potentially dangerous for the fetus and the newborn, in aspects such its length, diameter, insertion, entanglements, knots and coiled, increasing the risk of obstetric complications and fetal or newborn poor outcomes. Recently, a relation between umbilical cord abnormalities and preeclampsia has been found in the literature. Preeclampsia has been associated with abnormalities in the umbilical cord, in several ways: morphological, biochemical and functional. Alteration in blood vessels of the placenta, decidua and circulatory system of the fetus might be related to factors that cause preeclampsia and with alterations of the umbilical cord.

Objectives: This study aimed to analyze the relation between each type of umbilical cord abnormality and the different subtypes of HDP.

Methods: We conducted a prospective study on consecutive autopsies and its placentas, looking for abnormalities in the umbilical cord’s features and their clinical associations. Results: Umbilical cord abnormalities (length, diameter, insertion, entanglements, knots and coiled) were interestingly associated with maternal HDP.

Conclusion: Umbilical cord abnormalities might affect the prognosis of the fetuses and the newborn of mothers who suffer preeclampsia.

Biography:

Terence Lao graduated MBBS from the University of Hong Kong, and obstained his MD in 2002. He received training in Obstetric Medicine at the Queen Charlotte’s Maternity Hospital, London, UK in 1983-4, and completed the fellowship programme in Maternal-Fetal Medicine at the University of Toronto in 1989-93. He is professor at the Department of Obstetrcs & Gynaecology, The Chinese University of Hong Kong. He has published 300+ papers in international journals and is a reviewer for 24 journals, and serves on the editorial board of three international journals. His major interest is in maternal medicine and high risk pregnancy.

Abstract:

Thalassemia is the commonest monogenetic disease. Homozygous thalassemia manifests as severe anemia. The manifestation of the heterozygous form can vary from totally asymptomatic and being identified only on antenatal screening, to severe anemia even requiring blood transfusion. It is increasingly encountered outside the Mediterranean region, Africa, Middle East, and South East Asia, due to immigration. Pregnancy, previously uncommon in homozygous ß-thalassemia, is encountered increasingly due to improved management and assisted reproduction technology, but preconceptional problems that include anemia, iron overload, cardiac dysfunction, thromboembolism, alloimmunization, infections, and endocrine and bone disorders, could impact on maternal and obstetric outcome. Successful pregnancy in thalassemia trait carriers and women with hemoglobin H disease is more common, and the pregnancy outcome is usually similar to normal women, although there is still increased risk of obstetric and perinatal complications in case of severe anemia or iron overload. Prenatal diagnosis to exclude fetal homozygous thalassemia and other congenital anomalies, together with close monitoring of the pregnancy, would optimize pregnancy outcome. Further research is warranted to elucidate the fetal safety of iron chelation therapy, and potential impact of pregnancy on long-term maternal health outcome, especially following occurrence of maternal complications.

Biography:

Dr Ananya Das have completed MD Pediatrics from Medical College ,Kolkata. Now she is  doing senior residency in All India Institute Of Medical Sciences(AIIMS) in the Dept of Pediatrics. I have done thesis work on newborn hearing screening.

Abstract:

Background: Hearing impairment is one of the most common abnormalities in newborn. It is often detected late and associated with delayed language, learning, and speech development. New born hearing screening is essential to detect impairment early for improved outcome.

Aims and objective:

Comparison of prevalence of hearing impairment in high risk new-born and normal new-born.

Evaluation of different risk factors for hearing impairment.

Materials and methods:

Study design: Prospective longitudinal case control study

Study place: Medical College, Kolkata

Study period: Nine months

Sample size: Total 764 babies (545-normal newborn/219-high risk newborn) were screened. High risk group was allocation was performed using the Newborn Hearing Screening Programme (NHSP) Risk Factor Screening guidelines.

Methodology: 1st TEOAE was done on all the babies at the time of discharge. The result of the test was interpreted as “Pass” or “Refer.” Babies having ‘Refer’ response were sent for 2nd TEOAE screening 4 weeks later. Babies having a ‘Refer’ response in the second stage were sent for the third stage BERA screening immediately. Absence of wave V in BERA was taken as confirmation of hearing impairment.

Results:

Prevalence of hearing impairment in the normal newborn [0.56%] was significantly less than the high risk group[1.86%] with p value-0.049. Significant risk factors identified were - meningitis (p value 0.001), congenital infection (p value<0.001), mechanical ventilation >5 days(p value<0.001), serum bilirubin>20 mg/dl (p value<0.001).

Conclusion:

Hearing screening should be done in all new-born babies. UNHS (universal newborn hearing screening) protocol using OAE and BERA can be implemented in Indian setting.

Biography:

Dr.Damera Yadaih  Working as a consultant paediatrician at DH, Nalgonda since 23 years.

Working in SNCU from 2008 as CIVIL SURGEON ,HOD.

Instrumental in establish 1^st SNCU in INDIA ,1^ST level2 unit to get accreditation by NNF.

Working to strengthening the FBNC in India to reduce NMR.

Discharged 8000 babies till date, smallest baby discharged 650 gms, 28 wk GA,1^ST of its kind from dist.hospital

Abstract:

AIM : To evaluate the safety, feasibility and efficacy of KANGAROO MOTHER CARE  in VLBW babies.

 Background:Inorder to reduce NMR. Govt of INDIA with the help of UNICEF is strengthening FBNC through setting up SNCU in all districts. The KMC ward at Nalgonda established on our own by overcoming barriers in terms of space, infrastructure, human resources & training.Ours is the first pilot study done on KMC  at any district hospital in India.

Methods: All  VLBW <1.5kg. Were put on KMC & analysed  for the following parameters  : - weight on admission & discharge, breast feeding compliance, sepsis incidence, co morbidities and weight on follow up

 Results: Duration of NICU stay before KMC-9.8days ,Mean duration of KMC-14.3days ,Mean wt. at starting KMC-1.2KG ,Mean wt.at discharge -1.7KG ,Wt.gain/kg/day- 16gms,Mortality –Nil sepsis-nil,Breastfeeding at discharge 100%.

Conclusions: KMC should be implemented as a policy for care of LBW at all new born units.

Disclosure of Interest: None Declared

Biography:

Ida Fidelis Denosta has completed her degree of Bachelor of Science Major in Psychology at the age of 20 in Far Eastern University. She commenced schooling
at Our Lady of Fatima University-College of Medicine at the age of 25 where she graduated as Doctor of Medicine. She just completed her residency training in
Pediatrics at East Avenue Medical Center last December 2016 as an Assistant Chief Resident. She is a member of the Philippine Medical Association, Manila
Medical Society and currently affiliated with Caloocan City North Medical Center as a Junior Consultant in the Department of Pediatrics.

Abstract:

Objectives: This study aims to determine the maternal risk factors associated with the development of retinopathy of prematurity (ROP).
Design: A retrospective cohort study.
Setting: The study was done in a tertiary government hospital.
Patients: This study included admitted premature neonates in neonatal intensive care unit (NICU) who underwent ROP screening. All patients with congenital abnormality of the eyes were excluded in the study.
Methodology: List of admitted premature patients who underwent ROP screening was collected within the study period. Demographic data was collected from the patient’s medical records.
Statistical Analysis: Descriptive statistics were presented for categorical outcome measures. Wilcoxon rank sum test was used to compare two averages. Chi-square test, Yates’ chi-square test and Fisher’s exact test were used to compare proportions.
Univariate and multivariate regression analyses were used to estimate crude and adjusted odds-ratios, corresponding 95% CI and based on p-value ≤ 0.05 statistical significance.
Results: This study showed 57% cases of ROP, majority with Stage 1 (66%), mostly female infants (53.4%; p<0.001), mildly asphyxiated (51.2%, p=0.290; 77.2%, p=0.117) and were small for gestational age (57.3%; p<0.001). On the average, these infants underwent 1 day of either invasive or non-invasive mechanical ventilation, 2 days with FiO2 of >0.5 liters per minute, had two blood transfusions, and with shorter hospital stay (17 vs 26 days; p<0.001). The average age of mothers who delivered infants with ROP was 26 years old, multipara (59.2%), and underwent normal spontaneous delivery (67%). About half reported adequate prenatal check-ups (53.8%), and diagnosed with urinary tract infection (40.1%).
Conclusions: Data showed that mothers with urinary tract infection and preeclampsia are more likely to deliver infants with retinopathy of prematurity thus a significant maternal risk factors of ROP.

Biography:

K.I. has completed MD, PhD from Jichi Medical University and worked as a postdoctoral fellow at Penn State University (USA) and at Genzentrum of München University (Germany). Now she is a professor of Physiology in IUHW and doing experiments with her own hand.

Abstract:

Sodium pump (Na⁺, K⁺-ATPase) is a membrane protein that plays a critical role in maintaining Na⁺ and K⁺ gradients across the cell membrane. It consists of catalytic α and regulatory β subunits. Four α isoforms are found in mammals. In the central nervous system, the α₂ isoform is mainly expressed in glial cells and α₃ isoform in neuronal cells. Point mutations in the ATP1A2 (gene encoding α₂ isoform in human) cause Familial hemiplegic migraine type 2 (FHM2). Point and deletion mutations in the ATP1A3 (gene encoding α₃ isoform in human) cause alternating hemiplegia of childhood, apnea, and severe infantile epileptic encephalopathy often appear after birth. Through the analyses of knockout (KO) mice of the gene for α₂ (Atp1a2) or for α₃ (Atp1a3), here we report that both α₂ and α₃ subunits play important roles in respiratory rhythm generation. Homozygous Atp1a2 KO mice die shortly after birth due to respiratory malfunction resulting from abnormal Cl⁻ homeostasis in brainstem. On the otherhand, homozygous Atp1a3 KO mice showed various respiratory defect. Half of Atp1a3 KO mice made an effort to breath at birth, immediately followed by seizure attack, and resulted in their death. The other showed complete absence of spontaneous body movements and no breathing movements from the very beginning at birth. Consistently, we electrophysiologically recorded various abnormal respiratory activities in the brainstem of Atp1a3 KO mice. These data suggest that both isoforms are essential for survival at perinatal period and Atp1a2 and Atp1a3 play critical, but different roles in respiratory rhythm generation.

Biography:

Dr SYR Lee studied medicine in the University of Hong Kong and graduated in 1989.  After graduation, he pursued his career in Paediatrics in Hong Kong.  He received overseas training for half year in the Neonatal Service, the Monash Medical Centre, Melbourne, Australia in 1996.  He obtained fellowship in the Hong Kong College of Paediatrics in 1997.  Currently he is the consultant in neonatology in Pamela Youde Nethersole Eastern Hospital, Hong Kong.  So far he has 40 publications in peer-reviewed journals.

Abstract:

Metabolic bone disease (MBD) of prematurity is mainly caused by inadequate amount of calcium and phosphate in parenteral nutrition admixtures given to premature infants in early days of life before full enteral feeding is established.  The longer the duration of parenteral nutrition and the smaller the body size of premature infants, more severe is the MBD of prematurity.  According to published guidelines / survey of parenteral nutrition for premature infants in Australia, USA and Europe, it is still a common practice to prepare parenteral nutrition admixtures with calcium and phosphate concentrations such that these minerals are administered far below the fetal accretion rate.  Not surprisingly, MBD of prematurity is still prevalent worldwide.  An animal study on piglets showed that calcium and phosphate could be administered in parenteral nutrition at the rates of 15 mmol/kg/day calcium and 15 mmol/kg phosphate, which actually exceeded the fetal accretion rates.  These exceedingly high rates of calcium and phosphate cannot be recommended at this stage as there is lack of human data.  Instead we recommend: for growing infants less than 1.2 kg administer calcium and phosphate at 2.2 and 1.7 mmol/kg/day respectively.  These rates are lower than the fetal accretion rates but are sufficient to prevent the occurrence of symptoms of MBD of prematurity.  To prepare such parenteral nutrition admixtures, solubility of calcium and phosphate could be an obstacle.  Therefore, we recommend using organic phosphate and organic calcium, the compatibility of which has been proven beyond doubt.

Biography:

Dr Sunil Goyal did his graduation Armed Forces Medical College, Pune (India) and completed his post graduation in ENT in the armed forces in 2010. He underwent training in Neuro-otology including implant otology and skull base surgery for 2 years at Madras ENT Research Foundation, Chennai (India) under th guidance of Prof Mohan Kameswaran which he completed in Sep 2016. Presently he is working as Assistant Prof at the Armed Forces Medical College, Pune (India). He has published more than 15 papers in reputed journals including Chapters on vertigo in books.

Abstract:

Objectives: The objectives of study was to 1) Describe relevant surgical anatomy in defining and accessing the lateral recess for placement of electrode, 2) Propose a working classification for grades of Flocculus; 3) To determine if different grades of cerebellar flocculus effects placement of ABI electrode and subjective outcomes in implantees.

Methods: Our study was a prospective study, and comprised of cohort of 12 patients who underwent ABI surgery via retrosigmoid approach between 1 Jan 2012 to 31 Dec 2014. All children with congenital profound sensorineural hearing loss with either absent cochlea or cochlear nerve were included in the study. Relevant anatomy was noted. We also noted down the difficulty encountered during the placement of ABI electrode. Auditory perception and speech intelligibility was scored post operatively for 1 year.

Results: Cerebellar flocculus was divided into 4 grades depending on the morphology of cerebellar flocculus. It was noted that Grade 3 & 4 flocculus (Group B) had difficult ABI electrode placement in comparison to Grade 1 & 2 flocculus (Group A). The subjective outcomes of Group A was better than Group B. However the p value was not statistically significant.

Conclusion: Cerebellar flocculus can be graded depending on morphology and size. Flocculus of higher grades can make the placement of ABI electrodes difficult and adversely effects the postoperative subjective outcomes.

Biography:

Ahmet Selim Ozkan has completed his PhD at the age of 27 years form Kartal Medical Hospital and postdoctoral studies from Inonu UniversÅŸty School of Medicine. He is working in Inonu University Schho of Medicine, Anesthesiology and Reanimation Department. He has more papers about anesthesiology and pharmacology study.

Abstract:

Introduction

Klippel Feil Syndrome (KFS) is a congenital malformation which has a failure of segmantation of cervical somites in the 8th weeks of gestation and fusion at least two cervical segments. It is described as the triad of short neck, low posterior hairline and decreased range of neck motions. Especially decreased range of neck motions lead many anesthesiologists to difficult airway management. Dexmedetomidine is used for sedation especially without respiratory depression and for use in very early age group pediatric patients was not observed in reported cases. In this case; we aimed to present succesfull sedation by dexmedetomidine to infant patient who is 65 days aged, diagnosed KFS, limited neck motions and known difficult airway.

Case Report

Infant patient, who is 65 days aged, 4 kg weight, 81 cm height and diagnosed KFS, was scheduled for a neck MRI. On evaluation of patient; short neck, low posterior hairline, thorax deformity and floating finger was found. The mouth opening of patient was normal but the extension of neck was particularly restricted. Systemic examination revealed no other abnormalities. The chest X-ray showed hypoplastic ribs. In medical history of patient; there was intermittent respiratory distress. The patient was taken to the anesthetic preparation room. Standard monitorization (electrocardiography, heart rate, oxygen saturation) were performed and intravenous(IV) line was obtained. After preoxygenation for 5 minutes by facemask, dexmedetomidine infusion was administered by IV route as bolus of 0.5 mcg / kg dose for 10 minutes. Monitorization data and Ramsey Sedation Score of the patient were recorded at intervals of 5 minutes. Ear plugs was inserted into patient for protection of loud sounds in MRI room. After bolus administration, dexmedetomidine infusion was continued for maintenance dose as 0.6 mg/kg/hour. Dexmedetomidine infusion was continued for 20 minutes throughout the procedure. Mean values of monitoring data of the patient were recorded as peripheral oxygen saturation:98% (range 96-99), heart rate:138 beats/min (range 130-171), respiratory rate:26/min(range 23-30). During the process, Ramsey Sedation Score was found 4. Dexmedetomidine infusion was terminated at the end of operation and patient follow-up was continued in the postanesthesia care unit. Patient was sent to service after the full awakeness and the patient was discharged on the same day.

Conclusion

Because of beneficial effects, we approved the administration of dexmedetomidine to 65 days aged infant and diagnosed KFS patient. Sedation is important in such cases which is considered limitted neck motions and difficult airway. We believe that dexmedetomidine is an agent may be preferred an alternative agent ensuring respiratory control in anesthesia procedures for sedation.

Biography:

Yadaiah Damera is working as a Consultant Paediatrician at DH, Nalgonda since 23 years and in SNCU from 2008 as Civil Surgeon, HOD; instrumental in
establishing 1st SNCU in India, 1st level 2 unit to get accreditation by NNF. He is working to strengthen the FBNC in India to reduce NMR and discharged 8000
babies till date; smallest baby discharged 650 gms, 28 wk GA, 1st of its kind from dist. Hospital. His areas of interest include: Bubble CPAP, KMC, ROP screening,
Follow up NICU graduates and Presented research papers on CPAP, KMC and ROP.

Abstract:

Background: In order to reduce NMR Government of India with the help of UNICEF is strengthening FBNC through setting up SNCU in all districts. The KMC ward at Nalgonda was established by overcoming barriers in terms of space, infrastructure, human resources & training. Ours is the first pilot study done on KMC in India.
Aim: The aim of the study is to evaluate the safety, feasibility and efficacy of Kangaroo Mother Care in VLBW babies.
Methods: All VLBW < 1.5 kg were put on KMC & analysed for the following Parameters: weight on admission & discharge,
breast feeding compliance, sepsis incidence, co morbidities and weight on follow up.
Results: Duration of NICU stay before KMC was 9.8 days, mean duration of KMC was 14.3 days, mean wt. at starting KMC was 1.2 kg, mean wt.at discharge was 1.7 kg and Wt. gain/kg/day was 16 gms. Parameters of mortality and sepsis were nil and breastfeeding at discharge showed 100%.
Conclusions: KMC should be implemented as a policy for care of LBW at all new born units.

Biography:

Dr. Wataganara is an Associate Professor in the Division of  Maternal Fetal Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.  He has over 50 publications related to fetal medicine in international, peer review journals in the past 10 years.  He is an executive director of Ian Donald Inter-University School of Medical Ultrasound, board member of maternal fetal medicine sub-committee, Asia Oceania Federation of Obstetrics and Gynecology (AOFOG), board member of World Association of Perinatal Medicine (WAPM), and associate fellow of International Association of Perinatal Medicine (IAPM).

Abstract:

Introduction:  To define the effects of maternal factors, mean arterial pressure (MAP), placental volume (PV), and uterine artery Doppler pulsatility index (UtAPI) to serum level of free form of placental growth factor isoform 1 (free PlGF-1) measured with a novel automated assay.

Methods: We enrolled 200 Thai women singleton pregnancy from 11+0 to 13+6weeks gestation with low prior risk maternal factors (age, parity, tobacco use, assisted reproductive technology, and body mass index).  MAP was measured.  Serum free PlGF-1, PV, and UtAPI were measured with a new assay, transabdominal three-dimensional, and color Doppler ultrasounds, respectively.  Effects of these variables to serum free PlGF-1 level were assessed.

Results: Data from 195 eligible subjects showed an elevation of serum free PlGF-1 from 11, 12, and 13 weeks (mean± SD; 36.89 ± 24.92, 38.71± 17.44, and 49.68± 22.30 pg/mL, respectively (p<0.05)).  Serum free PlGF-1 level showed positive correlation with PV (r= 0.290, p < 0.01), and negative correlation with right and left UtAPI (r= -0.717, p=0.05 and r= -0.221, p<0.05, respectively).  PV showed negative correlation with right and left UtAPI (r= -0.243, p<0.05 and r= -0.372, p<0.05, respectively).  Serum free PlGF-1 level had no significant correlation with maternal factors or MAP (p>0.05).  There was no preeclampsia at <34 weeks in 161 subjects (82.6%) with known pregnancy outcomes.

Conclusions: There was modest correlation of serum free PlGF-1, PV, and UtAPI, but not with maternal factors or MAP.  Adjustment of serum free PlGF-1 in early preeclampsia screening algorithm should be considered

Biography:

Mehmet Sah ipek, born in 1978, specialized in Neonatal Medicine. He graduated from Hacettepe University Medical School, Ankara, Turkey. He received his specialization at Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey. Currently, he is working as a medical doctor at Memorial Dicle Hospital, Diyarbakir, Turkey. He is a member of Turkish Neonatology Society and Turkish Medical Association. He is author or co-author of more than 25 peer-reviewed published and accepted articles in international refereed journals. He has authored two book’s chapters.

Abstract:

Background: Even though a few recent studies have shown the efficacy and safety of IV colistin in children and neonates, there is still a vague due to the concomitant use of other drugs in addition to colistin and coexisting clinical conditions. The aim of this study was to assess the safety and efficacy of colistin therapy for multi-drug resistant gram-negative bacteria nosocomial
infections in neonates, considering the effects of concomitant medications and the coexistence of clinical conditions.
Methods: This case–control study included newborn infants with proven or suspected nosocomial infections between January
2012 and October 2015, at two centers in Diyarbakir, Turkey. The clinical and laboratory characteristics and outcomes of patients who received colistin therapy were reviewed and compared to patients who were treated with antimicrobial agents other than colistin during the same period.
Results: Forty-seven cases who received intravenous colistin (colistin group) and 59 control patients (control group) were included. There were no significant differences between the groups regarding outcomes and nephrotoxicity, including acute renal failure. Colistin therapy was associated with significantly reduced serum magnesium (1.38 ± 0.39 mg/dl vs. 1.96 ± 0.39
mg/dl, p < 0.001) and hypokalemia (46.8% vs. 25.4%, p = 0.026). The patients who received colistin also had longer hospital stays [43 (32‒70) days vs. 39 (28‒55) days, p = 0.047], a higher rate of previous carbapenem exposure (40.4% vs. 11.9%, p = 0.001), and a higher age at the onset of infection (13 (10‒21) days vs. 11 (9‒15) days, p = 0.03).
Conclusions: This study showed that colistin was both effective and safe for treating neonatal infections caused by multidrugresistant gram-negative bacteria. However, intravenous colistin use was significantly associated with hypomagnesemia and hypokalemia.

Biography:

Abstract:

Background: Poor maternal sensitivity leads to insecure infant attachment, which has been associated with negative consequences in cognitive and mental health in school-aged children that continue into adulthood. Maternal sensitivity is defined as the mother’s ability to recognize and respond to her infant’s cues consistently and appropriately; it is indicative of the interactions between mothers and their infants, which is characterized by mutual and concurrent interchanges, often referred to as the “mother-infant dance” If the mother is able to accurately recognize her infant’s cues, then she can provide an appropriate and secure foundation to encourage the infant’s exploration, watching over and protecting the infant when necessary Literature
suggests that maternal sensitivity is enhanced for women with high levels of oxytocin. Oxytocin is naturally increased during the early postpartum period, as a result of breastfeeding.
Purpose: The hypotheses tested in this study were as follows: (a) Mothers who breastfeed their infants between two to 12months after birth will demonstrate greater sensitivity than mothers who only formula-feed their infants, as measured by MAI. (b) Working mothers have greater maternal sensitivity than nonworking mothers in Jordan.(c) A difference in maternal sensitivity
levels using MAI measure will be observed between mothers who never breastfed their infants and those who breastfed their infants for two to 12months of age, while controlling for infant temperament.
Study Design: Cross-sectional survey descriptive design was employed. All study protocols were reviewed and approved by the university Institutional Review Boards from UWM University.
Participants: Participants included 258 Arabic speaking mothers who visited three health care centers in Irbid, Jordan.
Data Collection: A combination of strategies was used in recruiting participants for the study. Data were collected from participants on (a) Maternal Sensitivity (B) Infant Temperament (C) Sociodemographical Information (D) Antenatal Information. Generally, the survey questionnaire was distributed and self-administered to mothers at various times in the health centers. Women also took the survey with them to their home, completed the survey and dropped them in the box in the health care centers.
Analysis: The data was analyzed using the statistical package for the social sciences (SPSS, version 24).
Results: Participants ranged in ages (18yrs-40 years; mean = 20.8 SD = 2.20 years. Women were recruited from all educational levels. Participants were predominantly reported being married (99%).There were varying perspectives held by the mothers in the study related to their maternal sensitivity toward their infants. The following findings demonstrated the following:
a one-way analysis of variance (ANOVA) revealed significant differences in maternal sensitivity between breastfeeding and formula feeding mothers at two months (F=24.365, P=0.00); (b) Crosstab techniques were used to determine the contribution of the mother’s employment status on breastfeeding her infant. The probability of obtaining this chi-square statistic, 2.58, show
there is no effect from the independent variables (employment status), on the dependent variable (choosing breastfeeding). The model is not statistically significant because the P-value (0.095) is more than 0.05; (c) there was a statistically significant difference in maternal sensitivity between the breastfeeding and formula feeding group (F=24.358, p <.05) when using analysis of covariance to statistically control for infant temperament status, and holding temperament constant. The partial Eta squared of the groups indicates the effect was large (.101). At 12 months, there was a statically significant difference in maternal sensitivity between the breastfeeding and formula feeding group (F=3.98, p>0.05) when holding temperament constant.
Conclusion: Identifying maternal sensitivity level for breastfeeding mothers towards their infants is an appropriate initial first step to developing appropriate educational programs to help train future nurses to work sensitively and appropriately with their patient from mother and infant patients. A case study approach that uses stories from those mothers could be used to help
provide better perspectives of understanding maternal sensitivity