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

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