Day 1 :
Keynote Forum
Randal K Buddington
The University of Tennessee Health Sciences Center, USA
Keynote: Improving the outcomes of preterm infants-introducing the preterm pig as a translational model for improving NICU protocols and practices
Biography:
Randal K Buddington has completed his PhD at University of California, Davis and Postdoctoral training at UCLA before initiating an academic career spanning 30 years and dedicated to understanding how to improve care of infants and young animals. He recently moved to the University of Tennessee Health Sciences Center where, he is the Director of the new Institute for Prematurity and Perinatal Research and is developing an interdisciplinary, multi-institutional program supporting collaborative efforts by basic scientists and clinicians.
Abstract:
Advances in the technologies used in neonatal intensive care units (NICU) have improved survival of preterm infants and particularly extremely low gestational age neonates (ELGAN; <28 weeks of gestation). However, survival alone can’t be the measure of success as many preterm infants suffer childhood disabilities; the potential for adverse long term outcomes are not yet understood. The most effective way to improve outcomes is to develop and implement innovative strategies of care. There are two fundamental barriers to such innovation. First, current animal models are either not clinically relevant (neonatal rodents) or have limited availability (baboons and lambs). Second, clinical studies using NICU patients are constrained by ethical considerations to evaluating modifications of accepted practices. This presentation introduces the preterm pig as a translational model that replicates the clinical challenges of preterm infants and is providing needed insights into how existing and innovative protocols of care influence development of multiple organs and systems (lungs, brain, kidneys, gastrointestinal, cardiovascular, immune and others). We are validating novel ventilation strategies for ELGAN that recruit the lungs, prevent respiratory distress syndrome, and are predicted to reduce bronchopulmonary dysplasia and associated co-morbidities. Other efforts are improving nutrition and fluid support to enhance growth and normal development, investigating prophylactic closure of the patent ductus arteriosus, evaluating biomarkers and technologies for early detection of disease and responses to medications and procedures, and exploring the exciting possibility of fetal incubation. Preterm pigs are accelerating understanding the consequences of prematurity and improving the care and outcomes of preterm infants.
Keynote Forum
David J R Hutchon
Darlington Memorial Hospital, UK
Keynote: The role of mother’s and father’s voice and touch in improving neonatal transition at birth
Time : 10:50
Biography:
David J R Hutchon is an Emeritus Consultant Obstetrician at the Darlington Memorial Hospital after 35 years of clinical practice. He has spent the last 10 years studying and teaching the circulatory changes which occur at birth and the importance of the residual placental circulation. He has published more than 20 papers on the subject and is an Editorial Board Member of the Maternal Health, Neonatology and Perinatology journal. He led the team which has resulted in the production of the LifeStart, a mobile neonatal resuscitation trolley, now being used in a number of units in the UK, Europe and the USA.
Abstract:
Transition from placental respiration to pulmonary respiration at birth is one of the most radical changes in both the circulation and the pulmonary function, changes which have to occur within a few minutes after birth if the baby is to survive intact. It is the moment when the mother can see, touch and speak directly to their newborn for the first time. The neonate can recognize the voice of its mother (and father) and these voices have an immediate calming effect. The maternal voice has been shown to be recognized by the newborn baby having heard it in utero during the months before. Even before birth, processing of the maternal voice is apparent within the temporal cortex of the foetus. After birth, it is no surprise that the mother’s voice can quickly calm a crying baby. The father’s voice can also be recognized if the foetus has been exposed sufficiently during pregnancy. Emotional closeness through vocalization and touch are important in the future parent-infant relationship and may have beneficial effects on the recovery of the neonate. Nothing can be more reassuring than the mother’s voice. When the neonate is born asphyxiated, ventilation is a priority. This is carried out away from the mother, but mother side resuscitation, as opposed to the traditional room side resuscitation, allows the mother to speak to and touch her newborn baby and aid the recovery. Equipment is now available to allow this approach. With the neonate by the mother the placental circulation can remain intact.
- Neonatology | Perinatology | Neonatal intensive care unit (NICU) | Neonatal Research
Location: Gifford
Chair
Randal K Buddington
The University of Tennessee Health Sciences Center, USA
Co-Chair
David J R Hutchon
Darlington Memorial Hospital, UK
Session Introduction
Brahim Khalil Jawad
ESME Sudria, France
Title: Improving the time-frequency image of newborn EEG seizure like signal using Ambiguity domain characteristics of a general signal model
Biography:
Brahim Khalil Jawad has completed his PhD in Electrical Engineering at École des Mines de Nantes, France. He worked as a Postdoctoral Fellow on Electromagnetics Modeling in the Faculty of Electrical Engineering, Prague, Czech Republic in 2012. He then completed a new Postdoctoral degree, working on time–frequency signal analysis in Prof Boashash’s group in 2014, in the Department of Electrical Engineering at Qatar University, Doha. Since 2017, he is working as an Assistant Professor at Esme Sudria School, Lille, France. His research interests focus on numerical modeling of magnetic fields exerted by actuators and time–frequency signal analysis theory.
Abstract:
Newborn EEG seizure signals appear as piecewise segments in the time frequency domain. Improving the time frequency image can be done using a quadratic-time frequency distribution which has the disadvantage of introducing undesirable interference commonly called cross terms. Using a signal model which mimics the typical behaviour of newborn EEG seizure signals, cross-terms can be characterized in the ambiguity domain. A filter can then be defined and an improvement of the time frequency image quality of newborn EEG seizure signals can be made possible. The filter is tested on both simulated and real signals and compared with current ones.
Biography:
A Cristina Rossi has completed her Medical degree in 1998 and Residency in Obstetrics/Gynecology in 2003. She is both Author and Reviewer of peer-reviewed journals. She is mainly interested in prenatal diagnosis and maternal-fetal medicine. She is actually a Consultant in Obstetrics/Gynecology at Ospedale Della Murgia "Fabio Perinei", Bari, Italy.
Abstract:
Objectives: Management of SGA is under debate, since induction of labor, elective cesarean section and expectant management have been proposed. The aim of this review was to analyze literature about neonatal outcomes of small for gestational age (SGA) after planned delivery by induction of labor or elective cesarean section versus expectant management.
Method: A search in PubMed, EMBASE, Medline and a reference list was performed. Studies were included if SGA was defined as birth weight <10th centile for gestational age (GA), SGA fetuses were alive at labor, planned delivery was compared with expectant management. Exclusion criteria include multiple pregnancies, congenital malformations, Doppler anomalies and data reported in graphs or percentage. Planned delivery referred to both elective cesarean section and induction of labor. Any neonatal morbidity and neonatal mortality was abstracted by each article. Random effect model was generated if interstudies heterogeneity was >25%. Odds ratio and 95% confidence interval (OR, 95% CI) were calculated and defined significant if 95% CI did not encompass 1. PRISMA guidelines were followed.
Results: Out of 6519 SGA, 2552 (39.2%) and 3967 (60.8%) SGA underwent planned delivery and expectant management, respectively. Compared to expectant management, SGA in the planned delivery group were more likely to be affected with respiratory distress syndrome (OR: 2.93; 95% CI:2.54-3.40), sepsis (OR:2.21; 95% CI:1.60-3.04), intraventricular hemorrhage/ hypoxic-ischemic encephalopathy (OR:1.72; 95% CI:1.25-2.37), seizures (OR: 1.84; 95% CI:0.84-4.00), 5-min Apgar<7 (OR:2.65; 95% CI:2.04-3.44), neonatal death (OR:2.09; 95% CI:1.45-3.01). No difference was noted with regard to admission to neonatal intensive care unit (OR: 0.98; 95% CI: 0.71-1.34). Data about gestational age at delivery were scarce.
Conclusions: SGA fetuses without Doppler anomalies do not benefit of planned delivery. In contrast, expectant management is associated with a lower risk of neonatal morbidity and mortality. Limitations of literature include little information about the optimal gestational age at delivery, mode of delivery, and no randomization between planned delivery and expectant management.
Seridi houari boumediene
Centre Hospitalier Universitaire de Martinique, France
Title: Sleeping disorders in pregnancy and post-partum (review)
Biography:
Seridi Houari Boumediene has completed his Graduation in the Faculty of Medicine at the Medical School Hyacinthe Bastaraud Subdivision Antilles-Guyane in 2015. He works as a Psychiatrist at Centre Hospitalier Universitaire de Martinique/Martinique University Hospital (FWI) and takes care of the question of perinatal period. He has completed his Diplôme Universitaire (DU) of Perinatal Psychiatry in Bordeaux in 2016 and an Interuniversity Diploma (DIU) of Perinatal Period and Addiction in Montpellier.
Abstract:
Introduction & Aim: Sleeping disorders are presented during the pregnancy and during postpartum. The aim of our work is to understand the physiopathology of these disturbances and their roles in the psychopathology of pregnant woman and in post-partum.
Method: We realized a review of the systematic literature on sleeping disorders concerning pregnant women. We had to select 94 articles which made the link between sleeping and psychopathology during the pregnancy and during post-partum. We completed these articles by works on the psychological dynamics of pregnancy. We didn’t have any limit of date of publication.
Results: Pregnancy affects sleeping qualitatively and quantitatively. The disturbances of sleeping are evolutionary and subject to the physiological variations of pregnancy. Their repercussions on the humor of pregnant women can go from irritability to depression. The return in a repair sleeping during post-partum is difficult because of the rough hormonal modifications, baby blues, the feeding and the rhythm of the baby. Etiological factors of these disturbances are multiple, which limits the efficiency of the therapeutic answer besides the difficulties to the medicinal prescription.
Conclusion: Sleeping disorders are underestimated in the follow-up of pregnant women; they must be looked for and taken care when they are invalidating to warn the arisen of the disorders of the humor and their consequences on the link between mother-child.
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 inestablishing 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 8000babies 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:
Objectives: Primary objectives of the study were to look at survival rates and prevalence of morbidities in VLBW neonates admitted in SNCU.
Method: Retrospective study included all VLBW neonates (i.e., birth weight≤1500 grams) admitted for various reasons from January 2009 to December 2016. This SNCU is equipped with 20 beds and one bubble CPAP. No facility for ABG, blood culture, ventilator and surfactant. The data regarding variables like mortality, LAMA, referrals to other hospitals and morbidities during hospital stay were collected from electronic data.
Results: A total of 511 VLBW neonates were admitted during the study period. Median birth weight and mean gestational age of neonates were 1344 (183) grams and 32.7(1.54) weeks respectively. 50 of 511 VLBW infants had birth or admission weight<1000 gms. 86 infants (16.8%) died and 15 (2.9%) infants referred to higher centre. Forty (46.5%) neonates succumbed to death within 1 day of life and 31 neonates (36%) between 2 to 7 days of life. Most common morbidity was respiratory distress [439 (85.7%)] and 37 (8.4%) required CPAP. Clinical sepsis occurred in 399 (78%) infants and all infants received antibiotic for 5 days. Jaundice requiring phototherapy were 277 (54.2%) infants, apnoea occurred in 154 (30.1%) neonates.
Discussion: In this study, survival to hospital discharge was 80.2%. This is one of the best survivals of VLBW infants reported from an SNCU in India.
Conclusion: The survival and morbidity rates reported in the study are comparable to many of the tertiary care hospitals and the results shown here will help in conceptualizing the SNCU care.
Tahajamal
The Aga Khan University Hospital, Pakistan
Title: Frequency of hyperbilirubinemia at 72 hours of life in term newborns with a highintermediate risk serum bilirubin level at 48 hours of life, at a tertiary care hospital in Karachi
Biography:
Taha Jamal has completed his MBBS at Dow University of Health Sciences and Postgraduate Pediatrics Residency Training at Aga Khan University Hospital, Karachi. He is currently the Instructor of Pediatrics at the Aga Khan University Hospital, Karachi.
Abstract:
Neonatal jaundice is common in newborns affecting over half (50-60%) of all babies in the first week of life. Severe jaundice can result into significant morbidity in the form of kernicterus. Early screening along with quick treatment of neonatal jaundice helps to reduce the risk of developing severe hyperbilirubinemia, hence kernicterus. There is strong evidence that screening newborns with hour-specific serum bilirubin level measurements can help in identifying risk of developing hyperbilirubinemia in newborns. There is insufficient data from developing countries regarding hyperbilirubinemia and newborns with and without underlying risk factors for hyperbilirubinemia. This cross sectional study will help the physician to anticipate and manage newborns with high-intermediate zone total serum bilirubin (TSB) and will also help to established specific management guideline for these newborns to prevent bilirubin induced neurological damage (BIND). All term newborns of either gender (fulfilling inclusion criteria) with TSB level at high-intermediate risk zone at 48 hours of life, born at Aga Khan University Hospital were included in this study. Their demographics were recorded in structured proforma. Results were collected and analyzed by SPSS software, version 20.0. A total of 173 newborns were enrolled. There was a female predilection 56.6% (n=98). One-third of the newborns having TSB in high-intermediate risk zone at 48 hours of life progressed to level of significant hyperbilirubinemia requiring treatment (31.2%; n=54). Those who required phototherapy had the mean rate of rise of 5.00 mg/dL/day (0.20 mg/dL/hr.). For future implementations, we recommended that early recognition; monitoring and early treatment of neonatal hyperbilirubinemia may help in reducing morbidity.
Payam Seyed Kalateh
Isfahan University of Medical Science, Iran
Title: Studying the validity and reliability of infant sucking tester instrument
Biography:
Payam Seyed Kalateh has completed his Bachelor’s degree at Babol University of Medical Sciences and Master’s degree in Speech Therapy Studies at Isfahan University, School of Medicine. He was the Head of the Student Research Committee in Rehabilitation School. He has gained more than seven honors in innovation festivals.
Abstract:
The importance of controlling primary sucking skills has been emphasized for years and the need for reliable tools for newborn babies sucking has been mentioned in several researches. In this study, we investigate the functionality of IST device in order to evaluate babies suckling. In this research, sucking of a group of healthy babies with 20 members and a group of premature babies with 15 members were investigated by IST device. In the end, sucking characteristics of healthy babies for the first and second tests were compared. They were also compared with the test carried out for premature babies. In this research, the mean of data associated with the test and retest of healthy babies was calculated separately and compared. The comparison which we made and the obtained P-value=0.460 show repeatability or reliability of the device. Also, the means related to the sucking of premature babies were also analyzed using T-test and were compared with those of healthy babies. This comparison showed that P-value equals which is meaningful and verifies the difference between sucking characteristics of healthy and premature babies. IST device is a powerful and useful tool for studying the sucking characteristics of healthy and premature babies. Also the new version of this instrument can assess nutritive and non-nutritive sucking from bottle, sucking from nipple of mother and finger feeding.