Scientific Program

Day 1

KEYNOTE SPEAKERS
  • Application of latent class analysis and latent transition analysis to pediatric symptom studies

    Children’s National Health System
    USA
    Biography

    Jichuan Wang has completed his PhD from Cornell University and Post-doctoral studies from the Population Studies Center, University of Michigan. He is a Senior Biostatistician at Children’s Research Institute, CNHS. He has published three statistical books and authored/coauthored more than 100 peer-reviewed journal articles. He has been serving as an Editorial Board Member for five academic journals.

    Abstract

    Studying symptoms in pediatric health care is important. The terminology of “symptom cluster” in literature has different meanings. Symptom cluster may refer to a group of symptoms that are associated with simultaneous occurrence. Analysis of this kind of symptom cluster are variable-centered analytical approach. The present study focuses on “person-centered” symptom clusters that represent distinctive sub-populations/groups in the target population. Latent class analysis (LCA) is one of the person-centered analytical approaches that can be applied to identify potential latent classes/groups (subpopulations) that are a priori unknown in the population. Patients are similar within class, but differ in cross classes with respect to a set of symptom measures. When symptom measures are continuous (e.g., scale scores of depression), LCA becomes latent profile analysis (LPA). Applications of LCA and LPA to longitudinal data lead to latent transition analysis (LTA), in which latent classes or profiles can be identified simultaneously for each specific time point, measurement invariance over time can be tested, and transitions of symptom cluster/profile status over time can be estimated, and factors that affect the transitions can be examined. This study applied LPA and LTA to identify distinctive latent profiles in children undergoing chemotherapy based on four PROMIS symptoms measures (depression, anxiety, pain, and fatigue). Our results show that two latent profiles (‘Less Severe Symptoms, ‘Severe Symptoms) were identified throughout a chemotherapy (T1: start of the chemotherapy cycle; T2: mid-way through the cycle; and T3: after blood cell count recovery). The prevalence of severe symptom profile remained relatively unchanged from T1 to T2 but significantly declined at T3. A baseline single-item legacy fatigue score significantly predicted the child’s profile membership and its transitions over time.

  • Abdominal wall defects in newborns. A pediatric surgeon’s viewpoint on post par tum care

    SBK Klinikum
    Germany
    Biography

    Fette Andreas is a Consultant Pediatric Surgeon with a big interest in Newborn Surgery and Newborn Intensive Care. He likes to be in charge for Neonatal Surgery within the German Perinatal Centers. Besides his clinical engagements, he has published more than 80 original papers, contributed to 18 book chapters and has been serving as an Editorial Board Member of repute.

    Abstract

    Abdominal wall defects in newborns have an incidence of approximately 1:2000 live births and are considered to be the result out of a failure in the embryonic development sequence when the physiological umbilical cord herniation of the viscera fails to return back into the abdominal cavity before the 11th week of gestational age. The most common types are “gastroschisis” and “omphalocele”. In Germany, these babies are usually deliverd in a Level I Perinatal Centre and treated right from the beginning by an interdisciplinary team of obstetricians, neonatologist, NICU nurses, pediatric anesthetists and pediatric surgeons. Soon after stabilization of the newborn, usually surgical closure of the defect follows. For this closure several different techniques do exist in our neonatal surgical textbooks. In this communication an overwiew about these surgical techniques is given based on a lecture series held in our institution for all staff members involved. In a short appendix a novel technique with its advantages und disadvantages is discussed and shared with the audience.

  • Dextrose gel use in treatment of critical hypoglycemia in neonates

    Helen DeVos Childrens Hospital
    USA
    Biography

    Lana Gagin attended Bashkirian State University Medical School. She completed her Pediatric Residency at the Michigan State University’s College of Human Medicine GRMEP in 2007. She earned her Master’s degree in Public Health at the University of Michigan in 2010 while also working as a pediatrician in the Outpatient General Pediatric Clinic. She joined the staff of the Helen DeVos Children’s Hospital’s Academic General Pediatrics in 2010. In 2011, she joined the staff of Spectrum Health Medical Group and became a Medical Director of Newborn Services in Grand Rapids Campus. As a Medical Director she led the team of physicians in establishing new practices for breastfeeding support which resulted in a successful Baby-Friendly Hospital designation in 2014. She serves as a core faculty at the Pediatric Residency Program at Spectrum Health. She is a co-founder and a Director of Quality Improvement and Patient Safety Rotation, and has been leading multiple quality improvement initiatives. She completed her Lean Healthcare Certification at the University of Michigan in 2014. In 2015, she became an International Board Certified Lactation Consultant.

    Abstract

    Introduction: Transient neonatal hypoglycemia is a common problem affecting many newborns. Up to 15% of healthy newborns and up to 50% of babies in at risk groups are affected. Independent risk factors for hypoglycemia include prematurity, high or low for gestational age birth weight as well as infants born to mothers with diabetes. Correcting critically low blood glucose concentration is important to avoid more serious complications and adverse outcomes. Critical hypoglycemia can put newborns at risk for potentially life threatening consequences including seizures, brain damage, coma and death. Traditional approach in management of neonatal hypoglycemia included intense feeding interventions as well as close blood glucose monitoring. Intravenous dextrose was reserved to babies in whom the initial conservative approach failed. Despite varying protocols, many babies still struggle with low blood glucose and require more frequent monitoring which causes more lab draws, disruption of bonding between a mother and a baby, interruption of breastfeeding, and may need to transfer to a neonatal intensive care unit (NICU). More recently, oral dextrose gel use has been shown to be beneficial as an adjunct therapy in management of neonatal hypoglycemia. This study explores the effect of oral dextrose gel on correcting critically low blood glucose levels in neonates. Methods: Dextrose gel has been incorporated into a well-established hypoglycemia protocol which was based on the American Academy of Pediatrics guidelines. 40% dextrose gel was administered in addition to standard interventions with intense feeding when indicated. The trial has been initiated in March of 2016. Subjects included were all newborns that met criteria of small for gestational age (SGA), large for gestational age (LGA), infants of diabetic mothers (IDM), and preterm (<37 weeks) who are born within that time frame. Patients were divided into two groups based upon their admission date. Those admitted prior to oral dextrose gel trial and those admitted up to six months following oral dextrose trial. Data was collected from a retrospective chart review include blood glucose concentration, comorbid conditions, number of oral dextrose gel doses administered, need for transfer to NICU for treatment with an intravenous glucose and length of stay in NICU. Results: Primary outcome variables for this study are the need to transfer to NICU due to critical hypoglycemia and a length of stay in NICU. Critically low blood glucose concentration in the first 4 hours of age is defined as less than 25 mg/dl. There was a 12% reduction in need for NICU transfers for intravenous glucose treatment due to critical hypoglycemia in infants treated with oral dextrose gel vs. infants who received intense feeding intervention only (38% vs 50%). Moreover, there was a 27% reduction in length of hospital stay in infants who was transferred to NICU due to hypoglycemia after an initial trial of dextrose gel. The beneficial effect of oral dextrose gel in correcting critical hypoglycemia was observed across all four risk factors for hypoglycemia. Conclusion: 40% oral dextrose gel is an effective treatment in correcting critically low blood glucose concentration in newborn babies with risk factors. It is simple, inexpensive and safe intervention. It has been shown to be superior to intense feeding intervention alone in treating critical hypoglycemia, and an effective tool in decreasing the need for treatment with an intravenous glucose. Oral dextrose use shortens duration of hospital stay due to hypoglycemia.

Pediatrics | Pediatric Infectious Diseases | Pediatric Neurology | Pediatric Surgery
Chair
Co-Chair
Speaker
  • Nocturnal enuresis among Sudanese children with sickle cell disease
    Time: 12:20-12:50
    Speaker
    Fathelrahman E Ahmed
    Alneelain University
    Sudan
    Biography

    Fathelrahman E Ahmed has completed his MBBS from Khartoum University and has received Membership of the Royal College of Phyicians from the Royal College of Phyicians-London. He has published more than 25 papers and has been serving as an Editorial Board Member of two journal at his country and he is a Reviewer for four journals.

    Abstract

    Background: Nocturnal enuresis (NE) is prevalent in patients with sickle cell disease. This have been attributed to a decreased ability to concentrate urine caused by sickling-induced nephropathy (hyposthenuria).Whether this is true in Sudanese children with sickle cell anemia is unknown. Objective: To determine the frequency of NE in Sudanese children with sickle cell anemia and to see if hyposthenuria is the cause of NE in these patients. Method: A hospital based cross sectional descriptive study of 87 children with sickle cell anemia who met the study criteria and age sex matched 53 children with sickle cell trait and 50 children with normal hemoglobin genotype as control was conducted in the outpatient’s clinic of a major pediatric hospital in Khartoum. A questionnaire was used to collect relevant data; urine specific gravity was measured using urine dipsticks. Results: NE is present in38%, 13% and 12% of children with sickle cell anemia, sickle cell trait and the control respectively. Hyposthenuria was not detected in children with or without enuresis.NE is common in siblings of enuretic children but not their parents. Conclusion: NE is frequent in Sudanese children with homozygous sickle cell disease. The frequency is not increased in children with sickle cell trait. Hyposthenuria is not detected in these children. Familial tendency for NE is observed.

  • Calloso-septo-optic dysplasia-plus (De Morsier’s syndrome) with aqueductal stenosis and posterior cervical myelomeningocoele: magnetic resonance imaging: a case report/series of De Morsier’s syndrome
    Time: 13:50-14:20
    Speaker
    Joy A David
    Bicol Medical Center
    Philippines
    Biography

    Joy A David has completed her Doctor of Medicine from the University of Santo Tomas, Philippines. She has worked in the field of Public and Community Health for nine years before she entered Residency Training in Radiology. She is in her second year of training at Bicol Medical Center (BMC) Naga City, Camarines Sur, Philippines and is currently the Chief Resident of the BMC Department of Radiology. She has presented her case paper in both local and international gathering/congress. She is also a Certified Women and Child Protection Specialist.

    Abstract

    Introduction: Septo-optic dysplasia (SOD) or De Morsier’s syndrome is diagnosed when optic nerve hypoplasia is seen in conjunction with dysgenesis of the septum pellucidum. Its diagnosis is mainly neuroradiologic with an incidence of 1:50,000. This paper presents four cases of SOD diagnosed via magnetic resonance imaging in less than a year in our institution. The cases represent the classic SOD as well as an unusual blend of the neuroradiologic features of the different SOD subsets with unique associations (aqueductal stenosis and posterior cervical myelomeningocoele). Case Presentation: 1) An 18-month Filipino female with seizure, developmental delay and hydrocephalus revealed an absent septum pellucidum and corpus callosum, small optic nerves, dilated ventricles, aqueductal stenosis, grey matter heterotopia and a posterior cervical myelomeningocoele; 2) A 15-year old male with recurrent seizure showed dysplastic optic nerves, dilated ventricles with box-shaped frontal horns, absent septum pellucidum and a thinned-out corpus callosum; 3) A 17-month old male with blurred vision demonstrated cerebral atrophy, open-lip schizencephaly, absent septum pellucidum with dilated ventricles and atrophic optic nerves; 4) A three-week old male with seizures since birth showed absent septum pellucidum with box-like appearance of the frontal horns of the lateral ventricles. Conclusion: Coincidence of seizures, developmental delay, calloso-septo-optic-dysplasia plus, aqueductal stenosis, hydrocephalus and cervical myelomeningocoele is a unique constellation of the neuroradiologic features of the different subsets of SOD with indefinite prognosis. Patients with classic SOD or calloso-septo-optic dysplasia plus with rare associations should both be closely followed up for re-assessment, further evaluation and management of neurologic and non-neurologic deficits.

  • Dandy-Walker malformation: A case report on the importance of neuroimaging in diagnosis of the disorder
    Time: 14:20-14:50
    Speaker
    Neha Bista
    Bicol Medical Center
    Philippines
    Biography

    Bista N has completed her MBBS at the age of 26 years from Manipal College of Medical Sciences, Kathmandu University, Nepal on Novermber 2015. She is currently pursuing her residency training in radiology at the Bicol Medical Center, Naga City, Philippines. She is to share her interesting cases and looks forward to being actively involved in publication and further enhancing her academics and training.

    Abstract

    Dandy-Walker malformation is a rare intracranial congenital abnormality of the brain occurring in about 1 in 35000 live births. It is characterized by a classical neuropathological triad consisting of complete or partial agenesis of the cerebellar vermis, cystic dilatation of the fourth ventricle and enlargement of the posterior fossa. Treatment involves seizure control, ventriculo-peritoneal/cystoperitoneal shunting and psycho-social therapy. Although there is an extensive list of signs and symptoms associated with the disorder, final diagnosis is dependent on imaging techniques. Timely neuroimaging helps to diagnose the condition and the associated anomalies as early as possible. It also helps to evaluate the recurrence risk in subsequent pregnancies with timely diagnosis of the present disorder. A male child of age two years was brought to our institution for chronic seizure disorder since seven months of age in the out-patient department. He began to have progressive increase in head circumference since one year of age, limited cognition and motor skills for his age and had repeated hospital admissions for convulsions. Cranial CT scan with contrast and plain cranial MRI both revealed moderate hydrocephalus with cystic enlargement of the fourth ventricle communicating into a large cystically dilated posterior fossa, absent cerebellar vermis and absent septum pellucidum along with hypoplastic cerebellum and polymicrogyria. A diagnosis of Dandy-Walker malformation was made, and treatment was advised accordingly, including anticonvulsants and need of ventriculo-peritoneal shunting, to which the family consented to on a lateral date, after out-patient follow up. In the absence of any antenatal and postnatal neuroimaging modality, the case was being managed in line of hydrocephalus with chronic seizure disorder. With the availability of cranial CT scan study, a definite diagnosis of Dandy-Walker malformation could be made and further management could be planned.

  • Understanding HIV-positive experiences with antenatal care in Mozambique
    Time: 14:50-15:20
    Speaker
    Carlos Eduardo Cuinhane
    Vrije Universiteit Brussel
    Belgium
    Biography

    Carlos Eduardo Cuinhane is a PhD Student at Vrije Universiteit Brussel, Belgium. He is a Member of Research Centre Gender, Diversity and Intersectionality (RHEA), Brussels. He is a Sociologist and Anthropologist. He is a Lecturer and Researcher at Eduardo Mondlane University, Mozambique.

    Abstract

    Antenatal care plays a critical role in the health of pregnant women. We carried out a qualitative research to analyse women’s compliance to biomedical norms recommended to reduce the risk of mother-to-child transmission of HIV during pregnancy and childbirth in the rural province of Maputo. The study consisted of in-depth interviews and focus group discussions with women who had become mothers, in-depth interviews with community health workers and semi-structured interviews with mother and child health nurses. We used Bourdieu’s theory of practice as a guiding framework to analyse the data. Our findings showed that participants complied with some recommended biomedical norms to reduce the risk of mother-to-child transmission of HIV, such as subsequent antenatal visits, adherence to antiretroviral therapy and childbirth at the health facility. However, they did not comply with the timing of the first antenatal care, use of modern health care system to treat illness episodes and use of condom during pregnancy. The study results suggest, that compliance to the recommended prevention of mother-to-child transmission is the result of complex interactions in which participants rely on knowledge and resources within both the family and community and the modern health care system. Awareness among health care workers of pregnant women’s perspectives as well as an adequate education about the timing of the first antenatal care and the benefits of antenatal care in both the health facility and community could thus enable to improve prevention of mother-to-child transmission of HIV.

  • A rare entity with a rarer presentation: A case report on Dyke-Davidoff Masson syndrome presenting with status epilepticus
    Time: 15:20-15:50
    Speaker
    Pradesh Ghimire
    Bicol Medical Center
    Philippines
    Biography

    Ghimire Pradesh has completed his MBBS from Manipal College of Medical Sciences affiliated to Kathmandu University, Nepal. He is a third year Radiology Resident in Bicol Medical Center affliliated to Bicol University, Philippines.

    Abstract

    Dyke-Davidoff-Masson syndrome (DDMS) was described initially by C G Dyke, L M Davidoff and C B Masson in 1933. It results from an insult to the growing brain in utero or early infancy, leading to loss of neurons, compromising the growth of the brain. Diagnosis is established with clinical and neuroimaging data. Patients may require physiotherapy, speech and occupational therapy in addition to the management of the seizures. Awareness among the pediatrician, the radiologist and the team leads to early recognition, appropriate timely management and hence, better long-term prognosis. A nine years old female born prematurely, presented thrice in her lifetime as a case of status epilepticus due to improper and inadequate use of prescribed medications. She had delayed mental development for her age. Upon contrast, CT evaluation, hemiatrophy of the right cerebral hemisphere with compensatory ex-vacuo ventriculomegaly and midline shift towards the right, ipsilateral thickening of the calvarium, decrease in size of the ipsilateral cranial fossa, unilateral overdevelopment of the frontal sinus and overaerated right petrous were noted. Capillary malformation was seen as spoke-wheel appearance of the capillaries in the right basal ganglia, a novel finding in children with DDMS. She was diagnosed as a case of DDMS and was managed with IV and oral anticonvulsants and advised for the behavioral therapy to follow on out-patient basis. Neurosurgical consultation was also advised in case of intractable seizures for possible hemispherectomy, which has a success rate of 85% in selected cases. DDMS is a rare clinical entity and furthermore, status epilepticus is an unusual presenting complaint. The physicians must be aware of this relatively uncommon clinical presentation of status epilepticus in order for a timely and appropriate management and also for the outcome of a better long-term prognosis.

  • A new method for preventing the iatrogenic rupture of fetal membrane and amniotic fluid disposal in fetal surgery and a new amniotic catheter model for its implementation
    Time: 16:10-16:30
    Speaker
    Mikhail Schneiderman
    Ministry of Health of Russia
    Russian Federation
    Biography

    Schneiderman M is working as a Professor of Medicine. He received his Bachelor's degree from the Medical University of Orenburg in 1965. After obtaining PhD degree from the Medical University of Moscow in 1967, he worked as an Assistant Professor in Medical University of Moscow, and from 1972 he worked as Gynecological Surgeon at Moscow Gynecological Hospital No.5. In 1979 he became the Director of the Gynecological Clinic at Old Arbat Street in Moscow. Between 1997-1982, he also consulted as an Assistant Professor in the clinic of Dr. Rokhlin in San Francisco (USA). In 2013, he joined Academician V I Kulakov Research Center of Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russia (Moscow) as a Professor. He has received various awards in the field of infertility treatment, new methods of surgical treatment of gynecological diseases, in obstetrics.

    Abstract

    Complications of fetoscopic surgery for feto-fetal transfusion syndrome reverse arterial transfusion syndrome, diaphragmatic hernia, urethral valve, spinal cord hernia, and sacral coccygeal teratoma may include iatrogenic rupture of fetal membranes followed by miscarriage or pre-term birth and fetal death in 5% to 30%. This limits the clinical application of fetal surgery and requires the development of new methods of sealing the defects of membranes. This is the main objective of this study. The membranes are sealed using a new model of the amniotic catheter, which is made from a flexible elastic material and contains several channels from the proximal end, two of which are designed to release a sealant. To seal the trocar holes in membranes, we introduce the tissue sealant through the canal in the catheter, and slowly withdrawing the catheter, we gradually add the sealant through the main canal in the distal catheter. The sealant cumulates in the puncture channel and around it, completely closing the trocar hole. The platelet reach plasma-sealant, created in Research Center of Obstetrics, Gynecology and Perinatology in Moscow is used as a tissue sealant. This sealant is characterized by high adhesive ability and elasticity, having full biocompatibility with the tissues of the female body, possessing the convenience of use, allowing significantly reduction in the perioperative blood loss, reduces allogeneic transfusions and achieves the reliable sealing of the bladder. The new method of hermetic sealing of the bladder with an amniotic catheter was initially used on isolated amniotic membranes (38 experiments) and then on uterus of non-pregnant rats (32 experiments) with hermetic sealing of trocar holes in uterine horns and in the anterior abdominal wall followed by histological examination of the containment zones. The results allow us to suggest the reliable sealing of trocar holes with an extensive network of new blood vessels growing through the sealing zone. In future, we plan to use the new model of fetal amniotic catheter during the fetoscopic surgery. The application of the new method of hermetic sealing of membranes, based on the use of the new model of an amniotic catheter allows to reduce the risk of miscarriage and preterm birth and provides the possibility to conduct fetoscopy at earlier terms of pregnancy, increasing fetal survival in various pathologies requiring the use of fetal surgery.

  • A case report on a rare case of basilar impression caused by tuberculous infection
    Time: 16:30-17:00
    Speaker
    Neha Bista
    Bicol Medical Center
    Philippines
    Biography

    Bista N has completed her MBBS at the age of 26 years from Manipal College of Medical Sciences, Kathmandu University, Nepal on Novermber 2015. She is currently pursuing her residency training in radiology at the Bicol Medical Center, Naga City, Philippines. She is to share her interesting cases and looks forward to being actively involved in publication and further enhancing her academics and training.

    Abstract

    Basilar impression is a congenital or acquired cranio-cervical junction abnormality where the tip of the odontoid process projects above the foramen magnum, seen as upward displacement of the dens due to softening of the bones at the skull base. The resultant foramen magnum stenosis and compression of the medulla oblongata or spinal cord can cause neurological symptoms, obstructive hydrocephalus, syringomyelia or even death. It may be acquired due to rheumatoid arthritis, Paget’s disease, hyperparathyroidism and rickets. To the best of our knowledge, cases of tuberculosis causing basilar impression are regarded rare. This case highlights the importance of ruling in of tuberculosis in endemic areas, especially in young patients with a chronic history of neck pain and features of tuberculosis. A 17 years old female presented with progressively increasing right neck mass with fistula since a year and worsening neck pain since four months. It was associated with restriction of neck movements, low grade fever, anorexia and weight loss followed by gradually progressive right sided hemiparesis since three months before presentation. Neurological examination revealed right sided hemiparesis without cranial nerve palsy. Contrast CT scan of the cranium and cervical spine revealed osteolytic lesions of the C1 and C2 bodies and clivus, vertical displacement of dens above the foramen magnum with resultant mass effect at the cervicomedullary junction, perivertebral and epidural abscess at C1-C5 with consequent spinal cord compression and cervical lymphadenopathy. There was evidence of basilar impression; the dens appearing 1 cm above the Chamberlain line. A diagnosis of craniovertebral junction for Pott's disease was made. The patient started antitubercular treatment. She showed significant improvement in her neurological deficit during follow-up. As a rare case of craniovertebral junction Pott’s disease causing basilar impression, the timely suspicion and subsequent management with antitubercular treatment played a vital role in preventing further morbidity and mortality.

  • Anti-rotavirus activity of rhubarb extract and emodin in vitro
    Time: 17:00-17:30
    Speaker
    Yang Zhan-qiu
    Wuhan University
    China
    Biography

    Yang Zhan-qiu has completed his MD from Wuhan University School of Medicine. He is the Director of Institute of Medical Virology, Wuhan University. He has published more than 150 papers in reputed journals and has been serving as an Editorial Board Member of repute.

    Abstract

    The aim of this study was to evaluate the antiviral activity of rhubarb extract and emodin on rotavirus R709 strain in vitro. The titer and viral inhibition rate was evaluated for the antiviral activity of rhubarb extract and emodin in MA-104 cells infected with rotavirus?RV?R709 strain. Meanwhile, we carried out experiments through the three ways of preventive effect, virucidal effect, and antiviral biosynthesis effect against RV. The extracts from rhubarb showed significant inhibitory activity against rotavirus on MA-104 cells in a dose dependent manner when added at different stages of viral replication cycles. When added before, during or after viral infection, the 50% inhibitory concentration (IC50) was 101.08±1.57?gmL-1, 111.27±4.94?gmL-1and 46.88±3.5?gmL-1 respectively. The therapeutic index (TI) of rhubarb extract was 3.13±0.13, 3.45±0.06 and 7.45±0.56 respectively. Rhubarb extract was highly active against rotavirus in vitro. However, emodin showed mild antiviral activity.

  • Emergence of multidrug resistance enterobecter sepsis in a neonatal tertiary care setting: A three year study
    Time: 17:30-18:00
    Speaker
    Zareen Fasih
    Ziauddin University
    Pakistan
    Biography

    Zareen Fasih completed her MBBS from Karachi University. She achieved her MRCP from Royal College of Ireland and was secretary general of Pakistan Pediatric Association from 2010-2012. She is the Chairperson of Neonatology. She is presently working as Professor and consultant Neonatologist at Gulf Medical University, UAE. She has an experience in metabolic and critical congenital cardiac diseases screening at GMC hospital. She is on the Editorial Board of JppA

    Abstract

    Objective: To study risk factors for Enterobecter sepsis and sensitivity pattern of the organism. Method: Prospective hospital based study, conducted at tertiary neonatal intensive care unit of Ziauddin University Hospital from January 2011 to December 2014. Blood specimens for culture from 2166 babies were sent. Repeat cultures done when the neonate did not show improvement or deteriorated on first line antibiotics. Risk factors were looked for. Antibiotic resistance of the isolate was studied by the disk diffusion technique. Results: There were 540 (24.93%) cases of culture proven sepsis. Enterobecter was grown in 84 (15.55%) cases. Among the gram negative organism Enterobecter was the commonest organism n= 84(15.5%) followed by pseudomonas n= 54 (10%). Among the gram positive organism, Staph Lugdunensis seen in 150 (27.77%) cases followed by staph aureus n= 54 (10%). Increase incidence of late onset sepsis (4.6/1000 live births) was observed during this period. Univariate analysis of risk factors revealed a significant association between LBW 54 (P value 0.001), prematurity 78 (P value 0.001) and prolong stay 66 (P value 0.001) and Enterobecter sepsis. Resistance to the first line antibiotics (Cefotaxime sodium, Aminoglycoside) was seen in 72% of cases. Conclusion: Prolonged stay in the nursery due to prematurity/LBW is important risk factors of Enterobecter sepsis. Prolonged use of antibiotics results in emergence of multidrug resistance. Further studies are needed to establish the role of antibiotics in the emergence of multidrug resistant microorganism.

Day 2

KEYNOTE SPEAKERS
  • Genetic basis of inherited bone marrow failure syndromes

    Hospital for Sick Children
    Canada
    Biography

    Dr. Yigal Dror is the Head of the Haematology Section and Director of the Marrow Failure and Myelodysplasia Program, senior scientist at the Genetics and Genome Biology Program at The Hospital for Sick Children, Toronto, and a member of the Institute of Medical Sciences at the University of Toronto. Dr. Dror graduated from the Hadassah Medical School of the Hebrew University in Jerusalem, and completed pediatric residency in Kaplan Hospital, Rehovot, Israel. He completed clinical fellowship in pediatric hematology/oncology and a post-doctoral research fellowship in the field of hematopoiesis and marrow failure syndromes/myelodysplasia at SickKids hospital, Toronto. In 2000 Dr. Dror assumed his current position as a clinician scientist at SickKids. His main clinical interests are in the area of bone marrow failure and myelodysplastic syndrome. His research focuses on characterization of stem cells and blood cells in these conditions, genetic etiologies and clinical outcome. He heads the Canadian Inherited Marrow Failure Registry. Dr. Dror’s lab showed that Shwachman-Diamond syndrome (SDS) marrow progenitors are reduced, overexpress Fas and undergo apoptosis through the FAS pathway. SBDS-deficiency results in abnormal accumulation of functional FAS at the plasma membrane level. The slow cell growth of SDS cells is associated with increased levels of reactive oxygen species, and can be reversed by antioxidants. His lab also studied the landscape of mutations and affected genes in inherited bone marrow failure syndromes using samples and data from the Canadian Inherited Marrow Failure Regsitry. The lab identified PARN as a new IBMFS gene and described defects in ribosomes and telomeres that unravel previously unknown functions of PARN, and suggest a new disease mechanism in which PARN-deficiency disrupts the polyadenylated state of H/ACA box RNA molecules that in turn influences ribosome profile and telomere length. The lab also identified DNAJC21 as the second gene associated with SDS. His lab showed that IBMFS are associated with high risk (37%) of clones/MDS/AML in childhood, and found that SDS marrows are characterized by stromal dysfunction, increased angiogenesis and abnormal leukemia-gene expression in marrow progenitor cells.

    Abstract

    Inherited bone marrow failure syndromes (IBMFSs) are rare disorders with underproductive bone marrow, varying degrees of low blood counts, physical malformations and risk of myelodysplastic syndromes, leukemia and solid tumors. Over 25 different syndromes have been characterized. Phenotypic overlap among the IBMFSs frequently limits the ability to establish a diagnosis based solely on clinical features. Over 80 IBMFS genes have been identified that functions in fundamental biochemical pathways such as DNA repair, ribosome biogenesis, telomere maintenance and cell survival. The large number of syndromes and associated genes and phenotypic overlap often renders genetic testing prolonged and costly. Correct diagnosis, treatment, and cancer surveillance often depend on identifying the mutated gene. In this presentation, data about the phenotypic complexity of the IBMFSs and leukemia risk will be described. The results of applying new genomic methods to facilitate diagnosis will be discussed. Lastly, genes that were recently discovered as associated with IBMFS will also be discussed.

  • Sleep disordered breathing and psychiatric disorders in the pediatric population: Meta-analytic review

    Rowan University
    USA
    Biography

    Karim Sedky has completed his Medical School at Alexandria University, Egypt. He completed his Master’s degree in Anatomical Sciences and Neurobiology from the University of Louisiville, Louisville, KY. He gained his training in both General Psychiatry as well as Child and Adoelscent Psychiatry after completing his training at Drexel University, Philadelphia, PA. He is a Professor of Psychiatry and is the Medical Student Education Director at CMSRU. He has published more than 30 papers in reputable journals and has been serving as Chief Editor for the Journal of Sleep and Sleep Disorder Journal Research and on the Editorial Board for few other journals. His main interest is focused on the effects of sleep and sleep disorders and its relation to psychiatry disorders in children and adolescent population.

    Abstract

    Sleep disordered breathing (SDB) includes primarily; snoring, obstructive sleep apnea (OSA) and obstructive hypoventilation syndrome. This disorder has been linked to increased prevalence of weight gain, diabetes mellitus, strokes and even heart disease in the adult population. Attention deficit hyperactivity disorder (ADHD) is a common disorder in children and/or adolescent population manisfesting in hyperactivity, inattention and impulsivity. Additionally, depressive disorders are also not uncommon in this population and are usually present in the form of sadness or irritability, sleep and appetite problems, suicidal tendencies, concentration issues or lack of enjoyment in activities. The aim of this discussion is to explore, if there is a relationship between SDB and the prevalence of attention deficit hyperactivity and depressive symptoms in the pediatric population. Since adenotonsillectomy (AT) is the main treatment for OSA, a meta-analysis of the effect of AT on the ADHD and depressive symptoms are reviewed.

  • The use of whole-body MR imaging in children with herditary multiple osteochondromas

    Maastricht University
    Netherlands
    Biography

    H M Staal received a Master’s degree in Medicine, at Catholic University of Nijmegen in 1996, with a minor in Tropical Medicine and Applied Mathematics. Between 2001 and 2007, she did her post-academic education to become an Orthopedic Surgeon. Since 2007, she is working as an Orthopedic Surgeon at MUMC Maastricht, specialized in Child Orthopedics and Hand Surgery. She has a special interest in medical education and holds an academic educational qualification. In 2012, she became Program Director of trainee orthopedic surgeons. In 2016, she recieved a PhD for her research into the growth of osteochondromas in HMO.

    Abstract

    Background: Patients with hereditary multiple osteochondromas (HMO) undergo frequent radiographs to evaluate the growth of their osteochondromas. The conventional radiographic images clearly show the growth of the bony part of the osteochondromas and the growth direction of the long bones. The radiographs do not show the cartilage cap on top of the osteochondroma nor do they show the surrounding soft tissue or the cartilage of the nearby epiphysis. Alongside these disadvantages, taking frequent radiographs carry the potential risk of inducing malignant degeneration through ionizing radiation. We investigated the use of whole-body MR imaging as a screening tool to follow patients with HMO. Findings: Two HMO affected children underwent two whole-body MR imaging scans in one-year time to identify the osteochondromas and to evaluate their growth. The MR images were compared to regular follow-up radiographs of these patients. All radiographically detectable osteochondromas were visible on the whole-body MR images. At least one osteochondroma was clearly seen on the whole-body MR images before detection was possible on the radiographs. The proton density sequence with fat suppression proved to be the best sequence to visualize osteochondromas. Conclusion: Whole-body MR imaging is an effective follow-up tool for patients with hereditary multiple osteochondromas.

Pediatric Oncology | Pediatric Neurology and Psychiatry | Neonatology | Pediatric Infectious Diseases
Chair
Co-Chair
Speaker
  • Application of multilevel mediation model to nursing study
    Time: 12:25-12:55
    Speaker
    Jichuan Wang
    Children’s National Health System
    USA
    Biography

    Jichuan Wang has completed his PhD from Cornell University and Post-doctoral studies from the Population Studies Center, University of Michigan. He is a Senior Biostatistician at Children’s Research Institute, CNHS. He has published three statistical books and authored/coauthored more than 100 peer-reviewed journal articles. He has been serving as an Editorial Board Member for five academic journals.

    Abstract

    Multilevel mediation model has been increasingly applied in many fields, such as prevention, organizational, education studies and health studies. This study will discuss three widely used multilevel medication models (i.e., 1-1-1, 2-1-1, and 2-2-1 models). This study will demonstrate application of the popular 2-1-1 model in nursing study. Data are simulated with three variables: nurse’s job satisfaction (level-1 variable Mij), nurse’s intention to leave (level-1 outcome Yij), and hospital work environment (level-2 variable Xj), where the sub-script i represents level-1 (individual) unit and sub-script j represents level-2 (hospital) unit. The hypothesis is that, the effect of the work environment (Xj) on nurse’s intention to leave (Yij) is mediated by nurse’s job satisfaction (Mij). However, the level-1 variable Mij could serve as a mediator for both level-1 and level-2. The study will show how to examine within-cluster, indirect effect, as well as between-cluster indirect effect that is above and beyond the within-cluster indirect effect. In addition, how to control for covariates or confounding factors in the model using residualized score will be discussed.

  • Patient safety and risk management in pediatric surgery: Combining aviation safety standards with fast track pediatric surgery
    Time: 13:55-14:25
    Speaker
    Andreas Fette
    SBK Klinikum
    Germany
    Biography

    Fette Andreas is a Consultant Pediatric Surgeon with a big interest in Newborn Surgery and Newborn Intensive Care. He likes to be in charge for Neonatal Surgery within the German Perinatal Centers. Besides his clinical engagements, he has published more than 80 original papers, contributed to 18 book chapters and has been serving as an Editorial Board Member of repute.

    Abstract

    The increase in our patients` safety, the implementation of an effective risk management, the communication of medical errors and the start up of a fast track pediatric surgery are currently the key issues discussed within the public, among politicians and within pediatric medicine. In the past, first statements are found i.e. in the WHO safety checklists, the global initiative for emergency and essential surgical care (GIEESC) and in the millenium development goals (MDG) out of the years 2008 and 2015. In addition, in I° World countries like Germany, professional risk managers, patient safety experts and medical chambers have issued general guidelines and recommendations for institutional and clinical risk management in all hospital departments. For traditional reasons they focus more on adults rather than on children and of course, more on public health issues than on (pediatric) surgery. In this communication, well established patient safety and risk management goals and the current practice of communicating medical errors are re-focused. Recent proposals for their adaptation into the specific needs in pediatric surgery especially fast track pediatric surgery are re-visited as well. Finally, our results are presented and discussed to which extent safety tools and the safety culture out of the aviation sector or other high reliability organizations (HRO) can be implemented and combined within a progressive fast track pediatric surgery. The data are taken out of the all-day practice and experience of the author and are discussed in form of a literature review.

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This cancellation policy was last updated on April 04, 2015.Cancellation, Postponement and Transfer of Registration

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