17^th Annual World Congress on Neonatology June 27-28, 2018
(23 Forums, 2 Days, 1 Event) Vancouver, Canada

Biography:

Hanaa I Rady is working as an Associate Professor of Pediatrics and Pediatric Intensive Care, and is the Deputy Director of Children University Pediatric Hospital, AbolRish, Cairo University. She is the Director of PICU of the 7th floor (21 beds). She has completed her MSc and MD from Cairo University in the year 2005 and 2008 respectively. She has published over 18 publications in reputed journals.

 

Abstract:

Background: Wheezy chest remains one of the major causes for emergency department visits and admissions at Pediatric intensive care units (PICUs).

Objective: We aimed to determine the efficacy of magnesium sulphate (MgSO4) versus standard treatment in critically ill infants and children with wheezy chest.

Methodology: Randomized controlled trial comprised 81 patients suffering from wheezy chest divided into 3 groups. In addition to bronchodilators and systemic steroids, MgSO4 was given by inhalation in Group A, intravenously in Group B, and Group C received placebo. The improvement in our cases was determined by clinical respiratory score (CRS), ventilator setting and arterial blood gases (ABGs) before and after treatment.

Results: Median age was 11 months, mean weight 9.3kg and the median of SOFA score was one. After treatment: There was significant improvement of CRS in the three groups. In group A, there was significant reduction in ventilator rate (p=0.017) and improvement of arterial/inspired oxygen ratio (p=0.0056). In group B better mean arterial pH was noted (p=0.009).

Conclusion: Magnesium sulphate is a safe and beneficial adjuvant therapy in addition to standard treatment in critically ill infants and children with wheezy chest.

Biography:

Chantal Lau trained as a basic physiologist, my interest in clinical research introduced me to the preterm infant population. She was attracted to the oral feeding difficulties these infants encounter that so often prolong their hospitalization in Neonatal Intensive Care Units (NICUs) and the distinctive types of stressors expe­rienced by their mothers and their impact on maternal behavior, lactation, and mother-infant bonding. Her research on infant oral feeding gained momentum over the last two decades with the increased survival of infants born prematurely, many of whom encounter difficulty feeding by mouth safely and efficiently. Through the development of the Oral Motor Kinetic (OMK) monitoring system and the Oral Feeding Skill (OFS) assessment scale, I gained an extensive understanding of how nutritive sucking skills mature. This allowed for the development of a number of efficacious and safe interventions to enhance preterm infants’ oral feeding performance, e.g., oral tactile stimulation, massage therapy and swallow exercise. Efficacy of these interventions was validated by monitoring the maturity levels of infants’ nutritive sucking monitored with the OMK and/or the OFS scale against their oral feeding performances.

Abstract:

The field of infant oral feeding research is understudied as the recognition of its importance came about with the increased preterm population and the realization that a large number of these infants after overcoming life threatening events are not safe and competent oral feeders; the latter, unfortunately, often delaying their discharge home from Neonatal Intensive Care Units (NICUs). It is understandable that this research has taken a “back seat” to the more immediate concerns of saving these babies’ lives. However, due to the limited research so far conducted in this domain, currently available therapies are limited and lack evidence-based support from the multi-disciplinary healthcare professionals caring for these babies. Consequently, in NICUs, time for introduction and advancement of oral feeding remain tentative and the management plan for individual infants often is not agreed upon by all. With a greater understanding of the development of infant’s oral feeding skills, we have developed methods to monitor the maturation process of preterm infants’ skills and devised interventions to enhance their feeding performance. This presentation introduces some novel, safe, and efficient interventions, e.g., swallow exercise, massage therapy, that were validated by a simple and new method, the infant oral feeding skills (OFS) assessment scale. This is an approach that does not require any special device and can be used at any time for assessing an infant oral feeding performance. This tool has also allowed us to examine the efficacy of currently used practices, i.e., why some approaches may work for some infants and not others.It is advanced that the availability of evidence-based support for any recommended approach(es) will improve compliance from staff members for the benefit of their young patients.

Biography:

Shakuntala Chhabra is Director-Professor of Obstetrics and Gynaecology, She has served as head of the Department, Obstetrics and Gynaecology at MGIMS (1984-2007), Medical Superintendent of the hospital (2005- 2007) and Dean (2007-10). She is right now helping MGIMS develop a child and mother care hospital at Village Utavali in Melghat, a region with a dubious distinction of high prevalence of severe malnutrition. She received MBBS (1970), DGO (1973) and MD (1975) from the Government Medical College Nagpur. She moved to MGIMS as a lecturer in 1975. In 1984, she was named head of the institute’s Obstetrics and Gynaecology department. She received several awards during her illustrious career. The list includes, but is not limited to: distinguished community services in Emergency Obstetric Care (Federation of International Gynaecologists and Obstetrician), best teacher (Maharashtra University of Health Sciences, Nashik) Dhanwantari Award (Coal India) and best academician-physician (Mahakali Education Society). She has received fellowship of Indian Academy of Juvenile & Adolescent Gynaecology and Obstetrics, Certificate for excellent work in National Family Welfare Programme in Wardha district and also Scroll of Honour of Breast feeding of Promotion Network of India. She also received International fellowships from the British Council; The Network of Community Oriented Educational Institutes for Health Sciences; The Netherlands WHO Aga Khan Foundation; Mother care International, Swedish International Development Agency; Dutch Education Ministry and Maastricht University; Global Health through Education, Training and Service. Over the last 33 years, she has mentored and guided several MD, DGO and PhD students. She is a prolific researcher: she has authored 405 scholarly papers and five chapters in books and some booklets and has held many editorial positions (International Journal of Gynecological Oncology, Women's reproductive health and Gynecological Oncology). She is a reviewer for several journals: British journal of Obstetrics and Gynaecology, Studies in Family Planning, Archives of Gynaecology and Obstetrics, Indian Journal of Medical Sciences, Indian Journal of Clinical Medicine, and Who’s Who in Science and Engineering. An Adviser for AGCO, she is a life member of Association of British Council of Scholars and also a member, faculty of Medicine, Rashtra Sant Tukdoji Maharaj Nagpur University. She is a member of the Women and Health Taskforce of the Global Health through Education Training and Services as well as Master trainer for the programme of Prevention of Parent- to- Child-Transmission of HIV, programme for breast feeding and young child feeding, Violence against Women. Dr Chhabra is assessor for National Baby Friendly Hospital Initiative, a WHO consultant and a supervisor and lecturer for the Swedish International Development Agency (SIDA). She was President of Association of Gynaecologic Oncologists of India in 2002. She is the officer- in- charge of the Sevagram Project for welfare of unwed mothers and Community based Reproductive Health Care project. For over two decades she has also served as Chief Executive Officer of Aakanksha. Her special areas of interest include women’s reproductive health, Gynecological Oncology, and education of health professionals.

Abstract:

Context: Health of parents is important for healthy baby. It is essential that they do not have disorders. If disorders are there, are under control, more so in the mother. She must not use or get exposed to anything which affects gamets, conceptus, embryo, foetus and so neonate at birth, beyond. As knowledge, technology are expanding new information, safety concepts too are coming. Community based preconception/interconception/periconception literacy, therapy have emerged as potentially vital tools. It is not only important to ensure mother’s health during pregnancy, birth, postbirth but pre/peri/interconception also. It is essential to have awareness about men’s health too. In many situations, like extremes of age, pre-existing disorders,social problems, pre/peri/interconception literacy offers a lot to keep mother- baby healthy. Women with low pre pregnancy weight, anaemia, other deficiencies are likely to have foetal growth restriction, preterm births, low birth weight babies. Women who are overweight are at greater risk of hypertensive disorders. Women must not be exposed to radiation, harmful medication periconception. Some women might be having cardiac, endocrinal, other disorders, needing special care before conception, during conception, beyond too. They can find their way to referral well in time to get appropriate timely therapy for themselves and babies. Pre/peri/interconception literacy can reduce unplanned, too early and too many pregnancies which affect baby at birth, beyond. Awareness about preventive possibilities, possible dangers during pregnancy, need of behavioural, lifestyle change, seeking timely care, sure reduce perinatal morbidity, mortality, future health of baby. However there are challenges about contents, modalities and providers of such services.

Objective: To have brain storming about whys of pre/peri/interconception literacy/therapy, about contents, and modalities for better neonatal outcome, safe childhood, future and limitations.

Methodology: Presentation by facilitator, Group work and discussion for contents of pre/peri/interconception literacy, modalities likely challenges, limitations.

Biography:

Lazhar Labiadh has completed his PhD in STAPS: Science, Technical of Sports and Physical Activities from Paris Descartes University. The aim of my research is the study of perception/action links mechanisms for imitating a series of successive motor actions, concerning the locomotion movements and manual gestures and their laterality and coordination, memory, spatial framworks (ego and allocentric), both in healthy children and pathological and vulnerable populations (autism and alzheimer). In the developmental psychology and handicap farmework, I also study the well-being via sportive and physical activities over their relationships and psychological dimensions.

Abstract:

Imitation is commonly considered as a hierarchically organized mechanism. It is frequently used to explore various scientific fields, but few works have studied how locomotion movements are imitated. The current study aims to investigate and expand the findings regarding which information children of different age groups select and integrate for performing a series of locomotion movements. One hundred and thirty children from 3.5 to 7.5 years of age were instructed to walk in step-alternating mode on and between obstacles in different imitation forms following gestural demonstration, and in a control condition following verbal instructions. The children’s performances were videotaped, coded in binary data, and then put into percentage. Results showed first, that all children performed the modeled walking movements, but did not necessarily do so with the same step-alternating mode or footedness and second, that the model helped the preschoolers to adopt his step-alternating mode and stabilized the schoolers from the age of 5.5-year-olds. These findings reveal that the age of 5.5 is crucial for imitating a walking task while overcoming the constraints of balance and propulsion.

Biography:

Xiang-Peng Liao has his expertise in improving the quality of neonatal intensive care unit. He was a Chief Physician, Academic Director of Newborn Medicine Department at Wuxi Maternity and Child Health Hospital, Nanjing Medical University, China. He has participated in the Stecker International Scholars Program, and attended the Neonatal-Perinatal Medicine Observationship Program at the four affiliated hospitals of Harvard Medical School. He also was a scholarship holder from the Canadian Institutes of Health Research - Quebec Training Network in Perinatal Research Program. He is responsible for a guideline about vitamin D and bone health in China, and principal investigator for 5 government projects, and has published more than 40 articles and book charters.

Abstract:

Background: Previous surveys of neonatal medicine in China have not collected comprehensive information on workforce, investment, health care practice, and disease expenditure, yet it is necessary to know the situation.

Methods and Findings: We summarized the above components by extracting data from the databases of the national key clinical subspecialty proposals issued by national health authority in China, as well as publicly accessible databases. Sixty-one newborn clinical units from provincial or ministerial hospitals at the highest level within local areas in mainland China, were included for the study. Data were gathered for three consecutive years (2008-2010) in 28 of 31 provincial districts in mainland China. Of the 61 newborn units in 2010, there were 4,948 beds (median=62 [IQR 43-110]), 1,369 physicians (median=22 [IQR 15-29]), 3,443 nurses (median=52 [IQR 33-81]), and 170,159 inpatient discharges (median=2,612 [IQR 1,436-3,804]). During 2008-2010, the median yearly investment for a single newborn unit was US$344,700 (IQR 166,100-585,800), median length of hospital stay for overall inpatient newborns 9.5 (IQR 8.2-10.8) days, median inpatient antimicrobial drug use rate 68.7% (IQR 49.8-87.0), and median nosocomial infection rate 3.2% (IQR1.7-5.4). For the common newborn diseases of pneumonia, sepsis, respiratory distress syndrome, and very low birth weight (<1,500 grams) infants, their lengths of hospital stay, daily costs, hospital costs, ratios of hospital cost to per-capita disposable income, and ratios of hospital cost to per-capita health expenditure, were all significantly different across regions. The survival rate of extremely low birth weight (ELBW) infants (Birth weight <1,000 grams) was 76.0% during 2008-2010 in the five hospitals where each unit had more than 20 admissions of ELBW infants in 2010; and the median hospital cost for a single hospital stay in ELBW infants was US$8,613 (IQR 8,153- 9,216), which was 3.0 times (IQR 2.0-3.2) the average per-capita disposable income, or 63 times (IQR 40.3-72.1) the average per-capita health expenditure of local urban residents in 2011.

Conclusions: Our national database provides baseline data on the status of neonatal medicine in China, gathering valuable information for quality improvement, decision making, longitudinal studies and horizontal comparisons.

Biography:

Sharada Gowda is an Asst. Professor of Pediatrics, Division of Neonatology at Baylor College of Medicine and has special interest in Neonatal Cardiology. She have undergone a year of specialty training in CVICU to understand the physiology better in order to integrate in our daily practice as a neonatology team. She is actively working on a robust teaching curriculum for residents, Fellows and NNPs.

Abstract:

Introduction: In recent years, Dexmedetomidine (DEX) is being increasingly used in the setting of cardiac intensive care for newborns undergoing complex cardiac surgery. However, there is a gap in literature describing the association of DEX on exposure to other agents, particular benzodiazepines and opioids in the first few days post-operatively in newborns. The aim of this retrospective study was to determine if DEX infusion in neonates post norwood procedure would result in decreased exposure to benzodiazepine and opioids post-operatively.

Methods: All cardiac surgical patients who underwent norwood procedure from 1/2011 to 6/2015 ±cardiopulmonary bypass were included. All doses of opioid and benzodiazepine received via bolus or continuous within first 48 hours post-operatively were counted with cumulative doses converted to equivalent dosage (oral morphine equivalents, ME and benzodiazepine equivalents, BE and compared between norwood patients who received DEX for sedation (DEX+) and those who did not (DEX-).Only the index surgery was included and those treated with ECMO were excluded.

Results: 83 patients underwent norwood palliation in the time period. DEX+ were 17/83 (20%) and DEX- were 66/83 (80%). The two groups are not significantly different preoperatively. The average cumulative dose of opioid for DEX+ group was 29.3 ME/kg and for the DEX-group was 24.0 ME/kg without significant difference (p = 0.19). The average cumulative dose of benzodiazepine for DEX+ group was 13.0 BE/kg and the DEX-group was 16.6 BE/kg also without significant difference (p = 0.39). In our analysis, length of stay was significantly higher (p=0.034) for DEX+ patients (mean=88, SD=60) compared to DEX- patients (mean=63, SD=58). In multivariate analysis, there still remains no difference between the groups.

Conclusion: Dexmedetomidine infusion in the first 48 hours after norwood procedure in neonates may not be associated with limited exposure to opioids and benzodiazepines and may be associated with longer length of stay.

Biography:

Venkat Reddy Kallem, Neonatology resident in Fernandez hospital, Hyderabad, currently he is working on a research project titled “Comparison of Growth, Meta­bolic and Neurodevelopmental outcomes among preterm AGA and SGA infants at 12-18 months of corrected age”. He is working under the guidance of Dr. Srinivas Murki MD,DM Consultant Neonatologist in Fernandez Hospital.

Abstract:

Statement of the Problem: Extra Uterine Growth Restriction (EUGR) is a major problem in preterm neonates and adversely affects long term growth and development(1,2). The objective of this study was to identify the incidence and predictors of EUGR in neonates ≤ 32 weeks of gestational age.

Methodology: A retrospective observational study done including 603 neonates ≤ 32 weeks of gestational age admitted in a tertiary care neonatal centre from January 2015 to December 2017. Growth parameters at discharge from hospital were plotted on Fenton 2013(3) growth charts and neonates falling below the 10th percentile were considered as EUGR. Neonatal data during the birth and hospital stay was analysed for identification of predictors of EUGR.

Findings: The incidence of EUGR for weight, length and head circumference was 56.9%, 35.5% and 33.3% respectively. The incidence of EUGR is inversely related to gestational age and birth weight. Factors which were found to be significant for EUGR (Discharge Weight) are birth weight, IUGR at birth, pregnancy induced hypertension and time to reach full feeds. Predictors for EUGR (Discharge length) were found to be Doppler abnormalities, male sex, birth weight and IUGR at birth. Predictors for EUGR (Discharge head circumference) were found to be birth weight and IUGR status at birth.

Conclusion & Significance: More than 50% of our preterm neonates admitted into NICU have EUGR. Presence of lower birth weight was associated with increased risk of EUGR for weight, length and head circumference. Being SGA at birth was associated with decreased risk of EUGR for weight, length and head circumference.

Biography:

Heber Oliva is a 4^th year Student of Medicine and Surgery with consistent experience, leadership, and capacity oriented to work by objectives. Volunteer Coordina­tor at Fundacion Angelitos Recien Nacidos Hospital Escuela, it was founded in mid-2012, inspired by the doctors who run the medical rooms of the Newborn Area, our mission is to ensure permanent support to the Newborn wing of the Hospital Escuela, through the delivery of supplies, equipment, medicine, and materials in order to contribute to the sustainability and improvement of health services through actions and activities with the community and interest groups. It was also member of the Organizing Committee of the I National Congress of Neonatology in Honduras, Integral Management of Perinatal Asphyxia Workshop and Neonatal Dialogues both by Inter-American Neonatal Society (SIBEN), Academic Tutor of Structure and Function and National Exchange Officer on Professional Exchange in IFMSA-Honduras.

Abstract:

Health should be at the center of sustainable development. Accountability will be an important part of the new development agenda. Ban Ki-Moon, UN Secretary General, May 2014. WHO has defined the social accountability of medical schools as “the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public”. The concept of equity is firmly embedded within the right to health. “Health equity is both the improvement of a health outcome of a disadvantaged group as well as a narrowing of the difference of this health outcome between advantaged and disadvantaged groups-without losing the gains already achieved for the group with the highest coverage.” But how equity looks like in Honduras? 20% of the babies born in the maternal and child ward require special care, 50% of the babies that require a spot in the intensive care unit, die because of the lack of it, 7 out of 10 children who die in Honduras are newborns, 40% of the babies that are treated in the newborn area of the maternal and child ward, die from conditions associated with infections. According to international standards, the neonatal intensive care unit should have one available spot for every one thousand live births per year. In this case, this area in the Maternal and Child Ward has only 8 available spots for approximately 17,000 annual births. Social accountability of medical education means a willingness and ability to adjust to the needs of patients and health care systems both nationally and globally. We as medicine students must leave behind indifference, selfishness, the individualistic attitude and disregard of public affairs. We are not the future, we are the present and part of the solution, our opinion and proposals are indispensable

Biography:

Rena Eudy-Byrne, PhD has over 5 years of experience developing physiolgical systems models and other modeling and simulation applications for drug devel­opent. Her training is in Biomedical Engineering.

Abstract:

Malnutrition in infants in low- to middle-income countries is a complex problem caused, in part, by underfeeding and an increased prevalence of gastrointestinal (GI) disease. To understand and separate the effects of nutrition and disease on infant growth, a physiologically-based mathematical model was developed describing fat mass (FM) and fat-free mass (FFM) from birth to 2 years. This effort was based on a published model describing growth dynamics, expanded to include effects of infection and nutritional status on nutrient absorption in the gut. Model calibration used published data to quantify the physiology of healthy and non-healthy GI function and resulting physical growth, including: Macronutrient absorption efficiencies, deposition of metabolizable energy into FM and FFM, total energy expenditure, dynamics of severe bacterial and viral infections, effects of malnutrition on GI/immune function, recovery from malnutrition. The model was validated using individual data from different geographical locations representing various phenotypes, dietary intakes, disease susceptibilities and child rearing patterns. One important insight from this work resulted from the differential FM and FFM composition of weight loss during infection and weight gain during recovery, dependent on the degree of malnutrition and individual phenotype. For example, an interesting phenotype has been seen in infants at risk of malnutrition whereby FM is increased despite energy intakes smaller than age-appropriate requirements. The model was able to mechanistically recapitulate this phenotype by imposing repeated cycles of weight loss/gain due to infections or underfeeding, indicating the potentially large impact of non-dietary factors on infant growth outcomes.

Biography:

Negar Sajjadian has completed her neonatology fellowship since 14 years ago and works as an Associate Professor of Tehran University of medical sciences since 13 years ago. She was the head of shariati hospital, sNICU and now is the head of baharloo hospital, sNICU. She has published more than 20 paper in reputed journals and also has written 3 books in neonatology fields. She is also a membere of Iranian society of neonatology.

Abstract:

Objective: To evaluate the effect of low intensity recorded maternal voice on the physiologic reactions of healthy premature infants in the neonatal intensive care unit (NICU). Methods: Physiologic responses of 20 healthy preterm infants in the NICU of Shariati Hospital, Tehran, were obtained during a 15min intervention including three 5min periods (no-sound control, audio recorded playback of mother's voice, no-sound post-voice). The intervention was presented three times a day for three consecutive days. During each intervention, oxygen saturation (%, OSPR), heart rate (HR), and respiratory rate (RR) were recorded at 1min intervals over the 15min and then averaged over each 5min period, resulting in 3 averages for each variable for each intervention. Results: Repeated Measures Analysis of Variance were employed to examine each variable separately. Over the three days, comparison of oxygen saturation over each of the three periods (before, during voice, after) revealed an increase in oxygen saturation during the voice period, compared to the pre-voice period, which persisted over the post-voice period; there were no differences between the voice and post-voice periods. Analyses of the HR and RR data showed a decrease in both variables during the voice period compared to the pre-voice period which persisted over the post-voice period. Again, there were no differences between the voice and post-voice periods. Conclusion: Exposure to low intensity recorded maternal voice has positive effects on the preterm infants 'physiologic responses.
 

Biography:

Maria Papamichael is a Registered Dietician/Sports Nutritionist who has dedicated her life in educating people the importance of good nutrition and exercise in the prevention and management of disease as well as in improving health and well-being. Being an asthma sufferer since childhood, has motivated her to undertake a PhD research project at La Trobe University (Australia) to investigate the prophylactic potential of a Mediterranean diet enriched with fatty fish in the management of asthma in children.
 

Abstract:

According to the World Health Organization, 235 million people worldwide suffer from asthma. It is the most common chronic disease among children responsible for hospitalization, emergency visits, 10 million missed school days per year, impacts the productivity of working parents and inflicts a societal economic burden due to increased medical costs. Although genetic, environmental and epigenetic factors have been identified, an effective therapeutic intervention is yet to be identified. We conducted a single-centred parallel randomized controlled trial of six months duration to examine the prophylactic potential of dietary omega 3 fatty acid intake in pediatric asthma. Seventy-two children (54.2% boys; 45.8% girls), 5-12 years old with physician-diagnosed ‘mild asthma’ were selected from a paediatric clinic in Athens, Greece and randomized to two groups. The intervention group consumed two fatty fish meals per week (≥ 150g fillet fatty fish/meal) and the control group, their usual diet. Pulmonary function was assessed using spirometry, bronchial inflammation with exhaled Nitric Oxide analysis (eNO), asthma control and quality of life by questionnaires. Multiple linear regression model showed a statistically significant change in eNO in the intervention group (95%CI: -27.39, -0.91; beta = -14.15; p=0.037) adjusting for confounders of age, sex, regular physical activity and BMI. Fatty fish intake twice weekly reduced bronchial inflammation by 14 ppb. No differences were observed for spirometry, asthma control or quality of life scores. This study suggests that two meals of fatty fish per week (≥ 150g/ meal), a rich source of Ω3 fatty acids, might be an effective therapeutic intervention targeting inflammation in pediatric asthma.