Day 1 :
Keynote Forum
Rita Prasad Verma
Nassau University Medical Center, USA
Keynote: Early postnatal body weight changes in the extremely low birth weight infants (ELBW, birth weight < 1000 g): Clinical implications and determinants
Time : 09:05-09:45
Biography:
Rita Verma Prasad is an attending neonatologist and Professor of Pediatrics at Nassau University Medical Center, NY, USA. She graduated from medical school in India at the top of her class of 210 students with honors. She worked at the State University of New York School of Medicine, Stony Brook; and at the University of Maryland School of Medicine as Associate Professor before joining Nassau University Medical Center. She has published over 90 peer reviewed manuscripts and abstracts and has presented her research at national and international meetings. She serves on the editorial board and is a manuscript reviewer for several journals. She is a member of the Neonatal- Perinatal, Critical Care and Epidemiology subcommittees of the American Academy of Pediatrics and is acknowledged for her contribution in making pediatrics and neonatology protocols for the academy. She has mentored many medical students, pediatric residents and neonatology fellows over the years.
Abstract:
Background: Early postnatal body weight changes (Δ bw) and their clinical implications are poorly understood in preterm infants. We investigated the relationships between Δ bw and body fluid metabolism dependent morbidities in ELBW infants, the population which has highest incidences of such morbidities. Δ bw were evaluated as maximum weight loss (MΔbw); and as daily body weight changes from birth weight (DΔ bw) during the first 15 days of life. The mother-infants' variables relevant to body fluid balance, namely, oxygen dependence on day 28 (BPD28), patent ductus arteriosus (PDA), intraventricular-periventricular hemorrhage (IVH), antenatal steroid (ANS) and gestational age (GA) were correlated with MΔbw and DΔ bw via Pearson's correlation coefficient and Pearson's partial correlation tests. The effects of MΔbw, as low (5-12% of birth weight) moderate (18.1-12%) and high (18-25%) were also assessed.
Results: MΔbw (n=102) was 14.2+/-5.4%. Day of life of MΔbw was 5.5+/-2.1 and that of surpassing birth weight 14.5+/-4.2. MΔbw correlated negatively with GA, ANS and pregnancy associated hypertension (PAH); and positively with BPD28, days on oxygen, fluid intake and urinary output in a GA dependent manner. MΔbw did not correlate with RDS, hypotension, PIE, IVH, PDA and hospital stay. DΔ bw correlated inversely with GA on days 1–8, and was associated with decreased risks for BPD28, PDA and IVH after controlling for GA. ANS decreased DΔ bw. Maternal diabetes mellitus (MDM) and PAH were not noted in mothers in high MΔbw group. 38% of mothers in low MΔbw group suffered from PAH.
Conclusion: MΔbw, governed by maturation, does not promote morbidities independent of GA within the range of 14.5+4.2%. DΔ bw is protective for PDA, BPD28 and IVH independent of GA. ANS decreases DΔbw, which correlates inversely with GA during the first week of life. MDM and PAH have implications in Δ bw in ELBW neonates.
Keynote Forum
Ludo Mahieu
Antwerp University Hospital, Belgium
Keynote: Compliance to guidelines for prevention of central line infections in neonatal intensive care units in Belgium
Biography:
Ludo Mahieu has his expertise in epidemiology and passion for clinical infectious diseases, hospital hygiene and wellbeing of the newborn. His open and contextual evaluation model based on responsive constructivists creates new pathways for improving healthcare. He has built predictive scores after years of experience in research, neonatology, teaching both in hospital and education institutions. The prediction is based on computer based weighting using multivariate analysis and more recently machinery learning which is a ethodology that utilizes artificial intelligence for evaluation: measurement, description and judgment. It allows for complex prediction.
Abstract:
Statement of the Problem: Neonatal Intensive Care Unit patients are at high risk for central line associated bloodstream infections (CLABSI). International guidelines, based on evidence based recommendations for the prevention of CLABSI, have been published. However, the guidelines are largely based on adult studies. Great variability in CLABSI infection rates among NICUs have been reported, probably because of differences in adherence to CLABSI prevention guidelines. The purpose of this study is to describe the variability of current prevention practices among Belgian NICUs and to identify areas for improvement and for further research.
Methodology & Theoretical Orientation: We surveyed NICU staff reporting to the National healthcare associated infection working group (NeoKISS) to assess strategies used to prevent CLABSI and also hygiene quality audit performance the NICUs. Each item was scored in accordance to the level of evidence of the 3 reference guidelines (SHEA/ EPIC3/ CDC).
Findings: Fourteen (73%) out of 19 NICUs did respond to the survey. The compliance to the CLABSI prevention items were 64%, 47% and 50% for the insertion items, maintenance items and hygiene quality items respectively. The variability between units was considerably with a SD of 8, 13 and 22 for insertion items, maintenance items and hygiene quality items.
Conclusion & Significance: The overall compliance to international guidelines for the prevention of CLABSI is low (57%) in Belgium. Especially, during maintenance of the central line there is room for improvement in infection prevention. Our survey underscores the need for standardization of central line care in Belgium and was able to define priorities for education.
Keynote Forum
Mohammad Monir Hossain
Dhaka Shishu Children Hospital, Bangladesh
Keynote: Management of pulmonary hemorrhage in neonatal infant
Biography:
Mohammad Monir Hossain is currently working as Professor of Neonatal Medicine, NICU & Critical Care of Paediatrics at the Bangladesh Institute of Child Health (BICH) & Dhaka Shishu (Children) Hospital. He received his PhD from the University of Dhaka for his research work on neonate receiving intensive care in 2006. After his graduation (MBBS) in 1987, he completed Doctor of Medicine in Paediatrics (MD) in 1997. He became fellow (FCPS) of Bangladesh College of Physicians & Surgeons in 1999 and Royal College of Physicians and Surgeons of Glasgow (FRCP Glasg) in 2009, Royal College of Physicians of Edinburgh (FRCP Edin) in the same year and Royal College of Paediatric & Child Health (FRCPCH), UK in 2010. Since 2001 he has been serving as Assistant Professor, Associate Professor and Professor at Bangladesh Institute of Child Health & Dhaka Shishu (Children) Hospital. Professor Hossain has authored several publications in various journals and books. His publications reflect his research interests in critical care in neonatology. He was the Executive Editor of Bangladesh Journal of Child Health (BJCH).
Abstract:
Pulmonary hemorrhage (PH) is an acute, catastrophic event characterized by discharge of bloody fluid from the upper respiratory tract or the endotracheal tube. The hematocrit of the hemorrhagic fluid is often 15 to 20 percentage points below the venous hematocrit. The incidence of PH is 1 to 12 per 1,000 live births. PH occurs most commonly in the first few days after birth. Mortality rates as high as 50% have been reported. Prematurity is the factor most commonly associated with PH; other associated factors are those that predispose to perinatal asphyxia or bleeding disorders, including toxemia of pregnancy, maternal cocaine use, erythroblastosis fetalis, breech delivery, hypothermia, infection, Respiratory Distress Syndrome, administration of exogenous surfactant (in some studies) and ECMO. It is postulated that the infant suffers an asphyxial insult with resultant myocardial failure; this increases pulmonary microvascular pressure resulting in pulmonary edema. Subsequently, there is frank bleeding into the pulmonary interstitial and alveolar spaces. The typical presentation of the infant with PH is a premature infant who suddenly presents with frothy pink-tinged secretions from an ET. Over the next minutes to hours, the infant often requires increased ventilatory support and has increased work of breathing. As increasing amounts of blood are suctioned from the ET, PCO2 starts to rise, as does the need for oxygen. If the PH continues, the infant will develop apnea, generalized pallor, become cyanotic, with concomitant bradycardia and a drop in blood pressure. Chest radiography results are nonspecific. Based on severity and timing of the PH, the chest radiograph may have fluffy opacities, focal ground-glass opacities, or appear as a complete “white out” if the PH is massive. The immediate treatment of PH should include tracheal suction to ensure that blood clots have not obstructed the ET. The FiO2 should be increased as guided by the oxygen saturation of the infant. The standard therapy is to raise the positive end-expiratory pressure (PEEP) to 6 to 8 cm H2O. To decrease PH, the mean airway pressure should be increased in an attempt to reverse or slow down hemorrhagic pulmonary edema. In some cases, high-frequency oscillatory ventilation may be needed to increase the mean airway pressure. Endotracheal or nebulized epinephrine has been used in the treatment of PH because of its vasoconstrictive and inotropic effects. Immediate radiography of the chest should be obtained. Once the hemorrhage has resolved, the chest radiograph will show improvement within 24 to 48 hours. Because the radiographic appearance of PH is difficult to distinguish from pneumonia, therapy often includes antibiotics until infection is ruled out. An echocardiograph should be done to rule out left to right shunting through a PDA. In this setting, surgical treatment for PDA may be safer than medical treatment because the latter may exacerbate bleeding. Phytonadione (vitamin K) should be given to correct prothrombinemia. Based on an estimate of the volume of blood lost, packed red blood cells and platelets should be given after a complete blood count, prothrombin time, activated partial thromboplastin time, D-dimers, and fibrinogen are obtained. The administration of recombinant factor VII should be considered. Activated recombinant factor VII (rFVIIa) has been successfully used to treat severe PH refractory to conventional ventilator management in very low birth weight infants. Surfactant has also been used in the treatment of PH. with significant improvement in oxygenation index and no deterioration. Hemocoagulase has been reported as a new effective treatment for PH. by converting prothrombin to thrombin and fibrinogen to fibrin. Hence, it decreases bleeding time and enhances coagulation at sites of bleeding. The mainstay of treatment includes ventilation and vigorous resuscitation of a shocked and critically ill infant.
Keynote Forum
Shailesh Adhikary
BP Koirala Institute of Health Sciences, Nepal
Keynote: Perforating injury of abdomen, thorax and neck in a child with a bamboo stick
Biography:
Shailesh Adhikary is a Professor of GI and a Laparoscopic Surgeon currently serving as a Clinical Teacher at the Community Based Medical College in Eastern Nepal and has published 57 papers, columns at national and international journals and social news magazines and is also contributing as an Editorial Board Member for Asian Journal of Surgery. He is also the Governor of Endoscopic Laparoscopic Surgeons of Asia (ELSA) and is working to promote the Minimal Access Surgery across Nepal and in Asia.
Abstract:
Penetrating or perforating abdominal or chest injuries are very uncommon in the pediatric age group and are associated with a high mortality. Impalement injuries are consequence of penetration by elongated, usually fixed objects through the body. The case study begins with a 10-year young child suffered from a penetrating injury to the left iliac fossa, when he had fallen from a coconut tree on to the sharp bamboo fence. The bamboo stick penetrated the abdominal wall, perforated the jejunal loops at two sites along with the fundus of stomach, the left diaphragm, upper lobe of the left lung and the bevelled end of the bamboo had exited at the neck after tearing apart the neck muscles and skin sweeping along with it, few scattered pieces of jejunal tissues which were seen lying alongside. He was brought to the hospital 5 hours after the accident. On arrival he was in agony, dehydrated and scored 15/15 on Glasgow scale, remained hemodynamically stable, saturation of 93% with oxygen supplement. On examination a 75x5cm bamboo stick was in situ, which entered 4cm medial to the left anterior superior iliac spine and exited 3cm above the skin at the posterior triangle of neck. Operation imaging modalities were followed by exploration via the left thoracoabdominal incision. The thorax, mediastinum and neck were assessed in the beginning and after confirming that no great vessels were at risk, the foreign body was then carefully removed. The perforated stomach, jejunum and diaphragm were repaired. The upper lobe of lung had to be resected. An abdominal drain and two intercostal drains were placed. The total operative time was 3.30 hours and the child were managed in intensive care for 4 days and was finally discharged after two weeks. A rare penetrating injury with damage to the multiple organs could be managed successfully possibly because of a teamwork: and also, due to some sensible move by the villagers as they did not try to fiddle around with the foreign body.
- Pediatrics | Neonatology | Neonatal Cardiology & Neonatal Resuscitation | Neonatal Medications & Vaccines
Location: RED CEDAR BALLROOM C
Chair
Rita Verma Prasad
Nassau University Medical Center, USA
Co-Chair
Brenda Ivette Frias Madrid
Instituto Nacional de Perinatología, Mexico
Session Introduction
Hanaa Ibrahim Rady
Cairo University, Egypt
Title: Magnesium sulphate as an adjuvant therapy in critically ill infants and children presenting with wheezy chest
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.
Chantal Lau
Baylor College of Medicine, USA
Title: Evidence-based Interventions to enhance preterm infants’ oral feeding performance
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.
Shakuntala Chhabra
Mahatma Gandhi Institute of Medical Sciences, India
Title: Preconception / Periconception literacy, care for healthy newborn with safe future
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.
Xiang-Peng Liao
Centre Hospitalier Universitaire de Sherbrooke Research Centre, Canada
Title: Advanced neonatal medicine in China: A national baseline database
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.
Sharada H Gowda
Baylor College of Medicine, USA
Title: Dexmedetomidine use in neonates undergoing norwood procedure does not limit narcotic exposure
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.
Venkat Reddy Kallem
Fernandez Hospital, India
Title: Incidence and predictors of extrauterine growth restriction in preterm neonates
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.