Day 1 :
Jaipur Golden Hospital, India
Keynote: To evaluate the effi cacy of probiotics in reducing the incidence and severity of necrotizing enterocolitis in very low birth weight infants
Time : 09:40-10:20
Sandeeep Rawal is MD in (Paediatrics), Fellowship in Neonatology (IAP). Presently he is working as a Senior Consultant in the Department of Neonatology and Paediatrics, Jaipur Golden Hospital, Delhi, India. He is In-charge of Neonatal fellowship program of the hospital run under the aegis of Indian Academy of Paediatrics and National Neonatology Forum. He is also a faculty of Post-graduate teaching program (DNB) of National Board of Examinations under Ministry of Health, India. He is a National trainer of Advanced NRP course in India and has conducted many workshops. He has been the Faculty to many conferences and CMEs. His interests include Pain Management in NICU, Asepsis in NICU, KMC and Nutrition in Preterm. He has been guide to many post-graduates dissertations in neonatology (central lines and nosocomial sepsis, role of probiotics in preventing NEC, transcutaneous bilirubinometry, late preterm, and kangaroo mother care). He has many publications to his credit in esteemed Journals of Paediatrics and Neonatology.
Aim: To evaluate the efficacy of probiotics in reducing the incidence and severity of necrotizing enterocolitis in very low birth weight infants.
Study: Prospective double blind randomized controlled trial.
Setting: NICU of Jaipur Golden Hospital, Rohini, Delhi.
Methods: A prospective, double blind randomized controlled study was conducted in infants with gestational age ≤34 weeks and birth weight ≤1500 g. The study group received probiotics supplementation, and the control group did not. The primary outcomes were death or NEC (Bell’s stage ≥2), and secondary outcomes were feeding intolerance and clinical or culture proven sepsis.
Results: The results indicated that total of 151 infants were enrolled in the study, 76 in the study group and 75 in the control group. There was significant difference in the incidence of NEC (0.0% vs 6.7%; p=0.028) and feeding intolerance (22.4% vs. 44.0%, 95%; p=0.005) between the groups. However, the incidence of death and clinical or culture proven sepsis were non-significant between the groups.
Conclusions: Probiotic mixture containing the commonly used probiotics Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum, along with Saccharomyces boulardii; at the dose of 2.5x109 live cells; reduce the incidence of necrotizing enterocolitis and feed intolerance in very low birth weight infants.
Emory University School of Medicine, Georgia
Eva Lee is Virginia C. and Joseph C. Mello Chair and Professor in the School of Industrial and Systems Engineering, and Director of the Center for Operations Research in Medicine and HealthCare, a center established through funds from the National Science Foundation and the Whitaker Foundation. She is a Distinguished Scholar in Health Systems, Health System Institute at Georgia Tech and Emory University School of Medicine. She is also the Co-Director of the Center for Health Organization Transformation, an NSF Industry/University Cooperative Research Center. She has made major contributions in advances to business operations transformation, biomedicine and clinical research, emergency response and disaster preparedness, and healthcare operations. Lee has received multiple prestigious analytics and practice excellence awards including INFORMS Franz Edelman award, Daniel H Wagner prize for novel cancer therapeutics, bioterrorism emergency response and mass casualty mitigation, personalized disease management, transforming clinical workflow and patient care, vaccine immunity prediction, and reducing hospital acquired conditions. Dr. Lee is an INFORMS Fellow. She has received patents on innovative medical systems and devices.
Congenital heart defects (CHDs) are the most common birth defect and occur in around 1% of births. They are the most common cause of infant deaths due to birth defects, and survivors often face health issues into adulthood. This project describes the transformation that can happen when advanced analytics and operations research is applied to improve the outcome of CHD surgeries in a coordinated effort involving multiple pediatric heart hospitals. Working with the Pediatric Heart Network (PHN), we devised a customizable model and decision support framework that combines systems modeling, simulation-optimization decision analytics, clustering, and machine learning within a collaborative learning paradigm to help hospitals pinpoint key factors on practice variation, and design clinical practice guidelines (CPGs) for rapid implementation to improve the outcomes of CHD surgeries. The project involved the implementation of an early extubation CPG (removal of the breathing apparatus) for patients in five large pediatric heart hospitals. The post implementation results in all sites were positive; early extubation rates increased from 12% to 67%, the median duration of postoperative (post-op) intubation decreased from 21.2 hours to 4.5 hours, and the length of stay (LOS) for patients in intensive care units decreased from 68.5 hours to 51.0 hours. Overall, the five hospital sites experienced LOS reductions ranging from 12% to 35%, decreased time to oral feeds (37%), and an earlier discontinuation of IV analgesics (37% to 55% depending on drug type). This CPG has since become routine practice. Earlier resumption of normal feeding and reduction in analgesics lessen risks of medical complications. Fewer analgesics reduce risks of cognitive impairment and impaired brain development in children. And shorter mechanical ventilation time and LOS for patients reduce their exposure to critical care therapies and indwelling devices, which subsequently reduce the risk of hospital-acquired infections. The implementation resulted in cost savings of approximately 27%, amounting to $13,500 per surgical procedure, on average. It reduced clinical care cost by 65%, pharmacy costs by 46%, laboratory costs by 44%, and imaging costs by 32%.
- Pediatric Hematology
Location: Holiday Inn Paris � Marne La Vall�e | Paris, France
Eva K Lee
Emory University School of Medicine, Georgia
Introduction: The deficit of iron and anemia iron are considered as major problems of public health and lack of the most common nutritional worldwide due to their high prevalence, effective on growth and development, resistance to infections and linkage to mortality of less than two year babies. In Kosovo, we have no correct statistics on national level for the prevalence of iron deficiency anemia.
The purpose of the study: Was children with iron deficiency anemia and risk factors that may have affected children compared to non-anemic.
The Material & Methods: In this study are included 343 children; 244 children in the anemic study group and 99 children non-anemic in the control group.
Results: The result indicated that the children diagnosed with iron deficiency anemia consist more of male 57.4% compared to female 42.6% but they have no difference in the statistical significance. The age of these children consisted of approximately 19.2 months old (DS±13.7 months). Anemic children consisting of 62.2% were more often living in the city compared to those of controlling group by 52.5%; this difference had important statistical significance. The average mass of the child of birth body of the study group was 2973.5 gr while those of control group were 3405.7 gr. So, the average mass of the child of birth body of the study group (anemic) was significantly lower compared to children of the control group, which difference was statistically significant. Also, when involved in the study the average mass of the child of birth body of anemic children was much lower compared to the children of control group (difference was statistically significant.) Malnutrition was common in anemic children. Hypotrophy of the first instance was 36.5% and the second degree of hypotrophy was 6.6% of children of the study group. More than half (57.8%) of anemic children are fed with formula milk; 10.7% with commercial milk and 15.6% with natural milk or (cow milk). In 7.8% of cases they have mixed commercial with the formula milk or cow's milk and only one case was of commercial milk with cow's milk. Children of anemic group were less fed with meat, spinach, eggs; they were more fed with cereals compared with the children of control group; the difference consisted statistically significant. The average age of onset of artificial nutrition of children in the study group was 5.0 months; to children in the control group was 4.0 months without any statistically significance difference. Anemic children have started complementary food earlier than control group children with significant difference, which means that they are fed less exclusively breastfeeding and complementary feeding has started if not fed properly. Anemic children in the highest structure of anemic had their mothers anemic as well consisted of 47.1% compared with non-anemic children (27.3%) which difference was statistically significant. Bleeding during childbirth in similar structure of anemic children had mothers from (17.6%) and non-anemic from (18.2%) regardless statistically significant. Children of the study group were more often premature (14.3%) compared to those of control group (5.1%). They often resulted with lower body mass when in birth 29.1% versus 7.1%. More often twins 5.7% compared to those of control group 2.0%. To the anemic children we experienced a decrease in the number of erythrocytes, hemoglobin, MCV, hematocrit, and iron which was approximately 6.2 15.8 compared to the control group.
Conclusion: : From our data it is obvious that iron deficiency anemia is very often disease with many risk factors that can cause disease, as are the nutritional status and other diseases.
- Neonatal Intensive Care Unit (NICU)
Location: Holiday Inn Paris � Marne La Vall�e | Paris, France
Amber Valentine is a Speech-Language Pathologist who graduated from the University of Kentucky with her MS in Communication Disorders. She is a Board Certified Specialist in Swallowing and Swallowing Disorders and an International Board Certified Lactation Consultant. She worked for Baptist Health Systems, Inc., for eight years before moving to Florida where she worked for Wolfsons Children’s Hospital and Mayo Florida. She is now backing in Kentucky working for Baptist Health Lexington. She has experience in adults and pediatrics with feeding and swallowing difficulties including: bedside swallow evaluations, Modified Barium Swallow studies, FEES, and pediatric feeding evaluations including NICU. She has provided guest lectures for the University of Kentucky and the University of Louisville on feeding and swallowing topics. She has presented at the hospital level, local, state, national, and international levels on pediatric feeding/swallowing and breastfeeding.
Introduction: Feeding is the most complex tasks we ask of infants, even full term healthy infants. There are often many hurdles that mother baby dyads encounter when learning to successfully breast and/or bottle feed. This talk will discuss the increase in diagnosis of lip and/or tongue tie, the classifications of each, as well as the implications and treatment for successful feeding.
Learner Outcomes: Participants will identify the classes of labial restrictions; participants will identify the classes of lingual restrictions; participants will determine at least two signs and symptoms of oral restrictions on feeding difficulty; participants will discuss treatment options for feeding related to oral restrictions.
Day(s) & or Time(s) you cannot present: Attending all days/times.
Product Disclosure: Presentation will focus on information about a product or service: no.
Product to be presented: none. Presentation will solely focus on this product: no similar products/services will be introduced: no.
Paediatric Hospital Giovanni XXIII, Italy
Milella L has completed his study in Italy and Glasgow in the Field of Neonatal and Paediatric Cardiac Surgery. He is the Chief Department of Anesthesia and Intensive Care Unit (General and Post Cardiac Surgery), [Paediatric Hospital Giovanni XXIII – Bari, Italy].
Blood purification technique is very quickly taking place in septic shock and sepsis treatment. The application of these techniques to neonates and paediatric patients is still very difficult for many reasons: the absence of a dedicated device, the difficult stability of cardio-circulatory function, the difficult management of fluid volumes is not complete in organ development, and not adequate and specific inflammatory response. The increased incidence of complications related to a prolonged duration of blood purification treatment has to be overtaken. Different blood purification techniques as CRRT-CVVH-D, CVVHD, and plasmapheresis are used in sepsis and MOF treatment but the timing of cytokines removal is prolonged and the recirculation of the not removed products delays the cut off of inflammatory response. This is due to the structures of the removal filters that permit a recirculation of cytokines. A new concept was needed to reduce the timing of permanence of cytokines in blood and to avoid the recirculation of mediators in the blood during treatment. We found an optimal option in CytoSorb® device: promising extracorporeal device for cytokine adsorption. We describe the use of CytoSorb® in combination with standard therapy, continuous renal replacement therapy (CRRT) and plasmapheresis in 10 severely ill paediatric patients with multiple organ failures of various aetiologies; The present case series is the first documentation of a set of paediatric and neonatal patients in which a combined therapeutic approach of hemoadsorption and renal replacement therapy showed promising results with regard to hemodynamic stabilization, control of the inflammatory response, improvement in organ functions as well as safety and feasibility. In our experience CytoSorb® allows to eliminate both problems because is structured as an on line direct resinous patch that captures and definitively removes cytokines from blood. Further prospective randomized controlled studies in the paediatric field are necessary to elucidate the full potential of hemoadsorption in this set of patients.
Location: Holiday Inn Paris � Marne La Vallee | Paris, France
National System of Researcher, Mexico
Felipe Javier Uribe Salas has completed his Medicine from Michoacana University of San Nicolas de Hidalgo, he has done his Master’s in Public Health from National Institute of Public Health and also Master’s in Sciences in Epidemiology from National Autonomous University of Mexico. Apart from those he is Doctor in Social Sciences (El Colegio de la Frontera Norte). Currently he is working as a Senior Researcher by El Colegio de la Frontera Norte, National Researcher Level II (National System of Researchers in Mexico). He is also a Member of National Council for Science and Technology, Member of accredited evaluators (CONACYT). He is a Member of the International Organization for Training and Medical Research (IOCIM) and Member of the Mexican Public Health Society (SMSP). He is author of more than 50 indexed articles and Winner of several national research awards. His areas of interest in research: Epidemiology of Infectious Diseases; Population Mobility and Infectious Diseases, Epidemiology of Chronic Diseases.
Introduction: The prevalence of overweight and obesity has increased worldwide. This phenomenon also affects the Mexican population, particularly schooling children. In this context, lack of awareness of excess weight among overweight and obese children is a public health concern that needs to be explored in the Northern border of Mexico.
Methods: A cross-sectional study was carried out including children from third to sixth grades of basic education. Measurements of weight and height were obtained to calculate BMI and its percentiles. The Children’s Body Image Scale (CBIS) was applied to evaluate perceived and ideal BMI comparing against calculated BMI. We also analyze the frequency of accurate perceivers of actual weight and discrepancy of ideal weight against calculated BMI.
Results: The results indicated that we studied 155 children (43.8% were female) with an average of 10.2 years of age. Accuracy prevalence of BMI perceived respect to calculated BMI was 59.4% (weighted Kappa coefficient of 0.30). Discrepancy prevalence of ideal BMI respect to calculated BMI was 44.4%. Comparison of perceived BMI respect to calculated BMI showed an overestimation on low weight category (33%) and sub-estimations in categories of normal weight (12.4%), overweight (85%) and obesity (81.6%). Comparison of ideal BMI respect to calculated BMI showed an absolute overestimation of low weight and underestimations in categories of normal weight, overweight and obesity of 5.6%, 100% and 97.4%, respectively.
Discussion: The results of this work showed consistently an underestimation of children’s body weight, particularly among those classified in categories of overweight and obesity in a demographic context in which the prevalence of both categories was high of 38% in this study.
- Clinical Pediatrics
Location: Holiday Inn Paris � Marne La Vallee | Paris, France
Sohail Daniel is a Medical student in his fourth-year at the School of Clinical Medicine, University of Cambridge. He graduated in 2018 with BA (Hons) degrees in Medical Sciences from the University of Cambridge, specialising in Psychology with Cognitive Neuroscience. He has previously been involved in rodent probabilistic learning studies targeting the mesolimbic dopaminergic system. He is currently also involved in a national study analysing outcomes for patients after abdominal surgery.
Intellectual disability (ID) affects ~1% of children worldwide, with 25-50% of cases thought to result from a monogenetic cause. However, as a result of a nonspecific clinical phenotype, many go years without definitive diagnosis. KAT6A syndrome is a multi-system disorder resulting from a variant form of the KAT6A gene, which codes a Lysine Acetyltransferase protein. It functions to epigenetically regulate the expression patterns of genes involved in development and organogenesis. KAT6A syndrome has been identified as a major cause of ID. There has, in the past few years, been a rapid increase in the number of diagnoses. This is likely due to the heightened use of whole exome sequencing (WES), which is an effective means of diagnosing patients that carry de novo mutations. Despite this, the full extent of the phenotype has not been characterised. We present two individuals with variant forms of the KAT6A gene, who were identified through WES studies. Many of their phenotypic features, although diverse, fit with those reported in other individuals with mutations in the KAT6A gene. These include, but are not limited to: intellectual disability, global developmental delay, microcephaly, craniofacial dysmorphism, oromotor dyspraxia, GI complications, cardiac anomalies, ocular anomalies and abnormal muscle tone. We explore possibilities of how the variant forms of the KAT6A gene produce the clinical phenotype, and why there is such variability in the severity of presentation. A more focussed diagnostic criteria and increased awareness of the syndrome would facilitate more diagnoses, aiding early management, treatment and support.