Day 1 :
Keynote Forum
Matthew G Masiello
University of Massachusetts Memorial-Children’s Medical Center, USA
Keynote: The challenges to the pediatrician as a public health advocate: Reviewing the National Academies of Science, Engineering and Medicine report to prevent bullying through science, policy and practice
Time : 09:30-10:10
Biography:
Matthew G Masiello is a Clinical Professor of Pediatrics at the University of Massachusetts Medical Center, Worcester, Massachusetts. He serves on the Executive Board of the Massachusetts Chapter of the American Academy of Pediatrics. He has completed his MPH at George Washington University School of Public Health and Health Services. He served as an Editor of “A Public Health Approach to Bullying Prevention”, published by The American Public Health Association. He has served on a National Academies of Science Committee to address the biological and psychological effects of peer victimization.
Abstract:
In the United States, there has been a decade’s long emphasis on the importance of the role of the pediatrician from a community health and public health perspective. Yet, recent studies have commented on the diminishing role of the pediatrician in the community. In addition, as we are appreciating the need to have mental health services more available to our child and adolescent population, recent studies have also commented on the lack of comfort by pediatricians in diagnosing and managing these health issues. Presently, there is conversation taking place in the U.S. regarding the need to change the role of the pediatrician from that of hands on clinician at all levels to that of a consultant overseeing the work of clinical ancillary staff as well as coordinating community and practice based health promotion and disease prevention programs. Related to these ongoing challenges is the recent report by the National Academies of Science (NAS) on bullying. The latest evidence based opinion on the state of bullying should be considered. The NAS committee, along with the US and international consultants, called upon to offer opinions, found it difficult to identify evidence based tools or recommendations by pediatricians to address this public health epidemic. The presentation will review key reports related to these observations with specific recommendations to be made. A review of the NAS report will also be included in the presentation.
Keynote Forum
Rajeev Agarwal
Agave Pediatrics, USA
Keynote: Tongue ties and the effects of breastfeeding
Time : 10:10-10:50
Biography:
Rajeev Agarwal has completed his Graduation at All India Institute of Medical Science (AIIMS), in New Delhi, India in 1992. He has completed his Pediatric Residency at the University of Texas Medical Branch at Galveston; and, a Nephrology Fellowship at the University of Florida at Gainesville. In 2005, he opened Agave Pediatrics located in Phoenix, Arizona, which has grown to four locations. Through his years of training, practice and reading, he has developed a passion for supporting the mother baby dyad for breastfeeding, through evaluation and treatment of tongue and lip ties. Over the past 10 years, he has performed more than 10,000 frenectomies. In the field of tongue ties, he is a well pursued motivator, speaker, and teacher. He has developed a complete tongue tie program in his primary pediatric practice, where he has trained many other professionals in this field.
Abstract:
Breast feeding forms the foundation of infant health. Proven beneficial effects of breastfeeding to infant health include: decreased incidence of asthma, allergies, SIDS, Otitis Media and an increase in IQ. For the mother, it reduces the risk of postpartum depression, breast0 and ovarian cancers, hyperlipidemia and hypertension. Alternatives to a mother’s milk have been used for centuries, but current evidence is clear that human milk is uniquely suited for growth and development of our species. Today, medical professionals are not trained to handle breastfeeding issues and often find themselves inadequately trained to support breastfeeding. The American Academy of Pediatrics recommends a minimum of 12 months of breast milk with introduction of complementary foods at 6th month. Additionally, the World Health Organization (WHO) recommends breastfeeding for at least 2 years of age. In the United States, breastfeeding initiation rates are high but continuation to 12 months is uncommon with a rapid early drop off. Early cessation of breastfeeding is often due to pain and discomfort; however later cessation is due to perceived or real inadequate milk supply. Infant oral ties are one of the most common reasons for early discontinuation of breastfeeding. Symptoms linked to tongue ties include pain with breastfeeding, mastitis, decrease in milk production and failure to thrive among other issues, due to dysfunctional milk extraction by the infant. At Agave Pediatrics, we have completed more than 10,000 frenectomy procedures to address these issues with remarkable success! As breastfeeding becomes more prevalent, primary care physicians find themselves faced with additional issues associated with tongue ties and dysfunctional milk extraction. This presentation will help pediatricians learn the history of tongue ties, benefits of the procedure, controversies in treatment, and methods to coordinate care in their communities.
Keynote Forum
Lucia Celesti
Bambino Gesù Children’s Hospital, Italy
Keynote: Patient engagement: teenager’s involvement
Biography:
Lucia Celesti has completed her Degree in Medicine and Surgery at La Sapienza University in 1983 and is a Specialist in Pediatrics and Hygiene. She is the Director of Family Services at Bambino Gesù Children’s Hospital in Rome, Italy. She has published more than 25 papers in reputed journals and three books on children’s rights and relational and social issues in pediatrics.
Abstract:
Due to the increasing importance of patients’ engagement in the healthcare system, it is essential to make patients aware, educated and proactive. The aim of chronic patients’ therapeutic education is to improve patient’s quality of life making patient able to manage by itself the disease’s progressive development and its related complex medical treatments; enhance efficiency of healthcare process in facing chronic patients changing needs; provide doctor-patient and patient-patient relation with a peer-to-peer tool in the healthcare process. A training course led by psychologists, teachers, healthcare operators, communication professionals, chronic patients already trained, with not only scientific but also communicative skills can be useful. The course would be divided into different session: psychology, specific illness, communication strategies, etc. As results, the number of trained patients, decreased hospitalizations, decreased inappropriate requests to doctors, assessment questionnaires filled by participants, assessment questionnaires filled by those who benefit from counselling service, course completed, activation of a help line service, activation of a counselling centre for chronic patients, involvement of chronic trained patients in the wards can be considered. The patient’s therapeutic education represents a useful tool to foster the patient’s involvement in the healthcare process. A chronic patient trained is more conscious and aware about his/her clinic and psychophysical conditions and more able to adapt his/her everyday-needs to disease’s evolution. Therefore, the patient becomes protagonist of his/her healthcare and keen to collaborate with healthcare professionals, social services and his/her community of reference with a peer-to-peer approach.
- Pediatrics Primary Care | Pediatric Infectious Diseases | Pediatric Nutrition | Pediatric Allergy | Breast Feeding | Pediatric Surgery
Location: London A
Chair
Edmund Kessler
Weill Cornell Medical Center, USA
Co-Chair
Geertje Lewin
Lewin ToxConsulting, Germany
Session Introduction
Edmund Kessler
Weill Cornell Medical Center, USA
Title: Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked
Time : 11:50-12:15
Biography:
Edmund Kessler is an attending Pediatric Surgeon at a number of New York City hospitals and is an Associate Clinical Professor of Surgery at Weill Cornell Medical Center. His practice is limited to the surgery of infants, children and adolescents. He has completed his MBBCh in General and Pediatric Surgery training at the University of the Witwatersrand in Johannesburg, South Africa. He was a Visiting Fellow at the Hospital for Sick Children in London. He was a Lecturer in Anatomy and was a Consulting Surgeon and Senior Lecturer in Surgery at the University of the Witwatersrand. He is a Fellow of American College of Surgeons, Royal College of Surgeons (Edinburgh), South African College of Surgeons, International College of Surgeons. He is a Member of British Association of Pediatric Surgeons, South African Pediatric Surgical Association, American Pediatric Surgical Association, and a Surgical Affiliate Member of American Academy of Pediatrics.
Abstract:
Acquired diaphragmatic hernias are a rare occurrence. They can result from blunt, penetrating or inadvertent iatrogenic injury. When overlooked they can potentially be catastrophic. We report a case of iatrogenic diaphragmatic hernia in a six-month old infant presenting with acute respiratory distress as a result of strangulated bowel herniating into the left hemithorax caused from a traumatic chest tube insertion in the neonatal period. To avoid potentially life-threatening complications associated with misplaced chest tubes such as viscus perforation in the future, one might consider using soft pleural catheters using the Seldinger technique, especially in pre-term neonates as well as a general awareness of complications associated with misplaced chest tubes.
Amelie Stritzke
University of Calgary, Canada
Title: Neonatal arterial hypertension: What to do about it?
Time : 12:15-12:40
Biography:
Amelie Stritzke is an Assistant Professor, Clinical Neonatologist and Lecturer in the Cumming School of Medicine at the University of Calgary, Alberta, in Canada. She has completed her Graduation at Johann-Wolfgang-Goethe University in Frankfurt, Germany, and Pediatric Residency in Switzerland (Aarau and Berne). After fellowship and additional pediatric cardiology training in neonatal echocardiography, her primary educational and research interest is in cardiovascular neonatology and perfusion. She is currently involved with investigating perfusion patterns of intestinal blood flow after red blood cell transfusion and impact of maternal biologics on neonatal outcomes, as well as with teaching point of care ultrasound skills to neonatal practitioners.
Abstract:
Statement of the Problem: Extremely preterm infants are at higher risk than their term born peers to be affected by arterial hypertension beyond their stay in the Neonatal Intensive Care Unit (NICU). Modifiable and unmodifiable risk factors together create a phenotype that may contribute to cardiovascular and renal disease much later in life. For the primary care physician providing care after discharge from the NICU, guidance for diagnosis of arterial hypertension, treatment indications, and strategies aimed at improving outcomes are often not clear.
Methods: This is an evidence-based review of the risk factors, prevalence, and definition of arterial hypertension in neonates, particularly those born preterm. It includes state-of-the art renal conservation strategies inside and outside the NICU which may amend further, especially renal insult, in an attempt to improve long-term outcomes.
Findings: Determinants of blood pressure values and their measurement in neonates will be discussed. Implications of developmental origins of adult-cardio-vascular disease in preterm populations and management suggestions will be discussed.
Conclusion & Significance: This evidence-based review aims at giving health care providers a guideline in understanding the often renal impact on the development of neonatal arterial hypertension in this high-risk population. Furthermore, potential foundation of neonatal arterial hypertension in maturational disturbances are laid out, as well as the long-term implications and screening strategies, and especially, the treatment indications in an attempt to mitigate potential damage and improve long-term cardiovascular health.
Stefan Holland-Cunz
University Hospital of Basel, Switzerland
Title: Red flags: Small wounds and catastrophical consequences
Time : 12:40-13:05
Biography:
Stefan Holland-Cunz is Head of the Department of Pediatric Surgery at University Hospital of Basel. He is an expert in Visceral and Neonatal Surgery as well as in Pediatric Trauma Care. New wound therapy concepts are often evaluated and new approaches are developed in the unit and emergency unit at University Hospital of Basel.
Abstract:
Necrotizing fasciitis is a soft tissue infection that can rapidly progress and end lethally if not treated early and radically. With an extremely low prevalence (0.02% of all pediatric in hospital cases), most physicians will probably only see very few cases during their career. Unlike adult patients, the majority of children affected by this disease are healthy individuals. There is no chronic disease and necrotizing fasciitis often arises from minor lesions. We present two cases treated in our clinic within the past year. Our first case of necrotizing fasciitis was a 5 years old Caucasian male patient with a varicella lesion on the back. The second case, a 4 year old Caucasian male patient, presented after an insect bite at the lower limb. Both cases were triggered by a super infection after scratching. Rapid surgical treatment is necessary to reduce morbidity and mortality in cases of necrotizing fasciitis. Due to the rarity of the disease it is often misdiagnosed by physicians. We emphasize the importance of staying alert and to keep necrotizing fasciitis in mind.
Figure: Preoperative findings of necrotizing fasciitis following varicella infection on the back (left) and intraoperative result after the entire necrotic fascia was debrided (right)]
Marco Carotenuto
University of Campania Luigi Vanvitelli, Italy
Title: Mild traumatic brain injury affects sleep macrostructure in children: A polysomnographic study
Time : 14:00-14:25
Biography:
Marco Carotenuto completed his Degree in Medicine and Surgery in 2000 and Specialist degree in Child Adolescent Neuropsychiatry in 2005. In 2008, he completed his Doctorate in Behavioural and Learning Disorders Sciences. From 2008 to 2011, he was a Junior Researcher and from 2011 to 2017, he was a Senior Researcher in Child and Adolescent Neuropsychiatry at Università della Campania Luigi Vanvitelli. In December 2017, he became Associate Professor at Università della Campania Luigi Vanvitelli. His main field of interest and research includes: “Child neurology, pediatric sleep disorders, polysomnography, pediatric primary headaches, and pediatric rehabilitation”.
Abstract:
Background & Aim: Traumatic Brain Injury (TBI) may be considered as one of the main causes for childhood morbidity and mortality. TBI increases the risk of psycho-social problems, intellectual disability and cognitive impairment, but the most common consequence of TBI is sleep troubles. Aim of study is to assess polysomnographic findings in pediatric patients with TBI.
Materials & Methods: 37 children with TBI (mean age 9.69+/-1.81, 20 males and 17 females) were included in the study. The control group was composed by 37 children (mean age 9.34+/-1.78, 19 M and 18 F). Exclusion criteria were: psychiatric and neurological disorders, intellectual disability (IQ≤70) and psychoactive drug administration. All children in both group filled out a full overnight polysomnography (PSG). Statistical analysis t-student’s analysis was used to verify the mean differences between groups for PSG parameters. Statistical software package (STATISTICA 8.0, StatSoft Inc.) was used. P value <0.05 were considered as statistically significant.
Results: Children with TIB showed a statistically significant (p<0,001) reduction for TIB (Time in Bed) min, SPT (Sleep Period Time) min, TST (Total Sleep Time)-min, SE (Sleep Efficiency) % , N2 min, N3 min, REM min, N3 spt, REM spt , N2 tst, N3 tst, REM spt and a statistically significant increase in parameters such as SOL (Sleep Latency) min, SS-h (Stage Shifts/h), AWN (awakenings)-h, and WASO (Wakefulness After Sleep Onset) min, N1 min, N1 spt, N1 tst.
Conclusions: Our study shows that pediatric TBI may alter sleep architecture consistently, although further studies are needed. The audience will take away from presentation are: importance of polysomnographic evaluation for pediatric traumatic brain injury (TBI); TBI may affect the sleep macrostructure consistently and; sleep disorders in pediatric TBI may be considered as a mandatory sign to consider and evaluate in TBI management.
Geertje Lewin
Lewin ToxConsulting, Germany
Title: The developing lung: morphological and functional features in the context of gas exchange, immune function, metabolic properties and exogenous noxae
Time : 14:25-14:50
Biography:
Geertje Lewin has completed her medical degree in Biology at US and Germany with an ongoing passion for physiology and toxicology. After working as an Eco-toxicologist, she went back into academia to complete her PhD in the Toxicology department of University Hospital Munster in 2005. In 2007, at the Fraunhofer Institute for Toxicology and Experimental Medicine, she entered the world of reproductive toxicology as a Study Director and Risk Assessor. Starting in 2014, she runs her own consulting company and recently joined Preclinical Science as a senior partner, providing advice in the fields of Teratology, Pre-Clinical Toxicology and Risk management.
Abstract:
The lung is so much more than simply our organ for gas exchange. Its development starts early in embryogenesis as a derivative of the foregut and a multitude of functional aspects matures over time, including immunological and metabolic properties. At every step of development, exogenous noxae and factors derived from maternal-fetal interaction can interfere and have long-lasting consequences. An excursus in developmental pulmonary morphology along with functional maturational aspects is given. Â The adaptations during child birth and growth and expansion well into childhood are discussed. An emphasis is laid upon malformations, congenital diseases, drug influences and toxic impact during pre- and postnatal development. Since pediatric drug development is an ongoing hot topic but also a battle due to missing data in science and industry, testing strategies and data on comparative organ maturation in human babies and juvenile experimental animals are presented
Marta Carballal Mariño
Galician Association of Primary Care Pediatrics
Title: Prevalence of neurodevelopmental, behavioral and learning disorders in pediatric primary care
Time : 14:50-15:15
Biography:
Marta Carballal Mariño has her expertise in Primary Care Pediatrics in A Coruña, Spain. Psychiatric workshop of the Primary Care Pediatrics Galician Association (AGAPap) in Spain has the aim to improve knowledge about these disorders and to give primary care pediatricians skills in diagnosis and treatment of these conditions, and in this group is formed by two psychiatrics and nine primary care pediatricians. This study was presented as an oral communication at the 67th Congress of the Sociedad Galega de Pediatría, November 12, 2016, Santiago de Compostela, Spain. It was also presented as an oral communication at the 65th Congress of the Asociación Española de Pediatría, June 1-3, 2017, Santiago de Compostela, Spain, and awarded the prize to the best oral communication of the AEPap. Another relationated publication this year has been: Ageitos AG, Maseda MJD, Villaverde AB, González BP and Mariño MC. Attention Deficit Disorder with Developmental Coordination Disorder: A Subgroup of Clinical and Therapeutic Importance. SM J Schizophr Res. 2018; 1(1): 1004.
Abstract:
Objectives: To determine the prevalence of psychiatric disorders in primary care pediatrics in Atlantic Galicia.
Methods: An observational, descriptive, cross-sectional prevalence study was carried out in 9 outpatient clinics in A Coruña and Pontevedra; Spain, with a population of 8293 children between September and November 2015. A total of 1286 randomly selected patients from 0 to 14 years of age were included. From the medical history was registered: age, sex, psychiatric diagnosis established by DSM-IV-TR criteria in its five axes, professionals who participated in the diagnosis and treatment of the process and what type of treatment was received. Authorization was obtained from the Research Ethics Committee of Galicia number 2015/427.
Results: 148 of 1286 patients presented psychiatric pathology (11.5% IC 95% 9.73-13.29), 68% male. Between 0 and 5 years, the prevalence was 4.5%; between 6 y and 10 y, 18.5% and between 11 y and 14 y 22%. Symptoms lasted a median of 25 months. The most frequent pathologies in 1286 patients were ADHD (5.36%), language disorders (3.42%), learning disorders (3.26%), anxiety-depressive disorders (2.4%) and behavior disorders (1.87%). Of the 148 cases, 47% had comorbidity with another mental disorder. Most of them required attention by multiple social, health and educational professionals; 33% received psychopharmacological treatment.
Conclusions: The prevalence of psychiatric disorders in pediatric primary care is frequent, chronic and complex, increases with age and requires many health, educational and social resources.
Rise Consolação Iuata Costa Rank
UNIRG University Center, Brazil
Title: Infant oral health related to frequency in a public early preventive dental care
Time : 15:15-15:40
Biography:
Rise Consolação Iuata Costa Rank holds a Bachelor degree in Dentistry from University of Uberaba in 1988; Master's degree in Pediatric Dentistry from the São Leopoldo Mandic Dentistry Center in 2004; Specialization in Ortodontia from UNINGÁ (TO); Doctorate in Pediatric Dentistry from Universidade Cruzeiro do Sul. She is currently a titular Teacher II of Pediatric Dentistry at UNIRG University Center and Regent Teacher of Pediatric Dentistry at CEULP/ULBRA. She is Coordinator of the Research Ethics Committee (CEP) at UNIRG University Center, and Coordinator of the postgraduate course in Pediatric Dentistry of CEULP/ULBRA Palmas TO. She has experience in Dentistry, with emphasis on Pediatric Dentistry, acting mainly in the following subjects: promotion in oral health, interceptive orthopedics, dentistry for baby, behaviour and child anxiety.
Abstract:
In order to evaluate children’s oral health related to their frequency in a public early preventive dental care, this research was a retrospective cohort study with the purpose to evaluate 252 children, between 36 and 60 months of age, both sexes, in Gurupi city, in the Legal Amazon region, Brazil. Three groups were created for classification of the participants: G1 - effective participants since their birth; G2-children who have stopped participating for more than 24 months and G3 (group control)-children who have never attended a prevention program. The development of the evaluation occurred within two stages: interviewing mothers and children that have received a caries, gingivitis and occlusion clinical examination. The WHO index of decayed for primary dentition (deft) presented different data in the groups, G1 was 0.05, G2 was 1.96 and G3 was 3.30. Moreover, oral diseases were statistically more common in children that have never participated of an oral health program (p=0.025). As said by 54% of the mothers who left the program, the main reason was the forgetfulness of the appointment. In addition, the ruled children who always appear for the appointment have better results comparing to those who dropped out or never attended, regarding caries, gingivitis and malocclusion.
Omaima El Tahir
VU University Medical Center, Netherlands
Title: Integrating host genetic variants in clinical prediction rule for hearing loss after childhood bacterial meningitis: a model renewing study
Time : 16:00-16:25
Biography:
Omaima El Tahir has completed her Graduation in Biomedical Sciences and a Master’s degree in Medicine. She has her expertise in the role of host genetic variants in susceptibility, severity and outcome of childhood bacterial meningitis, aiming to create prediction tools for complications of bacterial meningitis integrating both clinical and genetic biomarkers because it is still a life-threatening infectious disease. She also aims to provide more insight into the possible very long-term sequelae which could have a significant impact on subsequent health state of childhood BM survivors during young adult life.
Abstract:
Statement of the Problem: Sensorineural hearing loss is the most common severe sequela in survivors of childhood bacterial meningitis. In the past, we developed a validated prediction model to identify children at risk for post-meningitis hearing loss based on clinical factors. As genetic variation in host immune response genes is also associated with susceptibility to and severity of bacterial meningitis, the purpose of this study is to determine host genetic risk factors to improve the performance of the prediction model.
Methodology & Theoretical Orientation: The generated data of 471 Dutch Caucasian survivors of childhood bacterial meningitis genotyped for four single nucleotide polymorphisms (SNPs) in three different genes involved in pathogen recognition and inflammation were used to improve the prediction model. Genetic data were included during model construction and performance of the model was compared to the original model by likelihood ratio tests and the area under the curve (AUC) of the receiver operating characteristic curves.
Findings: Addition of genetic predictors significantly improved the performance of the new model compared to the original clinical prediction rule (increase of AUC from 0.85(95% CI 0.78-0.91) to 0.91 (95% CI 0.84-0.97). Independent predictors for hearing loss were S. pneumoniae, presence of ataxia during illness, CSF glucose level≤0.6 mmol/L, duration of symptoms before admission >2 days, TLR4+896 A>G and TLR9-1237 T>C.
Conclusion & Significance: Including host genetic factors during model construction results in a significantly improved prediction model for post-meningitis hearing loss in children. Prediction of outcome using host genetic risk factors and clinical variables may contribute to better understanding, timely intervention and thereby appropriate follow-up of children after bacterial meningitis. Future studies should focus on additional value of other SNPS and investigate SNP combinations (SNP traits) in larger cohorts but also assess applicability of the model.
Benslimane Hammou
Children Hospital of Oran, Algeria
Title: Persistent Mullerian duct syndrome repair
Time : 16:25-16:50
Biography:
Benslimane Hammou has completed his MD from Oran School of Medicine. Currently, he works as a Pediatric Surgeon at Children Hospital of Oran, Algeria, in Pediatric Urology department. He published many of the research articles which are related to urethral problems in children.
Abstract:
Introduction: Disorders of Sex Development (DSD) is affecting 1 in 10,000 births. Current management is very heterogeneous because of the low volume of patients for Persistent Mullerian duct syndrome. The persistence syndrome of Mullerian derivatives (PMDS) is a rare form of abnormalities of sex development. The persistence of Mullerian derivatives can be seen as Persistent Mullerian duct syndrome (PMDS): intraoperative diagnosis in case of cure of a hernia in a boy normally virilized with the discovery of a fallopian duct or a uterus when opening the hernia sac during a laparoscopy, the treatment of a nonpalpable testicle. The treatment is surgical and some author recommends dissection to separate the vas mullerian duct, orchidopexy and mullerian duct excision. This treatment is done by laparoscopy and is consist of a longitudinal section of the uterus and the cervix to allow lowering each testicle by an internal pathway within the umbilical artery and preserving the testicular vasculature.
Patients & Methods: Four patients admitted in our department of pediatric urology for Persistent Mullerian duct syndrome from 2015-2017.
Results: One case diagnosis of PMDS either inguinal hernia repair, one case either urethrocystoscopy for utero hydronephrosis bilateral, one non palpable testis in two cases.
Conclusion: Laparoscopy is best way for PMDS diagnosis. Division of Mullerian duct is a safe way to do orchidopexy without damage of the vas.