17 ^th Annual Congress on Pediatrics & Neonatology August 13-14, 2018 Osaka, Japan

Biography:

Xiaoli Pang obtained her B.M Diploma in Dec 1982 from the Faculty of Medicine, South-East University, Nanjing, China and completed her PhD in 2000 from the University of Tampere, Finland. She is a Professor in the Department of Laboratory Medicine and Pathology University of Alberta, and a Principal Investigator in Li Ka Shing Institute of Virology, and a Program Leader in Provincial Lab for Public Health, Alberta, Canada. She has held numerous research grants and published approximately 90 peer review papers and book charters.

Abstract:

Acute gastroenteritis (AGE) is a very common childhood condition. Current pathogen-specifi c disease burden may be inaccurate due to bias introduced by diffi culties in obtaining stool samples, the low sensitivity of classic diagnostic assays and the inability of laboratories to conduct testing in vomiting-only cases. Th e Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) conducted a prospective study to detect enteropathogens causing diarrhea and/or vomiting in Albertan children using enhanced specimen collection and advanced diagnostic assays. Children under 18 years of age with AGE were recruited through two pediatric Emergency Departments (ED) and a telephone Health Advice Service (HLA). Rectal swabs and stool samples were collected and tested for 5 viruses, 9 bacteria and 3 parasites using enteric bacteria culture assays, an in-house RT-qPCR gastroenteritis virus panel and the Luminex xTAG GPP. 2,427 children with AGE were enrolled in the EDs and 647 were enrolled via HLA from Dec 2014 to Jan 2018. 72.9% (n=2,199) of the 3,018 symptomatic patients tested positive for ≥ 1 enteropathogen. Norovirus was the most commonly detected pathogen (n=807, 26.7%), followed by adenovirus (n=563, 18.7%) and rotavirus (n=507, 16.8%). Sapovirus (n=297, 9.8%) and astrovirus (n=106, 3.5%) were less prevalent. Clostridium diffi cile was detected in 14.4% (n=436) of AGE cases. Excluding C. diffi cile, other enteric bacteria and parasites were detected in 5.9% (n=176) and 16 (0.5%) patients, respectively. Th is study provides a better understanding of the relative proportion of enteropathogens in children with AGE.

Biography:

Ajay Desai DCH, DNB(Paed), MRCPCH, FRCPCH is a consultant in paediatric intensive care medicine at Royal Brompton Hospital in London, United Kingdom. He is the lead for the paediatric Extracorporeal Membrane Oxygenation (ECMO) programme, with a special interest in Extracorporeal Cardiopulmonary Resuscitation (ECPR). He has completed his postgraduate paediatric training in Mumbai, India. He gained further experience in paediatric intensive care and paediatric cardiology in London tertiary centres prior to his appointment as a consultant in 2010. And he is the RCPCH College Tutor, and Co-Chair for Science and Education Committee in Paediatric Intensive Care Society UK. He is also a faculty member for the International Pediatric Simulation Society (IPSS) – Education Subgroup. And research interests are ECPR – factors affecting morbidity and mortality. Impact of Down’s syndrome status on early intensive care outcomes in children following Complete Atrioventricular Septal Defect (CAVSD) repair

Abstract:

Background and Aims: Blood and blood products are an expensive and precious resource. Liberal use of blood and blood product use in ECMO patients does not improve survival rates. We hypothesised that increased sampling leads to unnecessary use of blood products in ecmo patients. We audited local clinical practice changes in blood sampling and blood-product transfusions aft er introduction of ECMO pathway and update of anti-coagulation guidelines.

Methods: We compared frequency of blood sampling and use of blood/blood products pre-Jan 2016 (Group 1, n=13) and post Jan 2016 (Group 2, n=13). Key changes introduced in Jan 2016 included a. Reduction in blood sampling frequency - 4-6 hourly to 2/day; b. No routine blood cultures during ECMO; c. ACT monitoring 1hrly to 2-4hrly when stable; d. no routine antithrombin III measurements. Th reshold for blood transfusion remained as per PICU protocol. Additional sampling only if clinically indicated. We evaluated the number of donor exposures in each group and measured cost efficiency.

Results: Th ere was signifi cant reduction in the number of blood samples in group 1. Th ere was signifi cant reduction in the use of blood/ blood products in group 2. Patients in Group 1 were exposed to signifi cantly increased number of donors. Cost implications were signifi cantly higher in Group 1 compared to Group 2. 3/11(28%) in Group 1 and 9/13(69%) in Group 2 survived PICU discharge. However, this audit was not aimed at evaluating factors for mortality in ECMO patients.

Conclusion: It is feasible to rationalise and reduce the use of blood and blood products and achieve good survival outcomes in paediatric ECMO patients.

References: 1. Murphy DA et al. Extracorporeal Membrane Oxygenation - Haemostatic complications, Tranfus Med Rev (2015). 2. Chalwin RP, Tiruvoipati R, Peek GJ. Fatal Th rombosis with activated factor VII in a paediatric patient on extracorporeal membrane oxygenation. Eur J cardiothoracic Surg 2008;34: 685-6.

Biography:

Nikole Gase is working as a Research Scholar from University of Texas Medical Branch. Her research experience includes various programs, contributions and participation in different countries for diverse fi elds of study. Her research interests as a Research Scholar refl ect in his/her wide range of publications in various national and international journals.

Abstract:

Background: Hypothermia is a major cause of neonatal mortality, accounting for 18-42% of annual global neonatal death. Th is can be linked to higher body surface area to body mass ratio of infants causing decreased ability to insulate body heat. Conventional methods to prevent neonatal hypothermia in the hospital includes blanket bundling. The purpose of this analysis was to evaluate the eff ectiveness of plastic wraps compared to standard blankets in preventing neonatal hypothermia aft er birth. 

Methods: Th e PubMed, Ovid (Medline), and Research Gate databases were used to begin research into the clinical question. Online fi lters set when searching articles included; full text available, English language, and infant/newborn subjects. Terms used in search included “Body temperature”, “Infant”, “Delivery”, “Neonatal”, “Th ermoregulation”, “Hypothermia”, and/or “Polyethylene”. Research articles with titles pertinent to the clinical question were initially collected, reviewed in detail, and then selectively omitted if inapplicable to the research question. Studies omitted include; meta-analysis designs, systematic review designs, or studies whose comparison did not match the clinical question (i.e. comparing neonates with plastic wrap technique vs neonates without any warming technique or comparing two diff erent plastic materials). Seventeen articles were initially selected based on search criteria, and ten were ultimately chosen based on relevant content.

Results: A meta-analysis using Biostat 2.0 soft ware was conducted on 9 of the 10 reviewed studies using intervention and control mean and P values. Th e article by Smith, J. 2013 was excluded due to a lack of available study metrics required for analysis. Th e results of the meta-analysis revealed a mean body temperature of +0.533 C in the plastic wrap intervention group, with a 95% CI 0.410-0.657; P=<.001. All included studies showed subjects’ body temperature remained higher when cared for using plastic wraps and, when assessed, required less aggressive radiant and thermal warming. Additional metrics observed within the reviewed studies showed subjects who were wrapped in plastic had a higher NICU admission temperatures, required less aggressive resuscitative eff orts, and had lower mortality rates.

Conclusion: Although conventional methods to prevent neonatal hypothermia focus on blanket bundling, the results of this meta-analysis reveal adequate evidence showing the superiority of plastic wrap intervention in increasing and/or maintaining higher body temperatures in neonates. By maintaining these higher body temperatures, this suggests plastic wraps play a key role in also reducing the rates of neonatal hypothermia. In addition, because the onset of hypothermia is a major cause of neonatal mortality, one should also expect mortality rates to decline. Incorporating the use of plastic wraps into thermoregulation guidelines across health care facilities should be considered as part of standard of care. However, further research may need to be conducted to determine a precise protocol that would provide the most overall benefi t.

Biography:

Faisal Ashour has completed his bachelor’s degree in Modeling, Simulation, and Visualization Engineering in 2015 from Old Dominion University, USA along with an associate degree in Electrical Engineering and Engineering Management. He gained his fellowship in Medical Simulation from INCASL in 2016. He joined the Ministry of National Guard Health Affairs-King Saud bin Abdulaziz University for Health Sciences-Jeddah in 2015 as a military and medical simulation engineer. The Personal Investigator for this research is Dr. Suliman Al-Ghamdi, MD, FRCPC. He is a Radiation Oncologist, and the head of Radiation Oncology at Princess Noorah Oncology Center. Dr. Suliman is also the deputy chairman of Princess Noorah Oncology Center and head of King Abdullah International Medical Research Center Jeddah (KAIMRC-J)

Abstract:

VR is a three-dimensional (3D) computer-generated environment that enables the user to explore and interact within a diff erent environmental perspective. It could be in the form of a realistic-artifi cial environment or a 3D imaging that is presented to the user as a real atmosphere with made-up information. Th e VR has-been considered as a non-pharmacologic form of analgesia through exerting attention processes on the body’s intricate pain system. It does so through profoundly immersing the body and mind by delivering enough sensory information to the extent where it suspense any disbelief that one is in a virtual environment. Th e aim of the study is to eliminate the General Anaesthesia (GA) procedure used on paediatric oncology patients undergoing multiple fractions of Radiotherapy. We aimed to utilise the VR technology as a replacement for the GA. Typically, the radiotherapy session under GA takes around 30 minutes from the machine time and that session can be repeated daily for several weeks. As a result, VR Technology was an excellent alternative in most of the patients treated with radiotherapy for non-Head/Brain Tumours. Th ere were signifi cant reductions on the number of the GA sessions. Th at reductions have a great impact on reducing side eff ect of GA and save more time on the Radiotherapy machine that can be used to treat more patients.

Biography:

Jill Blitz has been a Physical Therapist for 17 years, with the last 15 providing service at Children’s Hospital Los Angeles Division of Pediatric Medicine outpatient and rheumatology clinics. Her research has focused on exercise in adolescents with rheumatologic involvement, which has led her to speak at multiple national and community conferences, including the American College of Rheumatology Scientifi c Meeting and the APTA Combined Sections Meeting. She has also taught a continuing education course on physical therapy for children with rheumatic diagnoses. One of her many goals include fi nding ways to get kids of all abilities to be more active.

Abstract:

To evaluate the impact of pedometer use on the Physical Activity (PA) and Functional Walking Capacity (FWC) of adolescents with Juvenile Idiopathic Arthritis (JIA) and Lower Extremity (LE) involvement. Twenty-seven adolescents, ages 11-19 years with JIA and LE involvement participated in the 3-phase pedometer study that introduced the use of a pedometer and an education seminar at 6 weeks. Measurements were taken at the baseline fi rst visit and at weeks 6, 12 and 20. Th e primary outcome measure was the 6-minute walk test (6MWT). Th irteen completed the study. Six-minute walk distance (6MWD) signifi cantly increased from baseline (458.0±70.8 m) to the end of phase 1(501.4 ±59.8 m) (p = 0.035), prior to receiving the pedometer; and from baseline to the end of study (p=0.0037). No signifi cant changes in 6MWD were found between weeks 6 and 12 (intervention) (p=0.77) or between weeks 12 and 20 (follow through phase)(p=0.27). In adolescents with LE JIA, consistent guidance and support by rheumatology professionals appears to positively infl uence PA and measures of FWC as seen through improved 6MWD. Th ere was insuffi cient evidence to show that pedometers further increased FWC or PA.

Biography:

Sonam Chophel is currently working in NICU as a staff nurse at JDWNRH, Thimphu. After completing diploma in General nursing and midwifery from Faculty of Nursing and Public Health under Khesar Gyalpo University of Medical Sciences, Bhutan. As a focal person of Quality Improvement project of the unit is responsible for upcoming QI project on Post natal Care of newborn mother.

Abstract:

Introduction: Th ere are fi ft y key performance indicators in APA of JDWNRH to measure success of the organizational. Th e indicator 41, discharge of the patients before 11 am is one of them.

Objective: To increase the percentage of ‘before 11 am discharge’ from base line data of 38 % in (NICU) and 20% in (Neonate) to 50% in four months following interventions in in NICU and Neonate ward, JDWNRH

Method: Th e study was set in a 16-bedded NICU and 24-bedded Neonatal ward of National Referral Hospital in Bhutan. A Multidisciplinary Quality Improvement Team was formed. Baseline assessment included review of the daily activities and causes of delayed discharge were documented using root cause analysis. Th e data were collected daily and reviewed weekly. Th e interventions were developed based on the base line assessment and were implemented consistently. Th e change was monitored and reviewed periodically using the Plan Do Study Act (PDSA) method.

Result: Th e interventions included multiple system changes such as daily activity fl ow chart, new discharge checklist, screening checklist, high risk assessment checklist and due laboratory report fi le. Th e baseline percentage of patients discharged before 11 am before introduction of the interventions was 38.46% in NICU and 20% in Neonatal ward which drastically increased to 84.1% and 65.4% respectively following four months implementation of the interventions. Towards the end of 11th months, the percentage reached to 100% in NICU and 89% in neonate ward. In addition, it has improved teamwork, work effi ciency and brought in numbers of positive changes in the units.

Conclusion: A multidisciplinary team with quality improvement project improved this performance indicator and effi ciency of work but also teamwork.

Biography:

Sari has completed her education as general surgeon from Universitas Indonesia in 2018. Tri hening is pediatric surgeon in Ciptomangunkusumo Hospital and she is undergoing doctoral program in Universitas Indonesia. Sastiono is pediatric surgeon and senior staff in pediatric division Department Surgery Faculty of Medicine Universitas Indonesia.

Abstract:

Background & Objective: Budd-Chiari syndrome (BCS) in children is a rare case. Th e prevalence of SBC in India is reported to be 7.4%. No publication on the prevalence of SBC in RSCM. Because of that, there is diffi culty in diagnosing and choosing the best management of these patients, especially in BCS with moderate fi brosis.

Method: Conducted literature research on various sites, such as Clinical Key, PubMed, ScienceDirect, and EBSCOhost, by asking the research question "How is the scientifi c evidence supporting liver transplantation in Budd-Chiari Syndrome with moderate fi brosis in children?". Th e literature criteria are systematic review, randomized-clinical trial, cohort study, case report, or case series. Published studies should be performed on humans, whether living donor or cadaveric transplantation, English or Indonesian language, no publication year limit, and available in full-text form. BCS in adult or publication in the form of correspondence, editorial, or commentary excluded. Critical review was carried out using instruments downloaded from equator-network.org, then interpreted, and made a conclusion.

Result: One case series that reports BCS in children with moderate fi brosis. Liver transplantation is a treatment option for moderate fi brosis with level of evidence 4. Reversibility of tissue damage, etiology, and patient readiness are other factors to consider before deciding on liver transplantation.

Conclusion: Liver transplantation in BCS in children with moderate fi brosis is being supported by case series study with level of evidence 4. Th e need to consider other factors, including general condition of patient, duration of symptoms, and location of blockage.

Biography:

Mamta Jajoo is currently working as Associate Professor of Pediatrics and In-charge of level III NICU at Chahcha Nehru Bal Chikitsalaya, Delhi (Associated hospital of Maulana Azad Medical College, Delhi). She has more than 20 publications in the fi eld of neonatology and also Principal Investigator for many national and International multi-centric trials.

Abstract:

Introduction & Aim: Systemic infection is one of the leading causes of mortality and morbidity in the neonates and is responsible for about 30-50% of the total neonatal deaths in developing countries. Vitamin D is a steroid hormone and has important eff ect on immune functions as it enhances innate immunity and also regulates the acquired immune response: (1) To assess vitamin D level in neonates with late onset sepsis and compare it with the vitamin D levels of healthy controls and also see the correlation of Vitamin D levels with sepsis and (2) to study the correlation of maternal and infant vitamin D level.

Methods: Th is observation study was conducted from September 2015 to February 2016 in a neonatal intensive care unit (NICU) of a tertiary care hospital. Out born term and late preterm neonates of >7 days and less than 28 days, with signs and symptoms of severe sepsis with positive sepsis screen were enrolled as cases and neonates with the same gestational age and/or weight without sepsis were enrolled as controls. Neonates in whom there was history of previous hospitalization for more than 48 hours and whose calcium profi le was abnormal were excluded. At the time of admission sepsis screen, blood culture, urine C/S, CSF culture and chest X-ray was done. Levels of 25-OHD were assessed by chemiluminescent immunoassays method, by using Beckman Access 2 Immunoassay System (Germany). All neonates were further evaluated as pneumonia, meningitis, UTI or blood culture +ve sepsis and followed till discharge or death. Odds ratios were used to measure the association between vitamin D defi ciencies in neonatal sepsis in comparison to healthy controls.

Results: Total 421 neonates admitted to NICU from September 2015 to February 2016, out of which 120 fulfi lled the inclusion criteria. Only 60 consecutive neonates were included in the study as cases and 60 neonates with same gestational age and or weight with septic screen negative were enrolled as controls. Out of 120 infants, 77 (64%) were male and 42 (36%) were female. Th e mean age of presentation for study and control group was 15.53±6.429 days and 13.48 ±6.738 days, respectively. Mean weight and gestation age in both case and control group were comparable. Mean duration of hospital stay for study group was 10.68±8.11 days and for controls it was 3.30±0.77 days. Mean gestation age at admission for case and control was 37.78±1.66 and 37.68±1.82 weeks, respectively. Th e mean serum 25(OH)D concentrations in neonates with LOS (study group) was lower (15.37±10) than those of the healthy neonates (21.37±9.53) (p<0.05) with an Odd’s Ratio of 1.7. Maternal vitamin D level was also statistically signifi cant in both study and control group.

Conclusion: Vitamin D levels <30 ng/ml has high association with late onset sepsis. Treatment should be aimed for early detection of vitamin D defi ciency and timely supplementation in neonates with sepsis.

Biography:

Henok Tadele has completed his Speciality training in Pefi atrics and child health in 2012 at the age of 27 years from Addis Ababa University. He is an Assitant Professor of Pediatrics at Hawassa University. He has published 8 papers in reputed journals and has been serving as reviewer of reputable journals.

Abstract:

Background: Th e World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the fi rst six months of life. However, the proportion of EBF in Ethiopia is 58%. Th e EBF practice and factors aff ecting it have not been studied in Hawassa, Southern Ethiopia. Th e aim of this study was to assess the prevalence and determinants of EBF practice among infants less than six months age in Hawassa city, Ethiopia.

Methods: A total of 529 mothers with infants aged 0–6 months were involved in this study between November 2015 and January 2016. Trained interviewers collected data from the mothers of the infants. Exclusive breastfeeding was assessed based on infant feeding practice in the prior 24 h. Multivariable logistic regression analysis was conducted.

Results: Infants aged 0–5.9 months were studied with comparable gender composition (51.4% females). Th e exclusive breastfeeding prevalence was 60.9% (95% CI 56.6, 65.1). Mothers with infants aged 0–1.9 months and 2–3.9 months practiced EBF more likely than mothers with infants aged 4–6 months (Adjusted odds ratio [AOR] 3.59; 95% CI 2.07, 6.2) and (AOR 2.08; 95% CI 1.23, 3.5), respectively. Married mothers practiced EBF more likely than singles (AOR 2.04; 95% CI 1.03, 4.06). Housewives practiced EBF more likely than employed mothers (AOR 2.57; 95% CI 1.34, 4.9). Mothers who had a vaginal birth were more likely to practice EBF than mothers who gave birth via Cesarean section (AOR 2.8; 95% CI 1.7, 4.6). Mothers who gave birth at a healthcare facility were more likely to practice EBF than mothers who gave birth at home (AOR 8.8; 95% CI 5.04, 15.4). Mothers without a breast complication practiced exclusive breastfeeding more than mothers with breast complications (AOR 2.05; 95% CI 1.5, 4.1).

Conclusions: Th is study showed a low prevalence of exclusive breastfeeding. Younger infants, babies born to married women, who are housewives, having a vaginal birth in a health facility, and whose mother’s breasts were healthy, were predictors for EBF. Th e promotion of an institutional delivery, optimal breastfeeding practices, and designing strategies to better support employed mothers are recommended.

Keywords: Less than six months of age, Determinants, Ethiopia, Exclusive breastfeeding

Biography:

Cherry Ann Garcia is a nurse and an educator. She is passionate in conducting free public health teachings in rural communities in their province. Her expertise is on medical-surgical nursing and psychotherapy and counseling. She is a pastor’s wife.

Abstract:

Introduction: Atopic dermatitis (AD), also known as eczema, is the most common chronic relapsing skin disease in children, aff ecting approximately 10% to 30% of children worldwide. For this reason, the research community investigated possible innovative prevention and treatment strategies for AD. One of these strategies was the manipulation of the intestinal fl ora through probiotics. 

Method: Th is study is a cross-sectional, analytic study on 680 mothers and 680 children recruited in selected urban communities in Laguna, Philippines. 

Results: Most mothers (92%, n=625) had highly positive attitude to probiotics. Composite scores were computed and statistical data revealed that attitude is signifi cantly correlated with behavioral control (r=0.2087, p-value <0.001) and intention (r=0.2934, p-value <0.001). Furthermore, it was found out that both intention (r=0.3703, p-value <0.001) and perceived control (r=0.2355, p-value <0.001) were signifi cantly correlated to total amount of intake of probiotic food. Female children (42.43%) have higher intake than males (30.61%). High intake was also noted among children of mothers with educational attainment of Vocational (45.45%) and College and higher (41.09%); among low- (38.92%) and middle-income families (44.06%); and among those without family history of AD (38.55%). As for the frequency of consumption of probiotic food, 3 out of 10 of the respondents reported daily intake of at least one bottle of the probiotic foods enumerated. Among 680 respondents, 18.09% (n=123) were diagnosed as having atopic dermatitis, while 81.91% (n=557) were without AD. Th is study showed that the odds of having atopic dermatitis was 2.4 times higher among those with low intake status and 4.3 times higher among those with no intake compared to children with high intake status. 

Conclusion: Intake of probiotics are positively correlated with maternal education, income, highly positive attitude, high perceived control, and intention of mothers. Consumption of probiotics is a protective factor against atopic dermatitis.

Biography:

Andy Emmanuel is a PhD candidate at Griffi th University and had his masters degree from University of Cape Town South Africa. He is a lecturer in the Department of nursing, University of Jos , Nigeria. He has published more than 10 articles in peer review journals.

Abstract:

Background: Sub-Saharan Africa has the highest child mortality in the world (WHO, 2016). For instance, in 2014, UNICEF expressed concern that 1 in 11 children dies before the age of fi ve in sub-Saharan Africa and that one in every three neonates died on the day they were born (UNICEF, 2014). Th e aim of this review was to determine the impact of training on essential newborn care and neonatal survival in sub-Saharan Africa

Method: A systematic review of the literature was performed by searching databases including PubMed, Web of science, Scopus, CINALH, Cochrane library and Trip. Furthermore, the World Health Organization’s reproductive health library and reference checking for related articles was done. Th e Search was limited to English language and articles published from 2007 to 2017

Results: Nine articles were included aft er assessment. Findings revealed that training programs were generally diff erent in terms of duration and implementation. Th ere was between 8 to 400% increase in performance following test of knowledge. Th ere was an increase in performance by 19 to 34%. Th e frequency of inappropriate and potentially harmful practices reduced as a result of training. Neonatal mortality reduced by 15-45% while perinatal mortality reduced by 30%

Conclusions: Training health care workers on essential newborn care can improve newborn care and neonatal survival in Africa. However, there is need for additional evidence to support this because no study assessed the impact of training according to trainees’ satisfaction with training, knowledge and skills developed and health outcome at the same time.