International Conference on Pediatric Neurology November 28-30, 2016 Valencia, Spain

Biography:

Tuna Sahin has completed her Medicine from Erciyes University, Faculty of Medicine. She has completed her Post-doctoral studies from Cukurova University, Faculty of Medicine. She is presently working in Adana Numune Training and Research Hospital, as an MD, and Specialist in Anesthesiology and Reanimation at Clinic in Adana, Turkey.

Abstract:

Objective: Preoperative anxiety can be associated with poor postoperative clinical outcomes. We aimed to assess whether preoperative maternal anxiety level of obstetric patients scheduled for elective cesarean surgery has an effect on clinical outcome of the newborn.

Methods: Sixty (60) pregnant women with ASA physical status 1-2 scheduled for elective cesarean surgery were enrolled. All patients received spinal anesthesia with hyperbaric bupivacaine 12.5 mg. We performed a State-Trait Anxiety Inventory questionnaire to evaluate preoperative maternal anxiety. We used the Apgar scoring system to assess the physical condition of the newborn. Hemodynamic measurements (heart rate, systolic and diastolic blood pressure) were recorded at baseline, skin incision, childbirth, and 10, 15 and 30 minutes after skin incision.

Results: Average preoperative maternal state anxiety score was 41.1±4.6 and trait anxiety score was 50.9±5.7. Average Apgar scores of newborns were 7.6±0.8 and 9.2 ±0.6, at first minute and fifth minute, respectively. We found no significant relationship between the anxiety scores and Apgar scores at first and fifth minute.

Conclusions: We concluded that there was no relationship between preoperative maternal anxiety scores and Apgar scores at the first and fifth minute.

Biography:

Maja Tomicic is serving as the Head of Department for Platelet and Leukocyte Diagnostics and Hemostaseology, and Education Department at Croatian Institute of Transfusion Medicine (CITM) from 1992. She is Scientific Assistant at University of Zagreb Medical School from 2012. As a Head of Department her responsibilities include development and introduction of methods for platelet and leukocyte immunogenetic and haemostasis testing for outpatients, blood products quality control hemostasis testing, and investigation of transfusion associated acute lung injury, post transfusion purpura, fetal and neonatal alloimmune thrombocytopenia and neutropenia. Her MS thesis was on the topic “Frequency and Significance of Anti-Platelet Antibodies in Pregnant Women and Hematology Patients” and PhD thesis on the topic “Serological,Molecular and Clinic Characteristics of Alloimmune Neonatal Neutropenia”. She has published 27 papers; 18/24 cities in CC, 59 congress abstracts, 22/59 in CC Journals, and 37/59 in “Index Medicus” Journals.

Abstract:

Background: Alloimmune neonatal neutropenia (ANN) is the result of maternal alloimmunization during pregnancy to fetal neutrophil antigens inherited from the father. In most cases, ANN develops consequently to alloimmunization to the specific human neutrophil antigens HNA-1a and HNA-1b, less frequently HNA-2a, and to the neutrophil Fc gamma receptor IIIB (CD16). The clinical course of the disease is self-limiting, with a mean duration of 7 weeks. Generally, only mild bacterial infections are recorded, however, lethal outcome may occur in the severe forms of the disease associated with sepsis. The treatment usually includes antibiotics, intravenous (IV) gamma globulins, and recombinant human granulocyte colony-stimulating factor (hr G-CSF); however,with variable success.

Aim: The aim of this study was to analyze laboratory and clinical data of 36 newborns undergoing serologic testing for alloimmune neonatal neutropenia (ANN) during the 1998-2015 period in Croatian Institute of Transfusion Medicine (CITM).

Results: The average absolute neutrophil count in newborn blood at birth was 750/mm3 (min.115 and max.1470) and duration of neutropenia 6.5 weeks. Eleven (11) of 25 neonates did not receive any treatment and there were no signs of bacterial infection. Other were treated with antibiotics only and antibiotics and intravenous gamma globulins or granulocyte growth factor. Seven (7) of 25 newborns had mild bacterial infection (omphalitis) and 6 had severe respiratory infection and threatening sepsis. All of them reached full recovery. There was no fatal disease.

Conclusion: ANN is a rare but potentially life-threatening disorder. Serologic testing for ANN in case of isolated neutropenia in the newborn contributed considerably to timely detection of ANN.

Biography:

Pasqua (Mary) Betta is a Neonatologist, Anesthesiologist and Intensive Care Consultant. She is Vicar Chief Of NICU of the University of Catania. She is also specialist in Bronchopneumology . She has published more than 50 papers in indexed reputed Journals.

Abstract:

The retinopathy of prematurity (ROP) is an ischemic-vascular disease that affects preterm infants. Several studies show that the incidence of the disease is closely related to low gestational age (GE) and low birth weight (BW). The influence of being twins in the occurrence of ROP is not entirely clear yet. To date, the studies carried out so far on this matter have not showed unanimous
results. The aim of our study was to show the role of being twins in the development of ROP and to evaluate whether assisted reproductive techniques can be an additional risk factor for the disease development. So we performed a retrospective study upon 253 preterm infants (131 males and 122 females) born between January 2011 and March 2015, whose GE was between 24 and 34weeks of gestation (31.2; +/-2.4) and BW was between 450 and 2960 g (1619.2 +/-512.2). Of the 253 studied infants, 123 were twins (48.6%), including 23 babies born from triplet pregnancies (18.6%), and 59 (47.9%) were born after artificial insemination. Of the 253 infants, 83 (32.8%) developed ROP; 54 of them (65%) were twins. In particular, 38 infants (45.8%) developed stage I ROP (50% in twins, 31% in single children), 24 (28.9%) stage II ROP (27.7% in twins, 31% in single children) and 22 (26.5%) stage III ROP (22.2% in twins, 34% in single children). 32 patients (38.5%) have also developed signs of PLUS (35.9% in twins, 44% in single children). Of the 83 infants affected by ROP, 46 (55.4%) were treated with laser therapy; among them, 24 (52.17%) were twins. The 253 infants were divided into two groups: Group 1 (twins) and Group 2 (single children). The twins were also divided into 2 groups: Group A (twins born after artificial insemination techniques), Group B (the remaining ones). The populations were compared by performing the χ2statistical test. Our results have showed a significantly higher chance of developing ROP in Group 1 than in Group 2 (p=0.000256) but they have not showed a significant difference in the severity of the disease (p>0.05). Furthermore, we didn’t find any statistically significant difference by comparing Groups A and B (p>0.05). In conclusion, our data show that being twins is significantly related to the development of ROP. On the other hand, artificial insemination techniques do not seem to be an additional risk factor for ROP development.

Biography:

Abstract:

Neonatal convulsions (NC) are the most distinctive sign of disturbance of the central nervous system with incidence 2-3/1000 in term and 10-15/1000 in preterm infants. NC may cause irreversible changes to the immature brain and progress to epilepsy.The outcome is, to a large extent, dependent on the cause of the convulsions, while some other clinical and electrophysiologicalparameters are also predictive. Our study of 61 newborns with NC, born between 1989 -1995 found epilepsy in 18%. The group of causes with perinatal hypoxia was significantly associated with subsequent epilepsy. Predictive factors for outcome were neurological examination, the number of days with seizures and EEG findings. Considering the high incidence of neurological sequelae after NC our retrospective study of 176 newborns, born between 1999-2009, aimed to construct risk score for postnatal epilepsy. The incidence of epilepsy in this group was 18.1%; moderately to severely abnormal EEG background activity and aetiology were predictive for epilepsy. The duration of seizures had a different effect on the development of epilepsy with respect to the gestational age, which turned out to determine the association between the two predictors. Our results support the evidence that recurrent and prolonged NC may act on an epileptogenic substrate, causing further damage, which is responsible for the subsequent clinical expression of epilepsy. We conclude that the construction of a simple scoring system, based on independent predictors, as a universal useful tool for prognosis of epilepsy after NC is not reasonable due to connection and interaction between variables.

Biography:

Antonia Hargadon Lowe has completed her primary medical qualification, BMBS, at Nottingham University in 2006 and then became a Member of the Royal College of Pediatrics and Child Health in 2011 after completing membership exams (MRCPCH). She has just completed a Master’s at Imperial College London in Pediatrics and Child Health, and is currently a PICU Trainee at Evelina Children’s Hospital, London.

Abstract:

Accepted best practice for neonatal intubations now involves the use of medications beforehand (pre-medications); for both patient comfort and to increase chances of success. Time taken to prepare these medications is a barrier to their use. We implemented quality improvement strategies to reduce this time, and re-audited (following previous audits between 2009 and 2015). We instigated prescribing of pre-medications on admission to NICU, which was disseminated by consultants and reinforced regularly in order to change habit. Every nurse was questioned on what they felt caused delays. Unfortunately, staffing restraints prevented planned ‘Intubation’ simulations. Advanced emails, posters and regular reminders following intubations increased awareness. Data was collected from 1/5/15-1/8/15. Criteria measured were: %of patients with medications pre-prescribed; %of eligible patients receiving pre-medications; %of cases with drugs prepared in under 16 minutes (considered best practice). 19 intubations were recorded (6/19;emergencies). 79% of patients had medications pre-prescribed, 100% (vs. 95% last time) received pre-medications, and 53% (vs. 27%) took under 16 minutes, with a mean time of 19.4 (vs. 36) minutes. Nurses felt that the primary issue was lack of drug-checkers and suggested doctors being available for this. Increased awareness could have impacted on the demonstrable improvement, however the pre-prescribing will likely have contributed significantly; this was a successful quality improvement intervention. Therefore, we recommend the continued practice of prescribing on admission, along with doctors being drug-checkers if available. Future planning for new drug charts with specific pre-printed designated boxes is underway. With a full rota, real-time multi-disciplinary intubation simulations should occur repeatedly to have the widest impact.

Biography:

Alvarado Socarras Jorge Luis is a Neonatologist Pediatrician. He is Director of the unit Neonatal of the Fundacion Cardiovascular de Colombia. He is also a University Professor at Universidad Industrial de Santander and Universidad de Santander.

Abstract:

Aim: To evaluate hospital mortality of infants transported to a tertiary hospital based on clinical factors and type of transport.

Methods: Observational study of seriously ill neonates transported via air or ground, which required medical care at a center providing highly complex services, was done. A 6 month observational study was conducted to obtain clinical variables for intrahospital mortality among patients requiring inter-facility transport. Data on sociodemographic, clinical, the transport risk index of physiologic stability (TRIPS) and mode of transport were collected.

Results: A total of 176 neonates were transported by ambulance (10.22% by air) over 6 months. Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple models. Increased mortality was associated with the transport risk index of physiologic stability (TRIPS).

Conclusions: Weight<1500 g, renal failure, congenital defects (except congenital cardiopathies) and high TRIPS were associated with a higher risk of intra-hospital mortality. Mode of transport was not associated with the outcome.

Biography:

Ni Hong has completed his PhD from Zhejiang University and Post-doctoral studies from Peking University School of Medicine. He is the Director of Neurology Laboratory of Children's Hospital Affiliated to Soochow University and Deputy Director of the Institute for Pediatric Research, Soochow University.

Abstract:

Because leptin was affecting expression of brain energy metabolism-related genes and because zinc/lipid metabolism signals and its associated autophagy stress were also found to be involved in energy depletion, we hypothesized that leptin might exert its neuroprotective action via zinc/lipid and autophagic metabolism signaling. Here, we tested this hypothesis by examining the long-term expression of zinc transporter ZnT1 and ZIP7, lipid membrane injury-related cPLA2, its downstream autophagy marker Beclin-1, LC3, bcl2 and Cathepsin-E, as well as its execution molecule CaMK II following neonatal seizures and chronic leptin treatment. On postnatal day 6 (P6), 40 Sprague-Dawley rats were randomly assigned to two groups: Flurothyl-induced recurrent seizures group and control group. On P13, they were further randomly divided into the seizure group without leptin (RS), seizure plus leptin (RS+Leptin, 2 mg/kg/day, consecutive 10 days), the control group without leptin (Control), and the control plus leptin (Leptin, 2 mg/kg/day, consecutive 10 days). Neurological behavioral parameters of brain damage (negative geotaxis reaction reflex, plane righting reflex, cliff avoidance reflex, forelimb suspension reflex and open field test) were observed from P23 to P30. Morris water maze test was performed during P27-P32. Then hippocampal mossy fiber sprouting and the protein levels were detected by Timm staining and Western blot analysis, respectively. Flurothyl-induced RS rats show a long-term lower amount of CaMK II alpha, and higher amount of ZnT1, ZIP7, cPLA2, Beclin-1/bcl2, LC3II/LC3I and Cathepsin-E which are in parallel with hippocampal mossy fiber sprouting and neurobehavioral and cognitive deficits. Furthermore, chronic leptin treatment (RS+Leptin) is effective in restoring these molecular, neuropathological and cognitive changes. The results imply that a zinc/lipid metabolism-associated membrane peroxidation and autophagy pathway is involved in the aberrant hippocampal mossy fiber sprouting and neurobehavioral deficits following neonatal seizures, which might be a potential target of leptin for the treatment of neonatal seizure-induced brain damage.

Biography:

Mahdi Mashaiekhi has completed MD at Isfahan University, Pediatrics in 2009 at Tehran University of Medical Sciences and Neonatology in 2016 at Iran University of Medical Sciences. He has published 5 papers in medical journals.

Abstract:

Introduction: The diagnosis of acute kidney injury is based on calculating glomerular filtration rate rely on serum creatinine, however this method seems to be unreliable due to potential effects of underlying confounding parameters. Thus, recent efforts have been focused on new diagnostic specific markers with high sensitivity and accuracy for early prediction of acute kidney injury. Recentresults identified NGAL as a widespread and sensitive response to established AKI in humans. However, the role of this marker to early predict acute kidney injury in children remains uncertain. The present study aimed to assess and compare the level of urinary NGAL in neonates with acute kidney injury and those without kidney injury admitted to neonatal intensive care unit.

Methods: This cross-sectional study was performed on 75 consecutive neonates who were hospitalized because of acute kidney injury. Among neonates admitted to hospital due to causes unrelated to kidney disease (with normal serum creatinine level) were randomly selected as the control (n=81). In both groups and on admission, the urine levels of creatinine and NGAL were measured. The level of creatinine was assessed by enzymatic method and the level of NGAL was measured using ELISA method. The level of urine creatinine was measured at two time points.

Results: The mean level of NGAL was 825.81±175.08 ng/ml in case group and 292.20±322.03 ng/ml in control group with a significant difference. NGAL had a sensitivity of 100%, s specificity of 55.6%, a positive predictive value of 67.6%, a negative predictive value of 100%, and an accuracy of 76.9% to predict acute kidney injury. Assessing the area under the ROC curve showed that the measurement of NGAL could effectively discriminate acute kidney injury from normal condition (AUC=0.899). The best cutoff value for NGAL to predict acute kidney disease among neonates was estimated to be 427 ng/ml yielding a sensitivity of 100% and a specificity of 67.9%. The Pearson’s correlation test showed a strong linear association between the level of NGAL and the changed level of creatinine (r=0.395, p<0.001).

Conclusion: The measurement of NGAL has a high sensitivity and proper specificity compared to creatinine level in predicting acute kidney injury among neonates.

Biography:

Pawel Galecki has completed his PhD at the age of 25 years from Medical University of Warsaw. He is working at Neuonatal Unit of Plonsk Hospital. He also cooperate with Neonatal Pathology Unit of second degree referenced hospital in Ciechanow, Poland. He usually deals with issues in the field of care of infant from physiological pregnancy and childbirth. As the the result of the cooperation with the Clinic of Pathology and Intensive Care of the Newborn of Medical University of Warsaw was exsistance of work on ultrasound in neonatal care of physiological infant.

Abstract:

Ultrasonography of newborns born long before term and newborns with extremely low birth weight or other significant pathology has become a gold standard on the neonatal pathology units and NICU. It is rather simple method, non-invasive; they aren't bringing the increased risk for the newborns, and are providing much information about the condition of the patient, the course ofdisease, the effectiveness of the treatment and further predictions. However, only 10-15 % of children are born below 35-th week of pregnancy and, is being hospitalized on the II and III degree of neonatal care units. It will leave the majority of children left without ultrasound diagnostics, because of very few centers of first degree of neonatal care is conducting that kind of diagnostics apart from very rigorous recommendations, acknowledging that these children are "from the assumption" healthy. Perhaps such an assumption isn't fully correct and many children from so-called physiology of pregnancy are burdened with certain diseases, which could be to recognize and possibly healed, if all children were examined. In this paper, we have studied ultrasound examinations of the central nervous system and the abdominal cavity carried out at children born after 35th week of pregnancy at the Neonatal Unit of theHospital in Plonsk (first level of neonatal care) in the time period from 01.01.2014 to 02.12.2014. However, examinations didn't have screening character but readings for carrying them out were significantly widened, what had allowed providing with examinations with much larger group of children than average. A 49.1% of children were examined and in 14.63% cases abnormalities of different degree were stated through the ultrasound scan. Counted each abnormality individually changes within CNS slightly predominated over changes in the abdominal cavity (53.8%/45.2%). The majority of changes were requiring only a clinic control (63.89 %); however,serious changes requiring specialist diagnostics and treatment amounted to 36.11%.

Biography:

Biniam Ayele has completed his graduation from University of Gondar as a Medical Doctor in 2012. Currently, he is working as a Physician and Lecturer at Felegehiwot Referral Hospital and Bahir Dar University respectively. He is also a year 3 surgical resident at Bahir Dar University

Abstract:

Intussusception refers to telescoping of one portion of proximal gut to another distal part with further motion of the intussusception into the intussuscipiens by ongoing peristalsis; the commonest being ileocolic in about 85 to 90%. Rarely caecocaceo-colic, jejunojejunal or even ileo-ileo-colic occurs in a double or three-fold manner. Colo-colic is found more often in parasitic diseases. As far as aetiology is concerned, a mobile ascending colon, malrotation or non-rotation facilitates intussusception. Here, the author presents a case report of double intussusception in 20 days old male neonate after he presented with abdominal distension and vomiting of ingested matter of three days, the neonate has also intermittent crying since birth especially after breastfeeding. For this, the neonate was admitted and diagnosis is made by abdominal ultrasound and for that the neonate was prepared and explored. The intraoperative finding was, the baby was having gangrenous ileocolocolic intussusception with transverse colon perforation and about 5 cm of distalileum, the lumen was extremely narrow when compared with the proximal one with the leading point. And the cecum and ascending colon was mobile. For this the author had done end to end ileoascending anastomosis with end to end colocolic anastomosis of the transverse colon was done and biopsy sent for histopathology. The patient followed in the neonatal ICU for a week and discharged improved. So that, details of double intussusception and details of the intraoperative finding will be discussed.

Biography:

Lakshmi D Katikaneni has been a Neonatologist and NICU Graduate follow up Clinic Director for the past 30+ years and has a number of national and international presentations and publications related to nutrition, body composition and body fat measurements of preterm infants, brain and neuroinflammation markers, fetal drug exposure and hair analysis for cocain metabolites, retinopathy of prematurity and Avastin therapy, and sleep apnea issues in preterm infants. She is a Member of Pediatric Research Society, American Academy of Pediatrics, Brighton collaboration for vaccination issues as well as harmonized safety monitoring of immunization in pregnancyorganized through GAIA project.

Abstract:

Introduction: Chorioamnionitis is associated with white matter injury (WMI) in animal models. MRI diffusion metrics (MRIDM) may serve as early biomarkers of neonatal WMI in chorioamnionitis. Additionally, MR spectroscopy (MRS), used to quantify metabolites in specific neural regions, has been shown to be predictive of long-term developmental testing.

Objective: The purpose of the study was to determine the utility of MRS and MRI-DM markers arising from different brain regions as indicators of global brain injury in term newborns exposed to chorioamnionitis and confirmed funisitis.

Design/Methods: MRI-DM was performed on 25 term infants at 39-42 weeks GA at time of MR imaging with confirmed funisitis at birth. The ROI in OR (optic radiation) was quantitatively assessed for fractional anisotropy (FA) and mean diffusivity (MD) using MRICRON software. MRS metabolites were quantified at TE 30 & 270 in the basal ganglia (BG) and frontal white matter. Sixteen (16) infants had useable MRI-DM and MRS, which were correlated with a Pearson test.

Results: Left OR FA was found to be negatively correlated with lactate/NAA (R=-0.65, p=0.0066) and Lactate/Creatine (R=-0.64, p=0.008) in the basal ganglia.

Conclusions: Lactate/NAA has previously demonstrated better diagnostic accuracy than conventional MRI as in neonates with high lactate/NAA values predicting lower motor scores. The correlation of this ratio to the optic radiations, which undergo myelination shortly after birth, present two clinically applicable biomarkers for global WMI while, also, allowing insight into how chorioamnionitis affects and acts to delay development. Thus, early brain injury is detected by brain scans and early intervention is possible in those with abnormal brain biomarkers as noted in the current study.

Biography:

Jacquelyn R Evans attended Dalhousie University School of Medicine and completed her Pediatric Residency at the University of Cincinnati and the University of Minnesota. Her Neonatology Fellowship was completed at the IWK Hospital for Children and the Grace Maternity Hospital, Halifax, Canada. She is the Associate Division Chief of Neonatology at The Children’s Hospital of Philadelphia and a Clinical Professor of Pediatrics at The Perelman School of Medicine, University of Pennsylvania. She is the Director of Patient Safety and Quality in Neonatology at CHOP and the CHOP Newborn Care Network. She is the Chair of the US News and World Report Best Children’s Hospitals Survey Neonatal Advisory Group and is the Chair of the Children’s Hospitals Neonatal Consortium.

Abstract:

Excellent, longitudinal, worldwide benchmarking data have previously been available for infants cared for primarily in NICUs with delivery services. These databases primarily focus on preterm infants and their relatively small number of common associated morbidities, many of which can be used as outcome measures. Infant patient population that requires quaternary NICU care oftendiffers substantially from those previously well characterized. Launched in 2010, and with 32 participating sites in Canada and the US, The Children’s Hospitals Neonatal Database (CHND) was developed to allow quality benchmarking for infants with uncommon neonatal disease. In the CHND, the majority of patients are born >37 weeks’ gestation; there is a high prevalence of rare to uncommon diagnoses and surgical care is remarkably frequent. In addition, the population of preterm infants in the CHND differs from mostsystematically studied preterm populations because the timing of referral of preterm infants to these quaternary NICUs is usually well after birth, and frequently after a significant proportion has acquired severe prematurity-associated morbidities, which indeed are often existing at the time of or even the very reason for referral. Thus, these traditional outcome measures are inappropriate for benchmarking the care and outcomes in large regional NICUs and perhaps serve more appropriately as to highlight the severity of illness in the very preterm infants who were referred. However, the rarity of the diagnoses managed as well as the historical absence of a large, multicenter collaboration has precluded both the development of appropriate benchmarks for expected outcomes, as well as disease- or intervention-specific quality improvement efforts. Likely due to this lack of systematic multicenter data collection around these uncommon diseases, few standards of care for these infants have existed and data on the inter-center variation in care, resourceutilization and outcomes in the CHND sites have been striking. This presentation will highlight the findings of 6 years of quaternary NICU benchmarking in North America and the opportunities to improve care for infants with uncommon neonatal disease by collaborative efforts across many sites.