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

Suzann K. Campbell completed the BS and MS in physical therapy and the PhD in neurophysiology at the University of Wisconsin-Madison. She is Professor Emerita and former Head of the Department of Physical Therapy at the University of Illinois at Chicago. She has published more than 60 papers in peer-reviewed journals, is the founding editor of Physical and Occupational Therapy in Pediatrics, and the senior editor of Physical Therapy for Children, a textbook for the practice of pediatric physical therapy. She is the recipient of the Lifetime Achievement Award from the American Academy for Cerebral Palsy and Developmental Medicine.

More than 50 peer-reviewed publications document the reliability and validity of the Test of Infant Motor Performance (TIMP) for a) diagnosing developmental delay in infants from 34 weeks postmenstrual age through 17 weeks post-term corrected age (CA), b) educating parents about preterm infant motor development, and c) assessing outcomes of intervention in early infancy. The TIMP is a 25-minute test of functional motor activity, demonstrated to measure movement responses similar to those elicited by the handling of mothers during bathing, dressing, and play. A shorter screening version facilitates use of the TIMP for younger or more fragile infants. The TIMP was normed on 990 infants reflecting the population of low birthweight infants in the U.S. and yielding age standards for diagnosis of delayed motor development. Research in Brazil and the Netherlands suggest that the age norms are appropriate also for those populations. Focus group studies showed that watching a videotaped TIMP assessment is one preferred way for parents to learn about preterm infant motor development. Five controlled clinical trials in the U.S., Norway, and Thailand demonstrated that the TIMP is sensitive to sensorimotor interventions of various types, both in the neonatal intensive care unit and post-hospital discharge. Good performance on the TIMP at 3-4 months CA is highly predictive of normal motor performance at preschool age. The TIMP is available in English, French and Portuguese.

Xavier Urquizu has completed his medecine studies at Universitat Rovira i Virgili, and the specialitzation in Obstetrics & Ginecology in Hopsital Universitari MútuaTerrassa-Universitat de Barcelona. He is doing his postdoctoral studies in Universitat Autonoma de Barcelona (UAB). He is specilaizated in maternofetal medicine and High Risk Pregnancies and he is member of the Bioethics Committee in Hospital Universitari MútuaTerrassa (Barcelona-Spain).

Introduction and objective: The objective of the study was to assess the prevalence of anaemia in the immediate postpartum period (48–72 h), determine the risk factors and the value of haemoglobin before birth to reduce postpartum anaemia.
Material and methods: A prospective, observational and longitudinal study that included 1426 women who delivered consecutively and agreed to participate in the study. Different variables, analytical, epi- demiological, foetal and maternal symptoms were studied.

Robel Afeworki have a diploma (MSc) in biomedical sciences with specialization of Epidemiology and Infectious diseases from Radboud University. He worked as a research assistant in Global Data Lab, Nijmegen Center for Economics and Department of Internal Medicine in Radboud University Medical Center. His research concentration focuses mainly in Maternal and Child health based on the evidence generated from massive Demographic and Health Surveys (DHS) database which align to Millennium Development Goals.

Short birth intervals are independently associated with increased risk of adverse maternal, perinatal, infant and child outcomes. Anemia in children, which is highly prevalent in Africa, is associated with an increased risk of morbidity and mortality. Birth spacing is advocated as a tool to reduce anemia in pre-school African children, but the role of gender differences and contextual factors has been neglected. The present study aims to determine to what extent the length of preceding birth interval influences the hemoglobin levels of African pre-school children in general, as well as for boys and girls separately and which contextual factors thereby play a crucial role. This cross-sectional study uses data from Demographic and Health Surveys (DHS) conducted between 2003 and 2011 in 20 African countries. Multivariate analyses were done to examine the relationship between length of preceding birth interval and child hemoglobin levels, adjusted for factors at the individual, household, community, district, and country level. A positive linear relationship was observed between birth interval and the 49,260 included children’s hemoglobin level, whereby age and sex of the child, hemoglobin level of the mother, household wealth, mother’s education and urbanization of place of residence also showed positive associations. A longer birth interval has a modest positive effect on early childhood hemoglobin levels of girls, and this effect is strongest when their mothers are in their early twenties and have a high hemoglobin level. Remarkably, although the physiological iron requirement is higher for boys than girls, birth spacing has little influence on hemoglobin levels of preschool boys. We speculate that the preference for male offspring in large parts of Africa significantly influences nutritional patterns of African preschool boys and girls and as such also determines the different effect of birth spacing. Finally, gender aspects should be considered in intervention programs that aim to improve anemia in Africa children

Lana Gagin, MD, MPH, IBCLC, FAAP attended Bashkirian State University Medical School. She completed her Pediatric Residency at the Michigan State University’s College of Human Medicine GRMEP in 2007. She earned her Master’s degree in Public Health at the University of Michigan in 2010 while also working as a Pediatrician in the Outpatient General Pediatric Clinic. She joined the staff of the Helen DeVos Children’s Hospital’s Academic General Pediatrics in 2010. In 2011, she joined the staff of Spectrum Health Medical Group and became a Medical Director of Newborn Services in Grand Rapids Campus. As a Medical Director she led the team of physicians in establishing new practices for breastfeeding support which resulted in a successful Baby-Friendly Hospital designation in 2014. She serves as a Core Faculty at the Pediatric Residency Program at Spectrum Health. She is a Co-founder and a Director of Quality Improvement and Patient Safety Rotation, and has been leading multiple quality improvement initiatives. She completed her Lean Healthcare Certification at the University of Michigan in 2014. In 2015, she became an International Board Certified Lactation Consultant.

Introduction: Transient neonatal hypoglycemia is a common problem affecting many newborns. Up to 15% of healthy newborns and up to 50% of babies in at risk groups are affected. Independent risk factors for hypoglycemia include prematurity, high or low for gestational age birth weight as well as infants born to mothers with diabetes. Correcting critically low blood glucose concentration is important to avoid more serious complications and adverse outcomes. Hypoglycemia can put newborns at risk for potentially life threatening consequences including seizures, brain damage, coma and death. Traditional approach in management of neonatal hypoglycemia included intense feeding interventions as well as close blood glucose monitoring. Intravenous dextrose was reserved to babies in whom the initial conservative approach failed. Despite varying protocols, many babies still struggle with low blood glucose and require more frequent monitoring which causes more lab draws, disruption of bonding between a mother and a baby, interruption of breastfeeding, and at times need for transfer to the neonatal intensive care unit (NICU). More recently, oral dextrose gel use has been shown to be beneficial as an adjunct therapy in management of neonatal hypoglycemia. This study explores the effect of oral dextrose gel on correcting low blood glucose levels in neonates based on specific risk factors.rnrnMethods: 40% dextrose gel has been incorporated into a well-established hypoglycemia protocol which was based on the American Academy of Pediatrics guidelines. Dextrose gel was administered in addition to standard interventions with intense feeding when indicated. The trial has been initiated in March 2016. Subjects included were all newborns that met criteria of small for gestational age, large for gestational age, infants of diabetic mothers, and preterm (<37 weeks) who were born within that time frame. Patients were divided into two groups based upon their admission date. Those admitted prior to oral dextrose gel trial and those admitted up to four months following oral dextrose trial. Data was collected from a retrospective chart review include blood glucose concentration, comorbid conditions, feeding choice, number of oral dextrose gel doses administered, need for transfer to NICU for treatment with an intravenous glucose.rnrnResults: The primary outcome variable for this study is the blood glucose concentration following oral dextrose gel administration and the length of treatment to achieve euglycemic state defined as blood glucose concentration of 45 mg/dl. Oral dextrose gel was more effective in correcting hypoglycemia in large for gestational age infants and infant of diabetic mothers (70% and 62% treated successfully ) compared to small for gestational age infants and premature infants (37% and 49% respectively). Addition of oral dextrose gel in management of hypoglycemia was superior to re-feeding alone in all babies with risk factors. Overall, there was a significant reduction in the need for NICU transfers for intravenous glucose treatment due to persistent hypoglycemia.rnrnConclusion: 40% oral dextrose gel is a safe and effective treatment in correcting low blood glucose concentration in newborn babies with risk factors. It is simple, inexpensive and low risk intervention. It has been shown to be superior to re-feeding alone in treating hypoglycemia, and an effective tool in decreasing the need for treatment with intravenous glucose.

Mohammed Charfi has completed his medical studies at the age of 24 years from faculty of medicine. He is specialized in pediatrics since 2014. He accomplished trainings in different pediatric departments and neonatal centers. He participated in national and international conferences as speaker. He have published papers in reputed journals.

Introduction: Congenital short bowel syndrome is a rare disease that is often associated with intestinal malrotation and dysmotility. Classically, it looks like subocclusion. Rarely, the diagnosis is made because of chronic diarrhea with malnutrition. We report two cases of congenital short bowel causing a syndrome of neonatal occlusion. rnObservation 1: It is about a newborn from a consanguineous marriage who presented bilious vomiting since the age of 10 days. Radiological investigations (abdominal radiography without preparation, transit of small intestine, water-soluble enema, abdominal Doppler) have not viewed any obstacle. Surgical exploration found a short hail measuring 40 cm without associated intestinal malrotation. Histological examination of the appendectomy was normal. The evolution was marked by the persistence of the occlusive syndrome postoperatively. The infant died at the age of two months from a severe malnutrition.rnObservation 2: It is about a new born who was hospitalized at the age of 15 days for food vomiting and poor weight gain. Abdominal ultrasound with doppler was normal. A cow\'s milk protein allergy was suspected. The evolution was marked by the absence of clinical improvement under hydrolysed cow\'s milk protein. At the age of 30 days, he presented bilious vomiting. The abdominal radiography without preparation showed the presence of air-fluid levels of small bowel. Surgical exploration found a short non-peristaltic small bowel measuring 35cm associated with intestinal malrotation. The postoperative course was uneventful. At day 28 postoperatively, the infant died of a severe sepsis.rnConclusion: Early onset of clinical symptoms and the presence of abnormal intestinal motility are signs of poor prognosis of congenital short bowel syndrome. The pathogenesis is not clear but genetic transmission is a possible mechanism.

Andrei A. Pershin has completed his PhD Federal State Organization “Saint-Petersburg Scientific Research Institution of phthysiopulmonology”, Ministry of Health and Social Development of Russian Federation in 2007. Currently he is the Head of pediatric orthopedic department, Saint-Petersburg State Institution SPCMSEPR n.a. G.A.Albrecht, Ministry of Labour, Russia. He is the Member of AOSpine Europe (Gold member). He has published more than 25 papers in reputed journals . His research interests are Pediatric and adult Spinе Surgery; Pediatric Orthopedic Surgery and Bone and joint infections and tumors.

Absractrnrn9 pediatric patients aged from 7 till 19 month were operated due to severe kyphosis caused by spinal osteomyelitis as a manifestation of the late onset neonatal sepsis (LONS). The disease began at the age of 5 days to 2.5 months old. All patients had multiple foci of infection: pneumonia - 7/9, coxitis - 2/9, rib osteitis - 1/9, soft-tissue infection - 2/9, intestinal infection - 2/9; one was operated on cardiac abnomality. Spondylitis was diagnosed 3-12 months after the onset of the disease. Total destruction of 2-3 vertebral bodies in the thoracic spine complicated by paravertebral and epidural abscesses were in all cases. 4/9 patiens had multi-segmental spinal lesions incl. 3 cases of cervical and 1 thoracic-lumbar destruction. Angular kyphosis was 64° (min 44°, max 80°) with compression of the dural sac. All patients had surgical treatement (age 7 to 19 months) with anterior fusion and posterior instrumentation of the spine. All cases were neurologically intact (pre-op and post-op). rnrnSpinal osteomyelitis as a manifestation of late neonatal sepsis is rare and it diagnosed after the kyphosis’ apperance. The disease is characterized by extensive destruction of the vertebral bodies with paravertebral and epidural abscesses and have to be differ from tuberculosis spondylitis due to the cultural and molecular genetic study of pathologic tissues. Surgical treatment of spondylitis as a sequela of late neonatal sepsis is carried out when the infection is under control and aims to the anterior column reconstruction and kyphotic deformity correction.

Joana Aquino is MD at the Faculty of Medicine of the Lisbon University (2011). She is Medical Resident at Pediatrics Department, Centro Hospitalar de Leiria,Portugal.

Introduction: Familiar hypokalemic periodic paralysis is an autosomal dominant transmission channelopathy characterized by recurrent episodes of reversible muscle weakness and hypokalemia.
Case Study: We describe the case of a 16 year-old boy with recurrent episodes of decreased muscle strength whose mother had a history of similar episodes. He was admitted in the emergency department with flaccid tetraparesis and hypokalemia (1.4 mmol/L) which resolved after potassium administration. CACNA1S gene molecular study identified the mutation c.1583G>A-(p.Arg528His). Currently he is under an optimized nutrition plan, avoidance of triggers and acetazolamide and potassium chloride therapeutic.
Discussion: Although rare, familiar hypokalemic periodic paralysis’ timely recognition is crucial to initiate proper treatment and avoid associated complications. In this case, genetic testing confirmed the diagnosis and allowed the identification of asymptomatic relatives at risk of sudden acute paralysis and anesthetic complications.