Day 2 :
Keynote Forum
Dawn M Torrence Ireland
CHERUBS – The Association of Congenital Diaphragmatic Hernia Research, Awareness and Support, USA
Keynote: 20 year demographics and preliminary survey results from CDH International
Time : 10:00-11:00
Biography:
Dawn M Torrence Ireland is the Founder of CHERUBS – The Association of Congenital Diaphragmatic Hernia Research, Awareness and Support, USA. She is a Founding Member of the Rare Advocacy Movement and senior level patient advocate, mentors several other non-profit organizations, also a Founding Member of the Alliance of Congenital Diaphragmatic Hernia Organizations and she has written/edited four books.
Abstract:
Aim: Our objective was to assess the amount of medical information retained by parents of children born with Congenital Diaphragmatic Hernia. Our goal is to review the difference in our study with the population studies of other CDH research groups such as the CDH Study Group and DHREAMS in the amount of information given and correctly retained by CDH parents.
Methods: We reviewed the answers provided to a questionnaire between 1995 and 2014. Members included 2547 survivors, 1294 non-survivors and 740 expectant or who did not follow up. Parents were asked basic medical questions as well as a detailed medical and familial history.
Results: Our questionnaire was answered by 4548 families. A higher percentage of families of non-surviving infants than surviving infants did not know if their child's CDH occurred on the left versus right side (46.8% vs. 57.8%). When families were asked to further characterize the type of decent their child had, the percentage of those who did not know jumped to approximately 87%, showing that even fewer parents remembered the finer details of their child's diagnosis. Familial CDH is reported in the literature to be known in approximately 2% of all cases. Our membership reports 1.6%, which is similar to what has been reported.
Conclusion: Until this study is compared to the studies of DHREAMS and the CDH Study Group and exact patient matching occurs, it is difficult to measure the true medical knowledge that CDH parents grasp and remember.
Break: Networking and Refreshments @ 11:00-11:30
Keynote Forum
Ioannis Giakoumakis
Mediterranean Fertility Institute, Greece
Keynote: Clinical, legal and ethical aspects of surrogacy motherhood program in Greece
Time : 11:30-12:30
Biography:
Ioannis Giakoumakis studied in the Medical Department of the University of Athens, specializing in Obstetrics/Gynecology with 35 years of experience as a Gynecologist. He has completed his Internship at the Hospital 'Krankenhaus Holweide' in Koln, Germany, and his Specialty in the University Hospital Alexandra in
Athens. He took the position of Head of the Gynecological Department in the General Hospital of Chania and continued his career as Director of the Gynecological Department at a private hospital in his hometown, Chania. In 1992 he founded the Mediterranean Institute of Fertility and since then he helped hundreds of couples and singles, to achieve their own dream of holding their baby! He also helped the patients with the surrogacy program from 2005 when Greek Law allowed it. Wanting to constantly develop his knowledge in the field of assisted reproduction, actively participates in conferences around the world every year. He is an Active Member of several organizations, Founder Member of European Society of Human Reproduction and Embryology (ESHRE), Member of ASRM, MSRM, MEFS and was Honorary President of the Medical Council of Chania.
Abstract:
In the four decades, an increasing number of Assisted Reproductive Technologies (ARTs) have been developed, some of them already being used in clinical practice, while others will probably remain purely theoretical (in some countries) due to their associated ethical issues. Surrogacy is on the most controversial treatments which refers to a contract in which a woman carries a pregnancy for another couple or single lady. Greek Law allows surrogacy treatment as an ART and since 2014 the Greek Legislation allows foreign intended parents. Usually the reasons that a woman cannot become pregnant or carry out a pregnancy relates to the female reproductive system. The combination of patients, lawyers, clinicians and scientists with the added element of poor psychology creates the need for surgical actions to be performed during a surrogacy program. Our study focused on the medical reasons patients present for surrogacy, legal issues that arise during a surrogacy program and the ethical dilemmas patients incur before entering the program as well as during the program. We found after five years of referrals that the medical reasons patients (intended parents) a surrogacy program for anatomical abnormalities of the genital system as Rokitansky syndrome, partial or total hysterectomy after complications in pregnancy or childbirth or removal due precancerous or cancerous situations are some of the reasons. Lately, several failed IVF attempts can also be considered as a significant reason to opt for surrogacy. The most common legal issues are found in cross-border intended parents. This is due to legal obstacles that are present in their country which might not allow them to take their baby home as registered parents. The ethical concerns that affect patients mostly were found to be changing to donor gametes due to failed IVF attempts. Overall, we observed that a multidisciplinary team is required to inform patients prior to entering a surrogacy program. Furthermore, an international consensus should be held to establish guidelines to help patients with all aspects of a surrogacy program.
Break: Lunch Break @ 12:30-13:30
- Neonatology and Perinatology | General Pediatrics | Pediatric Cardiology and Pulmonology | Pediatric Surgery
Location: Rome, Italy
Chair
Dawn M Torrence Ireland
CHERUBS – The Association of Congenital Diaphragmatic Hernia Research, Awareness and Support, USA
Biography:
Sadiya Zinjani has graduated from the prestigious Armed Forces Medical College in the state of Maharashtra in India. She is attached to the Max Hospital, Saket, Delhi, as a Visiting Consultant but her major focus is her private clinic at her residence in Delhi, where she consults, conducts well baby clinics and does minor procedures. Her main interest is disease prevention and nutrition.
Abstract:
The first impression on seeing this 5.6 year girl with a Lt. parotid swelling was? Mumps, but it was only when antibiotics provided relief the possibility of a pyogenic infection was considered. In 2018 she made 2-3 visits with parotid swellings, but by October 2018 she had developed bilateral parotitis not responding to routine antibiotics. USG followed by CEMRI in November 2018 revealed bulky parotid glands with multiple thick walled loculated abscesses and regional lymphadenopathy. Both FNA and abscess debridement tissue microscopy revealed numerous epithelioid cell granulomas with multinucleated giant cells and some Langhans cells in a necrotic base. ZN stain for AFB was positive. Mycobacterium culture by MGIT and Genexpert MTB was negative. When the patient failed to respond to ATT, Clarithromycin was added and by 2 weeks the incision scar was all that was visible. Parotitis caused by NTM is an uncommon problem, commonly involving young children. Infections caused by NTM are now more frequently encountered perhaps due to a greater awareness and advanced diagnostics NTM are being recognized as causative agents in various symptomatic disease states. They are now being implicated in various disease manifestations in immunocompetent hosts. In most cases of parotitis, M. avium is the causative pathogen; other mycobacteria have also been reported as causative agents in some cases. In our case the histopathological picture augmented by the culture reports and failure to respond to ATT confirmed our diagnosis of NTM parotitis.
Anna Burford
Whittington Hospital, UK
Title: Documentation of neonatal resuscitation and creating a pro forma
Biography:
Anna Burford is a Pediatric Trainee in the UK with an interest in neonates. She has graduated from University College London Medical School and also has a BSc in Clinical Genetics.
Abstract:
Neonatal resuscitation is required in approximately 7% of births in the UK. One in 2000 deliveries requires both ventilation and chest compressions. Documentation during resuscitation is vital for delivering good patient care as well as for medicolegal reasons. We conducted a retrospective review of documentation within paper notes and a neonatal electronic database. We reviewed all babies admitted to NICU in a district general hospital in the UK over a 4 month period with an APGAR score of ≤7 at 5 minutes. We excluded babies resuscitated in NICU and ex utero transfers. We reviewed 5 domains: Demographics, APGARS, airway and breathing, circulation and transfer to NICU. We had a total of 23 babies in this study. 17 babies required inflation breaths, 4 required intubation, 2 required chest compressions and 1 required access and drugs. Not all demographic data relating to the resuscitation was complete. In written notes, only 70% of APGAR scores were documented. Where airway interventions were used, this was only documented in approximately 40% of cases. Only 1 out of 2 cases requiring chest compressions were documented fully. In only 40% of cases clinical state on transfer to NICU was documented. To improve documentation and reduce errors we have developed and implemented a pro forma to use within neonatal resuscitation.
Beatriz Orallo Rodriguez
TMPI-PIMT, Spain
Title: Influence of respiratory dysfunction in the development of the child
Biography:
Beatriz Orallo Rodriguez is a Pediatric Physiotherapist specialized in the respiratory field where she currently combines her passion with her work to improve the health and development of children. The desire to make better at a clinical level with her patients, she has trained in the field of pediatrics.
Abstract:
Everything seems to show that a good functioning of the respiratory system is essential to the development at an early age. Difficulties in both the upper and lower airways force the body to make adjustments that entail a series of physiological, postural, neurological, cranial and facial changes in patients. This happens even more clearly in early childhood, in which all biological systems are still immature. In this way, once the respiratory pathology has been stabilized or controlled, the adaptive effects could remain in the child, affecting its development and quality of life. A large number of current papers and specialized publications have highlighted the environmental and genetic factors involved in respiratory pathologies in childhood; moreover, especially harmful during periods of organogenesis and rapid lung growth during fetal development and early postnatal life. Besides, some studies show an increase of greater incidence in the last 20 years, mostly in developed countries. It is really important to understand the physiopathology of these adaptations and their consequences. In-depth the study of these mechanisms, their clinical manifestations and how all of these could affect the child’s life may be the key to find new therapeutic protocols and better prevention systems. To achieve this, the interdisciplinary approach is essential. Furthermore, this follows the indications of the ICF-CY. With these conditions both protocols and health policies will take into account the functional state associated with respiratory conditions.
Nadia Baasher
Whittington Hospital, UK
Title: Can we reduce the chest X-ray burden in children within emergency departments?
Time : 15:00-15:30
Biography:
Nadia Baasher is a Pediatric Trainee in London, UK. She has graduated in Cairo, Egypt in 2006 and has a particular interest in pediatric emergency medicine.
Abstract:
Chest X-Rays (CXR) are being increasingly used in pediatric A+E departments as a diagnostic tool at the expense of unnecessary exposure to radiation, use of resources, long waiting times in ED, and cost. There is little consensus with regards to which patient should receive a CXR. We carried out a retrospective study looking at 49 patients who received a CXR at a district general hospital’s pediatric A+E department for medical indications over a period of one month. We excluded foreign body ingestion and trauma. 21/49 patients were discharged having received a CXR, only one was positive. Out of the 20/21 negative CXR in the discharged cohort, 8 were treated with oral antibiotics regardless. 28/49 patients were admitted to hospital and 20/28 of these CXR were negative. In none of the cases did the CXR make a positive difference in giving antibiotics to the child. The decision to admit was based on the clinical status of the child rather than CXR findings as was the decision to discharge. The decision for antibiotics should be made clinically with history and examination findings. In conclusion we could reduce XR burden by targeting children in A+E who are well for discharge, whose diagnosis can be made clinically by introducing a guideline in A+E.
Break: Networking and Refreshments @ 15:30-16:00
Tetiana Stoieva
Odessa National Medical University, Ukraine
Title: Role of Prevotella enterotype during development of functional gastrointestinal disorders in children
Biography:
Tetiana Stoieva is a Professor at Odessa National Medical University, Ukraine. She holds the Pediatric Chair in Odessa National Medical University. Her research focuses on diagnostic and treatment of common conditions in children age. She is board certified practicing Pediatrician. She is particularly interested in pediatric aspect of gastroenterology, nutrition, and allergology. Her team works closely in partnership with the Institute of Nutrition and she is currently engaged in a project, exploring creation and application of food compositions in children with deficient conditions. She has published widely in peer-reviewed journals and has edited or contributed to several books.
Abstract:
Introduction & Aim: Qualitative and quantitative deviations of the intestinal microbiota provoke a number of diseases. The purpose of this study is to determine the significance of Prevotella enterotype with Functional Gastrointestinal Disorders (FGID) in children.
Materials & Methods: We examined 76 children at the age 1-18 years, among which 57 patients were diagnosed different FGID in accordance to Rome IV diagnostic criteria. The rest of the children without any digestive system pathology, constituted the reference group (n=21). Prevotella and P. copri identification was carried out in fecal supernatant by real-time PCR using of
specific primers Prevotella and P. copri.
Results: The leading FGID were the Irritable Bowel Syndrome (IBS) 54.4% and Functional Disorders of the Biliary Tract (FDBT) 45.6%. Representatives of the Prevotella genus in children with FGID were detected in 35 (61.4%), but in children of the reference group Prevotella was found in 90.5%, which revealed a significant connection (χ2=5.0; p=0.03) between the detection of Prevotella and the presence of FGID. P. copri amount in patients with FGID was 2-fold lower (106.9±8.4), than reference values (250.4±7.3). The mean value of P. copri in the fecal supernatant in children with IBS was (80.7±11.2) Relative Units (RU), and in children with FDBT ((124.3±10.5) RU) (p<0.05). It was shown that absence of P. copri and its minimum level are characterized by a high association with IBS with prevalence of constipation (χ2=6.0; p=0.02).
Conclusion: In children with FGID the intestinal microbiota is characterized by the absence of Prevotella in 38.6% (95% CI 51.4-25.8) and decreased count in 45.6% (95% CI 58.8-32.4). It was shown that decreased count of P. copri or its absence is associated with IBS (constipation) (OR 3.9; CI 1.3-12.0), which indicates to more profound intestinal microbiota disturbance in children with functional bowel disorders.
Talal Almalki
King Faisal Medical Complex Taif, Saudi Arabia
Title: Fecal incontinence post imperforate anus anomalies repair: Medical and surgical management protocol
Biography:
Talal Almalki is a Professor and a practicing Pediatric and Neonatal Surgeon. He attained his training at Toronto and McMaster Universities in Canada, in addition to Great Ormond St. Children Hospital (University of London, UK). Since then he is a practicing Pediatric & Neonatal Pediatric (General & Urological) Surgeon until now. Professor Talal is the Founding Dean of the College of Medicine and the College of Pharmacy in Taif University, Kingdom of Saudi Arabia on 2002. He was serving as the Vice President for Development and Quality in the same University between 2010 and 2016, where he was responsible for ALL quality control activities in the University. Professor Talal has an admirable publication record, as he published more than 75 research articles and three book chapters and a text book on Congenital Esophageal Stenosis. He is well recognized for his well-articulated and visionary talks, presentations and weekly columns in issues related to Higher Education, Leadership and Quality.
Abstract:
Introduction: Fecal incontinence is a misfortunate condition affecting children. It is associated with dramatic behavioral and personality changes. Management includes dietary modification, medical treatment, behavioral therapy and surgery.
Aim: To establish a protocol for management of fecal incontinence in children after repair of high imperforate anus. Patients & Method: Thirty-nine (39) cases were recruited; 14 of them were operated (dynamic graciloplasty) from the start
according to the input of history, examination and investigations. The remaining 25 patients were treated medically. Those cases who failed the medical treatment had alternatively biofeedback therapy. Cases failed to respond on biofeedback therapy
were operated.
Results: Response to medical treatment is favorable (71%). Biofeedback showed discouraging results (22%). Dynamics graciloplasty showed excellent outcome (100% improvement in continence on long term follow up).
Conclusion: Based on history, examination and investigations, recruited cases were primarily treated medically; those who had failed the medical treatment approach had dynamic graciloplasty, which demonstrated excellent long term results.