Day 1 :
Jeffrey Karsdon completed his medical education at the Free University of Brussels, Belgium. After completing his pediatric residency in New York and his neonatology fellowship in San Francisco he worked at the University of Leiden, the Netherlands for 7 years before returning back to the united states. He is a clinical neonatologist and scientist with a passion for preventing preterm birth. His innovative approach to inhibiting the uterine contractions of a preterm birth with an electrical pacemaker is a paradigm shift in preventing preterm birth. It allows for a very localized and rapid inhibitory effect with no systemic side-effects. He is pioneering the way to an electroceutical tocolytic and into a new era of interventional uterine electrophysiology. His unique method of inhibiting smooth muscle contractions and tone paves the way for treating other pathologies caused by increased smooth muscle tone
Background: Uterine smooth muscle electrical activity precedes and controls the preterm uterine mechanical contractions. This is monitored with electromyogram (EMG), electrohysterogram (EHG) and tocodynamometry (TOCO). EHG is a more objective measure of contraction force than the TOCO.
Objective: EI of preterm uterine EMG and subsequent inhibition of mechanical activity (frequency and force) . Study Design: Women in preterm labor at 24-34 weeks gestation had standard monitoring of TOCO and fetal heart rate (FHR) with simultaneous external monitoring (OBMedical, Gainsville, FL) of EHG and fetal electrocardiogram (fECG). An electrical pacemaker gave EI to an electrode catheter placed into the vaginal posterior fornix next to the cervix. EI was a bipolar constant current square wave pulse: 0-10mA, 0-28ms/pulse, 0-30Hz. There were 3 groups of EI: 20, 40 or 80 minutes. EI was a 10-second burst only during a monitored contraction. Each group had 20 minutes of pre-EI sham control (C1) and post-EI sham control (C2). Outcome measures were TOCO and EHG contraction frequency or peak-to- peak (P-P) interval and EMG power spectral density (PSD). Differences in the estimated means of P-P and PSD for the C1, EI, and C2 periods used a mixed-model analysis of variance and a paired t-test with a 0.05 two-sided significance level.
Results: Electrical PSD and mechanical TOCO and EHG P- P all decreased during EI compared to C1 and C2. FHR and fECG were unchanged. Also, EI decreased uterine resting tone.
Conclusions: This is the first EI study of human preterm uterine electrical and mechanical activity i.e. contraction frequency and force. EI is an electroceutical tocolytic with no systemic side- effects on mother or baby. The EI mechanism is unknown, but may produce membrane hyperpolarization. EI decreased preterm uterine resting tone that may increase placental blood flow. EI may decrease the resting tone of other smooth muscles in certain neonatal pathologies e.g. persistent pulmonary hypertension of the newborn.
Wayne State University School of Medicine, USA
Dr. Sood has completed Pediatrics Residency training and fellowship training in Neonatal-Perinatal Medicine at Children’s Hospital of Michigan and Wayne State University. She also completed a Masters Masters course in Clinical Research Design and Biostatistics at the University of Michigan. She has been appointed as Assistant and later Associate and then Full Professor on the Research Educator track at Wayne State University and the affiliated Detroit Medical Center since 2001. She has published over 50 papers in reputed journals. In 2014, she recieved federal funding to conduct clinical trials to evaluate delivery of aersolized surfactant in preterm infants
Purpose: Respiratory distress syndrome (RDS) is the leading cause of mortality and morbidity in preterm infants (PTI). Intratracheal instillation, the only approved means of surfactant delivery, requires endotracheal intubation and mechanical ventilation with their attendant risks. Widespread use of non-invasive ventilation (NIV) for initial respiratory support of PTI not only averts the need for intubation and MV but also delays surfactant instillation. We hypothesized that treatment of RDS with aerosolized surfactant (AS) in PTI undergoing NIV is safe and feasible.
Methods: We initiated a Phase I study of AS in PTI<37 weeks GA with RDS undergoing NIV. Sequentially enrolled infants received increasing doses and dilutions of surfactant using a MiniHeart jet nebulizer. Infants were monitored during AS and for 72 hours after AS.
Results: Of 17 patients enrolled, two extremely PTI exited the study for worsening respiratory distress. Fifteen infants completed study intervention; two were weaned to room air after the 1st dose of AS and 13 received 2 doses. The mean age (SD) at receipt of 1st and 2nd dose of AS was 7.2 (5.7) and 11.8 (6.4) hours respectively. Infants tolerated the aerosol treatment well. No significant adverse events were identified. Of 15 infants that completed the study, one required medical treatment for a patent ductus arteriosus; one received vasopressors, two were treated medically for necrotizing enterocolitis (NEC) and one was intubated at 19 days of age following a diagnosis of NEC. Majority of the 17 enrolled infants were discharged to home (n=15) without respiratory support (n=14) at a mean corrected GA of 355/7 weeks. Conclusion: We have demonstrated the feasibility of administering AS to PTI; AS was well tolerated by infants. A Phase II clinical trial of aerosolized survanta duirng NIV in PTI comparing two doses and two nebulizer devices is currently ongoing.
New Hanover Regional Medical Center, USA
Ann Quinlan-Colwell has completed her PhD at The University of North Carolina at Greensboro. She works as a Clinical Nurse Specialist and Chair of the Nurse Research Committee at New Hanover Regional Medical Center which is a regional trauma center in Wilmington, NC, USA. She has published in and reviews for reputed peer review journals, has published book chapters and a book on pain management. She is current president of the Nu Omega chapter of Sigma Theta Tau International; president-elect of the Southern Pain Society and serves on the board of the American Society for Pain Management Nurses.
The Pasero Opioid-Induced Sedation Scale (POSS) is a valid, reliable tool used to assess sedation when administering opioid medications to manage pain. POSS is endorsed by The Joint Commission and the American Society for Pain Management Nursing to help prevent adverse opioid-related respiratory events. Although POSS is used to assess sedation in pediatric patients at some hospitals, it was not formally evaluated in the pediatric population. This study used a quasi-experimental design with a convenience sample of pediatric patients admitted to a large regional medical center. POSS was evaluated from three perspectives. First the study was designed to compare documentation of sedation when opioids were administered before (n = 25) and after (n = 27) implementation of POSS to assess sedation. Second, occurrence of respiratory adverse events before and after implementation was compared. Third, appropriateness of using POSS in pediatric population was evaluated. When POSS was used, there was an increase in both clarity and frequency of documentation when sedation was assessed. There was no incidence of opioid-related adverse respiratory events after implementation of POSS. Finally, POSS was found to be appropriate and safe to use in pediatric population. Through survey, the majority of registered nurses who cared for the research subjects evaluated POSS as easy, appropriate and safe to use with pediatric patients. The nurses also noted using POSS provided standardized communication among staff regarding patients’ levels of sedation. No adverse effects, concerns, or objections were reported. Coincidentally, frequency of documentation of assessment of pain also improved with POSS.
Lily Wang completed her medical degree at the age of 22 from University of New South Wales, Sydney, Australia and has a Masters in Public Health from University of Sydney, Australia. She is a neuroradiologist at University of Cincinnati Medical Center and director of medical student radiology education at College of Medicine, University of Cincinnati
Congenital anomalies of the spinal cord can pose a diagnostic dilemma to the radiologist, neonatologist and neurosurgeons. Several classification systems of these anomalies exist. Antenatal ultrasound and fetal magnetic resonance imaging is playing an increasingly important role in the early diagnosis and management of patients. Understanding the underlying anatomy as well as embryology of these disorders is vital in diagnosing the type of spinal cord dysraphic defect. Common and uncommon malformations will be discussed, with focus on differentiating these entities using MRI
McGill University, Canada
Tieyuan Zhang has completed his PhD from Yonsei University, South Korea, in 2001. He did postdoctoral studies from McGill University, Canada from 2002. He is an assistant professor in the Department of Psychiatry, McGill University, Canada. He has published papers in reputed journals including JNeurosci, PNAS
The quality of parent-child interactions in humans predicts multiple mental health outcomes. We have little understanding of the neurobiological responses to the demands of reproduction in females. We found that high licking/grooming (LG) lactating rats had increased levels of phosphorylated CREB (pCREB) in the medial preoptic area (MPOA) and they displayed a reduced population of greater dendritic complexity index (DCI) neurons compared to Low LG mothers. High LG mothers show increased Rem2 and BDNF in the MPOA. There were no differences in Rem2 and BDNF expression in virgin high and Low LG female rats. CREB overexpression in the MPOA of lactating rats increased maternal LG. CREB overexpression in MPOA neuronal cultures associated with a decrease in dendritic complexity. We suggest that CREB activity in the MPOA associates with maternal behavior and changes in dendritic complexity in the MPOA possibly mediated by CREB induced regulation of Rem2 and BDNF. These results provide a novel neuroendocrine basis for individual differences in maternal behavior
Anne-Catherine ROLLAND is the chair of child psychiatrist at the University of Reims and the head of the child psychiatry ward at the University Hospital of Reims since 2012. After her medical studies in Reims Medical School, with a specialization in psychiatry and child psychiatry, she has completed her PhD from Paris VII Descartes University in 2010. She did a research year at Melbourne University next to Jeannette Migrom and Anne Buist in 2007-2008. She is specialized in mother infant interactions, and works preferentially on all the mothers’ feelings around the pregnancy and the maternity.
Introduction. – Postnatal depression (PND) affects 10 to 15 % of the women who gave birth. The “postnatal depression group” is a group therapy set up in the parents-infant unit of the child psychiatry department of the university hospital of Reims city in France. The purpose of this communication is to present how the women who suffered from postnatal depression feel about this group therapy in order to improve its quality and broaden its use.
Method. – It is a qualitative study based on a semi-directed interview with a survey. The study sample is a population of 9 mothers who participated in the PND group in the last six years.
Results. – All the mothers we interviewed were very satisfied with the PND group and considered their experience as “very positive”. They felt that the group therapy helped free them of their guilt, to resocialize and to improve their self-image (renarcissization). The results show that talking with their husbands improved the couple’s relationship, which is an important part of the process. Group therapy enabled patients to speak about their feelings in a space where they feel safe and supported.
Conclusion. – We are aware that this study is based on a limited number of women and that some interviews were conducted several years after their participation in the PND group, but the results are so encouraging that we think this method should be broadened.
Keywords: Postnatal depression; Postpartum; Group therapy; Perinatology; Qualitative Study
Dr. Olaya-C is pediatric pathologist and PhD from Pontificia Universidad Javeriana. She is the director of Pathology Department and associated professor at the same University and its Hospital Universitario San Ignacio. She has published more than 25 papers and has worked for fetuses’ health for 20 yerars.
Introduction: Preeclampsia is an important syndrome associated with gestation that causes mortality and morbidity not only for fetuses but also for mothers. The rest of the Hypertensive Disorders of Pregnancy (HDP) (including chronic hypertension -from any cause-,chronic hypertension with superimposed preeclamp sia, and gestational hypertension) also cause an important impact. Likewise, umbilical cord complications have been recognized as potentially dangerous for the fetus and the newborn, in aspects such its length, diameter, insertion, entanglements, knots and coiled, increasing the risk of obstetric complications and fetal or newborn poor outcomes. Recently, a relation between umbilical cord abnormalities and preeclampsia has been found in the literature. Preeclampsia has been associated with abnormalities in the umbilical cord, in several ways: morphological, biochemical and functional. Alteration in blood vessels of the placenta, decidua and circulatory system of the fetus might be related to factors that cause preeclampsia and with alterations of the umbilical cord.
Objectives: This study aimed to analyze the relation between each type of umbilical cord abnormality and the different subtypes of HDP.
Methods: We conducted a prospective study on consecutive autopsies and its placentas, looking for abnormalities in the umbilical cord’s features and their clinical associations. Results: Umbilical cord abnormalities (length, diameter, insertion, entanglements, knots and coiled) were interestingly associated with maternal HDP.
Conclusion: Umbilical cord abnormalities might affect the prognosis of the fetuses and the newborn of mothers who suffer preeclampsia.
Post Graduate Institute of Medical Education And Research, India
A global reduction in cerebral blood flow in infants and neonates results in reduced oxygen and glucose supply to the brain which induces brain damage. This results in hypoxic-ischemic encephalopathy in the affected infants. The cerebral manifestations of HIE depend on the period during which ischemic insult occurs, the duration and severity of ischemia. Therefore in preterm infants the peri ventricular white matter ,which happens to be the vascular water shed zone in the developing fetus and is the region of high metabolic demand due to ongoing myelination, is extremely susceptible to ischemic injury.
When ischemia occurs in the term infants on the other hand, cortical and sub cortical injury is more common with lesser degree of hypoxia; while severe hypoxias involves the deep gray matter of thalamus and basal ganglia.
MR imaging is the best modality available today to evaluate infants and neonates of suspected cerebral ischemic injury. Conventional MRI sequences have an established role in detecting both acute and chronic changes of cerebral ischemia. Of late, diffusion MR has shown high sensitivity in detecting acute ischemic changes in the brain parenchyma.
MR imaging diagnoses the extent of damage in the brain, the site of involvement, differentiates between acute and chronic changes in the brain, thereby assisting in prognosticating the clinical course in patients of Hypoxic ischemic encephalopathy. I shall be discussing the spectrum of changes of hypoxic ischemia in pediatric neonatal population on MR imaging.