Day 2 :
Location: Madrid, Spain
District HQRS hospital, India
Dr.Damera Yadaih Working as a consultant paediatrician at DH, Nalgonda since 23 years.
Working in SNCU from 2008 as CIVIL SURGEON ,HOD.
Instrumental in establish 1st SNCU in INDIA ,1ST level2 unit to get accreditation by NNF.
Working to strengthening the FBNC in India to reduce NMR.
Discharged 8000 babies till date, smallest baby discharged 650 gms, 28 wk GA,1ST of its kind from dist.hospital
AIM : To evaluate the safety, feasibility and efficacy of KANGAROO MOTHER CARE in VLBW babies.
Background:Inorder to reduce NMR. Govt of INDIA with the help of UNICEF is strengthening FBNC through setting up SNCU in all districts. The KMC ward at Nalgonda established on our own by overcoming barriers in terms of space, infrastructure, human resources & training.Ours is the first pilot study done on KMC at any district hospital in India.
Methods: All VLBW <1.5kg. Were put on KMC & analysed for the following parameters : - weight on admission & discharge, breast feeding compliance, sepsis incidence, co morbidities and weight on follow up
Results: Duration of NICU stay before KMC-9.8days ,Mean duration of KMC-14.3days ,Mean wt. at starting KMC-1.2KG ,Mean wt.at discharge -1.7KG ,Wt.gain/kg/day- 16gms,Mortality –Nil sepsis-nil,Breastfeeding at discharge 100%.
Conclusions: KMC should be implemented as a policy for care of LBW at all new born units.
Disclosure of Interest: None Declared
Inonu University, Turkey
Ahmet Selim Ozkan has completed his PhD at the age of 27 years form Kartal Medical Hospital and postdoctoral studies from Inonu Universşty School of Medicine. He is working in Inonu University Schho of Medicine, Anesthesiology and Reanimation Department. He has more papers about anesthesiology and pharmacology study.
Klippel Feil Syndrome (KFS) is a congenital malformation which has a failure of segmantation of cervical somites in the 8th weeks of gestation and fusion at least two cervical segments. It is described as the triad of short neck, low posterior hairline and decreased range of neck motions. Especially decreased range of neck motions lead many anesthesiologists to difficult airway management. Dexmedetomidine is used for sedation especially without respiratory depression and for use in very early age group pediatric patients was not observed in reported cases. In this case; we aimed to present succesfull sedation by dexmedetomidine to infant patient who is 65 days aged, diagnosed KFS, limited neck motions and known difficult airway.
Infant patient, who is 65 days aged, 4 kg weight, 81 cm height and diagnosed KFS, was scheduled for a neck MRI. On evaluation of patient; short neck, low posterior hairline, thorax deformity and floating finger was found. The mouth opening of patient was normal but the extension of neck was particularly restricted. Systemic examination revealed no other abnormalities. The chest X-ray showed hypoplastic ribs. In medical history of patient; there was intermittent respiratory distress. The patient was taken to the anesthetic preparation room. Standard monitorization (electrocardiography, heart rate, oxygen saturation) were performed and intravenous(IV) line was obtained. After preoxygenation for 5 minutes by facemask, dexmedetomidine infusion was administered by IV route as bolus of 0.5 mcg / kg dose for 10 minutes. Monitorization data and Ramsey Sedation Score of the patient were recorded at intervals of 5 minutes. Ear plugs was inserted into patient for protection of loud sounds in MRI room. After bolus administration, dexmedetomidine infusion was continued for maintenance dose as 0.6 mg/kg/hour. Dexmedetomidine infusion was continued for 20 minutes throughout the procedure. Mean values of monitoring data of the patient were recorded as peripheral oxygen saturation:98% (range 96-99), heart rate:138 beats/min (range 130-171), respiratory rate:26/min(range 23-30). During the process, Ramsey Sedation Score was found 4. Dexmedetomidine infusion was terminated at the end of operation and patient follow-up was continued in the postanesthesia care unit. Patient was sent to service after the full awakeness and the patient was discharged on the same day.
Because of beneficial effects, we approved the administration of dexmedetomidine to 65 days aged infant and diagnosed KFS patient. Sedation is important in such cases which is considered limitted neck motions and difficult airway. We believe that dexmedetomidine is an agent may be preferred an alternative agent ensuring respiratory control in anesthesia procedures for sedation.
King Abdullah Specialized children Hospital, Saudi Arabia
Statement of the problem: (292 words)
The importance of Early Intervention programs' effectiveness acknowledged worldwide. Based on its effectiveness Neonatal Early Intervention (EI) Physical Therapy (PT) Program was established one year ago, in King Abdullah Specialized Children's Hospital in Riyadh. The program starts by screening, evaluating and treating Neonates during admission and continued after hospitalization discharge following in the Early Intervention Clinic in Outpatient Physical Therapy Department.
The purpose of the study:
To determine the effectiveness of implementing the EI Program starting from Neonatal Intensive Care Unit (NICU) admission until 12-18 months, Post Conceptual age, on the Sensory-Motor performance after hospitalization discharge, until following the Early Intervention Clinic in Outpatient PT Department in one year duration.
Methodology and theoretical orientation:
Retrospectively all Medical charts were reviewed for all patients and data were collected and statistically analyzed by SPSS, for all patients included in the EI - PT Program ranging from birth until 12-18 months of age. Therefore, patients not included in the EI - PT program since NICU admission will be excluded from the study. Many factors, Information and Investigations were considered such as; Diagnosis, Respiratory support modalities, Gestational Age, Post Conceptual age, Radiology outcomes, Postural Alignment, Length of Stay in hospital and the developmental milestone level. Objective measures used are; Osteopathic approach assessment and evaluation, General Movements (GM), Alberta Infant Motor Scale (AIMS). The treatment approaches utilized are; NE-O Osteopathic approach, Bobath concept, family education.
The results of Neonatal Early Intervention Physical Therapy Program outcomes will be finalized in 4 months' time.
Conclusion and significance:
Some considerations as the co-relations between all factors and the collected data besides, the efficacy of Physical Therapy at the early age of intervention.
Croatian Institute of Transfusion, Croatia
Maja Tomicic is the Head of Department for platelet and leukocyte diagnostics and haemostaseology, and Education Department, specialist of transfusion medicine, from 1992. Scientific assistant, University of Zagreb Medical School from 2012.
CITM is National Blood Transfusion Center that collects and test donor’s blood, produces blood products and performs pretransfusion testing patients and pregnant women.
As a head of Department, I have responsibilities for development and introduction of methods for platelet and leukocyte immunogenetic and hemostasis testing for outpatients, blood products quality control hemostasis testing, and investigation of transfusion associated acute lung injury(TRALI), post transfusion purpura (PTP), fetal and neonatal alloimmune thrombocytopenia (FNATP) and neutropenia (ANN).
Alloimmune fetal and neonatal thrombocytopenia (FNATP) is the result of maternal alloimmunization during pregnancy to fetal platelet antigens (HPA) inherited from the father.
In most cases develops consequently to alloimmunization to the specific platelet antigens (HPA)-1a and-5b, less frequently HPA-3a and -15a/b. FNATP has an incidence of 1:1000 to 1:2000 births in white populations. It is self-limiting and transient disorder with an excellent prognosis in absence of intracerebral bleeding (ICH). Current guidelines recommended transfusion of HPA compatibile platelets to prevent ICH.
The aim of this study was to established an algorithm of laboratory testing for FNATP and to analyze laboratory and clinical data on platelet transfusions in anti-HPA-1a cases.
An algorithm of laboratory testing for FNATP included serologic screening of maternal and neonatal sera/plasma and platelets by immunofluorescence (IF) method; direct and indirect test. The monoclonal antibody immobilization of platelet antigens (MAIPA) and PAK 12-KIT (Lifecodes/Immucor, USA) were employed to determine anti-HPA antibody specificity. Results of serologic anti-HPA testing were confirmed by maternal and neonatal/paternal HPA-1, -2, -3, -5 and -15 genotyping by PCR-SSP method.
Serology screening for FNATP yielded positive results in of 56 of investigated cases. Anti-HPA antibodies were detected in 34 of 56 (61%) cases of serologically positive NATP, i.e. 19 anti-HPA-1a, 11 anti-HPA-5b, 1 antiHPA-1b, 1 antiHPA-3a, 1 antiHPA-5a and 1 anti-HPA-15a. In 6 of 56 (11%) pan-reactive (anti GP IIb-IIIa) autoantibodies in mothers with ITP were detected. In another 16 of 56 (28%) cases, anti-HPA specificity could not be demonstrated.
The average lowest platelet count in newborn blood was 60x 109/L (min.11 and max.104) and duration of thrombocytopenia 1,5 weeks (min. 0,5 and max. 3). 14 of 16 (87%) neonates did not receive any treatment and there were no signs of hemorrhage. One newborn received platelet transfusions, intravenous gamma globulins and corticoids, and another tree transfusions and intravenous gamma globulins. All of them reached full recovery. There was no fatal disease.
FNATP is rare but potentially life-threatening disorder. Serologic testing for FNATP in case of isolated thrombocytopenia in the newborn contributed considerably to timely detection of this disease. Platelet transfusions are needed in severe cases of FNATP to prevent ICH
In the absence of HPA compatibile platelets random donor transfusion is an acceptable approach in urgent situations.
Terence Lao graduated MBBS from the University of Hong Kong, and obstained his MD in 2002. He received training in Obstetric Medicine at the Queen Charlotte’s Maternity Hospital, London, UK in 1983-4, and completed the fellowship programme in Maternal-Fetal Medicine at the University of Toronto in 1989-93. He is professor at the Department of Obstetrcs & Gynaecology, The Chinese University of Hong Kong. He has published 300+ papers in international journals and is a reviewer for 24 journals, and serves on the editorial board of three international journals. His major interest is in maternal medicine and high risk pregnancy.
Thalassemia is the commonest monogenetic disease. Homozygous thalassemia manifests as severe anemia. The manifestation of the heterozygous form can vary from totally asymptomatic and being identified only on antenatal screening, to severe anemia even requiring blood transfusion. It is increasingly encountered outside the Mediterranean region, Africa, Middle East, and South East Asia, due to immigration. Pregnancy, previously uncommon in homozygous ß-thalassemia, is encountered increasingly due to improved management and assisted reproduction technology, but preconceptional problems that include anemia, iron overload, cardiac dysfunction, thromboembolism, alloimmunization, infections, and endocrine and bone disorders, could impact on maternal and obstetric outcome. Successful pregnancy in thalassemia trait carriers and women with hemoglobin H disease is more common, and the pregnancy outcome is usually similar to normal women, although there is still increased risk of obstetric and perinatal complications in case of severe anemia or iron overload. Prenatal diagnosis to exclude fetal homozygous thalassemia and other congenital anomalies, together with close monitoring of the pregnancy, would optimize pregnancy outcome. Further research is warranted to elucidate the fetal safety of iron chelation therapy, and potential impact of pregnancy on long-term maternal health outcome, especially following occurrence of maternal complications.
Dr.Bidari’s Ashwini Children Hospital and Research Centre, India
Dr. Hadalgi has 10 years of experience in Pediatrics, with 5 years of experience in Advanced Neonatology. She is NICU Incharge, Tertiary Care Centre. She is Faculty for DNB Postgraduation, Fellowship in Neonatal and Perinatal Medicine for Doctors/Nurses, NRP Instructor. She is Board member for public-private partnership in Vijayapur District(VIJINAP-2016). GIANI Scholar Awardee by AAP(2016)
Surgical emergencies in neonates are usually congenital malformations. Their smaller size, immature organ system and differing volume capacities, pose challenge during perioperative period.
AIMS AND OBJECTIVES
- To study the incidence and etiology of acute abdomen in neonates.
- To Study the outcome of above newborns.
MATERIALS AND METHODES
This is a 1 year prospective observational study. Patient’s profile, symptoms, etiology of acute abdomen, surgical intervention and their outcomes were analyzed.
Total admissions to NICU were 1206. A total of 27 neonates(2.2%) were admitted with acute abdomen. 5 babies had underlying medical condition -3 had Septic ileus, 1 had meconium ileus, 1 had portal vein thrombosis . Out of all surgical cases(22), majority were males 17(77%). 10 babies (45%)were born at term, 12 were preterms of gestational age 30-37wks. 6 babies were >2500 gms, 4 babies were LBW, 2 babies were VLBW. 9 babies(40%) presented with in 1st week of life majority diagnosed to have ARM and intestinal obstruction. Mean age of NEC presenting as acute abdomen was 2nd week. Malrotation and colonic perforation presenting as intestinal obstruction were encountered in 3rd week. Most common clinical presentation was abdominal distension with bilious vomiting. 22 babies required surgical correction. 7(32%) were diagnosed with Anorectal malformations, 2(9%) had hirschsprung disease, 6(27%) had stage III necrotizing enterocolitis ,5(23%) diagnosed with malrotation ,1(4.5%) for Gastroschisis and 1(4.5%) with Ruptured omphalocoele. 7 postop cases died, mortality being 32%, mainly attributed to infection, multiple atretic gut.
Most common surgical conditions in the newborn involve gastrointestinal tract. Most of our patients were male(77%). 40% of cases presented in first week of life, as ARM or intestinal obstruction, second most common cause being intestinal atresia. This pattern of etiology agrees with Deshmukh SN et al. Corrective surgeries done in most of our cases. Overall mortality rate in our study was 32%, nearing other studies. Highest mortality observed due to NEC, septicaemia, multiple atretic gut. No mortality observed in Hirschsprungs disease,ARM.
Early presentation observed in Anorectal malformations, intestinal atresias, meconium ileus.Hirschsprung and Malrotation presented later. Hence sick newborns borns with congenital malformations are salvageable if given proper NICU care,specialist surgeon and anaesthetist and ideal postoperative care.
Children’s Hospital of Soochow University, China
Xin Ding，MD. PhD, ever as an visiting scholar at Boston Children’s Hospital of Harvard University. Her director is Xing Feng, the secretary-general and permanent member of committee of Pediatrics Branch of Chinese Medical Association. She has published nearly ten papers in reputed journals on circadian rhythm disturbance.
Circadian rhythm disorder is a common neurological deficit caused by neonatal hypoxic-ischemic brain damage (HIBD). However, little is known about its underlying mechanisms. Our previous studies revealed a significant elevation of clock genes at the protein, but not mRNA, levels in the pineal gland after neonatal HIBD. To investigate the mechanisms of post-transcriptional regulation on clock genes, we screened changes of miRNA levels in the pineal gland after neonatal HIBD using high-throughput arrays. Within the miRNAs whose expression was significantly down-regulated, we identified one miRNA (miR182) that targeted the 3’-untranslated region (3’-UTR) of CLOCK, a key component of clock genes, and played a crucial role in regulating CLOCK expression after oxygen–glucose deprivation in primarily cultured pinealocytes. Our findings therefore provide new insight on studies of therapeutic targets for circadian rhythm disturbance after neonatal HIBD.
Intl. Univ. Health and Welfare, Japan
K.I. has completed MD, PhD from Jichi Medical University and worked as a postdoctoral fellow at Penn State University (USA) and at Genzentrum of München University (Germany). Now she is a professor of Physiology in IUHW and doing experiments with her own hand.
Sodium pump (Na+, K+-ATPase) is a membrane protein that plays a critical role in maintaining Na+ and K+ gradients across the cell membrane. It consists of catalytic α and regulatory β subunits. Four α isoforms are found in mammals. In the central nervous system, the α2 isoform is mainly expressed in glial cells and α3 isoform in neuronal cells. Point mutations in the ATP1A2 (gene encoding α2 isoform in human) cause Familial hemiplegic migraine type 2 (FHM2). Point and deletion mutations in the ATP1A3 (gene encoding α3 isoform in human) cause alternating hemiplegia of childhood, apnea, and severe infantile epileptic encephalopathy often appear after birth. Through the analyses of knockout (KO) mice of the gene for α2 (Atp1a2) or for α3 (Atp1a3), here we report that both α2 and α3 subunits play important roles in respiratory rhythm generation. Homozygous Atp1a2 KO mice die shortly after birth due to respiratory malfunction resulting from abnormal Cl− homeostasis in brainstem. On the otherhand, homozygous Atp1a3 KO mice showed various respiratory defect. Half of Atp1a3 KO mice made an effort to breath at birth, immediately followed by seizure attack, and resulted in their death. The other showed complete absence of spontaneous body movements and no breathing movements from the very beginning at birth. Consistently, we electrophysiologically recorded various abnormal respiratory activities in the brainstem of Atp1a3 KO mice. These data suggest that both isoforms are essential for survival at perinatal period and Atp1a2 and Atp1a3 play critical, but different roles in respiratory rhythm generation.