Day 1 :
Keynote Forum
Mohammad Monir Hossain
Bangladesh Institute of Child Health & Dhaka Shishu Hospital, Bangladesh
Keynote: Management of Pulmonary Hemorrhage in Neonatal Infant
Time : 9:00 to 9:45
Biography:
Professor Dr. Mohammad Monir Hossain is currently working as Professor of Neonatal Medicine, NICU & Critical Care of Paediatrics at the Bangladesh Institute of Child Health (BICH) & Dhaka Shishu (Children) Hospital. He received his PhD from the University of Dhaka for his research work on neonate receiving intensive care in 2006. After his graduation (MBBS) in 1987, he completed Doctor of Medicine in Paediatrics (MD) in 1997. He became fellow (FCPS) of Bangladesh College of Physicians & Surgeons in 1999 and Royal College of Physicians and Surgeons of Glasgow (FRCP Glasg) in 2009, Royal College of Physicians of Edinburgh (FRCP Edin) in the same year and Royal College of Paediatric & Child Health (FRCPCH), UK in 2010. Since 2001 Professor Hossain has been serving as Assistant Professor, Associate professor and Professor at Bangladesh Institute of Child Health & Dhaka Shishu (Children) Hospital.Professor Hossain has authored several publications in various journals and books. His publications reflect his research interests in critical care in neonatology.
He was the Executive Editor of Bangladesh Journal of Child Health (BJCH).
Abstract:
Pulmonary hemorrhage (PH) is an acute, catastrophic event characterized by discharge of bloody fluid from the upper respiratory tract or the endotracheal tube. The hematocrit of the hemorrhagic fluid is often 15 to 20 percentage points below the venous hematocrit. The incidence of PH is 1 to 12 per 1,000 live births. PH occurs most commonly in the first few days after birth. Mortality rates as high as 50% have been reported.
Prematurity is the factor most commonly associated with PH; other associated factors are those that predispose to perinatal asphyxia or bleeding disorders, including toxemia of pregnancy, maternal cocaine use, erythroblastosis fetalis, breech delivery, hypothermia, infection, Respiratory Distress Syndrome, administration of exogenous surfactant (in some studies) and ECMO. It is postulated that the infant suffers an asphyxial insult with resultant myocardial failure; this increases pulmonary microvascular pressure resulting in pulmonary edema. Subsequently, there is frank bleeding into the pulmonary interstitial and alveolar spaces.
The typical presentation of the infant with PH is a premature infant who suddenly presents with frothy pink-tinged secretions from an ET. Over the next minutes to hours, the infant often requires increased ventilatory support and has increased work of breathing. As increasing amounts of blood are suctioned from the ET, PCO2 starts to rise, as does the need for oxygen. If the PH continues, the infant will develop apnea, generalized pallor, become cyanotic, with concomitant bradycardia and a drop in blood pressure. Chest radiography results are nonspecific. Based on severity and timing of the PH, the chest radiograph may have fluffy opacities, focal ground-glass opacities, or appear as a complete “white out” if the PH is massive.
The immediate treatment of PH should include tracheal suction to ensure that blood clots have not obstructed the ET. The FiO2 should be increased as guided by the oxygen saturation of the infant. The standard therapy is to raise the positive end-expiratory pressure (PEEP) to 6 to 8 cm H2O. To decrease PH, the mean airway pressure should be increased in an attempt to reverse or slow down hemorrhagic pulmonary edema. In some cases, high-frequency oscillatory ventilation may be needed to increase the mean airway pressure.
Endotracheal or nebulized epinephrine has been used in the treatment of PH because of its vasoconstrictive and inotropic effects. Immediate radiography of the chest should be obtained. Once the hemorrhage has resolved, the chest radiograph will show improvement within ∼24 to 48 hours. Because the radiographic appearance of PH is difficult to distinguish from pneumonia, therapy often includes antibiotics until infection is ruled out. An echocardiograph should be done to rule out left to right shunting through a PDA. In this setting, surgical treatment for PDA may be safer than medical treatment because the latter may exacerbate bleeding. Phytonadione (vitamin K) should be given to correct prothrombinemia. Based on an estimate of the volume of blood lost, packed red blood cells and platelets should be given after a complete blood count, prothrombin time, activated partial thromboplastin time, D-dimers, and fibrinogen are obtained. The administration of recombinant factor VII should be considered. Activated recombinant factor VII (rFVIIa) has been successfully used to treat severe PH refractory to conventional ventilator management in very low birth weight infants. Surfactant has also been used in the treatment of PH. with significant improvement in oxygenation index and no deterioration. Hemocoagulase has been reported as a new effective treatment for PH. by converting prothrombin to thrombin and fibrinogen to fibrin. Hence, it decreases bleeding time and enhances coagulation at sites of bleeding. The mainstay of treatment includes ventilation and vigorous resuscitation of a shocked and critically ill infant.
- General Pediatrics | Child Abuse and Neglect | Pediatric Critical care and Emergency medicine
Session Introduction
JingHui Yang
KK Women’s and Children’s Hospital, Singapore
Title: Integrated Health and Social Service delivery using Trans-disciplinary approach in the prevention of child abuse and neglect, the Singapore Model
Biography:
Dr Yang JH graduated from NUS with an MBBS in 2005, and continued to pursue her passion in Paediatrics with various rotations in KKH and SGH. She completed her specialty training in Paediatrics in June 2014. She won the “Best Houseman Award” for her posting in General Surgery, CGH in 2006 and the “Singhealth Service from the Heart Silver Award” for her work in KKH in 2012 and 2016. She is currently working as a consultant in the Department of General and Ambulatory Paediatrics. She is also contributing to the Kids Integrated Development Service (KIDS 0-3). This is a programme aimed at equipping mothers and children from vulnerable families to have the knowledge and skills for a good start in early childhood. This is in partnership with the Early Childhood Development Agency, Ministry of Social and Family Development, under the kidSTART programme. The journey with KIDS 0-3 has ignited an interest in early childhood development and community paediatrics. The exposure has given her an insight into how we can fashion our paediatric landscape, with good partnership with our primary care providers, as well as the early childhood professionals. She looks forward to greater collaboration, with a view to develop community paediatrics in Singapore.
Abstract:
Adverse Childhood Experiences (ACES) are known to impact child health and development as well as future adult health. Kids Integrated Development Service 0-3(KIDS0-3) is a pilot preventive early intervention program to mitigate impact of ACES from pregnancy till the child turns 3 years old. The program aims to deliver an integrated health and social home visiting program through a transdisciplinary key-worker model( Fig 1).The key worker is the point of contact in equipping families with skills in parent-child interaction, monitors child health and development and to detect early signs of child neglect. Standardized tools are used for screening of maternal mental health and monitoring of child’s developmental progress. The target populations are low income families with multiple risk factors
Families risk factors are assessed by the Family Advocacy and Support Tool (FAST) and ACES check-list that helps communicate the complexity of the families. After which, a team of professionals comprising paediatricians, social workers, nurses, community health visitors and allied health professionals support the key worker in the transdisciplinary skills. The trans-disciplinary skilled worker is well placed to detect the presence of early signs of infant emotional and physical neglect. KIDS 0-3 collaborate with Child Protection Services (CPS) in using a common tool, Sector Specific Screening Guide (SSSG) and Child Abuse Reporting Guide (CARG) for assessing risk factors in the family environment. By applying this tool, CPS is able to take appropriate action and work with the KIDS0-3 team or community supporting agencies to step up infant protection strategies. In this paper, we illustrate how an integrated Health and Social service for families at risk of neglect and abuse is implemented through a Transdisciplinary key worker approach. To ensure the healthy development of our future generation, the Paediatricians need to understand the social determinant of health factors and skills to practice preventive medicine and advocacy.
M R Savitha
Mysore Medical College and Research Institute, India
Title: The study of lipid profile and other cardiovascular risk factors in children born to parents having premature ischemic heart disease
Biography:
M R Savitha is currently working as Professor of Pediatrics at the Department of Pediatrics of Mysore Medical College and Research Institute, Mysore, India. She has 22 years of experience in the field of pediatrics. She has published 39 papers in various national and international journals. She has presented 41 papers in various states, national and international conferences. Her field of interest is allergy and asthma in children and lipid profile in children
Abstract:
Objectives: To study lipid profile and other cardiovascular risk factors like hypertensive status, BMI in children aged between 5 years and 18 years born to parents having premature IHD, to study diet and life style factors in study group having family history of IHD and to study the socio-demographic profile of dyslipidemia.
Methods: Lipid profile and other cardiovascular risk factors were studied in 200 children with family history of premature IHD and compared to 200 children without family history of IHD.
Results: Amongst the cases there were 130 males and 70 females (M:F=1.8:1) as compared to 103 males and 97 females amongst controls (M:F=1.06:1).On comparison of mean lipid profile between cases and controls, HDL cholesterol was very low amongst cases as compared to controls (p=0.001). The triglycerides and VLDL were very high amongst cases as compared to controls (p=0.001). The atherosclerotic index which was determined by TC/HDL was high among cases as compared to controls (p=0.001). However there was no statistically significant difference between cases and controls as far as total cholesterol (p=0.089) and LDL cholesterol were concerned (p=0.105). Dyslipidemia was more evident after 10 years of age and also more evident in boys than girls. More number of cases had prehypertension and hypertension (p=0.004), excess junk food intake (p=0.001), sedentary lifestyle (p=0.001). 20.5% of cases had family history of IHD apart from parents. Except for increased BMI (p=0.016) there was no increased dyslipidemia in this group as compared to those without multiple family history of IHD.
Conclusion: Children of premature ischemic heart disease patients have significant incidence of dyslipidemia and risk factors like elevated BMI, excess junk food intake and sedentary life style with increased incidence of pre hypertension and hypertension.
Udayani Prabha Kumari
Ministry Of Health, Sri Lanka
Title: The prevalence of undernurition and associated factors among children aged one to five years in a rural area in Sri Lanka
Biography:
Abstract:
Introduction
High prevalence of child undernutrition is a well-known issue in rural areas. The objective of this study was to describe the prevalence and associated factors among children aged 1-5 years in Siyambalanduwa MOH area in Moneragala District.
Methods
A community based cross-sectional study was conducted among 421 child-mother pairs in Siyambalanduwa MOH area using two stage cluster sampling method with a cluster size of 36. Children of mothers who cannot communicate in Sinhala were excluded. Data were collected by pre tested interviewer administered questionnaire and conducting anthropometric measurements according to WHO guidelines. Statistical analysis was done using SPSS 20. The chi-square test was used, and P<0.05 was considered for statistically significant.
Results
Overall 41% of children aged 1-5 years were undernourished in Siyambalanduwa MOH area. Among the study subjects 24% were underweight, 25.7% were stunted, 16.4% were wasted,9.2% were both underweight &stunted, 6.8% were both, underweight & wasted ,0.5% were both, stunted & wasted and 9.9% were underweight & stunted &wasted. Only the low total monthly income (P<0.001) and low birth weight (P<0.001) were significantly associated with child undernutrition. Among parents or caregivers 18.6% had good knowledge, 35.6% had favorable attitudes and 12.6% had good practices related to child nutrition. None of the above three factors were significantly associated with child undernutrition.
Conclusions and recommendations
Prevalence of undernutrition among children aged 1-5 years is high and urgent efforts to reduce undernutrition should be a priority.Future studies should focus on assessing how to reduce the burden with low cost appropriate interventions.
Zahrah Khimani
Uraan – Paediatric Therapy Services, Pakistan
Title: Cognitive Insights into ADHD: Exploring the Relationship Between ADHD, Parent’s/School’s Knowledge, Dysfunctional Expectations and Beliefs, and Stigmatization in Pakistan
Biography:
Zahrah Khimani has completed her MSc in Clinical Neuropsychology from University of Bangor, UK. She is Master Neuro Linguistic Practitioner - Licensed (USA) and Specialised in Cognitive Behaviour Therapy (USA). At present she is working as a Senior Behaviour Therapist at Aga Khan University Hospital and Senior Clinical Psychologist at Karachi Vocational Training Centre. She ia also working as A-Level Psychology Faculty at Foundation Public School. She is the founder and and CEO of URAAN-Paediatric Therapy Services
Abstract:
Objective: In Pakistan, there is an extreme dearth of awareness about the developmental needs of children, especially those suffering with ADHD is sorely lacking. A comprehensive analysis of the published empirical research literature of Pakistan demonstrates that no studies so far have been conducted on the significance of parents and teachers knowledge of ADHD. This study is an initial step to create awareness and tolerance for all those children who are different. The primary purpose of this study is to explore the existing knowledge and understanding (if any) of parents and teachers about ADHD. Moreover to inquire, how their cognition and belief towards mental health services for ADHD influences their decision to seek psychological assistance and medical help for their child’s treatment.
Methods: Purposive sampling technique was used to select primary students (6-8 years) from lower middle class schools from three different towns of Karachi, Pakistan. Ten Focus group interviews were conducted to collect data from 150 (semi-literate) parents and teachers (untrained).
Findings: The findings of the study shows cognitive dysfunction of parents due to stigmatization of learning disabilities, societal pressure and rigid thinking (tunnel vision). There is a 2:1 ratio proportion of fathers & mother in laws hindering the treatment as compared to the mother. 80% of the mothers in the focus group outlined/suggested lack of decision making (especially in case of children) in a male dominant society. Moreover, mothers attributed lack of guidance/professional help/inclusive schools in Pakistan as compared to the west (developed nations) where ADHD treatment is much more common. While 45% of the fathers attributed lack of finances and overload of responsibilities. This concludes that parents disregard the needs of their child over societal needs.
Biography:
Manmeet Kaur is currently working as an Assistant Professor (Pediatrics) in Chitkara School of Health Sciences, Chitkara University, Punjab, India. She is currently perusing her PhD (Autistic Spectrum Disorder) in Health Sciences from the same organization. She has published in total 6 research articles in international journals. Also, she presented her 2 posters in 10th World Pediatric Congress 2017 held in Dubai, United Arab Emirates and 1 poster nationally. Her title registration form has been selected by the Campbell Collaborations, Norway and the project entitles “Interpersonal Psychotherapy for reducing symptom severity in Post-Partum Depression: A systematic Review which will be completed along with the expert team
Abstract:
Pregnancy is a time period from conception to a birth in which the egg is implanted in the uterus which develops into placenta and embryo and later into fetus. The life of fetus and physiological changes depends upon the transition from intrauterine life to extra uterine life which occurs after the birth. Placenta plays an important role in between the mother and fetus and enables respiratory gas exchange, transports nutrients, eliminates fetal waste products, and secretes peptide and steroid hormones. Amniotic fluid surrounds the unborn baby in womb and acts as a cushion to protect fetus from injury and push fluid out of lungs. After birth the fluid isn’t completely expelled out from the lungs due to which lungs unable work properly further leading to lack of oxygen in new-born. Due to inability to combat with vascular resistance and maintained respiratory exchange new-born resuscitation is required. About 10% of new-born requires resuscitation at birth to breath and less than 1% will require extensive resuscitation. Since, the health care providers play an important role in implementing the steps of Neonatal Resuscitation among the babies in a serious need to be resuscitated, the aim of the study is to assess the effectiveness of hands on training on the knowledge and practice regarding Neonatal Resuscitation Program among the Health care providers in the selected institute rendering Bachelor’s educational facilities. The major objectives of the pre-experimental study was to assess the level of knowledge ,mean pre-test and post-test knowledge and practice scores before and after hands on training and to find out the association of selected demographic variables with knowledge and practice scores on Neonatal Resuscitation Program among the health care providers. The study findings revealed that the mean post-test knowledge and practice scores were relatively higher than the mean pre-test knowledge and practice scores. Thus, the hands on training session of knowledge and practice on Neonatal Resuscitation Program was proved to be effective in improving overall knowledge and practice among the Health care providers.
Christina Oldfield
University of Colorado Health, USA
Title: Pediatric Differential Diagnosis: Is It Abuse or Not?
Biography:
Christina has been a nurse for nine years with an extensive background in the intensive care unit. Christina continued her journey in the forensic field in 2011 where she is now serving as the clinical team lead for the program. The program where she works sees over 1800 patients yearly. Christina has performed over 1000 exams on patients impacted by violence. She has taught at the State level for communities and provided over 75 educational classes for forensic nursing. Christina has also taught at the International level and taught in 3 sessions at the Colorado convention for the IAFN in 2016. Christina instructs the Colorado skills labs for new SANEs and has run the Indian health services clinical labs. Christina was the previous Colorado Chapter president of the IAFN in 2013 and has received the Ted T Lewis award in 2016 for her work done in the community. Christina sits on the elder abuse committee, along with the District 49 Academy of Health Sciences Advisory Committee. She is also actively involved in the community outreach programs. Christina will graduate in the spring of 2018 with her Bachelor’s degree and plans on continuing her education for her Masters.
Abstract:
Each year more than 3.6 reports are made of child abuse. On an average of 4-6 children die every day from child abuse or neglect. Children in their first year of their life have the highest rate of victimization. Four out of five abusers are the children’s parents. . Violence is a healthcare issue. Knowing how to accurately screen for abuse and recognize the red flags that increase abuse in the home can help save a child’s life. This presentation will go over the signs and symptoms of abuse along with the lack of visible injury seen with child abuse and neglect.
On average 20 people per minute are physically abused by an intimate partner. 1 in 3 women and 1 in 4 men have been victims of some sort of violence in their lifetime. Addressing the Danger Assessment tool and educating the lethality with the patient on the situation can assist with safety planning. Being able to recognize the signs and symptoms of abuse and addressing it in a sensitive appropriate way can assist with disclosure. Children that witness intimate partner violence are more susceptible to be victimized as an adult along with multiple negative health consequences. This portion of the presentation will allow for the audience to be able to verbalize the signs/symptoms along with the lack of signs of intimate partner violence. This will also show the correlation of being in a stressful environment and how this may affect the child’s future. The Adverse Childhood Experiences will be discussed along with case studies on actual patients that were seen in the hospital.
Narges Gholami
Shahid Beheshti University of Medical Sciences, Iran
Title: Lead poisoning in pediatrics in Loghman Hakim Hospital, Tehran, Iran.
Biography:
Narges Gholami is Pediatrician, Assistant professor of pediatrics, Loghman Hakim Hospital, Shahid Beheshti University of medical sciences, Tehran, Iran.
Abstract:
Phani krishna
AJ Institute of Medical Sciences, India
Title: Serial Estimation of the Severity of Multiple Organ Dysfunction Syndrome in Critically ill Children by Using Pelod – 2 Score
Biography:
He has been working as a Junior Resident in department of Pediatrics at AJ Institute of Medical Sciences, Mangalore India.
Abstract:
Aim and Objectives of the study:
To Validate the daily PELOD-2 score using the set of seven days as predictors of PICU death.
Material and methods:
Source of data : Prospective, Observational, Analytical, Cross sectional Design Patients admitted to the PICU of AJIMS, Mangalore from November 2015- November 2017 are considered.
All patients fulfilling the inclusion criteria will be included as study subjects after obtaining informed consent. PELOD-2 score will be used to predict the outcome of the patients.
This includes 11 variables as mentioned in below table. Patients baseline characteristics and calculated PELOD-2 score at days 1, 2, 5, 8, 12, 16 and 18 in PICU.
For each variable, the most abnormal value each day was used in calculating the PELOD-2 score.
Organ dysfunction was defined as a PELOD-2 score >0 for a given organ, and MODS as the simultaneous presence of two or more organ dysfunctions The PICU discharge status (death/survival) was used as the outcome dependent variable.
RESULTS :
A total of 106 children were analyzed. 52.8% patients survived and 47.2% expired. The overall mortality rate was 47.2 %. 66 were males, accounting for 62% and 40 were females, accounting for 38%. The male to female ratio was 1.6:1. Major cases had nervous system involvement., i.e.,43%, among which 48.8% expired and 51.2% survived. The next common system involvement was respiratory (31%) followed by cardiovascular (21%).71 patients had a score of >20 on day 1(i.e., day of admission),48 patients had a score of >20 on day 2, 26 patients on day 5, 15 patients on day 8 and 7 patients on day 12., and it correlated with the mortality (p <0.001). 90% cases where 4 organ systems were involved expired, as compared to only 4.8 % when it was single organ involvement.,confirming that mortality is directly proportional to the number of organ systems involved.
PELOD score of >20 was associated with higher mortality rate, being 60.6% (p=0.001).81.8% of the patients with a score of <10 survived in our study.
The correlation between high PELOD scores on admission and also high mortality was obtained and it was statistically significant . (p=0.001).
CONCLUSION:
The PELOD-2 scores increased significantly with increase in organ involvement.The best indicators of poor outcome in our study were number of organ dysfunction and PELOD-2 score.
Eng. Faisal Ashour
King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
Title: Virtual Reality (VR) Technology in the Absence of General Anaesthesia during Radiotherapy Procedure for Paediatric Oncology Patients
Biography:
Abstract:
VR is a three-dimensional (3D) computer-generated environment that enables the user to explore and interact within a different environmental perspective. It could be in the form of a realistic-artificial environment or a 3D imaging that is presented to the user as a real atmosphere with made-up information. The VR has-been considered as a non-pharmacologic form of analgesia through exerting attention processes on the body’s intricate pain system. It does so through profoundly immersing the body and mind by delivering enough sensory information to the extent where it suspense any disbelief that one is in a virtual environment. The aim of the study is to eliminate the General Anaesthesia (GA) procedure used on paediatric oncology patients undergoing multiple fractions of Radiotherapy. We aimed to utilise the VR technology as a replacement for the GA. Typically, the radiotherapy session under GA takes around 30 minutes from the machine time and that session can be repeated daily for several weeks. As a result, VR Technology was an excellent alternative in most of the patients treated with radiotherapy for non-Head/Brain Tumours. There were significant reductions on the number of the GA sessions. That reductions have a great impact on reducing side effect of GA and save more time on the Radiotherapy machine that can be used to treat more patients.
Biography:
Dr. Anita Patil has 20 year experience of working on children health and wellbeing. Looking after the health issues of the school going children, started working on the preventive aspects of the childhood obesity. She has formed the strategy plans in schools program to control the child obesity like healthy eating habits, physical activities etc. This preventive program also include yearly screening of the school going children to rule out overweight-obesity.
Abstract:
Statement of problem: Prevalence of childhood obesity has risen globally in recent years. Some studies like International Association for the Study of Obesity (IASO) and International Obesity Task Force (IOTF) have documented childhood obesity prevalence rate and its trend based on data of six countries. There is lack of national representative data on childhood obesity for India. However, nationally representing studies like Indian Academy of Pediatrics (IAP) have studied adolescent population in few thousand (n=87022). We attempted to find prevalence of overweight and obesity based on national registry data (District Level Household Survey). Also to find overweight children falling between 85th-95th percentile and obese >95th percentile of BMI in studied population.
Methodology & Theoretical Orientation: All children (5-8 Years) and adolescents (9-18 Years) from District Level Household Survey with valid records of height, weight, age and sex and locality were selected. BMI using Age and Sex of an individual were compared with standard growth charts recommended by IAP. BMI-Z score were calculated and compared with standard values and accordingly each individual were tagged as Severely-underweight, Underweight, Normal-weight, Overweight and Obese. Based on overall data, age-sex specific BMI percentile values were calculated for 3rd, 5th, 85th and 95th. Proportion of overweight and obese children across each state is represented using ArcGIS 2.0.
Findings: 255614 children data of 20 states from India were studied. 15% children and adolescents were found overweight and obese. Age wise decreasing pattern was seen in obesity, 17% obesity for 5 years to 13% in 18 years. Gender wise no significant difference was seen. Prevalence of obesity is seen high in some of southern states compared to eastern states.
Conclusion & Significance: Prevalence of obesity and overweight is found higher in urban than rural region. Higher obese-overweight prevalence adolescent were found in states like Goa, Kerala and Pondicherry.
Maged El Wakeel
National Research Centre, Egypt
Title: A Novel Predictor of Obesity-Related Complications in Children
Biography:
Dr/ Maged A. El Wakeel has completed his PhD in childhood studies at the age of 33 years from Ain-Shams University and was promoted to associate professor position at The National Research Centre, Cairo, Egypt. He has published more than 15 papers in reputed journals and has been serving as an reviewer in other journals.
Abstract:
Background and Aim: The rapidly increasing prevalence of childhood obesity has become a major burden on health worldwide, giving an alarm to healthcare clinicians and researchers. Adipocytes act as an active endocrine organ by releasing a plenty of bioactive mediators (adipokines) that play a vital role in regulating metabolic processes. Apelin is a newly discovered adipokine that is expressed in adipocytes. The present work aimed to study the association between serum apelin and childhood obesity and its related complications as hypertension and hyperglycemia
Method: 50 obese and 45 non-obese age- and sex-matched children were enrolled in our study with mean age of (9.5±2.1) and (8.7±1.3) respectively. Anthropometric measurements, blood pressure were assessed in all studied participants, we also determined the lipid profile, serum insulin, fasting blood glucose (FBG) level, HOMA-IR and serum apelin.
Results: Obese children had higher levels of FBG, HbA1c, serum insulin, HOMA-IR, triglycerides, total cholesterol, and low-density lipoprotein (LDL) and diastolic blood pressure (DBP Z-score); compared to controls (all p<0.05). Apelin was significantly higher in obese children versus controls and correlated positively with BMI Z-Score (p=0.008), DBP Z-Score (P= 0.02), cholesterol, TG (both p= 0.02), serum insulin (p=0.003), FBG and HOMA-IR (both p=0.001). Linear regression analysis showed that FBG was the most effective factor predicting the level of serum apelin (p=0.04)
Conclusion: This work supports the hypothesis that apelin may have a pivotal role in the pathogenesis of obesity-related complications in children including hypertension and insulin resistance and a higher risk of occurrence of metabolic syndrome.
Rania Nabil Sabry
National Research Centre, Egypt
Title: Urinary Bisphenol-A: its relation to food intake and packaging in Egyptian Children
Biography:
I am graduated from faculty of medicine, Cairo University in 1997, had PHD in child health and nutrition from faculty of postgraduate childhood studies in 2010, now I am associate professor , child Health Department, National Research Centre, Egypt.
Abstract:
Introduction: Bisphenol A (BPA) is a high production volume industrial chemical used in manufacturing of polycarbonate and other plastic products and epoxy resin that line food can. The aim of this study is to analyse whether increased consumption and packaging of different food types in a sample of Egyptian children will be associated with higher urinary levels of BPA or not. Subjects and methods: A random sample of 305 children and adolescents from 2-18 years old of different social levels were included. Three public and two private Egyptian Schools were chosen using a list of random numbers. Forty nine preschoolers were enrolled in the study. Personal history as well as anthropometric measurements including: weight, height, waist & hip circumference were taken. BMI was calculated. Urine samples were collected from 297 children and adolescents. Urinary BPA, was categorized into quartiles (<1.3 ng/mL, 1.3–< 2.6 ng/mL, 2.6–4.9ng/mL, >4.9 ng/mL). Results: Higher BPA levels were found in elder children ≥12 years (p=0.01). Increased different food types consumption or food packaging is not associated with increased urinary BPA levels. Chips consumption only is significantly associated with increased urinary BPA levels (p=0.046). There is no significant relationship between water usage or storage and urinary BPA levels. Conclusion: Food consumption have no effect on urinary BPA levels except for chips. Keywords: urinary BPA, food consumption, Egyptian children.
Teh-Ming Wang
Taichung-Veterans General Hospital, Taiwan
Title: Pulmonary Interstitial Emphysema in Newborn Infants
Biography:
A 30-year experienced physician is now specializing in neonatal & pediatric intensive care, neonatal and pediatric respiratory care.
Abstract:
Objective: Pulmonary interstitial emphysema (PIE) is a serious complication of mechanical ventilation and more frequent seen in PT babies with RDS. There is no standard treatment. Here, we reported 14 NB infants who had radiological evidence of PIE in a 4-year period and stress the effect of gentle mechanical ventilation. Method: This is a retrospective study. Total 14 NB were enrolled from Jan, 2012 to Dec, 2015 in our NICU. Aggressively reduced MAP to keep PaO2 around 45-60 mmHg and PaCO2 50-70 mmHg, as long as PH>7.25 within 24-72 hrs after PIE appeared on CxR. Other treatment modalities such as recruitment with Neopuff, on prong position and early extubation were also applied. If patients couldn’t tolerate the conventional ventilator, we switched to HFOV support.
Results: Collected radiological finding of PIE, including 11 PT babies mechanical-ventilated for RDS (78.6%) and 3 FT babies with the diagnosed of MAS (14.3%) or congenital pneumonia (7.1%). The average GA I 29.8±5.5 wks (24-39), and the average BBW is 1644.6±1088.2 gm (640-3675). PIE onset time: within the 1st 10 days of life, and 9 of 14 (64.3%) occurred within the 1st 3 days. There are 3 (21.4%) unil. PIE cases, and other 9 are bil.. Otherwise, 9 cases (64.3%) had concurrent other air-leaks such as pneumothorax and pneumomediastinum. When the PIE occurred, 3 infants were treated with NIPPV, and other 9 infants received intubation under conventional ventilator or HFOV support. The mortality rate was 21.4% (one died from NEC with perforation and two expired due to large PDA with massive pulmonary hemorrhage). All survival cases had complete radiological resolution of PIE and experienced successful extubation. Conclusions: Eearly detection of PIE, all patients could be extubated with complete radiographic resolution under gentle mechanical ventilation support. Further studies with larger sample size are needed.
2 Speaker slots are available. Please contact us at pediatriccongress@pediatricsconferences.org
Biography:
Manmeet Kaur is currently working as an Assistant Professor (Pediatrics) in Chitkara School of Health Sciences, Chitkara University, Punjab, India. She is currently perusing her PhD (Autistic Spectrum Disorder) in Health Sciences from the same organization. She has published in total 6 research articles in international journals. Also, she presented her 2 posters in 10th World Pediatric Congress 2017 held in Dubai, United Arab Emirates and 1 poster nationally. Her title registration form has been selected by the Campbell Collaborations, Norway and the project entitles “Interpersonal Psychotherapy for reducing symptom severity in Post-Partum Depression: A systematic Review which will be completed along with the expert team
Abstract:
Pregnancy is a time period from conception to a birth in which the egg is implanted in the uterus which develops into placenta and embryo and later into fetus. The life of fetus and physiological changes depends upon the transition from intrauterine life to extra uterine life which occurs after the birth. Placenta plays an important role in between the mother and fetus and enables respiratory gas exchange, transports nutrients, eliminates fetal waste products, and secretes peptide and steroid hormones. Amniotic fluid surrounds the unborn baby in womb and acts as a cushion to protect fetus from injury and push fluid out of lungs. After birth the fluid isn’t completely expelled out from the lungs due to which lungs unable work properly further leading to lack of oxygen in new-born. Due to inability to combat with vascular resistance and maintained respiratory exchange new-born resuscitation is required. About 10% of new-born requires resuscitation at birth to breath and less than 1% will require extensive resuscitation. Since, the health care providers play an important role in implementing the steps of Neonatal Resuscitation among the babies in a serious need to be resuscitated, the aim of the study is to assess the effectiveness of hands on training on the knowledge and practice regarding Neonatal Resuscitation Program among the Health care providers in the selected institute rendering Bachelor’s educational facilities. The major objectives of the pre-experimental study was to assess the level of knowledge ,mean pre-test and post-test knowledge and practice scores before and after hands on training and to find out the association of selected demographic variables with knowledge and practice scores on Neonatal Resuscitation Program among the health care providers. The study findings revealed that the mean post-test knowledge and practice scores were relatively higher than the mean pre-test knowledge and practice scores. Thus, the hands on training session of knowledge and practice on Neonatal Resuscitation Program was proved to be effective in improving overall knowledge and practice among the Health care providers.