Day 2 :
Keynote Forum
Tan Guan Hao
KK Women’s and Children’s Hospital, Singapore
Keynote: KidSTART – Singapore’s approach towards a community-based, family centered paediatric care
Time : 9:00 to 9:45
Biography:
I have been working in the Department of General Paediatrics in KK Women’s and Children’s Hospital, Singapore, since 2007, with keen interest in general paediatric patient care, and both undergraduate and postgraduate education.
At present, I am also involved in KidSTART, a pilot collaboration between Early Childhood Development Agency (ECDA) and KK Women’s and Children’s Hospital aiming to help disadvantaged families and children by identifying early developmental issues, growth delays, maternal mental health issues. Through early interventions, the pilot project hopes to achieve better integration of such families into the community agencies, rectifying paediatric growth and developmental delays through counselling and referral to tertiary institutions, to ensure good outcomes for them.
Abstract:
Community Paediatrics is a recognized subspecialty overseas, and is a relatively new concept in Singapore. The American Academy of Pediatrics (AAP) defines it as the philosophy of delivery of child health care with the principles of high accessibility, holistic vision, collaboration with parents, interagency care and teamwork, advocacy directed at the needs of all children, and a preventive orientation. It synthesizes clinical practice with public health principles directed towards providing optimal health care to a given child within the context of the family, school, and community.
Research has also shown that experiences in a child’s early years can significantly influence his/her physical, cognitive and social development. In particular, children from vulnerable circumstances may face developmental challenges compared to their peers. On the other hand, a stronger parent-child relationship and holistic early childhood development can bring about positive impact on the child’s lifelong outcomes and narrow the developmental gaps.
KidSTART is a pilot program which aims to provide support and create a conducive environment for learning and development for Singaporean children from economically disadvantaged families. The components include a home visitation programme, a supported playgroup programme and enhanced support to pre-schools. Children from eligible families can attend one or more of these components. Through these interventions, KidSTART hopes to ensure that children benefit from warm and nurturing relationships, age-appropriate and holistic child development, and a safe and secure home environment to grow up in. For home visitation, each at-risk expectant mother and her child will be given integrated support in the domains of health, child development and social services.
In summary, there is a need to give children from these families in Singapore a good start in life. The programme is currently at the pilot stage. The creation of an integrated sustainable working model will allow for future up-scaling of such model across the entire country.
Keynote Forum
Lourdes Mary Daniel
KK Women’s and Children’s Hospital, Singapore
Keynote: Poverty, development and the brain
Biography:
Lourdes Mary Daniel has been a Pediatrician in Singapore and a full-time Neonatologist. She is currently working as the Head of the Department of Child Development in KK Women’s and Children’s Hospital. She has received her Child Development training at the Kennedy Krieger Institute in Johns Hopkins Hospital, Boston Children’s Hospital and the Harvard Graduate School of Education in USA.
Abstract:
Children in poverty have worse cognitive, socio-behavioral and health outcomes than their more affluent peers. Poverty affects the brain in 4 main ways: Language and reading, memory, Executive Functions (EF) and socio-emotional processing. Numerous studies have demonstrated differences in brain structure and function between children from high and low socio-economic status. Income and total hippocampal gray matter, which are important for learning and memory, have been shown to be correlated, as well as frontal and prefrontal regions which affect emotion and stress. Poor cognitive and academic performance among children in poverty has been shown to be mediated by a small hippocampus and frontal and temporal lobes, with the decrease in the latter 2 areas explaining as much as 15-20% of the achievement deficits. The relationship between poverty and the brain has been shown to be logarithmic and not linear. Income related, most strongly to brain structure among the most disadvantaged children with the effect seen as early as 6-9 months of age. Children’s EF skills have been shown to be robustly predicted by chronic exposure to poverty and the associated environmental hazards. In adults, EF skills (which start developing in childhood) are core capabilities that are important for managing life, work and effective parenting. Bridging the achievement gap between children of low socio-economic status and their more affluent peers requires co-ordinated public policy measures. This is a huge challenge, but addressing it is necessary to protect these children from the long-term effects of poverty. This talk will also summarize the effects of various intervention programs.
- General Pediatrics | Pediatric Nutrition and Obesity | Pediatric Psychology | Neonatology | Pediatric Infectious diseases
Session Introduction
Mohammad Monir Hossain
Bangladesh Institute of Child Health & Dhaka Shishu Hospital
Title: Cause Specific Management of Shock in Neonate
Biography:
Abstract:
Shock is characterized by inadequate oxygen delivery to tissues to meet demand because of circulatory failure. The immediate aim of management of neonatal shock is to optimize perfusion and delivery of oxygen and nutrients to the tissues. Understanding the pathophysiology of neonatal shock helps to recognize and classify shock in the early compensated phase and initiate appropriate treatment. Hypovolemic shock in neonate is usually due to antepartum hemorrhage, post-natal blood loss iatrogenic, or secondary to disseminated intravascular coagulation or vitamin K deficiency, or excessive insensible water loss in extreme pre-terms. Cardiogenic shock in the neonate may be caused by myocardial ischemia due to severe intra-partum asphyxia, arrhythmias, primary structural heart disease, mechanical reduction of cardiac function or venous return secondary to tension pneumothorax or diaphragmatic hernia and disturbance of transitional circulation due to persistent pulmonary hypertension in newborn, or patent ductus arteriosus in premature infants. Distributive shock caused by Neonatal sepsis, vasodilation, myocardial depression, or endothelial injury and obstructive shock is caused from tension pneumothorax or cardiac tamponade. The immediate aim of management of neonatal shock is to optimize perfusion and delivery of oxygen and nutrients to the tissues. The American College of Critical Care Medicine estimates that 60 min is the average time needed to provide adequate circulatory support and block the development of shock. The first step in managing shock in the newborn during the first 5 minutes is to recognize cyanosis, respiratory distress and decreased perfusion. This should be followed immediately by airway access and ventilation to optimise oxygenation. Rapid peripheral, central venous, or intraosseus access is of primary importance in the initial management of the newborn in shock. Any baby with shock and hepatomegaly, cyanosis or a pressure gap between upper and lower limbs should be treated with prostaglandin within 10 min of birth until congenital heart disease is excluded. Inotropes like dopamine, dobutamine, epinephrine and norepinephrine are indicated via iv or io route before central access is achieved when myocardial contractility remains poor despite adequate volume replacement. Delay increases mortality 20-fold.
Chia Hui Ling
KK Women’s and Children’s Hospital
Title: Effective Correction of Ear Anomalies with Non-Surgical Ear Molding
Biography:
Abstract:
Background
One-third of infants have ear anomalies and less than one-third self-correct. Correction of ear deformities by molding exploits the plasticity of the auricular cartilage due to circulating maternal estrogen during early infancy.
Objectives
We assess the efficacy of non-surgical ear molding in the correction of ear deformities and determine the factors that affect its outcome.
Methods
This is a prospective study over a three-year period. Consecutive full-term infants who underwent ear molding were recruited. Primary outcome was successful correction of ear anomaly. Secondary outcomes included complications and maintenance of ear shape. Factors identified include type of anomaly, age and duration of application, and breastfeeding.
Results
Sixty-seven patients with a total of 105 ears were recruited. The anomalies were classified into deformations (66.7%) and malformations (33.3%). The median age group of presentation was zero to seven days old (67%). Average duration of application was 4.1 weeks. Successful correction was achieved in 86% of patients. Ear deformations achieved a significantly higher rate of successful outcome (98%) compared to malformations (64%) (p=0.01). Skin complications were common (46%) and attributed to our tropical climate. Patients with complications were of a higher mean age (22.1 days), compared to patients with no complications (10.6 days) (p=0.03).
Conclusion
Ear molding is an effective non-surgical option for the treatment of ear anomalies, especially in ear deformations where successful correction was achieved in 98% of infants. Type of anomaly is an important predictor of successful correction. Early initiation of ear molding has a crucial role in minimizing complications.
M R Savitha
Mysore Medical College and Research Institute, India
Title: Sharing 18 months of experience in free allergy asthma clinic in Mysore, India
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:
Introduction: The prevalence and incidence of allergic diseases and asthma are on the raise globally, mostly in urbanized locales. Developing countries like India are undergoing rapid urbanization and prevalence of allergic diseases is surely on the raise. We are running a Free Allergy Asthma Clinic (Swaasha Clinic) at a major tertiary medical center with medical school and extensive hospital set up catering mainly to low and middle socioeconomic class patients.
Methods: Retrospective analysis of patients registered at the center from Jan 1 2017 through July 1 2018 was performed.
Results: A total of 240 patients were registered during this period. 165 patients (68.75%) belonged to low socioeconomic class, 62 (25.8%) belonged to middle class and only 13 patients belonged to upper class. Since the clinic is attached to the pediatric department, majority of patients were below 18 years of age. 58 patients were in less than 5 year age group, 118 patients were in 5-12 year age group, 45 patients were in 12-18 year age group and 19 patients were above 18 years age group. There were 142 males and 98 females (M:F=1.4:1). 176 patients had asthma of whom, 13 had intermittent asthma, 69 mild persistent asthmas, 76 moderate persistent asthmas and 18 severe persistent asthma. 52 patients had allergic rhinitis of which 15 had mild allergic rhinitis and 37 had moderate-severe allergic rhinitis. 15 children had allergic conjunctivitis, 8 children atopic dermatitis and 5 children had recurrent urticaria. Allergy Prick skin test was performed on 171 patients using the standard pediatric panel. Major sensitizations were found to house dust mite (DP, DF) in 36 patients (21%) and cockroach in 25patients (14.6%). Spirometry was done in 139 patients. It was normal in 72 patients (52%) and showed reversibility in 38 patients (27%). Follow up visits was seen in only 68 patients (28.3%) of which only 24 (10%) cases had more than 3 follow ups.
Conclusion: It can be concluded that most of our patients are suffering from mild and moderate persistent asthma with house dust mite being the most common allergen causing sensitization and there is a poor long term follow up of our patients even though services are provided free of cost. Hence, there is an urgent need to implement suitable intervention strategies for optimum management of asthma.
Biography:
Bhupinder K Girn is a graduate of Doctor of Medicine from Far Eastern University-Nicanor Reyes Medical Foundation, Institute of Medicine. She took her Post-Graduate Internship at Rizal Medical Center and Pediatric Residency Training in the same institution
Abstract:
Background: Estimation of disease severity and probability of death are essential in determining the prognosis. An objective measurement tool is necessary to accurately communicate prognosis of critically ill children to their parents.
Objective: This study aimed to analyze the prognostic value of Pediatric Logistic Organ Dysfunction (PELOD) score in the presence of organ dysfunction.
Design: It is a prospective observational cohort study.
Setting: Pediatric Intensive Care Unit (PICU) of tertiary government hospital in the Philippines.
Participants: All prospective admissions from term newborn to <19 years of age were included from July 15, 2016 to July 14, 2017. A total of 149 patients admitted; sixty six (66) excluded due to consent denial (n=20), incomplete diagnostic work-ups (n=12), death within 8 hours of admission (n=12) and prematurity (n=22). Eighty three (83) subjects were enrolled.
Main Outcome Measures: PELOD score was calculated in the first 24 hours of admission with outcome measures as survival or non-survival.
Results: Of the 83 patients, 51 (61%) were male and 32 (39%) were female; with a mean age of 5 years old and median length of stay of 5 days. Mortality rate was 43.4%. PELOD scores of non-survivors 25.4 (22.4) was significantly higher (p<0.001) than survivors at 4.9 (5.9). Fifty five percent (55%) had Multiple Organ Dysfunctions Syndrome (MODS) upon admission with 100% mortality rate for organ dysfunction of ≥4. ROC curve analysis for predicting death was 0.827 (95% CI, P<0.001) indicating a very good discriminatory ability. PELOD score of 15 correlated with 50% probability of death and risk ratio analysis (P<0.001) reveals the risk of dying of patients with PELOD score >15 is 3.3x that of with score ≤15.
Conclusion: PELOD score is a reliable prognostic predictor of mortality. Cardiovascular and neurologic dysfunctions were highly associated with mortality. Increasing number of organ dysfunction was correlated with increasing PELOD scores and mortality rate.
Lourdes Mary Daniel
KK Women’s and Children’s Hospital, Singapore
Title: Poverty, Development and the Brain
Biography:
Adjunct Associate Professor Lourdes Mary Daniel has been a pediatrician in Singapore for almost 30 years and a full-time Neonatologist for more than 20 years. She currently heads the Department of Child Development in KK Women’s and Children’s Hospital, the largest child development service in Singapore which sees more than 3000 new preschool children every year. She received her Child Development training at the Kennedy Krieger Institute in Johns Hopkins Hospital, Boston Children’s Hospital and the Harvard Graduate School of Education in the USA. The department and hospital provide clinic-based developmental assessments and interventions, pilot and/or run community-based developmental programs and collaborate extensively with government ministries and philanthropic organizations to enhance the developmental services available to both the general population of children as well as vulnerable children.
Abstract:
Children in poverty have worse cognitive, socio-behavioral and health outcomes than their more affluent peers. Poverty affects the brain in 4 main ways: language and reading, memory, executive functions (EF) and socio-emotional processing. Numerous studies have demonstrated differences in brain structure and function between children from high and low socio-economic status. Income and total hippocampal gray matter, which are important for learning and memory, have been shown to be correlated, as well as frontal and prefrontal regions which affect emotion and stress. Poor cognitive and academic performance among children in poverty has been shown to be mediated by a small hippocampus and frontal and temporal lobes, with the decrease in the latter 2 areas explaining as much as 15-20% of the achievement deficits. The relationship between poverty and the brain has been shown to be logarithmic and not linear. Income related most strongly to brain structure among the most disadvantaged children with the effect seen as early as 6-9 months of age. Children’s EF skills have been shown to be robustly predicted by chronic exposure to poverty and the associated environmental hazards. In adults, EF skills (which start developing in childhood) are core capabilities that are important for managing life, work and effective parenting. Bridging the achievement gap between children of low socio-economic status and their more affluent peers requires coordinated public policy measures. This is a huge challenge, but addressing it is necessary to protect these children from the long term effects of poverty. This talk will also summarize the effects of various intervention programs.
Abdulrahman Al-Frayh
King Saud University, Saudi Arabia
Title: A Nationwide Study of Allergy and Asthma Sensitizers in Homes of Saudi Arabia
Biography:
Abdulrahman Al-Frayh has his expertise in Paediatric Allergy and Pulmonology. He is a respected Professor and also a Consultant at the same time. His research interest involved Bronchial Asthma, Paediatric Allergy and Pulmonology, Promotion of Breast feeding and growth and nutrition/children in development countries. He has authored or co-authored, published and presented over 190 papers and meeting abstracts in the field of Allergy & Immunology in both national and international journals.
Abstract:
Statement of the Problem: Prevalence of asthma and other allergic symptoms has increased in the Pediatric populations in Saudi Arabia. Apart from traditional living in areas, the hot temperature force the families to spend more time indoors. Methodology & Theoretical Orientation: In order to evaluate the impact of indoor allergens in the community, a nationwide study of various allergy and asthma sensitizers and triggers, mainly inhabiting the indoor environment, was conducted simultaneously in several cities of Saudi Arabia in 2015-2016, including coastal and non-coastal regions. The project (RAC# 2170 023) was supported by NSTIP (13-BIO814-20) and approved by American Association for Advancement of Sciences (AAAS). This is the first ever simultaneous study of major indoor allergenic components nationwide. A total of 560 house dust samples from 164 patients and 396 control homes were collected from seven regions. Samples were sieved and extracted in PBS-PH-8 and analyzed by ELISA using different antibodies. The targeted allergens included Dermatophagoides pteronyssinus (Der p 1), Dermatophagoides farinae (Der f 1), Blattella germanica (Bla g 1 –group 1), Blattella germanica (Bla g 2 – group 2, Felis domesticus (Fel d1), Rattus norvegicus (Rat n1) and Blomia tropicalis (Blo t 5). Findings: The analyses of data between patients and controls and coastal verses non-coastal regions revealed quantitative variations in their threshold values. Chi-square test and odd ratio to test the association between cases and controls as well as detection rate in coastal and non-coastal cities were conducted. Significant levels for Bla g 1 in Makkah (p<.0001) and Riyadh (p<0.0006), Rat n 1 (p<.0001) and Blo t 5 (p<0.0038) for Riyadh were obtained. The results will help health care directorates, allergists and hospitals in selection of appropriate diagnostic test panels and their therapeutic and preventive approach on regional basis
Sema Yilmaz
Yeditepe University Faculty of Medicine, Turkey
Title: Polymorphism of hypoxia-inducible factor-1α gene in children with Acute Respiratory Distress Syndrome
Biography:
Sema Yilmaz has completed her Medical Education from Istanbul University, Cerrahpasa Medical Faculty, and Zeynep Kamil Maternity and Children's Hospital, Istanbul, Turkey. Currently she is working as Assistant Professor in Pediatric Hematology/Oncology department, Yeditepe University Faculty of Medicine, Turkey. She has published 23 articles in reputed journals and has Research Experience in Cancer Biology and Therapeutics Program, Harvard Medical School, USA. She has Volunteer Experiences in MD Anderson Cancer Center, Houston, Tx, USA, University of Texas, Hermann Hospital, Tx, USA, John Hopkin’s Children Hospital, Baltimore, USA and Istituto Giannina Gaslini, Italy.
Abstract:
Aim: To investigate hypoxia-inducible factor-1α (Hif-1α) polimorphism in children with Acute Respiratory Distress Syndrome (ARDS).
Objectives: ARDS may resulted in by pulmonary and extrapulmonary causes. In the present study, we examined whether hypoxia-inducible factor-1α (HIF-1α) polymorphisms are associated with the Acute Respiratory Distress Syndrome.
Subjects/ Methods: Twenty two patients with ARDS and 11 non-ARDS controls were examined in pediatric intensive care unit in Cukurova University Hospital. Blood samples were collected from subjects. Polymerase chain reaction-restriction fragment length polymorphism was used to assess the C1772T and G1790A polymorphisms in the HIF-1α gene, and differences in genotypes between the 2 groups were compared.
Results: C1772T polymorphism was not observed between pulmonary ARDS cases and non-ARDS controls. Particularly, G1790A polymorphism was significantly different in between pulmonary ARDS and non-ARDS cases. In addition, G1790A polymorphism was statistically related to the extensity of ARDS in lung parenchyma in ARDS patients (p<0,05).
Conclusion: Our results indicated that Hif-1α G1790A polymorphism was associated with an increased susceptibility to pulmonary ARDS in children. The investigating of G1790A polymorphism seen commonly could lead pediatricians to predict the extensity of ARDS early in lung tissue.
Ghada El Kassas
National Research Centre, Egypt
Title: Role of Procalcitonin as inflammatory marker in a sample of Egyption children and adolescent with simple obesity
Biography:
I have completed my PhD at the age of 30 years from Ain Shams Univesity. I have published more than 13 papers in reputed journals and have been serving as an editorial board member of four journals.
Abstract:
Obesity is a multifactorial disease, associated with metabolic disorders and chronic low-grade inflammation. Circulating procalcitonin (PCT) is produced by adipose tissue and several cell types following cytokine stimulation. Procalcitonin is well known as a biomarker of infection, sepsis and severe systemic inflammation. Recently it has a potential as a marker for chronic low-grade inflammation in obese population. We aim in the current study to evaluate the role of serum PCT as an inflammatory biomarker in diagnosis of obesity-related low-grade inflammation.
Method: In this case control study, 50 obese and 50 normal weight children and adolescents aged 6–16 years were enrolled. Anthropometric parameters and blood pressure were measured in all study subjects. The body composition was evaluated by Body mass index (BMI), body circumferences and skinfold thickness Fasting blood samples were collected for measurement of lipid profile, blood glucose, insulin, high sensitivity-CRP (Hs-CRP) and serum procalcitonin. Serum (PCT) levels were assessed using enzyme linked immunosorbent assay. Insulin resistance was represented as the homeostatic model assessment value (HOMA-IR).
Results:
Obese participants had increased (BMI) z-score, blood pressure, insulin resistance (HOMA-IR) and higher concentrations of serum PCT, total cholesterol, triglycerides, glucose and Hs-CRP than control group. On correlation analysis, procalcitonin had significant positive correlation with (BMI) z-score (P=0.03), waist circumference (WC) (P=0.05), Hs-CRP (P=0.02)), total cholesterol (P=0.04), triglycerides (P<0.001) and (HOMA-IR) (P<0.001) in obese group.
Conclusion:
The increased serum procalcitonin concentrations were closely related to measures of adiposity, Hs-CRP and insulin resistance, suggesting that PCT may be an excellent biomarker for obesity related chronic low-grade inflammation in children and adolescents.
Mercy Manyema
University of the Witwatersrand, South Africa
Title: Stress begets stress: The association between adverse childhood experiences with psychological distress in the presence of adult life stress
Biography:
Mercy Manyema is an early career public health researcher whose areas of interest include non-communicable disease prevention, childhood and adult obesity and early child development. She has been involved in several projects including the evaluation of the potential of a sugar-sweetened beverage tax to reduce obesity, diabetes and stroke in South Africa, and a study to map the gaps between expert, stakeholder, and public understandings of early childhood development in South Africa. She is currently studying for a PhD in Public Health focusing on the impact of adverse childhood events on adult health and well-being.
Abstract:
Statement of the Problem: Adverse childhood experiences (ACEs) have emerged as a significant public health problem in the past two decades, and are highly prevalent in high income countries. Literature suggests an increased risk of mental health problems in those who experience childhood adversity. The objectives of this study were to describe the distribution of retrospectively reported ACEs in a cohort of young adults and investigate the association between ACEs and psychological distress. Methodology & Theoretical Orientation: Data from the Birth to Twenty Cohort Plus were used to determine the prevalence of ACEs (retrospectively measured) and of psychological distress in young adults aged 22 years. Hierarchical regression was employed to determine the association between the two and the role of adult stress events in the relationship. Findings: 88% of the sample (n=1223) reported at least one ACE before the age of 18 years while 28% reported psychological distress. Compared to experiencing no ACEs, having 4 or more ACEs increased the risk of psychological distress five times, OR 5.45 (95% CI 3.10-9.57). The effect of ACEs attenuated after the addition of adult stress to the model signifying possible mediation of the association between ACEs and PD through adult stressors. Conclusion & Significance: Adverse childhood experiences are high in the cohort and are positively associated with psychological distress in young adulthood. Adult life stress may moderate the link between ACEs and psychological distress. Interventions to reduce the burden of poor mental health may need to not only address adult life stress but also the experience of childhood adversity.
Biography:
Elaine Joy O. Viernes graduated from pediatric residency training in a government hospital in the Philippines. She is from a rural town where pregnancy in adolescents is a norm. She hopes to contribute to the holistic care of pregnant adolescents thru her research.
Abstract:
Background of the study: Screening for antepartum depression is not routinely integrated in prenatal care despite its high prevalence rate and adverse maternal and neonatal outcomes.
Methods: A cross-sectional descriptive study of 143 pregnant adolescents age 12 to 18 years old was conducted at the OB-Gyne outpatient department of a tertiary hospital. Participants were enrolled to complete a self-administered socio-demographic and obstetric questionnaires and the validated Filipino version of the Edinburgh Postnatal Depression Scale. The presence of depression was assessed using the validated EPDS cut-off score of > 13.
Results: The prevalence of antepartum depression during the time of the study was 23.1%. The mean EPDS score among the depressed group is 15.12 + 0.918. Pregnant teens with low monthly household income were at an increased risk of antepartum depression. Conversely, those currently studying and in their third trimester were less likely at risk for depression during pregnancy.
Conclusion: A significant proportion of pregnant adolescents were at risk of developing antepartum depression. The lack of predisposing risk factors does not rule out the possibility of depression during pregnancy; thus, screening through a validated tool should be integrated in antenatal care. Early detection and appropriate intervention for depression in pregnant teenagers is crucial to prevent the associated adverse maternal and child outcomes.
3 Speaker slots are available. Please contact us at pediatriccongress@pediatricsconferences.org