20^th Annual World Congress on Pediatrics March 18-19, 2019
(14 Forums, 2 Days, 1 Event) Chicago, USA

Biography:

She is senior consultant pediatric, neonatal & urology surgeon MIS and single incision pediatric endoscopic surgeon president elect ipeg me chapter member of Saudi general surgery executive board Jeddah kingdom of Saudi Arabia

Abstract:

Aim: To compare the outcome of laparoscopic hernia repair and open herniotomy.

Patients and methods: Retrospective study conducted between January and June 2017. Forty-six patients underwent either laparoscopic surgery or open surgery for pediatric inguinal hernia repair. The outcome was compared. Patients were followed up from 6-12 months. The collected data were analyzed using Statistical Package for Social Science version 22, p-value<0.05 was considered significant

Results: Total 46 patients were operated, the majority were male 84.8%. Fifty-six % were less than 1 year, 19.6% were between 1-5years, and 23.9% were 6-13years old. Twenty-seven patients underwent open herniotomy OH, 8 underwent laparoscopic percutaneous internal ring suturing PIRS, 11 laparoscopic sac dissection & intracorporeal suturing SDIS. Mean age is 3.61years, 1.86years, and 2.56years for OR, Lap PIRS and SDIS respectively. For unilateral procedures mean operative time was 36.68 min for OH and 48.80 min for PIRS p=0.12 & 102.16 min for SDIS p<0.001. For bilateral procedures mean operative time was 37.00 min for OH and 63.33min for PIRS p=0.12, and 109.00min for SDIS p<0.001. Seven CPPV found in laparoscopic surgery. Unnecessary inguinal exploration avoided in one patient. Stitch granuloma developed in one patient underwent SIRS

Conclusion: There is no significant difference in the operative time of PIRS and open OR. Although the number of cases is small we could conclude that Lap PIRS is safe with a good learning curve and excellent cosmetic result in the treatment of pediatric inguinal hernia.

Biography:

She is senior consultant pediatric, neonatal & urology surgeon MIS and single incision pediatric endoscopic surgeon president elect ipeg me chapter member of Saudi general surgery executive board Jeddah kingdom of Saudi Arabia

Abstract:

Background: While NEC is primarily a disease of prematurity, full-term infants account for approximately 10% of cases. The aim of this study was to highlight the association of Hirschsprung’s disease and NEC in full-term babies which, as far as we could ascertain, has not been reported before.

Material and Methods: A retrospective study of all surgically treated neonates presenting with NEC from November 1999 to January 2007 was performed. A total of 20 surgically managed neonates presented with NEC during the study period. Three were excluded from the study because they underwent other treatments. Patients were divided into 2 groups: Group 1 consisted of pre-term neonates with weights below 2400g and Group 2 consisted of full-term neonates with a weight above 2400 g. Nine out of 17 were in Group 2. Peritoneal drain and proximal diversion ileostomy in the most viable part of intestine was done in the neonatal intensive care unit (NICU). A rectal biopsy was taken from 7 out of 9 in Group 2 and from one presenting with cecal perforation in Group 1. Full-thickness open rectal biopsy (H&E staining) was the definitive procedure for diagnosis until 2000, when AChE staining began to be used. Duhamel’s pull- through was the procedure of choice for neonates with a positive rectal biopsy.

Results: Aganglionosis was found in 4 of 7 rectal biopsies in patients weighing more than 2400g (Group 2). One died at home while waiting for definitive surgery. Duhamel’s pull-through was performed for the rest. All together 3 patients died (17.6%). The survivors are developing normally, only one has exhibited retarded growth. One infant suffered from cholestatic jaundice.

Conclusion: Our results support the suspicion that a large proportion of term neonates presenting with NEC have a long segment or total colonic Hirschsprung’s disease. This observation is in contrast to the currently available literature on this problem from the last decade

Biography:

Abstract:

Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by progressive atrophy of the voluntary muscles of the limbs and trunk. The rarity of SMA along with an overlap of early clinical features with other neuromuscular disorders contributes to persistent diagnostic delay that varies from 3.6 months (type I) to 43.6 months (type III); these timeframes overlap with a period of irreversible denervation. Clinical trial data suggests early treatment is critical to modifying the rapid loss of motor neurons while improving life expectancy and clinical outcomes.

Objective: To further understand the diagnostic awareness of SMA amongst general pediatricians as they interact with undiagnosed infants presenting early symptoms.

Methods: The survey was distributed to general pediatricians via email by Medscape Education. The survey was designed to review the clinical decision making of general pediatricians upon observation of hypotonia and/or gross motor delay, as well as overall awareness of the early signs of SMA and neuromuscular disorders.

Results: 300 general pediatricians completed the survey. Upon observation of hypotonia, 55.59% of pediatricians indicated they would immediately refer to early intervention, while 51.64% would immediately refer to a pediatric neurologist for further evaluation. 52.67% correctly indicated that genetic testing is required to make a definitive diagnosis of SMA. Additionally, 70% of respondents indicate comfort identifying the early signs of neuromuscular disease (Extremely comfortable 3.33%; Very comfortable 18.67%; Moderately comfortable 48.33%). Likewise, 67.3% of respondents noted a familiarity with SMA (Extremely familiar 4.33%; Very Familiar 13.67%; Moderately familiar 49.33%), yet of this group, only 59% identified the genetic testing requirement.

Conclusion: This research yielded important insights into current clinical knowledge gaps regarding the diagnosis of SMA and a varied clinical response upon observation of hypotonia amongst pediatricians. Practice guidelines and continuing education may alleviate variation while reducing diagnostic delay.

Biography:

Reham AA Abouelkheir, Assistant Professor of pediatric physical therapy, Medical Rehabilitation College, Qassim University, she holds a bachelor's degree in physiotherapy, master's degree and a doctorate degree in pediatric rehabilitation, she has his expertise in the field of physical therapy and pediatric rehabilitation after about 18 years of experience in teaching and practice in hospital and education institutions in Egypt and Saudi Arabia. She is a pediatric rehabilitation consultant in Saudi Commission for Health Specialties; she is interested in the fields of Pediatric physical therapy and rehabilitation- Growth and Development– Neonatal Intensive Care– women's health rehabilitation.

Abstract:

Statement of the Problem: Pre-term and low birth weight children are at risk for developmental deficits, many pre-term children even who do not develop cerebral palsy not having reached normal motor development level regarding their chronological age. Researchers have reported that recently neonatal care Improved which have increased the survival of premature babies. Normal motor development starts at conception and continues throughout life according to a typical sequence, pattern, and timing. Evaluation and early detection of developmental deviation in pre-term infants will improve the concept of early intervention and result in better quality of life to the pre-term infants and their families.

Methodology & Theoretical Orientation: A longitudinal, quantitative, comparative study-one hundred infants: Pre-term and full-term infants were evaluated through the first 6 months of life. They were classified into two groups: (Group A) contained fifty pre-terms, (Group B) contained fifty full-term, infants were evaluated by Alberta Infant Motor Scale (AIMS).

Findings: The parents in this study were very cooperative. There was a significant difference in mean values AIMS of pre-term and full-term newborns and there was a significant difference in mean values AIMS of pre-term and full-term infants after six-month.

Conclusion & Significance: Low-risk pre-term infant had non-optimal motor development in comparison with full-term infants. Recommendations are made for further studies to assess motor development in pre-term using corrected age and motor development assessment in pre-term infants should be done periodically

Biography:

Abstract:

Introduction: Osteochondritis Dissecans (OCD) is an alteration of subchondral bone and adjacent articular cartilage. The goal of treatment is to allow patients to return to activities pain-free and avoid progression to osteoarthritis. Radiographic healing helps determine return to activities. The goal of this study was to compare sizes and time to healing of OCD lesion between surgical and non-surgical treatment from 0-24 months follow-up using serial anterior-posterior (AP) and intercondylar notch radiographs and identify differences in Lysholm activity scores between stable and unstable lesions.

Methods: Retrospective chart review of patients diagnosed with OCD at Children’s Hospital of Wisconsin from 2004 to 2016. This study evaluates patients who had surgical intervention, including both stable and unstable lesions as compared to non-surgical treatment based on demographics, activity level, lesion size, and treatment course.

Results: In total, 625 patients had an OCD diagnosis, of which 116 lesions on 107 knees in 100 patients fit our inclusion criteria. Mean patient age was 11.5±2.5 years and the mean length of follow-up was 2.3±1.2 years. Unstable OCD lesions had significantly improved Lysholm activity scores at 24-months compared to stable lesions (p=0.0009). Surgical treatment showed reduced lesion size compared to non-surgical patients in the coronal plane on AP radiograph at 12 and 24-months (p=0.0007). Surgical treatment of larger lesions produced relatively rapid healing, the overall defect area decreased sharply and by 24-months only 4.6% of the mean original defect area remained compared to 21.0% in non-surgical patients (p<0.0001).

Conclusion: This study demonstrates that surgical intervention of unstable and larger OCD lesions leads to a significant radiographic healing rate and significantly improved functional activity scores compared to stable and nonoperatively treated lesions.

Biography:

S. Lakshmi Prasanna has expertise in pediatric ophthalmic anesthesia. Over thirteen years she has been exposed to a multitude of cases ranging from Preterm babies coming for retinopathy of prematurity surgery to a huge load of pediatric cases presenting with congenital cataract and squints through to geriatric cases presenting for eye surgery with a host of multiple systemic problems. She is a member of Ophthalmic Forum of Indian Society of Anesthesiologists (OFISA) She has been part of the Scientific Committee of the first Ophthalmic Forum of Indian Society of Anesthesiologists Conference (OFISACON). She was also invited as a faculty for the second OFISACON, 72^nd All India Ophthalmic society and 63^rd Indian society of anesthesiologist’s conference. She has had poster presentations in Ophthalmic Anesthesia Society, Chicago 2016, Principles of pediatric anesthesia and critical care in Boston 2017 and in International Anesthesia Research society meeting held in Chicago last year.

Abstract:

Introduction: Administering safe and effective anesthesia to a neonate is a challenging task for an anesthesiologist. There are many studies on safety and role of pediatric anesthesia in general and dental surgeries but none reported in ophthalmology. The purpose of this study was to elucidate anesthesia-related challenges in 78 neonates who underwent ophthalmic surgery in a tertiary eye care center.

Methodology: It was a retrospective cohort study where medical records of 78 consecutive neonates who underwent ophthalmic surgery between 1^st January, 2007 to 31^st December, 2016 were collected, studied, and analyzed.

Results: The mean age of the patients was 16.97+7.73 days. The most common indication for performing ophthalmic surgery in the neonatal period was found to be Congenital Glaucoma (57.69%). All neonates considering their age were found to have ASA grade III. Comorbidities were seen in 28.2% of the neonates operated. Neonates who were shifted to a neonatal care facility for routine postoperative observation amounted to 79.48%. We did not encounter any morbidity or mortality in this study.

Conclusion and Significance: Although the ophthalmic surgical procedure is considered "low risk" in terms of blood loss, third spacing of fluids and postoperative pain, the patient population as a whole tends to be a "high-risk'' Anesthesiologist concerns include, the sterile draping preventing access to the airway and the equipment never being at the head end of the patient. These issues however minor they may sound become more pronounced when the patient is a neonate. There are numerous challenges in anesthetizing a neonate. No one single anesthetic drug or technique will prove to be ideal for all situations. The ‘art of neonatal anesthesia’ requires and needs a sound scientific base in order to optimize the conduct of anesthesia care for this population.

Biography:

Mohamed E. Khalil, Assistant Professor of pediatric physical therapy, Medical Rehabilitation College, Qassim University, He holds a bachelor's degree in physiotherapy, master's degree and a doctorate degree in pediatric rehabilitation, He has his expertise in the field of physical therapy and pediatric rehabilitation after about 18 years of experience in teaching and practice in hospital and education institutions in Egypt and Saudi Arabia. He is a pediatric rehabilitation consultant in Saudi Commission for Health Specialties, He is interested in the fields of Pediatric physical therapy and rehabilitation - Growth and Development- Gait and Motion analysis– Electrodiagnostic studies.

Abstract:

Statement of the Problem: Asthma is a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that when uncontrolled it can place severe limits on daily life and is sometimes fatal. The prevalence of asthma is increasing in most countries, especially among children. Researchers have reported that asthmatic children have significant deterioration of pulmonary functions that result in impairment in functional capacity and quality of life. Chest physical therapy remains an essential component of pulmonary rehabilitation. There is a large body of literature supports the effectiveness of aerobic exercise on pulmonary function, dyspnea, and functional capacity.

Methodology & Theoretical Orientation: In this study was a trail to compare the therapeutic effects of aerobic exercise versus chest physical therapy on the pulmonary functions in asthmatic children for 16 weeks of training- 40 asthmatic children of both sexes participated in this study. They were assigned randomly into two groups: (Group A) 20 children who received chest physical therapy program including (breathing exercise and Incentive Spirometer training, (Group B) contained 20 children who received arm ergometry training protocol and Forced vital capacity "FVC", Forced expiratory volume after 1 second "FEV1", Peak Expiratory Flow Rate “ PEFR” were evaluated by Discovery Spirometer pre and post-treatment for both group.

Findings: The pre-treatment results of this study showed that there were no significant differences in all measured parameters among both groups, The post-treatment results of this study revealed that there was a significant improvement in both groups of the patient's ventilatory function  “FVC, FEV1, and PEFR”.

Conclusion & Significance: The arm ergometry training protocol used in this study can be considered as a beneficial therapeutic program that can be used to improve the pulmonary functions in asthmatic children Recommendations are made for establishing the arm ergometry training protocol in schools for asthmatic children.

Biography:

Abstract:

Statement of the Problem: Delayed investigations may result in skewed patient assessment especially with varied clinical presentations.

A 2 year old male presented with fever, abdominal pains and generalized seizure activity two days after receiving Penadur for an exudative tonsillitis. Symptoms persisted resulting in depressed Glasgow Coma scale (GCS 10/15), associated with nystagmus, absent gag reflex, hypotonic upper limbs and hypertonic lower limbs, hyperreflexia and clonus. Currently, the patient is alive, but minimal neurological improvement is seen up to 3 months after presentation.  Initial investigations revealed a hemoglobin of 7.8, thrombocytopenia of 61 and elevated transaminases. No electrolyte imbalance was noted. Dengue viral studies done 6 days after symptom onset showed negative NS1 antigen and positive IgM and IgG antibodies. CSF analysis showed no cells, and no increase in CSF globulins. CSF dengue antigen and IgM antibodies and serum and CSF PCR was unavailable. TORCH, HIV, syphilis, hepatitis, or Zika virus investigations were negative. Cranial CT revealed possible pontine infarct with hypodensity in bilateral frontal lobe white matter, possibly ischemic or inflammatory in origin. Magnetic resonance diffusion weighted imaging of the brain, done 20 days after presentation, showed subtle T2 hyperintense signal changes in the posterior periventricular white matter, which may be related to ongoing myelination. Imaging suggests underlying metabolic disturbance, central-pontine myelinolysis or sequelae of infection. Although dengue is not considered a neurotropic virus, in recent years, there has been documentation of neurological complications associated with dengue fever.¹ These complications in general are unusual. MRI findings are usually normal, but may vary. In a cohort of patients, findings include cerebral oedema, encephalitis-like changes and one patient had intracranial hemorrhage.² Diagnosis in this case is limited by the absence of CSF dengue antigen and IgM as well as CSF PCR. Also, MRI findings are time-sensitive and delayed imaging results in inability to assess acute intracranial changes.

Biography:

Young Youn Choi has completed his PhD at the age of 29 years from Chonnam National University Medical School, Korea. She had been studied at Tokushima University, Kurume University in Japan, and Joint Program in Neonatology at Harvard Medical School in USA. She was the director of NICU of Chonnam National University Children’s Hospital and vice dean of Chonnam National University Medical School. She is a member of Korean Society of Pediatrics and of Korean Neonatology Society. She has published more than 80 papers in reputed journals and had been serving as an editorial board member of repute.

Abstract:

Introduction: International marriages have been steadily increasing since the 1990s and began to increase rapidly after 2003 in Korea. The recent data by Statistics Korea 2016, the rate of multi-cultural family (MCF) marriage accounted for 7.7% of the total number of marriages. The health status and socioeconomic and cultural differences of immigrant pregnant women can affect the fetal and neonatal health. The aim of this study is to investigate the periodical changes of the rate of newborns of MCF with their perinatal risk factors and neonatal outcome who admitted to Chonnam National University Hospital for the past 15 years and to emphasize the role of women doctors in this field.

Methods: Medical records of newborns admitted to NICU between January 2001 and December 2015 were collected retrospectively. Study period was categorized into three periods: data from 2001 to 2005 was defined as period I, from 2006 to 2010 as period II and from 2011 to 2015 as period III. The clinical data of the rate of newborns of MCF with their perinatal risk factors and outcome were reviewed.

Biography:

Mohammed Beshir is a pediatrician in Jimma University, Ethiopia. He graduated from Jimma Medical School, Ethiopia.

Abstract:

In Ethiopia, malaria is endemic and commonly caused by Plasmodium vivax and Plasmodium falciparum species. Among the hematological alterations occurring in malaria: anemia, leucopenia, and thrombocytopenia are known. While severe thrombocytopenia is a feature of Plasmodium falciparum species. It is rare in Plasmodium vivax malaria. Similarly, acute renal failure due to Plasmodium vivax malaria is rare in Plasmodium vivax malaria. In view of the rarity of this unusual combination of the case, here we report a 14 years-old boy presented with a 5 days history of intermittent fever with chills & rigors, 3 days history of abdominal pain, distension of abdomen, unable to pass feces and decreased urine output. He was diagnosed to have Plasmodium vivax malaria. Acute pancreatitis, ascites, severe thrombocytopenia, severe anemia, and acute renal failure was diagnosed. These constellations of complications in P. vivax infection has never been reported in the past. The patient responded to antimalarial and supportive treatment. Its presentation, diagnosis, management & natural course will be discussed.

Biography:

Basma Elhaddad is a faculty member (demonstrator) at the Pathology Department, Faculty of Medicine, Alexandria University, Egypt. Basma graduated from the faculty of medicine, Alexandria University in 2010 (MBBch)". Basma is a master’s degree student with a thesis in the Pathology of Gastrointestinal tract and liver  “Master of Basic Medical Sciences in Pathology (MSc.); GPA: Excellent with Honour”.

Abstract:

Liver cell regeneration takes place through mature hepatocytes. However, in cases of chronic or severe injury, an alternative pathway takes place through the proliferation of hepatic progenitor cells (HPCs). The aim of the study was to investigate the distribution and number of Foxl1 positive HPCs in the livers of infants with different cholestatic diseases. Therefore, immunohistochemistry using Foxl1 antibody (ab190226) was conducted on fifty-three formalin fixed paraffin embedded blocks of liver biopsies from infants with neonatal cholestasis with the following diagnoses: Thirty cases of extrahepatic biliary atresia (EHBA), eleven cases of paucity of intrahepatic bile ducts (PIBD), eight cases of idiopathic neonatal giant cell hepatitis (NGCH) and four cases of galactosemia. Trichrome staining was done to asses the stage of fibrosis according to a previously published modified scoring system. Foxl1 Positive cells were seen in the periportal area and their numbers were much higher in liver biopsies obtained from infants with EHBA compared to the other diagnoses. Significant positive correlations were found between the number of HPCs and stage of fibrosis, the degree of ductular proliferation, the presence of portal tract neutrophils as well as higher levels of serum gamma-glutamyltransferase. In conclusion, HPCs are markedly activated in EHBA and their activation might be the reason for the associated ductular proliferation and fibrosis. However,  the type of inflammatory infiltrate might play a role in HPC activation as well. This may help to guide further research on animal models to design HPC-based antifibrotic therapies for cholestatic liver diseases.