Day 1 :
Keynote Forum
Istvan Danko
University of Wisconsin-Madison, USA
Keynote: Routine iron supplementation with intravenous iron sucrose in children with inflammatory bowel disease
Biography:
Istvan Danko has a research background that includes transplant immunology and gene therapy for muscular dystrophy and inherited disorders of bilirubin glucuronidation. After completing his residency in pediatrics and his fellowship in pediatric gastroenterology he joined the faculty of the Department of Pediatrics at the University of Wisconsin-Madison in 2001. Currently, he is Associate Professor and attending pediatric gastroenterologist at the American Family Children’s Hospital of the University of Wisconsin-Madison, School of Medicine and Public Health. His current research focus is iron deficiency anemia in children with inflammatory bowel disease.
Abstract:
Statement of the Problem: Iron deficiency anemia (IDA) is a common and persistent problem in children with inflammatory bowel disease (IBD), affecting cognitive development and school performance. Despite poor adherence and malabsorption related to inflammation, oral iron remains the mainstay of management, and intravenous iron is not used for routine supplementation in pediatric IBD. Although health-related quality of life (HRQL) is a key outcome measure, the effect of correction of IDA on HRQL in children with IBD is poorly understood.
Methodology & Theoretical Orientation: HRQL was analyzed with Peds QL 4.0 (Pediatric Quality of Life Inventory) Generic Core Scales in a cohort of children with IBD as a function of anemia and disease activity, and compared with published data in pediatric IBD and healthy controls. A protocol was developed to correct IDA with periodic intravenous iron sucrose (IVIS). Using this protocol, a prospective study was conducted to assess the association between correction of anemia and changes in HRQL over a period of over 3 years. A linear mixed effects model with patient-specific random effects and an autoregressive correlation structure was used to evaluate changes in laboratory parameters measured on a continuous scale and HRQL scores over time.
Findings: Anemia was associated with significantly lower HRQL scores. Hemoglobin and iron indices normalized within six months of starting the IVIS protocol and remained normal throughout the study. Side effects were mild and rare. Correction of IDA was accompanied by significant improvement in HRQL scores over time. While there was a trend of decreasing disease activity over time, it was preceded by improvements in HRQL.
Conclusion & Significance: Anemia impairs HRQL in children with IBD. Periodic IVIS safely and efficiently corrects IDA. Correction of anemia is associated with improvements in HRQL. Aggressive diagnosis and management of IDA are warranted in pediatric IBD.
Recent Publications
- Danko I, and Weidkamp, M. (2018) Effect of Anemia on Health Related Quality of Life in Pediatric Inflammatory Bowel Disease: Comparison of a Single Center Cohort to Published Data. Int J Pediatr Neonat Care; 4:142-147.
- Danko I, and Weidkamp M. (2016) Correction of Iron Deficiency Anemia With Intravenous Iron Sucrose in Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr; 63(5):e107-e111.
- Danko I. (2016) Response of Iron Deficiency Anemia to Intravenous Iron Sucrose in Pediatric Inflammatory Bowel Disease. J Pediatr Pharmacol Ther; 21(2):162-168.
Keynote Forum
Lidija Petrovic-Dovat
Penn State Hersey College of Medicine, USA
Keynote: Treatment of depression in children and adolescents; Expanding access to education opportunities for pediatricians
Biography:
Lidija Petrovic-Dovat is a Director of the Child and Adolescent Anxiety Disorder Program at the Penn State Hershey College of medicine. She is the Associate Director of Pediatric Behavioral Health Collaborative Care Program and the Associate Site Director for Child Services. Dr. Petrovic’s clinical and research interests include anxiety disorders and depression. She actively collaborates with the Department of Pediatrics at the clinical and research level and is involved in the clinical care, as well as resident and medical student’s education.
Abstract:
Only about 25% of children with mental illness are seen by a child psychiatrist. Pediatricians are often the first line of care for the majority of children with mental and behavioral health issues. However, few primary care providers report confidence in their ability to successfully manage mental illness. Additional educational support is needed to help primary care providers in treating children with the mental health issues. Our group administered survey in 2014 to pediatricians to identify if there is interest in additional education opportunities that can fit the busy pediatrician’s schedule. Primary care providers were administered the investigator-designed online survey that was hosted by the secure web application REDCap (Research Electronic Data Capture). Participation was anonymous and voluntary. Of the Total N=83 providers sent a survey, n=28 (33%) responded. The topic the majority primary providers wanted to address in lectures was case management and medication treatment. Most providers reported having difficulties in coordinating services and expressed interest in lectures. We attempted to address this topic in the live lectures at the clinical site. However, after implementation of the initial round of live short lectures on selected topics at the clinical site, it became apparent that busy pediatrician’s schedule was resulting in low lecture attendance. Penn State Hershey Division of the Child and Adolescent Psychiatry decided to develop education web series, addressing symptoms, diagnosis of the most common mental health disorder, including the warning signs for self-harm. Our group has experience with this type of educational activity on the smaller scale. We have participated as the speakers in a Webinar on the mental health topic targeting school nurses across the Common wealth of Pennsylvania that was the part of the Penn State Hershey PRO Wellness Center and the Highmark Foundation webinars. It was well received. The first challenges were to identify: the level of interest, topics, and possible modes of delivery for this supplemental professional development. The new “needs analysis” survey was conducted in 2017. This time survey was sent to pediatricians who worked at our pilot site and 60.53% responded. Participation was anonymous and voluntary and the responses demonstrated a significant level of interest in the idea for lecture type mode of delivery. This time, 87% responded that they are interested in the lecture delivered online as a webcast training, with a majority expressing a wish for online lectures to be no longer than 30 minutes, which should target specific topics and case studies, and which they could access at their own time and as needed. The Division of the Child and adolescent Psychiatry at our institution made a decision to design record and offer Open Educational Resources in a format of web series, addressing symptoms diagnosis of the most common mental health disorder, Depression, Anxiety, Autism Spectrum Disorder, Behavior Problems, School Psychiatry and Attention Deficit Hyperactivity Disorder. Speaker with expertise in each area agreed to record lectures. Initial lecture on the topic of Depression and Suicide prevention is available as no-cost, pre-recorded Webcast psycho educational opportunity for pediatricians at our institution on the website dedicated to pediatricians and also child advocate website available to the public. Within few weeks public link had over 500 visits and we will continue to monitor the interest. This education opportunity might also benefit providers and families who live in areas with a shortage of behavioral health specialists by providing no cost short lecture series through school or other organization.
Keynote Forum
Igor Klepikov,
Emeritus Professor, USA
Keynote: The new doctrine of acute pneumonia: A guaranteed way of prevention of purulent complications
Biography:
Igor Klepikov who is now retired has worked as a Professor in Kemerovo State Medical Academy, USA.
Abstract:
- General Pediatrics | Pediatric Neurology | Neonatal/Pediatric Intensive & Critical Care | Pediatric Cardiology | Pediatric Endocrinology | Pediatric Gastroenterology | Pediatric Pulmonology
Session Introduction
E Raboe
KFAFH, Saudi Arabia
Title: Preliminary result laparoscopic hernia repair
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.
EH Raboei
King Fahad Armed Forces Hospital, Saudi Arabia
Title: Necrotizing enterocolitis in full-term neonates: Is it aganglionosis?
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.
Reham A.A. Abouelkheir
Qassim University, Saudi Arabia
Title: Motor development evaluation of low risk preterm infants through the first six months of life
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
Daniel Roadman
Medical College of Wisconsin Milwaukee, USA
Title: Retrospective study of pediatric knee osteochondritis dissecans: Effect of surgical treatment
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, 72nd All India Ophthalmic society and 63rd 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 1st January, 2007 to 31st 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.
Mohamed E. Khalil
Qassim University, Saudi Arabia
Title: Upper limb aerobic training versus chest physical therapy in asthmatic children rehabilitation
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.