Biography:

Peter Wong, MBBS, MMed (Paediatric Medicine), MRCPCH (UK), is a Consultant in the Children’s Emergency and Suspected Child Abuse and Neglect Team of KKH. He chairs the hospital’s Sub-Committee for the Management of Paediatric Sexual Assault. Peter has been an invited speaker and track chair at the International Conference on Emergency Medicine (ICEM). He has received national recognition for service excellence and contributions to public service: the Singapore Health Quality Service Award (Star) (2015), the PS21 Star Service Award (Singapore Public Service Awards 2015), and the Healthcare Humanity Award (2016).A passionate teacher, He is an Adjunct Assistant Professor of Paediatrics in the National University of Singapore (NUS) Yong Loo Lin School of Medicine; Adjunct Assistant Professor, Duke-NUS Medical School; and faculty member of 3 Residency Programs (Paediatrics, Emergency Medicine, Family Medicine). He has won the Dean’s Award for Teaching Excellence (2012) and Residency Outstanding Faculty Awards (2013, 2016).

Abstract:

Child Abuse Investigations by the national Child Protective Service (CPS) in Singapore have tripled over 9 years, from 272 cases in 2009 to 894 cases in 2017. This likely reflects better reporting and increased allocation of resources to tackle child abuse.Observed trends in KKH (Singapore’s largest paediatric hospital) and nationally have guided strategies for multi-pronged, multi-agency approaches to manage child abuse. 1917 cases of alleged physical child abuse presented to the Children’s Emergency of KKH in the 4 years up to 2015. In 1238 cases (65%), the alleged perpetrator was a parent of the child; in 117 cases (6%), she was an employed domestic help. 928 cases (48%) involved children whose parents were divorced or separated. Cane marks were the commonest physical injury found (in 21% of cases).Child sexual abuse cases as a proportion of all CPS child abuse investigations has increased, from 15% in 2014 to 20% (181/894 cases) in 2017. In addition, KKH manages over 100 non-CPS cases a year of consensual sex with persons under 16 years old, which is a criminal offence. A worrying trend is the increasing involvement of digital images, video recordings and “sexting” in such cases.KKH has a multidisciplinary Suspected Child Abuse and Neglect (SCAN) Team to help victims and their families. Interim Placement and Assessment Centres (IPACs) set up by CPS have reduced the need for hospital admissions. We are piloting joint interviews of victims by Police, CPS and SCAN paediatricians, to avoid repeat interviews by different agencies.

Biography:

Prof Karel Allegaert, MD, PhD is a pediatrician-neonatologist and clinical pharmacologist. He is associate Professor at the Department of Development and Regeneration, Biomedical Sciences KU Leuven (20%) and Consultant at the Departments Intensive Care and Pediatric Surgery, and Neonatology, Erasmus MC Rotterdam (80%). His clinical research has a focus on perinatal and pediatric pharmacology and pediatric pain management and has resulted in more than 360 PubMed publications.

Abstract:

Neonatal withdrawal or neonatal abstinence syndrome (NAS) is a withdrawal syndrome in neonates due to acute cessation of the exposure to either illicit or prescribed drugs. Similar to tolerance or dependence, withdrawal may occur as a result of repeated or chronic administration of drugs, but also after short-term high dose use, like e.g. during neonatal stay. Consequently, NAS can appear both following discontinuation of drugs taken by the pregnant mother, as well as following discontinuation of drugs administered intentionally to the newborn.The most commonly involved compounds are opioids, selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, as well as cannabis or nicotine. The incidence of opioid related neonatal abstinence syndrome (NAS) has increased significantly in the last decade, co-linear with the increased medical use of prescription opioids in adults, including in young women.The clinical picture of neonatal abstinence syndrome mimics to a large extent the syndrome of opioid withdrawal in adults (‘cold turkey’), and includes both neurological (e.g. agitation, crying, sleep disturbance, feeding difficulties, but also seizures) as well as extra-neurological symptoms (e.g. diarrhea, vomiting, perianal excoriations, sneezing, sweating, hyperthermia). Besides pharmacological interventions, we strongly recommend to consider the impact of other interventions like swaddling, traditional supportive interventions, but also breastfeeding since this results in a reduced incidence and severity of NAS (NNT 6-8°. This diagnosis is also associated with subsequent impaired neurological outcome.

Biography:

Dr Noorhuda Abdul Mutalif has completed her Medical Doctor (M.D.) degree from The National University of Malaysia 2013. She is currently working as Medical Officer in Orthopaedic Department, Melaka General Hospital, aspiring to be Orthopaedic Surgeon.

Abstract:

Introduction

Septic joint morbidity and mortality risks are significantly reduced with advent of antibiotics. Despite arthrotomy washout and long-term antibiotics this patient still developed pan-osteomyelitis and later a pathological fracture

Case Report

This is 1 year 8 months old boy, presented with left knee pain and fever for two days. Physical examination revealed inability to weight bear on left leg, elevated temperature, swelling, tenderness and limited left knee ROM. WCC, ESR and CRP increased. Xray of showed no abnormality. Ultrasound revealed knee effusion. He was started on intravenous antibiotics. We proceeded with arthrotomy washout. Intraoperative specimens grew S.aureus. He completed 4 weeks of intravenous and 2 weeks of oral antibiotics. Two weeks later after discharge, he was seen again with recurrent symptoms. Xray shows pan-osteomyelitis and supracondylar of left femur fracture. He was again started on 2 weeks of IV antibiotics. As the symptoms improves, patient was put on above knee POP and discharge with oral antibiotics for another 4 weeks. Xray repeated 6 weeks upon discharged showed united fracture and improving bone density. Four months later, child came well, and ambulating normally.

Discussion

Incidence of osteomyelitis in septic joint patient is 68%. Strict monitoring and protected weight bearing until there is evidence of radiological improvement is suggested. Shortened intravenous and oral antibiotic therapy should be reserved for uncomplicated cases.

Conclusion

Prolonged monitoring and treatment is a must in complicated septic joint. Protected weight-bearing is important until bone quality improves as evident by serial radiography

Biography:

Dr. Mohamed Khaled ElMenabbawy is the Professor Of Pediatrics & Child health and Head of Child health Department. He is also working as Consultant of Pediatric Neurology. He is having memberships of ICNA and IBRO. Also he is WHO temporary Advisor of Nutrition 2005.  

Abstract:

Background: Diabetes mellitus (DM), describes a group of chronic metabolic disorders characterized by increased blood glucose concentration, There is increased prevalence of Type 1 DM  in children and adolescents with its adverse complications especially microvascular ones (retinopathy, nephropathy and neuropathy) that might cause multiple organ damage.

Aim of the study: is to examine the relation between DM and neuro-behavioral affection.

Subjects and Methods: This study is a Case-Control Study. Sixty Children with type I DM, aged 8-18 years old of both sexes were enrolled in this study; we divided them randomly into 2 groups. All children were subjected to full history taking, physical, neurological and systemic examination.  IQ and behavioral assessment were done in the same sitting of history taking. Neurophysiological studies (EEG) was done for only 47 patients.

Results: There was affection of motor power in both upper limbs as well as lower limbs, also we found that there was affection of the superficial peripheral sensation affecting both upper and lower limbs. EEG study revealed that positive EEG findings in those cases with only 10% showed clinically epileptic fits. Behavioral assessment showed alteration in school progress, lack of concentration and there was regression in their IQ. Conclusion: Neurological and behavioral assessment of children with diabetes mellitus type I must be put into consideration as those children are able to have a poor school progress due their affection of their behavioral  and neurological systems with their reflected on their  intellectual functions and school progress.

Biography:

Dr Sarah Kyne is a Paediatric Senior House Officer. She is currently on the second year of her training scheme in Ireland in Paeditrics.  She graduated from Trinity College Dublin in June 2016 and completed her first year of intern training in St James’s Hospital in Dublin. After this she applied straight to the Paeditric Training scheme and carriied out her first year on this scheme on General Paediatrics in Galway. She is currently working at the National Maternity Hospital, Holles Street, Dublin on Neonatology. Dr Kyne is in the process of completeing her Paediatric Membership exams.
 

Abstract:

Wheeze and cough are common presentations to the Paediatric Emergency Department. The aim of this closed loop retrospective audit was to assess compliance with the current clinical guidelines in University Hospital Galway regarding the management of acute wheeze. Emergency Presentations were first examined during an eleven week period from the 1^st of July to the 18^th of September 2017 (Audit Period 1) where the management of acute wheeze in the Emergency Department was evaluated. A teaching session was then held to all Consultant and NCHD staff on the 9^th of November 2017. A re-audit (Audit Period 2) was   then carried out between 20^th of November to the 31^st of December 2017. With this closed loop audit, we saw that there was an improvement from an overall 78% compliance of Acute Wheeze guidelines during Audit Period 1 to 89% in Audit Period 2. In particular, we saw an improvement in the use of meter-dose-inhalers for the moderate wheeze category. Despite this improvement; there was still an under-admission of severe wheeze children to the Paediatric Ward with a portion of these being discharged home with an asthma action plan. This audit identified a number of key areas to improve compliance with the University Hospital Galway Acute Wheeze Guidelines. Improvements were seen after the first teaching session however, with the change of staff frequently every six to twelve months among the paediatric staff; it is important to have ongoing education and audits to ensure compliance with treatment guidelines.

Biography:

T Thuileiphy has completed her MSc Nursing in Pediatric from All India Institute of Medical Sciences, New Delhi. She previously worked as a Staff Nurse for seven years at AIIMS, New Delhi.

Abstract:

Background: Glaucoma is the leading cause of irreversible blindness worldwide. It is preventable if timely effective and successful treatment is provided. Quality teaching, support and guidance are needed to ensure the compliance to glaucoma medication. The present study was aimed to develop IEC package on compliance to glaucoma medication and to assess its effectiveness in increasing knowledge and practice of caregivers of children glaucoma.

Methods: Quantitative research design - pre experimental one group pretest and posttest was used. Ethical approval was obtained from institute ethical committee. Sixty caregivers of children attending glaucoma clinic in tertiary care hospital were included in the study. Knowledge questionnaire, practice questionnaire observational checklist and medication log sheet are used for pretest and one month after the administration of IEC package (posttest) were self-developed, validated and found reliable. One to one teaching, demonstration and return demonstration was provided.

Result: Majority of the caregivers were females, the mean posttest knowledge score was increased from 7.3±2.19 to 12.23±1.36, which was significant at p<0.05. There was significant (p<0.05) increase in posttest practice score from 11.5±1.91 to 18.08±1.12. The pretest and posttest knowledge scores had significant association with educational status and family monthly income (p<0.05). The pretest and posttest practice score had significant association with gender and relationship to child (p<0.05). Increase in the knowledge and practice was dependent of caregivers selected variables such as educational status, monthly income of family, gender and relationship to child.

Conclusion: The study revealed that an information, education and communication (IEC) package played a crucial role in increasing knowledge and practice regarding compliance to glaucoma medication among caregivers of children with glaucoma one month after the intervention. The most and effective factor identified in the study is the teaching session which takes only 15 minutes in teaching and demonstrating the content in the information pamphlet.

Biography:

Sidra Ishaque is currently working in Aga Khan University Hospital, Pakistan. She has published various papers in reputed journals.

Abstract:

Introduction & Aim: Venous and arterial thromboembolic events (TE) are increasingly recognized in infants and children with approximate incidence of 0.7 per 100000. This increase is related to increasing survival of children with chronic complex problems, more use of central venous catheters in critically ill children as well as improved imaging modalities for accurate and timely diagnosis of thrombosis. Similarly to adults, these TE may cause serious long-term morbidity in children. Our specific goal was to assess efficacy of thrombolysis and bleeding risks across a range of tPA dosing.

Methods: This was a retrospective case series, conducted in pediatric intensive care unit (PICU) of Aga Khan University Hospital. All children age group with 0 day to 16 years admitted in PICU, who received tPA (dosage: 0.01-0.06 mg/kg/hr.) for thrombolysis were included in the study. Operational definitions were defined as clot resolution. It was divided into three categories: None; partial resolution; complete resolution. Data was collected on a structured proforma. Data was entered and analyzed using SPSS version 20. Only descriptive statistics will be applied.

Results: Seven children, (five males and two females) underwent thrombolysis with tPA during our study period. Three out of the seven children had intracardiac thrombi, whereas the rest had vascular thrombi. Amongst the intracardiac thrombi, two children with congenital heart disease had left ventricular thrombus, while one had a right sided thrombus. The primary diagnoses in children with intracardiac thrombosis were infective endocarditis, thalassemia major and post diphtheria myocarditis. Two out of the three children with intracardiac thrombosis expired, making intracardiac thrombus an important association with mortality. Complete resolution of the clot was noted in six patients (85%). Stroke was the major complication noted in a patient suffering from post-diphtheria myocarditis, which had extensive right external iliac and right ventricular thrombus and eventually expired. No complications were observed in rest of the patients. The degree of clot resolution was not significantly related to age or tPA duration

Conclusion: Our case series provides an assessment of thrombolysis using tPA in the PICU. This case series is the first from the country and with complete clot resolution in six out of our seven patients; we can safely predict that tPA should be used for thrombolysis in children.