Day 1 :
Maternal and Child Hospital Guadalupe Victoria of Atizapan, Mexico
Keynote: Guidelines on immediate management in pediatric patients with childhood pyloric hypertrophy
Time : 10:00 am -10:45 am
Noe Villanueva Lopez is a Pediatric Surgeon dedicated to the care of newborns. He is a Chief in charge of Pediatric Division in the Maternity and Children Hospital Atizapan State of Mexico. He has completed his Master’s in Public Administration from UVM and has obtained his Bachelor of Medicine from UNAM.
Childhood pyloric hypertrophy is a common cause of gastric outlet obstruction in infants presenting as a more common surgical emergency of childhood. The incidence is between one and three in every 1000 live births, with a higher frequency of 4:1 in the male sex. It is more frequent in the Caucasian race and less frequent in Asian countries. It is an acquired disorder of unknown etiology causing hypertrophy of the pylorus muscle fibers, causing mechanical obstruction in the gastric chamber, producing associated metabolic alterations. Patients with suspicion of this diagnosis have non-biliary vomiting, from three to six weeks of age, vomiting is in projectile, and in severe cases it can cause significant weight loss and developmental delay. Clinically, the palpable “pyloric olive” can be found in the epigastric region, in ultrasound the dimensions with a predictive value greater than 90% are muscular thickness greater than 4 mm and the length of the pyloric canal greater than 17 mm, the classic radiological signs are the “sign of the cord” and the “shoulder sign” caused by the hypertrophied muscle that protrudes into the gastric canal. Hypertrophic pyloric stenosis is not a surgical emergency, the loss of fluids and electrolytes must be corrected with the established schemes according to the degree of dehydration prior to the surgical intervention. If the imbalance is mild to moderate, the correction will take 24 to 48 hours and if it is severe up to 72 hours. The correction of the hydroelectrolytic imbalance prior to surgery prevents metabolic complications. In the Maternity a Children Hospital Atizapan State of Mexico, we attend 3,500 births per year, of which 350 require management in the intensive care units of the newborn (10%), with extensive experience in surgical procedures with pyloric hypertrophy resolution of 25 to 30 cases per year.
University of Limoges, France
Time : 11:00 am - 11:45 am
Michel-Henri Delcroix is a PhD student in Biology and Health at the Doctoral School of Limoges. He is an author and co-author of 10 books in Gynecology-Obstetric. He has written several articles on Smoking and Pregnancy.
France is the country in Europe where the prevalence of pregnant women who smoke is highest (35.9% before pregnancy and 21.8% in the third trimester, in 2008). According to the national perinatal survey of 2016, 17.1% still smoke in the third trimester. Currently, the screening and management of smoking in pregnant women is done on the basis of the daily cigarette number and minimum advice is provided. Improving the efficiency of prenatal care regarding maternal smoking is essential. No systematized practice, including the measurement of carbon monoxide (CO) in exhaled air, has generally been implemented in pregnancy followup.
A 36-month, comparative, randomized, interventional study is being conducted in two parallel arms (experimental vs. normal management) of 300 patients each. The main objective is to assess the impact of the measurement of maternal expired CO followed by personalized information versus standard care on the rate of effective cessation of maternal smoking at childbirth. Secondary objectives are to evaluate its impact on maternal-fetal pathologies and on the intention of breastfeeding. Smoking cessation is based on patient self-report expired CO <3 ppm.
The results indicated that our hypothesis is the expired CO measurement strategy as part of prenatal consultations will increase by 50% the rate of smoking cessation among pregnant women.
The study aims to promote a clinical approach integrating biological (measurement of expired CO) and psycho-social dimensions against smoking during pregnancy.
The measurement of expired CO aims to reduce maternal smoking and perinatal health inequalities by increasing the efficiency of prenatal care.