Day 1 :
Keynote Forum
Villanueva L. Noe
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
Biography:
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.
Abstract:
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.
Keynote Forum
Michel-Henri Delcroix
University of Limoges, France
Keynote: Smoking cessation by pregnant woman tobacco addictive behaviors in pregnant women
Time : 11:00 am - 11:45 am
Biography:
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.
Abstract:
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.
- Neonatology
Session Introduction
Richa Rajawat
Vardhman Mahavir Medical College & Safdarjung Hospital, India
Title: Perception of mothers of the newborns receiving kangaroo mother care in a tertiary care hospital
Time : 11:45 am - 12:15 pm
Biography:
Richa Rajawat has completed her MBBS degree from Barkatullah University, India. She is currently pursuing Post-graduation in Pediatrics from GGSIP University, India. She has presented many posters in national level Pediatric conferences in India.
Abstract:
“Study of kangaroo mother care – as perceived by the parents” attempts to scrutinize the parent's satisfaction and confidence in terms of their needs, expectations and outcomes from a tertiary care hospital regarding the care of low birth weight (LBW) infant during their stay in KMC ward by a structured questionnaire method and thereby analyzing the quality of care from parent's perspective. A cross-sectional study was conducted from December 2018 to February 2019 in Department of Pediatrics, VMMC & Safdarjung Hospital, New Delhi on 400 mothers of admitted newborns weighing less than 1.8 kg. Exclusion criteria were parents of newborns with gross congenital anomalies, congenital heart diseases and surgical diseases. On discharge, mothers were interviewed by a pre-structured questionnaire regarding various domains contributing to the needs of the parents and satisfaction with the neonatal care. Each domain was scored independently for the overall quality of care of LBW infant on a Parent Satisfaction Scale of 1 to 4. Mean domain scoring was computed and the frequencies were correlated with the characteristics of the caregiver. Ninety point twenty-four percent (90.24%) of interviewed parents gave positive responses regarding information, communication and parental education aspects of KMC services. Parental dissatisfaction is noticed prominently (27.75%) in the inadequacy of the information provided by the treating doctors particularly in explaining about the probable outcome of the baby's illness. Open ended questioning revealed that information conveyed via nursing staff was easier and more understandable (88.00%) as compared to convey via doctors (80.50%). Parents considered behaviour of the healthcare staff as very important part of communication and told that the positive behaviour encouraged the mothers to overcome the difficult situations while handling their babies and provided emotional support. Interpersonal relationship with the staff members emerged as one of the most important factors affecting satisfaction of mothers regarding the care of the newborn.
Eesha Garg
Vardhman Mahavir Medical College & Safdarjung Hospital, India
Title: Iron deficiency anemia among exclusively breastfed term infants at age four-six months
Time : 12:15 pm - 12:45 pm
Biography:
Eesha Garg has completed her MBBS degree from the GGSIP University, India. She is currently pursuing her Post-graduation in Paediatrics from GGSIP University, India. She has presented many posters in national level Paediatrics conferences in India.
Abstract:
A cross-sectional study was done in department of paediatrics, VMMC and Safdarjung Hospital, New Delhi to find prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in inborn exclusively breastfed term infants at the age of four-six months. Exclusion criteria's were preterm babies, neonatal resuscitation at birth; known case of any cyanotic congenital heart disease, h/o iron supplementation to baby, blood transfusion and bleeding diathesis. Iron deficiency was defined as s. ferritin <12 mcg/L. Iron deficiency anemia was defined as iron deficiency along with Hb <105 g/L at age of four to six months. Total no of study population taken was 208. Out of total 208, eight samples were hemolyzed. Results of the 200 infants were analyzed. Age wise distribution of infants was 45.5%, 31% and 23.5% at age four, five and six months respectively. Out of total study population 63% were males and 37% were females with male to female ratio of 1.7:1. Mean value of hemoglobin and serum ferritin was estimated 10.817 (±0.25) g/dl and 44.60 (±25.02) mcg/L respectively. Prevalence of iron deficiency (ID) was 12.9%, 25.81% and 34.04% at age four, five and six months respectively. Prevalence of iron deficiency anemia (IDA) was 9.89%, 19.35% and 23.4% at age four, five and six months respectively. Out of total infants it was found that 11% were underweight and 2% were overweight. Seven percent (7%) infants were found to be stunted and 5.5% were having microcephaly. On univariate analysis age of mother <20 years, parity, underweight, stunting and microcephaly was found associated with both ID and IDA (p value <0.05). On multivariate analysis age of mother <20 years was associated with ID and increasing parity was associated IDA (p value <0.05).
Neha Raghava
Safdarjung Hospital, India
Title: To study the efficacy of inhaled budesonide vs oral montelukast in control of mild persistent asthma in children between five-18 years of age
Time : 12:45 pm - 13:15 pm
Biography:
Neha Raghava has completed her MBBS in year 2013 from Manipal University, India and her MD in Pediatrics in 2017 from Meerut, India. Currently she is working as a Senior Resident in the Department of Pediatrics in Safdarjung Hospital New Delhi.
Abstract:
Asthma consensus guidelines recommend the use of controller agents to control asthma symptoms and reduce inflammation in patients with mild persistent asthma. In children, budesonide inhalation suspension and montelukast have demonstrated efficacy in controlling mild persistent asthma.
Children with mild persistent asthma, aged five to 18 years, were recruited from the OPD of pediatrics of C S Subharti Hospital. A prospective, controlled study design was used. Patients received either inhaled budesonide [(GROUP A, N=30), 200 mg once a day]; or montelukast [(GROUP B, N=30) (5≤14 years, 5 mg; >14 years, 10 mg)] for 90 days. Outcome measures included improvement in the number of asthma attacks, percentage improvement in the absolute eosinophil count (AEC), percentage predicted of normal force expiratory volume in 1 second (FEV1%) and percentage improvement in the peak expiratory flow rate (PEFR) after 90 days of treatment.
Significant improvement in the frequency of asthma attacks, % improvement in the AEC, FEV1%, % improvement in the PEFR in both, group A and B were seen. More significant improvement in frequency of asthma attacks (p=0.05) and FEV1% (p=0.002), was seen in group A, compared to group B. Oral montelukast was better in terms of % improvement in the AEC (p=0.002). Inhaled budesonide is superior to oral montelukast in treatment of mild persistent asthma in five to 18 years children in terms of improvement in frequency of asthma attacks, percentage improvement in AEC and PFTs over 12 weeks period.
Conchita Delcroix-Gomez
University of Limoges, France
Title: Smoking, pregnancy and vulnerability (SPV): Intra-uterine growth retardation (IUGR) of toxic origin can it be influenced by the early cessation
Time : 14:15 pm - 14:45 pm
Biography:
Conchita Delcroix-Gomez is a PhD student in Biology and Health at the Doctoral School of Limoges. She is a midwife and co-author of three books in Gynecology-Obstetric. She has written several articles on Smoking and Pregnancy.
Abstract:
Maternal smoking has a negative impact on the evolution of pregnancy, fetal development and perinatal indicators.
The objective of the study is to demonstrate that early smoking cessation influences the onset of intrauterine growth retardation and the occurrence of complications such as gestational diabetes, preeclampsia, the threat of premature birth and finally premature delivery.
This study is a prospective, multicenter cohort, carried out between November 2013 and March 2016, in four French maternity hospitals. This research was classified at low risk by the Ethics Committee of the motherchild hospital of the University of Limoges in France, March 2013. Nine hundred twenty pregnant women who smoked were included in our study. The timing of smoking cessation during pregnancy (1st, 2th, 3th trimester) was filled as well as the type of care. Smoking cessation was defined if the pregnant woman declared zero cigarettes smoked per day and obtained a measurement of CO in the exhaled air < at 3 ppm. The rate of cessation of smoking during pregnancy was 31.4%. The average weight of the newborn mother was decreased by 433 g with a p<0.0001 associated with a decrease of 14.19% of the mean percentile (p<0.018): average weight of the newborn mother who stopped smoking was 3,350 g±485, with respective percentiles of 45.98%
Conclusion: <span segoe="" ui",="" roboto,="" "helvetica="" neue",="" arial,="" "noto="" sans",="" sans-serif,="" "apple="" color="" emoji",="" "segoe="" ui="" symbol",="" emoji";="" font-size:="" 14.4px;="" background-color:="" rgb(255,="" 255,="" 255);"="" style="color: rgb(33, 33, 33);">Early cessation of smoking influences the number of intrauterine growth retardation of toxic origin below the 10th percentile.
Shaoping Yang
Huazhong University of Science and Technology, China
Title: Effects of exposure to green space on problem behaviors in preschool-aged children
Time : 14:45 pm - 15:15 pm
Biography:
Shaoping Yang is a Chief Physician, Professor. She is the Director of Department of Child Healthcare, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology. She has been involved in public health and clinical work for children for more than 30 years and published more than 40 papers in reputed journals and five monographs as Editor-In-Chief. She is currently a Member of the Children's Insurance Branch of the Chinese Preventive Medicine Association, a Member of the Psychological Behavior Group, and a Member of the Environmental and Social Eugenics of the China Healthy Birth Science Association.
Abstract:
There is limited evidence regarding the association of green space exposure with childhood behavioral development. We aimed to investigate the associations between exposure to green space and multiple syndromes of problem behaviors in preschool children.
This retrospective cohort study was conducted in Wuhan, China from April 2016 to June 2018. We recruited a representative sample of 4,774 children, aged five to six years, from 17 kindergartens located in six urban districts of the city. We determined the presence of green space from high spatial-resolution (30 m 30 m) satellite data. We measured greenness using the average Normalized Difference Vegetation Index within a buffer with radius of 100 meters surrounding the locations of residences and kindergartens. We estimated the associations between green space exposure and childhood problem behaviors using the childhood behavior checklist (CBCL) and employing generalized estimating equations.
We observed decreases in problem behaviors associated with exposure to green space in preschool children. For example, one standard deviation increase in kindergarten NDVI was associated with decreased T scores of anxiety/depression (-0.440, 95% CI: -0.725, -0.155), somatic complaints (-0.293, 95% CI: -0.568, -0.018), aggressive behavior (-0.344, 95% CI: -0.629, -0.060), and hyperactivity/inattention (-0.348, 95% CI: -0.632, -0.064). Similar associations were observed between exposure to residence-kindergarten weighted surrounding greenness and childhood problem behaviors. Stratified analyses indicated that boys benefited to a greater degree than girls with respect to different indicators of green space exposure.
Children attending kindergarten with more green space exhibited enhanced behavioral development. Interventions to develop green spaces in kindergartens could produce significant benefits in the behavioral development of preschool children.
Issa Wone
Ziguinchor University, Senegal (West Africa)
Title: Catastrophic expenditures related to anticancer drug supply to patients in Senegal (West Africa)
Biography:
Issa Wone MD, is an associate Professor of Public Healtn in Ziguinchor University, in the south of Senegal (West Africa). He studied Medicine and Public Health in Dakar (Senegal) and New Orleans (USA) where he got a Master of Sciences in International Development.
Abstract:
Health systems in developing countries are globally unprepared to address NCDs
In Senegal, the cancer case illustrates these 3 challenges. We studied the ability to pay of 2 workers profiles: the lowest Senegalese official salary, and the minimum wage of a farm worker. We considered 9 types of cancers, based on their frequency, and the availability in the country of relevant chemotherapy: breast, uterine cervix, prostate, colorectal, esophagus, ovary, stomach, lung, ENT, testicle.
Given the financial inaccessibility of cancer chemotherapy in Senegal, measures involving the government, cancer control associations, researchers must be taken to avoid the renunciation to treatments and its subsequent high mortality rate.
Neha Raghava
Safdarjung Hospital, India
Title: Double aneuploidy-a rare congenital anomaly of down’s syndrome with klinefelter syndrome
Biography:
Neha Raghava has completed her MBBS in year 2013 from Manipal University, India and her MD in Pediatrics in 2017 from Meerut, India. Currently she is working as a Senior Resident in the Department of Pediatrics in Safdarjung Hospital New Delhi.
Abstract:
The coincidence rate of both Down and a Klinefelter syndromes in the same individual is estimated to lie in the range 0.4 to 0.9 per 10,000 male births. The cause of double aneuploidy chromosomal abnormalities may arise from two meiotic non-disjunctional events, but up to date the mechanisms by which these arise, have not been well studied. The prevalence of Down syndrome is one in 770 live births and is increased with advanced maternal age. It is one of the best-recognized and most common chromosome disorders caused by the presence of all or part of a third copy of chromosome 21. Klinefelter syndrome is a chromosomal condition that affects male physical and cognitive development. Its signs and symptoms vary among affected individuals. The prevalence of Klinefelter syndrome is one in 800 male births. Males with Klinefelter syndrome are not usually detected in the newborn period. These individuals are generally normal in appearance before puberty. Due to rarity of this case, we are reporting this unusual case of double aneuploidy showing trisomy 21 and Klinefelter syndrome together.
Baby presented at day of life three. The chief complaint was yellowish discoloration of skin up to legs. The neonate was of birth order sixth and last born from non consanguineous parents, aged 45 years for the father and 40 years for the mother at the time of his birth. On physical examination, the patient presents typical features for Down syndrome with up slanted palpebral fissures, sandal gap and mongoloid face, small nose and flat nasal bridge, uncurled hair, short neck and hyperlaxity of joints. The present case of 48, XXY, +21 showed features typical of Down syndrome alone. This is only expected, as features characteristic of Klinefelter syndrome are not apparent until the post-pubertal stage.
Down-Klinefelter syndrome is a rare occurrence. It presents trisomy 21 characteristics early in life and Klinefelter syndrome features after 10 months of age. Pediatric cardiologists are familiar with screening of babies with Down’s syndrome for congenital heart disease. However, in children diagnosed with Klinefelter syndrome, a congenital heart disease has only rarely been reported. Reports on congenital heart disease with double aneuploidy of Downs syndrome and Klinefelter syndrome are scarce.
Richa Singh
Pt BD Sharma Post Graduate Institute of Medical Sciences,India
Title: Correlation of spot urinary protein: creatinine ratio and quantitative proteinuria in patients of nephrotic syndrome in pediatric age group
Biography:
Richa Singh has completed her MBBS from Government Medical College, Haldwani. And then she has completed her MD in Paediatrics from Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak as a Gold medalist. Currently she is pursuing her Senior Residency from past two years in Safdarjung Hospital, New Delhi, in Pediatric ICU which one of the leading centers in India. She has published one international paper, one oral paper, one poster and published one case report.
Abstract:
Nephrotic Syndrome is a common disease in pediatric age group with multiple relapse. Twenty-four hour (24 hour) urinary protein excretion is the accepted method used in quantification of proteinuria, but it's a time consuming, inconvenient and cumbersome method. Spot urine examination would be more simple, easy, acceptable, and less timeconsuming method for detection of proteinuria in children.
Aim of our study is to evaluate the utility of protein: creatinine ratio in random urine sample as a reliable diagnostic tool to rule in or rule out proteinuria and to find the correlation of protein: creatinine ratio with 24 hour protein excretion which is the gold standard reference method.
The study was done on 40 pediatric patients admitted as nephrotic syndrome, either presenting for the first time or relapse case. Nephrotic syndrome was diagnosed on the basis of massive proteinuria (>40 mg/m2/hr), hypoalbuminemia and generalized edema.
The results indicated that the correlation between spot protein and creatinine ratio and 24 hour proteinuria is statistically significant with r=0.833 (p<0.01) by Pearson's correlation coefficient.
Spot protein creatinine ratio can be used as reliable test for detection of proteinuria in pediatric age group in patients of nephrotic syndrome.