Day 1 :
Keynote Forum
Amin Gohary
Burjeel Hospital, UAE
Keynote: Common neonatal and pediatric surgical problems
Biography:
Amin Gohary completed his MB BCh in 1972 and his Diploma in General Surgery in 1975 at Cairo University, Egypt. Prof. Dr. Amin is well known in Abu Dhabi for his extensive interest and involvement in scientific activities. He is the President of the Pediatric Surgical Association of UAE. Prof. Dr. Amin is also the founder and member of the Arab Association of Pediatric Surgeons. Currently, he is an external examiner for the Royal College of Surgeons.
Abstract:
Keynote Forum
Ameya Ghanekar
Founder and Chief Learning Officer -Orange Zebra, UAE
Keynote: Significance of perception management in healthcare industry globally
Biography:
Ameya Ghanekar is a TEDx speaker, award winning leadership facilitator, published author, learning strategist, strength coach, and experienced body language guru and perception management specialists. He has 14 years of experience in corporate, consultancy and education domain specializing in healthcare, oil and gas, hospitality (Luxury), retail, banking, wellness, real estate, equine, manufacturing, entertainment and fitness industry. He has successfully coached and trained chief medical directors, doctors and healthcare professionals.
Abstract:
- Neonatology and Perinatology | Maternal and Child Care | Child and Adolescent Behavioral Health | General Pediatrics | Neonatal Intensive Care and Nursing | Premature babies and birth
Session Introduction
Monika Kaushal
Emirates Specialty Hospital, UAE
Title: Point of care ultrasound in NICU
Biography:
Monika Kaushal has extensive experience and several publications in journals which are indexed both nationally and internationally indexed journals. She is currently undertaking MSc in Neonatology from Southampton University, UK. She is honored with Fellow of Royal Collage of Pediatrics and Child Health, UK (FRCPCH).
Abstract:
Most of ultrasounds are in tertiary care setting with radiologist supported services available, not all of these settings have pediatric radiologists and most of these settings would not be able to provide instantaneous service within minutes, however these patients are usually not mobile. To overcome these problems, the neonatologists should be performing point of care ultrasound at bed side to take quick decision. Machines have become smaller and portable, image quality has improved and cost has dramatically declined making inexpensive units available. Common problems in the NICU evaluated with sonography are: (1) Neuro – Screening for ICH and PVL – Monitoring evolution of ICH (including ICP) – Confirmation of prenatally suspected malformations or injuries – Evaluation for occult defects of the lower spin; (2) Renal/GU – Confirmation of prenatally suspected malformation, dysgenesis or obstruction – Assessment for obstruction of blood flow to or from the kidney in the setting of hypertension or hematuria – Suspicion for testicular torsion – Confirmation of bowel in inguinal hernia; (3) GI – Evaluation of biliary tree in the setting of cholestasis; (4) fECHO/TNE – PDA significance – Response to inotropic agents; (5) Umbilical line tip placement – Reduction in radiation exposure; (6) Bladder catheterization or tap; (7) Pleural effusion drainage; (8) PICC and PIV placement; (9) Increased ICH requiring LP; and (10) ETT placement. When neonatologist is performing the ultrasound the positive things are that he has the knowledge of the patient’s clinical history and needs, can rapidly return of information that can inform acute management, can have access optimized for non-mobile patients (timing, portable) and ultrasound has lower radiation exposure for line, tube placement as compared to X-ray. But the problems are that most of us lack of training in imaging, lack of knowledge of anatomy, lack of knowledge on physics of ultrasound, lack of technical knowledge regarding the machine, loss of control by radiologist (QI, reporting, billing), shortage of access to machine and dearth of technical support/service. To overcome this, we should get trained in point of care of ultrasound and save our little ones by timely management.
Abeer Mohi El-Din Saleh
International Medical Center Hospital, Egypt
Title: Ambiguous genitalia! Is it still ambiguous?
Time :
Biography:
Abeer Mohi El-Din Saleh has completed Bachelor’s degree from Ain Shams University Faculty of Medicine in 1995, Master’s degree from the same university in 2001 and MRCPCH London, UK in 2013. She has previously worked in Yeovil District Hospital, UK. She is currently is working as a Pediatric Consultant in the International Medical Center Hospital and Nasser Institute, Cairo, Egypt.
Abstract:
When a baby is born and it is difficult to determine whether it is a boy or a girl then it is said that the baby has ambiguous genitalia It is a traumatizing information to the parents and it should be dealt with in a very delicate manner It could signify a life threatening condition that’s why it is crucial to determine the etiology as soon as possible and start a plan of management The formation of a typical female or male external genitalia results from a series of genetic and physiological events starting with sex determination and progressing through differentiation of the internal and external sexual organs Failure of determination and differentiation in the usual manner can result in what is called disorder of sex development We will try to go through causes and management and ways to simply understand and deal with it.
Biography:
Wael Mohamed Abdelaal has graduated in Egypt completed his PhD 2009 from Ain Shams University faculty of Medicine. He had a lot of researches and has published many papers in reputed journals in the field of neonatal anemia and neonatal sepsis and his area of interest is Pediatrics hematology and infection. He was working in Zagazig university hospital (Egypt), Alsabah hospital (Kwuait) and Hamd medical corporation (Qatar), Currently he is working in NMC Royal hospital UAE.
Abstract:
All drugs are poisons.Only proper usage and proper dosage determine what is therapy and what is poison. Antibiotics are powerful medicines that fight against bacterial infection. Before the 1930s there were no treatments for bacterial infections, following the discovery of penicillin industry started searching for more antibiotics in nature In his 1945 nobel prize lecture, Fleming warned of the dangers of antimicrobial resistance: The time may come when penicillin can be brought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Many bacteria have developed the ability to become resistant to antibiotics. These bacteria are now a major threat in our hospitals. Mechanisms Of Resistance Enzymatic inhibition: First is alteration of bacterial membranes:Outer membrane permeability, Inner membrane permeability and Rapid ejection of the drug [efflux] or reduced drug influx. Bypass of antibiotic inhibition: Alteration of target sites, Altered ribosomal target sites and altered cell wall precursor targetsand Altered target enzymes How antibiotic resistance can be prevented: Antibiotics should be the last line of defence NOT the first, Most common infections will get better by themselves through time, bed rest, liquid intake and healthy living, Only take antibiotics prescribed by a doctor, If prescribed antibiotics, finish the cours and lastely Do not use other peoples or leftover antibiotics they be specific for some other infection.
Lamidi Isah AUDU
Kaduna State University, Nigeria
Title: Gestational age related neonatal survival at a tertiary health institution in Nigeria: The age of fetal viability dilemma
Biography:
Lamidi Isah AUDU is a Fellow of the National Postgraduate Medical College of Nigeria, previously Chief Consultant Pediatrician/ Neonatologist and Director of Clinical Services, National Hospital Abuja. He is currently a Senior Lecturer at Kaduna State University, Nigeria, Examiner for the National Postgraduate Medical College, Co-Chair Maternal and Perinatal Death Surveillance and Response Committee of the Federal Ministry of Health. He also reviews manuscripts for local and international medical journals.
Abstract:
Background: Although official age of fetal viability in Nigeria is 28 weeks, there are pockets of reports of survival of babies delivered at younger Gestational Age (GA) from different parts of the country. This is likely to generate important ethical and medical concerns in our approach to management of births occurring before the official GA of 28 weeks. Aim: To determine the gestational age specific neonatal mortality among preterm deliveries at the National Hospital Abuja. Methods: A retrospective review of relevant data from the National Hospital Neonatal Registry Database (REDCap) was undertaken to determine the mortality rate of preterm babies managed in NICU from January 2017 to February 2018. Disaggregated GA specific mortality rates were also computed to determine the fetal age at which extra uterine neonatal survival rate was at least 50%. GA estimation was based on mothers’ LMP in over 96% of cases. Results: Sixty two (62) of 305 preterm babies admitted died during hospitalization giving a mortality rate of 20.3%. This was significantly higher than the mortality rate among term babies (7.5%, P=0.01) hospitalized over the same period. Antenatal steroid use was low (11.2%), 188 (25.8%) received CPAP for RDS and none of the babies received surfactant. There were no survivors among babies delivered at GA of 22-25 weeks (11, 3.6%). However survival rate at 26 weeks gestation was 53.8% and this subsequently increased reaching a peak of 80% survival at 36 weeks. RDS accounted for 53.9% of all deaths. Conclusion: GA, place of delivery and birth weight were significantly associated with risk of death. It is concluded that the survival rate (53.8%) of babies at GA 26/52 despite minimal antenatal interventions and limited postnatal respiratory support was reasonably high and this could serve the basis for discussions for a downward review of age of fetal viability in Nigeria.
Ahmed Mohamed Refaat
Ain Shams University, Egypt
Title: Complication of Ryle tube insertion in neonates: Management and fate
Biography:
Ahmed Mohamed Refaat has completed his MD in phoniatrics at the age of 34 years from Ain Shams University, after finishing his Master Degree in ENT and Phoniatrics at age of 27 and 31 years. Dr. Ahmed Refaat is lecturer of Phoniatrics at ENT department, Ain Shams Unviersity Hospital.
Abstract:
7 neonates with pharyngeal trauma due to forceful untrained use of nasogastric feeding tube causing a variety of signs and symptoms starting from excessive frothy secretions and difficulty in passing feeding tube, reaching pneumothorax, this articles presents these cases with the proper advices regarding the diagnosis and prognosis of such cases based upon observation of the cases and tracing the literatures.
Ciba Sunil Raphael
Medcare Women and Children Hospital, UAE
Title: Family centered neonatal care: Evidence to practice
Biography:
Ciba Sunil Raphael is currently the NICU Unit Manager/Training and Education Coordinator, NRP Instructor at Medcare Woman and Child Hospital, a prestigious division of Aster DM Healthcare Group of Hospitals in Dubai. She passionately continue to contribute more than 24 years of her clinical and management experience and expertise in the field of patient care and has crossed many milestones and received accolades during her extensive work experience.
Abstract:
Family-centered care is a philosophy of care that embraces a partnership between staff and families. It has become an integral part of providing high quality neonatal care Unrestricted parental presence in the NICU, parental involvement in infant care giving, open communication with parents are basic tenets of family-centered care in our Neonatal unit. By virtue of their continual presence and role in the NICU, Nurses are in a unique position to support family-centered care. There is growing evidence that relationship based, family centered and developmentally supportive approach to NICU Care is effective in reducing neonatal morbidity and improving neurobehavioral development of preterm infants. The main components of this approach are: opening of (NICUs) to parents, involvement of parents in care of their baby, parents’ psychological support, Neonatal Individualized Developmental Care Program (NIDCAP), breast milk feeding and kangaroo mother care. Neonatal care with a family focus helps minimize adverse effects with: * A Family-Centered Care philosophy * Family-friendly facilities * Family oriented training and support > Ensure appropriate environment for babies in NICU > Ensure safety & efficacy of neonatal treatments. > Develop policies & programs that promote parenting skills & encourage maximum involvement of families in care > Promote meaningful long-term follow-up for all high-risk NICU survivors. Evidence suggest that, family integrated care is the voice of the modern family in Neonatal unit and provides significant benefit not only in terms of infant medical outcomes, but will also reduce stress, anxiety and depression in the family; improve their ability to cope and through structured competency based educational programs will result in true partnership with parents. In this presentation the historical perspective and recent evidence will be discussed also highlighted the basic principles of A Family-Centered Care and then compared the various existing professional and parent focused neonatal care programs and the advantages over those traditional models of care. Family-Centered Care provides parents with training, education, support which enables them to be primary careers and gives them confidence, knowledge and independence to take care of their infants while in the neonatal unit and post discharge who may have complex medical needs.
Biography:
Monika Kaushal is MBBS, MD Pediatrics, DM Neonatolgy, FRCPCH and has extensive experience and several publications in journals which are indexed both nationally and internationally indexed journals. She is currently undertaking MSc in Neonatology from Southampton University, UK. Dr Monika started the Fellowship program in Neonatology with affiliation to National Neonatology Forum and Indian Academy of Pediatrics India. She is honored with Fellow of Royal Collage of Pediatrics and Child Health, UK (FRCPCH).
Abstract:
Neonates are the future of the society and care of the neonates in the first few days of life is extremely unique. The neonates who have some health problems right after birth need special care in special units like NICU or SCUBU. To take care of these babies especially those who need help for their breathing we need not only special unit, but special infrastructure, equipments and especially trained medical professionals that are doctors and nurses. When there are extreme preterm then the care required is much more important. The care required starts from antenatal period to the delivery room care and then postnatal period. There are very good research on improving the care of these premise. Some of them have really changed the outcome to an extent that we are able to have babies surviving at 22 week or so. The research starts from antenatal period of giving antenatal steroids, magnesium sulfate to the mothers and managing the infections. In delivery room temperature control, airway management, giving PEEP, sustained inflation, delayed cord clamping and to maintain normoxia, normocarbia, perfusion, are most important interventions. Stabilization of the neonate in delivery room and then transporting the premise maintaining the temperature and PEEP is important. We have new ways to give surfactant to these little ones and so we use less invasive ways to deliver surfactant to them this technique is called LISA and helps in preventing Bronchopulmonary Disease (BPD). We need to discuss on IVH prevention strategies to have good long term neurodevelopmental outcomes. Nutrition is another important factor which will decide on outcome of baby not only on growth but also on development. These premise in spite of all these measures may develop BPD and so when to give steroids and if we can give inhaled steroid to have better outcome.
Maithili Joshi
Jawaharlal Nehru Medical College, India
Title: Study of maternal attributes of neonatal respiratory distress in NICU
Biography:
Maithili Joshi is a Junior Resident at Department of Pediatrics at Jawaharlal Nehru Medical College, Wardha, India. She is passionate for the field of pediatrics and wish to pursue a career in neonatology.
Abstract:
Background: Neonatal respiratory distress is a common clinical entity in the neonatal intensive care unit. The very first breaths of a newborn are distressed, but within minutes the respiration settles and becomes regular. There are many factors which can affect this transition from dependent fetal respiration to independent newborn respiration. The maternal factors causing neonatal respiratory distress are important in developing countries where socioeconomic variations exist. The preterm neonates are more likely to have respiratory distress. Regardless of the cause, if not recognized and managed quickly, respiratory distress can escalate to respiratory failure and cardiopulmonary arrest. Therefore, it is imperative that any health care practitioner caring for new born infants can readily recognize the signs and symptoms of respiratory distress, differentiate various causes and initiate management strategies to prevent significant complications or death. The neonatal mortality by respiratory distress can be decreased by proper monitoring of neonates in NICU and knowing the etiology of respiratory distress in neonates and managing according to the etiology; knowing the maternal illness and other conditions leading to respiratory distress. Objective: To study maternal causes of neonatal respiratory distress admitted in the NICU. Materials & Methods: The present study was conducted at a well-equipped NICU. NICU has separate inborn and out-born sections where neonates were admitted. It was conducted for a period of two years from 1st August 2014 to 31st July 2016. It was a prospective study of consecutively selected patient less than 1 month of age admitted in the NICU of this hospital fulfilling the inclusion criteria. All the newborns less than equal to 28 days admitted in the NICU (Inborn/Out-born) with clinically identified respiratory distress. In this study newborns who were admitted to the Neonatal Intensive Care Unit with clinically identified respiratory distress were included in the study. 400 newborns were recruited for this study as per the criteria. Results: Using the data gathered, a correlation coefficient of 0.5806 was obtained indicating a strong linear relationship between caesarian section and respiratory distress in the newborn. Babies born via caesarian section had likely chances of having respiratory distress. Conclusion: Caesarean section was the most common predisposing factor associated with the development of respiratory distress in neonates. Antenatal risk factors increase the incidence of respiratory distress. There is a need to prioritize antenatal care and counseling to pregnant mothers that includes multivitamin and folic acid supplementation, screening for diabetes, hypertension and, if possible, provision of detailed fetal evaluation in mothers with bad obstetric history or those having febrile illness during first trimester.
Aida Ali Mohammed
Kuwait University Hospital, Yemen
Title: Severe acute malnutrition (update) in Yemen
Biography:
Aida Ali Mohammed has completed her MBBS from Sana’a University at Yemen. She was the Director of training in emergency unit in Ministry of Health, Yemen. She has attended many international conferences. Now she is working as a pediatric specialist and nutritional consultant in Kuwait University Hospital, Yemen.
Abstract:
Severe acute malnutrition is defined by a very low weight for height (below-3z scores of the median WHO growth standards), by visible severe wasting or by the presence of nutritional edema. Severe acute malnutrition is a life threatening condition requiring urgent treatment. Child malnutrition in Yemen is a major public health problem, showing prevalence 200% for acute malnutrition (UNICEF report 2016) in 22 million of Yemeni children. 462000 Yemeni children suffer from acute severe malnutrition and 1.7 million Yemeni children suffer from moderate acute malnutrition compare to a prevalence of 53% for stunting, 46% for underweight and 13% for wasting among children under five in 2006. According to the WHO classification, the levels for stunting and underweight are considered very high severity and for wasting it is of high severity in Yemen (WHO 2006). Hospitalization of children suffering from this state is essential they are selected according to criteria and hospitalization goes through many stages according to guidelines and discharge is followed by follow up. Education of the mother, breast feeding normal healthy feeding and hygiene, poor, inability to reach to obtain food duo to war, lost healthy service are essential factors to prevent and develop such status.
Pradeep Kumar Gupta
Norvic International Hospital, Nepal
Title: Role of serum procalcitonin as a marker of neonatal sepsis
Biography:
Pradeep Kumar Gupta is currently working as a Pediatrician in Department of Pediatrics in a non-government non-profitable hospital in Nepal. He has completed his post-graduation (MD in Pediatrics) from Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India. He has completed Fellowship in Neonatology by Indian Academy of Pediatrics. Currently he is doing research on septic markers in new-born and use of bubble CPAP in resource limited setting.
Abstract:
Background: Despite the advances in perinatal and neonatal care and use of newer potent antibiotics, the incidence of neonatal sepsis remains high and the outcome is still severe. Objective: To study the role of serum procalcitonin as a marker of neonatal sepsis and to compare procalcitonin with CRP as a diagnostic marker for neonatal sepsis. Methodology: Hospital based prospective observational study. 50 neonates (preterm and term) with clinically suspected sepsis were studied during 1 year from January 2016 to December 2016 in Chaitanya Hospital, Chandigarh. Conventional sepsis workup was done in all cases and the diagnosis of neonatal sepsis was proved based on the results of blood culture. The serum procalcitonin was measured by quantitative Enzyme Linked Immunofluorescence Assay (ELISA) and the results were compared to CRP levels between the neonates with or without proven sepsis. Results: Of the total 220 babies admitted in NICU during that period, 50 were eligible for study and analyzed. 24% babies had definite sepsis, 60% had probable sepsis and 16% babies had no sepsis. Of the neonates with suspected sepsis, 24% had culture positive and 76% were culture negative. Mean PCT level was 13.27±33.2 ng/ml. The mean PCT levels was highest in neonates whose TLC>5000 (Mean PCT-18.5) (p value-0.002). Evaluating CRP as a diagnostic marker for definite neonatal sepsis with cut off value as 0.5 mg/dl, had sensitivity of 41.67%, specificity of 89.47%, positive predictive value of 55.56% and negative predictive value of 82.93%. Evaluating PCT as a diagnostic marker for definite neonatal sepsis, the sensitivity, specificity, positive predictive value, negative predictive value were 83.3%, 26.32%, 26.32% and 83.3% respectively taking cut-off level of procalcitonin to be >0.5 ng/ml. Conclusion: The importance of procalcitonin in diagnosing neonatal septicemia cannot be denied but it becomes more useful when it is used along with other investigations for decision making.