Day 1 :
Necrotizing enterocolitis in a preterm infant newborn and role of feeding: An update! Said Moustafa M Eldeib2 and Amr I M Hawal
NMC Healthcare Group, UAE
Keynote: Necrotizing enterocolitis in a preterm infant newborn and role of feeding: An update! Said Moustafa M Eldeib2 and Amr I M Hawal
Time : 10:00-11:00
Said Moustafa M Eldeib is a Pediatrician and Neonatologist whose experience in the field spans 15 years backed by a higher education degree from Royal College of Pediatrics’ and Child Health in UK, in addition to Master’s degree from Ain Shams University in Egypt one of the oldest and top ranking universities in the MENA region. He is pioneering an Open and Contextual Evaluation Model Based on Constructive Responses, which has led in the creation of new methods to improve Pediatric Healthcare, Neonatology and Pediatric Nutrition. He has established this model following his years of experiences in medical practice, research and evaluation, and teaching and administration in hospitals and medical universities in the region, including Egypt, Kuwait and the UAE. He has published studies in reputable international journals in Neonatology and Pediatric Nutrition. He has also presented his findings in prestigious international conferences and symposia.
Statement of the Problem: It’s a clinical case presentation of a male preterm infant newborn (+31 weeks) that was delivered in our hospital & transferred to our NICU because of prematurity, VLBW and need to respiratory support. Baby shortly undergo necrotizing enterocolitis (NEC) on fifth day of life shortly after start of expressed milk feeding..! This was early detected by use of near infrared abdominal spectroscopy (NIRS). Baby was deteriorated clinically in a couple of hours and undergoes intestinal perforation with peritonitis, so, abdominal exploration surgery with intestinal resection and end – to end anastomosis was done urgently. Baby improved gradually and early feedings was started and gradually increased up to full feedings with use of human fortified milk (HMF) and probiotics, prebiotics.
Findings: The Study stated the evidence-based feeding strategies guidelines for necrotizing enterocolitis (NEC) among very low birth weight infants and role of trophic feedings, probiotics, prebiotics and micronutrients in prophylaxis, prevention and management of NEC.
Recommendations: Prematurity is the single greatest risk factor for NEC and avoidance of premature birth is the best way to prevent NEC; the role of feeding in the pathogenesis of NEC is uncertain, but it seems prudent to use breast milk (when available) and advance feedings slowly and cautiously; NEC is one of the leading causes of mortality, and the most common reason for emergent GI surgery in newborns; NEC remains a major unsolved medical challenge, for which no specific therapy exists, and its pathogenesis remains controversial; a better understanding of the pathophysiology will offer new and innovative therapeutic approaches, and future studies should be focused on the roles of the epithelial barrier, innate immunity, and microbiota in this disorder; bioinformatics modeling is a new emerging strategy aimed at understanding the dynamics of various inflammatory markers and their application in early diagnosis and treatment.
- Plenary Tracks
KIMS Institute of Medical Sciences and Research Centre, India
Nannapaneni Meghana is doing her Postgraduate course in a Medical Institute. She has done one Oral paper presentation in her state conference; she has a paper presentation coming up in national conference, and has not yet published her studies.
Introduction: Jaundice is a common condition seen in neonates requiring phototherapy. Phototherapy on the other hand leads to depression of pineal gland by transcranial illumination resulting in decrease in melatonin level. Melatonin stimulates secretion of cortisone; cortisone usually causes resorption of calcium and magnesium leading to hypocalcemia and hypomagnesaemia. Bilirubin is known to cause neuronal injury by activating the NMDA receptors were as magnesium is an NMDA receptor antagonist, thus, having a protective effect on neuronal injury by bilirubin. In preterm it is known to have hypomagnesaemia, so this study was to see if phototherapy will further affect the magnesium metabolism.
Aims & Objectives: The main aim of this study is correlation of magnesium and bilirubin levels; effect of phototherapy on magnesium levels.
Materials & Methods: Study was done in NICU of KIMS Hospital, from June 2018 to June 2019 on late preterm neonates. Samples were collected for bilirubin and magnesium levels before and 48 hours post phototherapy, excluded all babies with pathological jaundice, other comorbidities.
Results: The results indicated that the study was done on 56 babies of whom average magnesium values noted before phototherapy was 2.8 mg/dl and post phototherapy was 1.7 mg/dl showing a significant difference; p<0.05 with 95% confidence interval, and using Chi-square method and SPSS software.
Conclusion: Magnesium is an important element for body functioning and its deficiency leads to many morbidities. As in preterm many supplements are being given, may be its time for magnesium supplements to be considered for late preterm neonates undergoing phototherapy.
Dr. Ram Manohar Lohia Institute of Medical Sciences, India
Vandana Tiwari has completed her PhD in Biochemistry from Banaras Hindu University in 1998. She is an Eminent Researcher in Biochemistry from past 20 years. Currently she is serving as a Professor and Head of the Department of Biochemistry at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, a premier Medical Research Institute in India. She has published and presented more than 100 research papers and has been serving as an Editorial Board Member of repute in various medical journals.
Epilepsy is a central nervous system disorder with abnormal brain activity, causing seizures or unusual behavior, sensations, and loss of awareness. The present study aimed to evaluate the effect of valproate and oxcarbazepine therapy in newly diagnosed epileptic children. Changes in serum asymmetric dimethyl arginine (ADMA), homocysteine (HCY), folate and B12 levels were assessed as possible markers of cardiovascular risk and correlation between HCY and ADMA levels was ascertained. Two hundred drug naïve newly diagnosed patients with epilepsy, age seven-17 years with no known cause of hyperhomocysteinemia (HHCY), were enrolled for the study. Pre and post-treatment (after six months) analysis of HCY, folate and B12 were done. Valproate and oxcarbazepine treatment was started on 100 patients each respectively. No significant variation was observed in age, gender and seizure type. Children on valproate and oxcarbazepine therapy had HHCY 45% and 23% respectively after six months. There was a significant increase (p<0.05) in ADMA and HCY levels in both the groups after six months of therapy. A decrease in folate levels was registered in both the groups. In subjects on valproate, ADMA levels exhibited a positive correlation with B12 while HCY levels correlated negatively with folate. In patients on OXC therapy, negative correlation was found between ADMA and B12 at recruitment and HCY and folate levels after therapy. Anti-epileptic therapy can affect ADMA, HCY, folate and B12, but increase in ADMA may be independent of HHCY. Further studies are needed to understand the etiology of ADMA increase.
Dhaka Shishu (Children) Hospital, Bangladesh
Sarabon Tahura is a Medical graduate (MBBS) from Mymensing Medical College under Dhaka University and has obtained her professional degree FCPS (Paediatrics) from Bangladesh College of Physicians and Surgeon (BCPS). Afterwards, she has completed fellowship in Paediatric Intervention Pulmonology from Qilu Children Hospital under Shangdong University, China and training from All India Institute of Medical Science (AIIMS). She is the Associate Professor of Pediatric Respiratory Medicine and the 1st Pediatric Interventional Pulmonologist of Bangladesh. She is experienced in teaching and conducting Post-graduation examinations of Pediatrics in Bangladesh. She has been published many articles under her name in different national and international journals and has been serving as an Editorial Board Member of repute.
Introduction: Foreign body (FB) aspiration in airway is a common occurrence in pediatric age group, need prompt recognition and management. However, it is not always diagnosed (especially in radiolucent FB) due to non-specific symptoms of varying severity. Often the symptoms are subtle and mistaken for other more common conditions like pneumonia and asthma and do not respond as expected to standard therapy and present a diagnostic challenge. Rigid bronchoscopy still remains the gold standard in Bangladesh to remove airway FBs.
Aim: The main aim of this study was to emphasize the importance of considering airway foreign body as a cause of acute and chronic respiratory symptoms in children and to outline the clinical evidences of the utility and feasibility of flexible bronchoscopy for management of airway FB in children.
Methods: This prospective study was performed on children (aged six months to 16 year) having acute or recurrent or long standing, non-resolving or partially resolving respiratory complaints who underwent flexible bronchoscopy for suspected FB from July 2018 to July 2019 in a tertiary care hospital in Bangladesh. History, clinical, radiological, bronchoscopic ﬁndings and immediate effect after bronchoscopy were analyzed.
Results: The results indicated that among total 32 children, only 25% (n=8) had definite history of FB aspiration. The most frequent symptom was paroxysmal cough (72.7%) followed by wheezing, stridor and recurrent and persistent pneumonia. FB was found in 47% (n=15) children and removed successfully by Dormia basket in nine children, four by rat-tooth forceps and two by cryo probe. The most common (n=8) FB was peanut. Others are pin, metallic clip, plastic bead of Tasbih, filament of pencil torch light, custard apple seed, pea pulse, plastic safety ware joint. Thick mucus plugs were found in four children. Respiratory symptoms improved after removal of foreign bodies in all cases. Respiratory symptoms improved after removal of foreign bodies in all cases. During procedure, transient hypoxia developed in three children which were alleviated by temporary cessation of the procedure.
Conclusions: The possibility of foreign body aspiration should be considered in any child who present with acute or persistent and recurrent respiratory symptoms. And flexible bronchoscopy documented a crucial diagnostic and safe therapeutic tool for foreign body management in pediatric age group.
Makerere University College of Veterinary Medicine Animal Resources and Biosecurity, Uganda
Ndibalekera Sylvia has completed her Bachelor’s degree in Biomedical Laboratory Technology Makerere University and Diploma in Laboratory Techniques from Nsabya School of Laboratory Technician, Health Care Administration from Atlantic International University. She is a Principle Laboratory Technologist at Mulago National Hospital private wing Laboratory, Uganda. And additionally she is involved in Teaching and Training good laboratory practices at different laboratory institutions across the country.
Helicobacter pylori is a gram-negative bacteria attributed to be the causative agent of serious gastrointestinal diseases such as peptic and gastric ulcers and high possibility of developing into a carcinogens and lymphomas as a result of prolonged occurrence of the infection. Half of world’s population is affected based on previous epidemiologic studies and mainly acquired during childhood. The role of Helicobacter pylori contributing to infection among children is still unclear. In Uganda, there are few documented studies carried out among children to establish Helicobacter pylori status. This study sought to establish the prevalence of Helicobacter pylori among children attending selected schools of Goma Sub County Mukono District, Uganda. A total of 120 stool samples were collected from symptomatic primary school children aged four-14 years. The stool samples were packed in the cool box and transported to Mulago National Referral Hospital clinical laboratory for analysis. The collected samples were then cultured using standard culture methods on Columbia agar and sensitivity tests were further set on the isolates. The overall prevalence of H. pylori colonization in 120 children was 24.2% among primary school children in selected schools of Goma Sub County Mukono District. The isolates were highly susceptible to amoxicillin (96.6%), followed by clarithromycin (82.8%), tetracycline (72.4%), levofloxacin (65.5%), metronidazole (37.9%) and lastly ciprofloxacin (37.9%). The study reveals that H. pylori are among the causative agents of infection amongst school with increased antibiotic resistance to the most used antibiotics. Therefore further testing of other schools should be considered to establish the burden more clearly.
Introduction: Gilbert's syndrome is the benign condition, characterized by recurrent episodes of asymptomatic mild unconjugated hyperbilirubinemia. It is presented mostly in the adolescent period. The episodes are mostly caused by intercurrent illness, fasting or due to stress. Almost all the persons having Gilbert's syndrome have decreased level of UDP-glucuronosyltransferase activity that decreases the uptake of bilirubin by the liver and bilirubin conjugation. This case is reported because of its rarity.
Case report: A 14 year old girl, resident of Tamaka, Kolar, came with complaints of yellowish discoloration of eyes and skin from four days. There were no other complaints. Urine colour was normal. On physical examination, mild jaundice is present with yellowish discoloration of sclera and face, but no other abnormal finding was evident. Vital parameters and anthropometry measures were within normal limits. Systemic examination was normal, with no organomegaly. Investigations done revealed normal haemoglobin total and differential counts, and also platelet level. Reticulocyte count and peripheral blood picture showed normal findings, without any hemolysis evidence. Liver function tests done were also normal including HBsAg and anti-HCV, but episodes of unconjugated hyperbilirubinemia was present on various occasions. Urine routine, chest radiography and USG abdomen done were also normal. She had similar episodes in the past with frequency of once in three months from last two years. History of similar complaints was present in the father and her father’s maternal grandmother (expired). There is h/o consanguineous marriage in the family from past six generations. In view of benign unconjugated hyperbilirubinemia, adolescent presentation and also similar complaints in the father and maternal great grandmother and h/o consanguinity from six generations and also having all the investigations within normal limit, Gilberts syndrome was suspected for which genetic analysis was done for the patient and her parents after obtaining consent ,which came homozygous for A(TA)7TAA allele in the promoter region of UGT1A1 gene which implies that they were affected with Gilbert syndrome.
Conclusion: Gilbert syndrome which is the best predicted possibilities can be confirmed by PCR, which is a novel and rapid method. Absence of Gilbert genotype, implies that person have a harmful cause for their jaundice. The presence of gene cannot exclude liver and hemolytic disease because they can coexist with Gilberts, but other causes are less likely. Patients with Gilbert syndrome can lead a complete normal life style with some small dietary and life style modifications to prevent jaundice episodes.
- Video Presentation
Guadalupe Victoria Maternity Hospital, Mexico
Maria Bertha Romo Almanza is the Head of the Intensive Care Unit of the newborn at the Guadalupe Victoria Maternity Hospital in Atizapan, Mexico as well as Doctor in Neonatology Unit. She was previously the head of Neonatology at the Star Medica Luna Parc Hospital at a private level.
Within the range of alterations that may occur in the perinatal period, we find the phenomenon known as arrhythmias: that is, lack in the regulation or alteration of the frequency of heartbeats or a variety of rhythm disturbances, which may be present in both the intrauterine stage, as in healthy newborns. Considering mostly benign and transient in the pediatric patient can be documented in 1 in 1000 children frequency that varies in the newborn of 1 - 10% during the first days of extrauterine life. In critically ill newborns hospitalized in the Neonatal Intensive Care Units, arrhythmias increase their mortality. Being very frequent the presence of tachyarrhythmias, mainly type supraventricular tachycardia. In this presentation, we will identify disturbance of the rhythm type Supraventricular tachycardia, which requires treatment? And when it is necessary to use electrical cardioversion. We will present Cases report and review of the literature. We must to rememberd: in the neonatal group, their natural history diff ers from other age groups, as previously mentioned, supraventricular tachycardias that are mostly benign and occur in susceptible patients, but we should keep in mind that when it is not possible to reverse the rhythm disorder with conservative and /or pharmacological management, and fi nding the patient with hemodynamic instability, the use of electrical cardioversion should be assessed, with an electrocardiographic record, and evaluation by pediatric cardiology should be carried out, as well as follow-up and chronic treatment to this patients.
- Poster Presentations
Obihiro University of Agriculture and Veterinary Medicine, Japan
Xuenan Xuan has obtained his PhD at the University of Tokyo in 1991, and currently he is the Director General of National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Japan. He has published more than 300 papers in the field of Parasitology and Virology.
In this study, the protective effect of recombinant Babesia microti apical membrane protein 1 (rBmAMA1) and rhoptry neck protein 2 (rBmRON2) against B. microti infection was evaluated in a hamster model. The genes encoding the predicted domains I and II of BmAMA1 and the gene encoding the predicted transmembrane regions 2 and 3 of BmRON2 were expressed as his fusion recombinant proteins in Escherichia coli. Three groups with five hamsters in each group were immunized with rBmAMA1, rBmRON2 and rBmAMA1þ rBmRON2, and then challenged with B. microti. The result showed that only the group immunized with rBmAMA1þ rBmRON2 exhibited protection against B. microti challenge infection, characterized by significant decreased of parasitemia and higher hematocrit values from day’s six-10 post challenge infection. However, there was no significant difference in the groups immunized with rBmAMA1 or rBmRON2 alone. The absence of a significant difference in the total amount of antibodies against rBmAMA1 and rBmRON2 between the groups immunized with single and combined proteins. This result indicates that the protection cannot be solely attributed to the quantity of antibodies produced, but also to their ability to target important epitopes from both antigens. These results suggest that combined immunization with rBmAMA1 and rBmRON2 is a promising strategy against B. microti infection.
Houari Boumediene University of Sciences and Technology, Algeria
Sara M Atmani has completed her PhD and Postdoctoral studies from Houari Boumediene University of Sciences and Technology in Algeria, Laboratory of Cellular and Molecular Biology. Her research interests are linked to Bacterial Virulence and Antimicrobial Resistance.
The study aimed to investigate the antimicrobial resistance and involved mechanisms in uropathogenic Enterobacteriaceae strains isolated from patients in Algeria. The study concerned 41 non repetitive strains isolated between from 2018-2019. Bacterial identification by the API 20E system showed Escherichia coli (n=18) as a dominant uropathogen followed by Klebsiella pneumoniae (n=13), Enterobacter cloacae (n=6), Providencia rettgeri, Morganella morganii, Proteus mirabilis and Proteus vulgaris (n=1). Antibiotic susceptibility by the disc diffusion method showed a high prevalence of acquired resistance to β-lactams (78%) which was extended to 3rd and 4th generation cephalosporins in 21.9% strains (all positive by the double-disc synergy test). Among non-beta-lactams, resistance rates were of 46.3% (aminoglycosides), 22% (sulfamethoxasole-trimethoprim) and 17.1% (quinolones/fluoroquinolones). A rate of 21.9% of isolates were MDR phenotype (4 E. cloacae, 3 K. pneumoniae, M. morganii and P. mirabilis), all but one were ESBL-producers. PCR screening showed the presence of blaSHV (31.7%, all K. pneumoniae); blaTEM (46.3%); blaCTX-M in ESBL-producers; plasmid-mediated quinolone resistance determinants identified as qnrB (24.4%), aac(6’)-Ib-cr (14.6%) and qnrS (9.7%); aminoglycoside-modifying enzyme genes aac(6’)-Ib (24%) and aac(3)-II (24%); sulfamethoxasole-trimethoprim resistance genes identified as sul2 (83.3%), sul1 (50%), sul3 (8.3%), dfrA5 (66.6%), dfrA12 (25%), dfrA1 (16.7%) and dfrA7 (8.33%). Class 1 integrons were detected in 31.7% of isolates. The study showed a high prevalence of acquired resistance to antibiotics among uropathogenic Enterobacteriaceae. The presence of MDR ESBL strains is an important clinical concern. A constant monitoring of antimicrobial resistance is required to ensure therapeutic efficacy and prevent the emergence and spread of multidrug resistance.