22^nd World Congress on Neonatology & Perinatology September 19-20, 2018 Hong Kong

Biography:

Amir Ashraf has completed his BHMS (Bachelor of Homoeopathic medicine and surgery) at the age of 24 years from Rajiv Gandhi University of Health Science, Mangalore and started his Private Practice at October 2014 at Ashirvad Hospital Kannur. He is a visiting Consultant in Department of Vein Clinic at RM Homoeopathy Multispecialty clinic and AIHMS Homoeopathy Multispecialty clinic. He was joint Secretary of Indian Homoeopathic Medical Association at Kannur Chapter and presently Public Relation (PRO) in Qualified Private Homoeopaths Association.

Abstract:

Introduction: Homoeopathy is an alternative system of medicine discovered by German physician Samuel Hahnemann in 1796. It has been used by several people for various health conditions globally for more than last 200 years. In India, homoeopathy is considered as a major system of alternative medicine. Homoeopathy is found effective in various medical conditions including Pyuria. Pyuria is condition in which pus cells are found in urine. Homoeopathy is very useful for reducing pus cells, and homeopathically potentized Conium Mac (Hemlock) is an important remedy commonly used for reducing pyuria.

Aim: To reduce the amount pus cells found in urine using Conium Mac 200C.

Methods: Design: Small N Design. Samples: Purposive Sampling with 5 cases diagnosed as pyuria. Tools: Personal Data Schedule and ICD-10 Criteria for Pyuria. Techniques: Potentized homoeopathic medicine, Conium Mac 200^th potency is used. Statistical Analysis: The statistical analyses were done using non-parametric tests.

Results: There is significant pre/post difference has been identified.

Conclusion: Homoeopathic potency, Conium Mac 200 C is effective in reducing the increased level of pus cells found in urine samples.

Biography:

Francisco Medrano Muñoz has finished his MD at the Universidad Autonoma de Guadalajara in 2005, later on he has completed his Pediatric Residency at the Instituto de estudios superiores del Tecnologico de Monterrey and is currently a fellow in Pediatric Pulmonology at the Instituto Nacional de Pediatria. He has published in a high impact European Medical journal and is currently enrolled in two ongoing studies, regarding neonatal and pediatric pulmonology topics. He was a speaker at the world Zummit on pediatrics in Sophia, Bulgary.

Abstract:

Central nervous system tumors represent 15-20% of all childhood tumors. Primary spinal cord tumors are rare entities that only for 4-10% of all primary tumors of the CNS. Intramedullary tumors are the least common, representing only 35% of spinal tumors. The most common intramedullary tumor is astrocytoma in 75% of the cases, being grade III the least common with a frequency of 25%. We present the clinical manifestations and diagnostic approach of a grade III intramedullary astrocytoma in a 21-month-old female with no prior history of illnesses. Symptoms started 11 days prior to admission, as limping, weakness, diminished movements and inability to handle objects with the right arm. The neurological evaluation was normal except for diminished strength 3/5 (distal), 4/5 (proximal), muscle deep reflexes 2/4 of left extremities. Column and hip radiographies, as well as a head CT were reported normal. Head and spinal MRI, reported an heterogenic intramedullary lesion that went from C3 to T3 with hypo-intense areas in T1 and hyper-intense areas in T2, 7.6 cm long which obliterated sub-arachnoid space. A biopsy reported a fibrilar hyper cellular, astrocytic neoplastic lesion with hemorrhagic areas and 2 active mitosis without necrosis. Grade III intramedullary astrocytoma was diagnosed following WHO criteria. Clinical features classify our patient in stage II according to McCormick’s scale. The most widely accepted classification is the WHO’s, which is based in biopsy findings, and because of the mitosis found, it would correspond to a stage III neoplastic lesion.

Biography:

Hailemariam Mekonnen Workie has completed his RN, BSc, MSc. in child health and pediatrics and is currently a Lecturer in Haramaya University College of Health and Medical Sciences.

Abstract:

Background: The adverse neonatal outcomes are the major public health concerns and causes of high neonatal mortality in developing countries with 1.76 million deaths in 2013. Adverse neonatal outcomes have a significant effect on perinatal survival, infant morbidity, and mortality as well as the risk of developmental disabilities and illnesses throughout future lives. Hence, the objective of this study was to identify adverse birth outcomes and associated risk factors in public and private Hospitals of Mekelle city, Tigray, Ethiopia.

Method: Institutional based unmatched case-control study was conducted from December 3^rd to June 28^th, 2015. Neonates who had adverse outcome were cases with their index mothers and those neonates who hadn’t had adverse outcome were controls with their index mothers. Case-control incidence density and systematic random sampling techniques were used to select cases and controls respectively. Socio-demographic, information on potential neonatal risk factors and clinical data were taken from the mothers and medical records. Data were checked for completeness, consistency and entered into Epi Info v7 and then analyzed using SPSS v23. Binary and multivariable logistic regression analysis was carried out to determine the association and the possible risk factors for adverse neonatal outcomes, respectively. Results were presented in result statements, graphs, tables and charts.

Results: In this study, six different types of adverse neonatal outcomes were identified. Among them, low birth weight [30 (57.7%)], preterm birth [28 (53.9%)] and low Apgar score [28 (53.9%)] were the majorities. Based on the multivariable logistic regression analysis, rural place of residence [AOR=5.992, 95% CI (1.011-35.809)], low monthly income [AOR=4.364, 95% CI (1.050-18.129)], middle monthly income (AOR=4.364, 95% CI (1.050-18.129), and emergency cesarean section [AOR=9.969, 95% CI (1.023-7.148)] were the potential risk factors for adverse neonatal outcomes.

Conclusions: The adverse neonatal outcomes and the risk factors identified in this research have a negative impact on the neonate and mothers health. Thus, it needs emphasis to tackle the problems and save the life of the newborn through better and strengthened ANC follow-up accesses for health care and income generation activities for all reproductive-age women in general and pregnant women in particular.

Biography:

Suman Dabas is currently pursuing the MSc Nursing and earlier a Registered Nurse in Neonatal intensive care. She has completed her Post-graduation thesis to reduce maternal stress with the help of relaxation technique. In research work, this is her 1st project.

Abstract:

Statement of the Problem: Hospitalization of preterm neonate in NICU can lead to increased stress and anxiety in postpartum mothers and eventually this can lead to decreased milk output. Maternal stress in NICU is a neglected area and it need to be addressed and demand some intervention in form of relaxation therapy.

Materials & Methods: Out of 160 postpartum mothers of hospitalized neonates born in 26-33 weeks gestation, 50 mothers were enrolled and randomly assigned to experimental and control groups. Baseline data including socio-demographic profile, maternal stress and anxiety were collected using subject data sheet, standardized Parental Stress Scale (PSS): NICU and Perinatal Anxiety Screening Scale (PASS) on 4±2 postpartum day. The experimental group was administered audio assisted relaxation technique followed by every day practice for 10 days, while the control group continued to receive the routine care. The impact of the relaxation technique on stress and anxiety along with milk output was assessed after 10 day of enrolment.

Result: Baseline characteristics and pre-intervention mean maternal stress (3.9±0.5 vs. 3.8±0.5, p=0.34) and anxiety scores 31.12±11.4 vs. 31.08±12.0, p=0.99) were comparable in both the groups. The intervention resulted in significant reduction in maternal stress (2.9±0.5 vs. 3.6±0.6) and anxiety scores (19.8±6.7 vs. 28.18±11.7) (p≤0.05) and improvement in milk output (69.2±19.3 vs. 54.1±22.5, p≤0.05) in experimental group as compared to control group.

Conclusion: Relaxation technique has significant role in reducing maternal anxiety, stress and in improving milk output.

Biography:

Dhruv Mamtora has completed his MBBS in 2010 from Lokmanya Tilak Municipal Medical College, Mumbai. He also has completed his MD in Medical Microbiology from Government Medical College, Miraj, Maharashtra in year 2013. He has completed Diploma in Hospital Administration and is also certified infection control practitioner. He is currently Head of Microbiology and Infection control at S. L. Raheja Hospital, a 154 bedded multispecialty hospital and center of excellence for diabetes and oncology. He has published papers in journals and has been serving as editor and reviewer for journals. He has organized conferences on systemic approach on infection control in January 2018. He is also faculty for multiple conferences at regional, national and international level. He is also media subject expert on infection control, microbiology, antimicrobials and outbreaks. He is also heading few of projects of which some of importance is national survey on infection control, point of care testing devices in infection control and on antimicrobial stewardship programs.

Abstract:

Bacteremia in pediatric oncology is associated with high morbidity and mortality. Its etiology is diverse and timely treatment can improve outcomes. Septicemia is one of the most common causes of death in pediatric age group where the febrile illnesses go unnoticed. Many times cultures are sent when there is fever and it does grow some of the rare organisms. It is clinician’s dilemma as to understand whether appropriate antibiotic therapy needs to be administered or not. We describe a rare case report of Roseomonas gilardii bacteremia in pediatric oncology in a febrile, neutropenic patient on chemotherapy from oncology unit. The patient responded well to treatment given and was cured of it. Genus Roseomonas has been recently established and hence the clinical experience caused by the organism is limited. Though the organism has low pathogenic potential, some species may cause fatal illness in immune-compromised hosts like those with septicemia, bacteremia, leukemia, cancer chemotherapy and dialysis. The case reports of this organism causing bacteraemia are rare from Indian subcontinent. Potential clinical significance of pink pigmented, gram negative coccoid, oxidase – positive microorganisms should be known to clinicians, particularly when isolated from blood of patients with immune-compromised condition. Also important is case based discussion between oncologist and microbiologist and timely treatment based on antibiotic susceptibility.

Biography:

Ida Fidelis E Denosta has completed her degree of Bachelor of Science major in Psychology in Far Eastern University. She has completed Graduation as Doctor of Medicine from Our Lady of Fatima University-College of Medicine in 2006. She has completed her Residency training in Pediatrics at East Avenue Medical Center last December 2016 as an Assistant Chief Resident. She is an active member of the Philippine Medical Association, Manila Medical Society and currently affiliated with Allied Care Experts (ACE) Medical Center-Quezon City and Caloocan City North Medical Center (CCNMC) as a Junior Consultant in the Department of Pediatrics.

Abstract:

Objectives: This study aims to determine the maternal risk factors associated with the development of Retinopathy of Prematurity (ROP).

Design: A retrospective cohort study.

Setting: The study was done in a tertiary government hospital.

Patients: This study included admitted premature neonates in Neonatal Intensive Care Unit (NICU) who underwent ROP screening. All patients with congenital abnormality of the eyes were excluded in the study.

Methodology: List of admitted premature patients who underwent ROP screening was collected within the study period. Demographic data was collected from the patient’s medical records.

Statistical Analysis: Descriptive statistics were presented for categorical outcome measures. Wilcoxon rank sum test was used to compare two averages. Chi-square test, Yates’ chi-square test and Fisher’s exact test were used to compare proportions. Univariate and multivariate regression analyses were used to estimate crude and adjusted odds-ratios, corresponding 95% CI and based on p-value≤0.05 statistical significance.

Result: This study showed 57% cases of ROP, majority with Stage 1 (66%), mostly female infants (53.4%; p<0.001), mildly asphyxiated (51.2%, p=0.290; 77.2%, p=0.117) and were small for gestational age (57.3%; p<0.001). On the average, these infants underwent 1 day of either invasive or non-invasive mechanical ventilation, 2 days with FiO2 of >0.5 liters per minute, had two blood transfusions, and with shorter hospital stay (17 vs. 26 days; p<0.001). The average age of mothers who delivered infants with ROP was 26 years old, multipara (59.2%) and underwent normal spontaneous delivery (67%). About half reported adequate prenatal check-ups (53.8%) and diagnosed with urinary tract infection (40.1%).

Conclusion: Data showed that mothers with urinary tract infection and preeclampsia are more likely to deliver infants with retinopathy of prematurity thus a significant maternal risk factors of ROP.

Biography:

Amir Ashraf has completed his BHMS (Bachelor of Homoeopathic medicine and surgery) at the age of 24 years from Rajiv Gandhi University of Health Science, Mangalore and started his Private Practice at October 2014 at Ashirvad Hospital Kannur. He is a visiting Consultant in Department of Vein Clinic at RM Homoeopathy Multispecialty clinic and AIHMS Homoeopathy Multispecialty clinic. He was joint Secretary of Indian Homoeopathic Medical Association at Kannur Chapter and presently Public Relation (PRO) in Qualified Private Homoeopaths Association.

Abstract:

Introduction: Homoeopathy is an alternative system of medicine discovered by German physician Samuel Hahnemann in 1796. It has been used by several people for various health conditions globally for more than last 200 years. In India, homoeopathy is considered as a major system of alternative medicine. Homoeopathy is found effective in various medical conditions including renal hypoplasia. Renal hypoplasia is defined as abnormally small kidneys with normal morphology and reduced nephron number, is a common cause of pediatric renal failure and adult-onset disease.

Objective: To reduce the amount of Blood Urea and Serum Creatinine in blood sample, and to prevent the peritoneal dialysis.

Method: A male aged 13days old came with complaint of congenital bilateral renal hypoplasia with blood urea 106 mg/dl and serum creatinine 4.95 mg/dl.

Results: There is significant change noticed since after intake of homeopathic medicine with the evidence of pre and post blood investigations.

Conclusion: Homoeopathic Medicine is effective in reducing the increased level of blood urea and serum creatinine found in blood samples.

Biography:

Ana Daneva Markova has completed her PhD at Medical University in Serbia and specialization at University School of Medicine in Skopje, Macedonia. She is the chief of Department of Obstetric operation room, working on University clinic of gynecology and obstetrics for 15 years. She has published more than 14 papers in reputed journals and she has been serving as an editorial board member, and working as main researcher in various projects of perinatology science. She is active member in many International organizations as MEDUOG and Ian Donald school of Medicine. She was invited author on Theme: Cytokines and pregnancy in InTech - open science, book in progress.

Abstract:

Accommodation of the feto-placental unit in human pregnancy requires maternal immune tolerance to this “semi allograft”. Despite close examination of the features of the process, preeclampsia remains one of the most sophisticated problems of modern obstetrics and gynecology. It generally determines maternal and perinatal morbidity and mortality. The analysis of scientific literature reveals conclusion that many aspects of the pathogenesis of preeclampsia are related to a syndrome of systemic inflammatory response characterized by development of a destructive inflammatory process, immune disorders and imbalanced cytokine regulation of gestation processes. Studies showed that in pregnancy complicated by preeclampsia, cytokine levels essentially change compared to the respective levels in physiological pregnancy. Thus, even a moderate form of preeclampsia shows directional change, i.e., elevated levels of pro and anti-inflammatory cytokines, with the exception of IL-10, while a downward trend is recorded in severe preeclampsia. The findings of significantly lower serum IL10 concentrations in patients with severe preeclampsia in comparison with respective concentrations in patients with moderate preeclampsia are highly important. These results can be considered as a major pathognomonic laboratory sign of severe preeclampsia that can be used by clinicians to make difference between severe preeclampsia and normal pregnancy, as well as between severe and moderate degree of this specific pathology. These indicators may help in recognizing patients with the highest risk of severe preeclampsia. Precisely defined time for the termination of preeclampsia pregnancy will decrease morbidity and mortality from this most difficult disease in pregnancy.

Biography:

Dhruv Mamtora has completed his MBBS in 2010 from Lokmanya Tilak Municipal Medical College, Mumbai. He also has completed his MD in Medical Microbiology from Government Medical College, Miraj, Maharashtra in year 2013. He has completed Diploma in Hospital Administration and is also certified infection control practitioner. He is currently Head of Microbiology and Infection control at S. L. Raheja Hospital, a 154 bedded multispecialty hospital and center of excellence for diabetes and oncology. He has published papers in journals and has been serving as editor and reviewer for journals. He has organized conferences on systemic approach on infection control in January 2018. He is also faculty for multiple conferences at regional, national and international level. He is also media subject expert on infection control, microbiology, antimicrobials and outbreaks. He is also heading few of projects of which some of importance is national survey on infection control, point of care testing devices in infection control and on antimicrobial stewardship programs.

Abstract:

Epidemiology of fungal pathogens is changing with time, with emergence of new species and increased virulence and resistance to antifungal agents in existing pathogens. Clinical spectrum of diseases caused by fungus is expanding due to multiple reasons. One such emerging fungus is Kodameae ohmeri¹. Of late, a number of case reports are reported due to same causing fatality unless identified and reported^2,3.

We describe a rare case report of neonatal sepsis due to Kodameae ohmeri.

A term female baby was born by normal vaginal delivery and cried immediately after birth. No active resuscitation was required. Her Apgar score was 8. She developed respiratory distress day two onwards which was progressive in nature. She was treated with Injection ceftriaxone and sodium bicarbonate and shifted to the neonatal intensive care unit for further management. Due to respiratory distress baby was intubated same day, fluid bolus was given and mechanical ventilation started. Ionotropic support (Dobutamine) started along with other supportive treatments. Intravenous antibiotics were escalated to piperacillin-tazobactam and amikacin. Baby was extubated after 48h, that is, on day 3. However, immediately after extubation distress worsened, baby developed features of sepsis, for which she was re-intubated and ventilated again. Blood culture was sent in BacT/Alert FP Plus bottle after re-intubation, which showed budding yeast cells, was immediately informed to the neonatologist and the baby was started on IV Fluconazole.

The yeast cell was identified as Kodameae ohmeri by Chrome agar Candida (HiMedia, Mumbai, India) and VITEK2YST card (BioMerieux® Marcy l’ Etiole -France). A second blood culture was sent on day 4, which also grew Kodameae ohmeri. The isolate was intermediately sensitive to Fluconazole (MIC=4) and sensitive to Amphotericin B (MIC=0.25), Flucytosine(MIC=1), Caspofungin (MIC=0.25) and Voriconazole (MIC=0.25). Intravenous Amphotericin B was started on day 5 and continued for 21 days and the baby responded well. A repeat blood culture showed no growth. Baby was discharged. Mother’s high vaginal swab also grew budding yeast cells, which was later identified as the same, confirming that probably baby got the infection during parturition.

We sincerely acknowledge Dr Arunaloke Chakrabarty from Division of Mycology, Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh for molecular confirmation of the two isolates.

To conclude, correct identification up to species level, interpreting the significance as a pathogen along with antifungal susceptibility results is necessary for best clinical outcome.

Biography:

Christina Leung completed two Bachelor degrees in England, BSc Management Sciences followed by the BPharm Pharmacy. Following the registration as a pharmacist in the UK, she worked in different London Teaching Hospitals for 16 years. In UK, she specialised in Paediatrics (especially in PICU and Paediatric Liver), Obstetrics and Gynaecology. She published a number of articles including drugs use in paediatric liver diseases in the UK and management of vomiting in pregnancy and hyperemesis gravidarum. Ms Leung is also a registered pharmacist in Hong Kong. Since 2012, she had worked as the Senior Pharmacist (Clinical Pharmacy in Charge) at the University of Hong Kong-Shenzhen Hospital, a reformed hospital in China. Currently, Ms Leung is the Honorary Tutor at the University of Hong Kong. She delivers lectures to the Master and Undergraduate Pharmacy students relating to drugs use in Paediatrics, Obstetrics and Gynaecology.

Abstract:

Biliary atresia (BA) is a condition in which inflammation develops within the bile ducts around the time of birth. This leads to bile duct damage and reduces the flow of the bile which subsequently causes scarring of the liver. The initial treatment for biliary atresia is a surgical operation called the “Kasai Porteoenterostomy” (KPE). The aim of KPE is to make a drainage channel to allow bile to drain from the liver. Before the surgery, the patient will be prescribed with fat-soluble vitamins for patients with prolonged jaundice. Examples are multivitamin preparations (Abidec® or Dalivit® drops in the UK), vitamin K preparations (phytomenadione injection which can be given by oral, IV or IM routes and menadiol tablet), Vitamin E (tocopheryl acetate), and Vitamin D (Alfacalcidol). 24 to 48 hours before the surgery, the patients will receive bowel preparations and the common ones are Lactulose liquid, Neomycin liquid, and Metronidazole suspension. After the operation, the patient will receive drugs via intravenous or intramuscular route for about 3 to 5 days, standard maintenance IV fluid will be given for about 3 to 4 days. Nurse Controlled Analgesia (NCA) IV pump with morphine is always used for the initial 3 days, and the patient is also prescribed with regular paracetamol (IV or rectal) for breakthrough pain for about 3 days then change to oral. Prophylactic IV antibiotics will be given after the surgery for at least 72 hours. Examples are Gentamicin and Piperacillin/Tazobactam as dual therapies. After 72 hours, if no high temperature is developed and the oral feeds are started, the prophylactic antibiotics can be changed to oral for 28 days (an example is oral Cefalexin). Ranitidine is also used to prevent a stress-induced ulcer. The recommended dose is 15mg daily, increasing to 45mg daily in steps of 15mg per week. Colestyramine helps to remove the bile salts which cause jaundice and itchiness. Since Colestyramine can reduce the absorption of some drugs, especially vitamins, it is recommended to leave vitamin preparations at least 2 hours before or 4 hours after giving Colestyramine. Spironolactone suspension helps the patient reduces the amount of fluid accumulated as a result of ascites, but it is not needed in all cases. There have been clinical studies to use high dose oral steroids (oral prednisolone) post KPE to benefit in reduction of postoperative bilirubin and clearance of jaundice. However, the findings show that the effect of steroids may be limited or inhibited by an increasing degree of fibrosis and onset of cirrhosis. If KPE is successful, many of these medicines can be stopped over time. If KPE fails, the liver transplant can be one of the treatment options. The care of the biliary atresia patients is best with the multi-disciplinary approach, and clinical pharmacists play a significant role in this care management. Examples of the contributions are dosage recommendations, choice of drugs, stopping or initiation of a therapy, guidelines development, drug history talking and medication reconciliation, therapeutic drug monitoring and other blood results monitoring to optimise drug therapies, patient education such as developing of patient leaflets and delivering of patient education talks, patient counselling of discharged medications such as using of tailored-made discharge medication card, discharge planning to reduce the waiting time, adverse drugs reactions monitoring, medication incidents management, drugs interactions, advice on drug administration (e.g. with or after food, timing of drug administration, method of IV drug administration), review of medications in the out-patient clinics after discharge, and participation in the clinical trials.