10^th Annual World Congress on Pediatrics, Pediatric Gastroenterology and Nutrition March 23-25, 2017 Orlando, Florida, USA

Biography:

Shridevi Pandya Shah MD. She is a board certified anesthesiologist with subspecialty expertise in pediatric anesthesiology in practice for more than 15 years. She has had many presentations at both national anesthesia and pediatric anesthesia professional meetings. She is currently an Assistant Professor at Rutgers, NJMS and has made contributions related to pediatric anesthesia in several professional journals.

Abstract:

Almost half a million babies are born prematurely (< 37 weeks gestation) e ach year in the United States. Preterm infants are subject to hospitalization, and surgery is often required to sustain life. Anesthesia for obstetric and pediatric surgery is unavoidable as pregnant mothers and newborn infants with life-threatening conditions can require surgery or prolonged stay in the intensive care unit. Although, brain development begins during the last trimester of intrauterine life, the human brain is not fully developed at birth and continues to grow over the first couple of years of postnatal life.

The delayed effects of anesthetics are not well known because potential interventions cannot be studied directly in humans. Given current findings, the Federal Drug Agency (FDA) has provided preliminary recommendations stating that, if possible, anesthesia should be postponed until the child is at least 6 months of age. Consequently, there exists a need for ongoing research to further elucidate safer anesthetic agents and techniques.

Herewith, I would like to bring up topics of concern when children are exposed to anesthetics, when they are considered vulnerable to toxic effects of anesthesia.

Biography:

Dr. Nena Luster-Tucker is an educator with over 16 years of experience in nursing. Since beginning her nursing career as a LPN, she has earned her BSN, MSN with a Family Nurse Practitioner concentration, post-master’s certificate in nursing education, DNP and MBA. Dr. Luster has published a number of journal articles, authored textbook chapters, and presented both nationally and internationally. Currently, she is an assistant nursing professor at Southeastern Louisiana University and the interim director of the university's Center for Faculty Excellence. Dr. Luster's clinical practice is as a nurse practitioner in an inner-city emergency department.

Abstract:

Initially founded to serve those with unexpected, life-threatening illnesses, emergency departments across the country now care for a variety of patients including those without urgent medical conditions. With doors that never close and providers who administer care without regard to ability to pay, the emergency department has become the "safety net" of medicine. This "safety net" is especially important for vulnerable populations such as pediatrics. In addition to traditional emergency conditions, pediatric patients often have limited communication skills, lack of established immunity, minimal health histories, and are at the mercy of their caregivers. The combination of these factors increase the risk for developing unexpected health care needs and the emergency department is the only solution that is available whenever a problem occurs. Emergency departments provide critical healthcare services but they do not provide the same degree of comprehensiveness as primary care providers. Patients and caregivers may believe care is complete when they leave the emergency department but in reality, this is where care actually begins. It is the responsibility of providers, nurses, case managers, educators, and all members of the interdisciplinary team to ensure appropriate follow up care and continuity following an emergeny department encounter. To facilitate this practice amongst healthcare practitioners, this session will discuss the history of the emergency department, standard emergency department resources, standards of care, pediatric preventative health, legal requirements, and best practices.

Biography:

Jyoti Bhagia, M.D., is a Consultant in the Division of Child and Adolescent Psychiatry and Psychology in the Department of Psychiatry & Psychology at Mayo Clinic. Dr. Bhagia serves as the director of the ADHD Clinic at Mayo, where she oversees the treatment of pediatric patients diagnosed with ADHD and related disorders.  She has led quality projects for standardizing the assessment and treatment of ADHD and had received certificate of silver level quality fellow by Mayo Clinic. She is a member of several Mayo Clinic committees including, the Child and Adolescent Psychiatry Education Committee and the Multidisciplinary ADHD Workgroup. Dr. Bhagia’s research is focused on areas including the response to stimulant medications in children with ADHD based on genotype and clinical correlation of ferritin with ADHD. Dr. Bhagia has published articles in Mayo Clinic Proceedings, Therapeutic Drug Monitoring and Global Pediatric Health.  She has written a book chapter in Mayo Neurology Board Review.

Abstract:

ADHD is the most common Neuropsychiatric disorder, affecting 4-7 % of children. Diagnosis of ADHD is done through a clinical interview and the use of ADHD specific rating scales. Diagnosis is challenging in many cases, as presentation is different in different age groups, including in preschool, school age and adolescent children. ADHD also presents with symptoms in two settings, including home and school, and it is very important to address the disorder in both settings. With ADHD, there are many cases where symptoms are present in one setting and other disorders need to be ruled out first. Additionally, there are co-morbid disorders which may change the presentation of ADHD and may need to be addressed separately. For example, diagnosis of Oppositional Defiant Disorder is missed on many occasions and needs to be treated. Furthermore, it is important to tease out ADHD symptoms from learning disabilities and cognitive disorders in children presenting with academic concerns at school. In this talk, the method of using rating scales for ADHD diagnosis will be presented. Treatment of ADHD, particularly the algorithm used for such treatment, will also be discussed. With ADHD, there are many treatment challenges based on age of patient, co-morbidity and medical/neurological problems. When to use short versus long acting medications, and how to address treatment emergent side effects will be discussed.

Biography:

Medical school at Hadassah University Hospital, Jerusalem, Israel. Pediatric Residency and Pediatric Pulmonary training at Hadassah Institute of Pulmonology, Jerusalem  and Health Science Center, at Winnipeg, Canada. My main interest in the last two decades is in the diagnosis of asthma and its differentiation from other chronic respiratory diseases and aspiration syndromes, using specific bronchial challenges for asthma and the PCWheeze method to challenge young children who are unable to cooperate with regular lung function tests. The connection of feeding position of infants with upper and lower airways problems has lately been challenged.

Abstract:

in the pathogenesis of ear and airway diseases has not been well established. Methodology: We investigated the influence of instructing mothers to feed their 3-month old infants with their head in an upright position on infant ear and respiratory morbidity during a one-year follow-up. Mothers of 88 infants born during 2011 were instructed by trained nurses at Maternal-Child-Health clinics to feed their infants with their head in upright position (intervention group). The control group consisted of 75 mothers of infants of similar socioeconomic background who fed their infants regularly without any special instructions and were followed at another Maternal-Child-Health clinic. Feeding position was evaluated at the beginning and the end of the twelve-month study, and morbidity data of both groups were evaluated at every 3-month follow-up meeting. Findings: Infants from the intervention group were fed at a more upright head position and had significantly less episodes of ear diseases, less respiratory infections, less episodes of prolonged fever and needed less bronchodilator inhalations and antibiotic courses than infants from the control group.  Conclusions and significance: Instructing mothers to feed infants with their head in upright position led to less morbidity and treatment burden. The successful campaign against prone position of infants during sleep to prevent "Sudden Infant Death           Syndrome" could be reinforced to “back to sleep and up to eat”.

Biography:

Dr  Nabil Kamal M.D, had his Docotor degree from faculty of medicine ,Alexanderia university in Egypt.Current position is Acting Dean of the college of nursing ,which is one of 5 colleges belonging to the public authority for applied education and training in Kuwait.Intersted in reseraches about the konwledge and attitude of the public in kuwait regarding OTC drugs as a step for establishing educational programs.        

Abstract:

BACKGROUND: Many parents consider fever a disease with the continuation of fever phobia and overuse of antipyretics to reduce it.

OBJECTIVES: Identifying Kuwaiti parents’ knowledge, beliefs, practices about fever management.

METHODS: A descriptive cross-sectional study, in which 614 Kuwaiti mothers of well children aged between 6 months and five years were recruited. Data was collected over six month’s period from 1/9/2015 to 1/3/2016, using a self-administered questionnaire.

RESULTS: Over the study period, a total of 614 mothers participated in the study, with a response rate of 94.5%. Mild fever was reported to be ≤ 37.5 °C by 33.2 %(196) of mothers, and 27.1 %(166) considered a temperature ≤ 38.5 °C to be a high fever. Educational attainment significantly influenced parents’ reports for high fever (F = 4.68, d.f. = 4, P = 0.001, n = 207). Almost all the mothers believed that fever could cause harm, and 48%(294) of them stated that fever is very harmful. Fifty-three percent of mothers (n=309) would give antipyretic medication when body temperature is ≤38 °C. The most commonly administered antipyretic was paracetamol. Sixty-one percent (375) of the mothers had alternated antipyretic paracetamol and ibuprofen. Forty-five percent (274) of mothers thinks that antipyretics are without potential harm. Level of education had a positive impact on the perception of fever [ χ2 (df = 8) = 70.68, p < .001]. Usual practices targeted temperature reduction, antipyretic administration (53.7%), temperature monitoring (49.7%), offering more fluids (43.6%) and light clothing (38. 3%). Forty-nine and 45% of the mothers practiced alcoholic and cold compresses respectively.

CONCLUSION: The knowledge of the parents about fever is poor. Fever phobia” remains extremely widespread, with an overuse of antipyretics. Healthcare professionals have a duty of care to provide parents with accurate and consistent information about childhood fever based on the latest scientific evidence.

Biography:

Adel Abdullah Alhusaini is an assistant professor in Rehabilitation department, College of Applied Medical Sciences at King Saud University, Riyadh, KSA. He has obtained his master’s degree in in Physiotherapy from Cardiff University, Cardiff, UK (2005). Also, he has obtain PhD in Pediatric Neurorehabilitation from School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia (2010). He has published More than 15 peer-reviewed publications and one book published. Chairman of Pediatric Neurorehabilitation Research group at KSU. Presently working on the KACST project regarding sedentary behavior characteristics and physical activity levels in children of Saudi Arabia.

Abstract:

Statement of the Problem: During the past few years’ rapid developments in standards of living, mechanization and urbanization has a profound impact in the Kingdom of Saudi Arabia resulting in low physical activity and high sedentary behavior. Therefore, the purpose of the research is to provide normative data of physical activity and sedentary behavior indices of the Saudi Arabian school children in relation with BMI. Methodology: This school-based cross-sectional study was conducted during the years 2015-2016 in Riyadh. A total of 357 children (boys-82, girls-275), within an age group of 10-16 years, from different schools of central Riyadh constituted the sample. Measurements included weight, height, sedentary behaviors (TV viewing, playing video games, computer use and homework), and physical activity using Physical Activity Questionnaire for Children (PAQ-C), and Godin and Shephard questionnaires. Findings: The proportion of total sample (357), with boys comprising of 82 (23%) and girls of 275 (77%). The sample proportion stratified based on percentile of body weight constituted of 5.3% of underweight (19), 54.6% of normal (195), 18.8% of overweight (67) and 23% of obese (76) children. A high proportion (68.3%) of Saudi school children spent more than 2 hours on screen time (TV+PC) daily. PAQ-C reported 26.3% are less active, 51.5% are moderately active and 22.1% are highly active. Using ANOVA, no significant variation was shown in PAQ-C scores in relation to BMI. PA findings by Godin and Shephard questionnaire concluded that 70.3% are insufficiently active, 20.4% are moderately active and 9.2% are active. Analysis done by Kruskal-Wallis test showed significant difference observed in Godin moderate scores (P = 0.01) and total scores (P = 0.03) but not in other subcategories (strenuous, mild, Sweat) in relation to BMI. Conclusion & Significance: Sedentary behaviors, physical inactivity and increased BMI among Saudi school children is a major public health concern. There is an urgent need for national policy promoting active living and healthy eating and reducing sedentary behaviors among children in Saudi Arabia.

Biography:

Ganeswara Rao Melam is a Researcher in Rehabilitation department, College of Applied Medical Sciences at King Saud University, Riyadh. Formerly, he worked as Associate Professor and Head of Physiotherapy Department at Maharishi Markandeshwar University, Ambala, India. He has obtained his master’s degree in Physiotherapy (Neurology) from Hamdard University (2004), New Delhi, India. He has published 24 international articles, and an active member of pediatric research group under the leadership of Dr Adel A Alhusaini. Presently working on the KACST project regarding sedentary behavior characteristics and physical activity levels in children of Saudi Arabia.

Abstract:

Statement of the Problem: Handwriting problems in childhood can have lifelong repercussions, affecting learning and career. Sensorimotor(SM) intervention therefore helps to alleviate these problems. The purpose of this study was to evaluate the additive effects of SM intervention on the child’s handwriting. Research questions involved the possible effects of the intervention on specific qualities of handwriting (legibility, form, alignment, size, and spacing) and on speed. Secondary research questions involved possible effects of training in teacher assessment using the HPSQ and grip strength. Methodology: Thirty-one students (16 boys, 15 girls) were screened using Minnesota Handwriting Assessment (MHA) to assess legibility, form, alignment, size, and spacing (the primary variables) as well as rate. Finally, 10 students (seven boys, three girls) aged 6–8 years (mean age, 77.1 _ 1.45 months) participated in an intervention program. Baseline MHA, Handwriting Proficiency Screening Questionnaire (HPSQ), and grip strength were measured. The same group of students acted as their own controls and were analyzed before the interventions and later after completion of the protocol. The SM-based intervention group met twice per week (Monday and Wednesday) from 11:45 am to 12:35 pm for 5 weeks during regularly scheduled school hours. Each 40 min session consisted of 10 min of gross and fine motor warm-up activities, followed by 30 min of SM component activities in visual perception, visual–motor integration, proprioception/kinesthesia, and in-hand manipulation. Findings: There was a significant improvement in MHA scores for legibility, form, alignment, size and spacing (P <0.05), with the exception of rate. There were also significant changes in legibility, time performance and physical and emotional wellbeing domains in the HPSQ, and grip strength (P < 0.05, paired t-test).Conclusion & Significance: Short-term sensorimotor-based intervention produced significant improvements in the handwriting performance of elementary school children.

Biography:

Abstract:

Statement of the Problem: Handwriting problems in childhood can have lifelong repercussions, affecting learning and career. Sensorimotor(SM) intervention therefore helps to alleviate these problems. The purpose of this study was to evaluate the additive effects of SM intervention on the child’s handwriting. Research questions involved the possible effects of the intervention on specific qualities of handwriting (legibility, form, alignment, size, and spacing) and on speed. Secondary research questions involved possible effects of training in teacher assessment using the HPSQ and grip strength. Methodology: Thirty-one students (16 boys, 15 girls) were screened using Minnesota Handwriting Assessment (MHA) to assess legibility, form, alignment, size, and spacing (the primary variables) as well as rate. Finally, 10 students (seven boys, three girls) aged 6–8 years (mean age, 77.1 _ 1.45 months) participated in an intervention program. Baseline MHA, Handwriting Proficiency Screening Questionnaire (HPSQ), and grip strength were measured. The same group of students acted as their own controls and were analyzed before the interventions and later after completion of the protocol. The SM-based intervention group met twice per week (Monday and Wednesday) from 11:45 am to 12:35 pm for 5 weeks during regularly scheduled school hours. Each 40 min session consisted of 10 min of gross and fine motor warm-up activities, followed by 30 min of SM component activities in visual perception, visual–motor integration, proprioception/kinesthesia, and in-hand manipulation. Findings: There was a significant improvement in MHA scores for legibility, form, alignment, size and spacing (P <0.05), with the exception of rate. There were also significant changes in legibility, time performance and physical and emotional wellbeing domains in the HPSQ, and grip strength (P < 0.05, paired t-test).Conclusion & Significance: Short-term sensorimotor-based intervention produced significant improvements in the handwriting performance of elementary school children.

Biography:

Dr. Kumiko Taira received her medical degree from Kobe University in 1982. Since 2001, she has been involved in studying the effects of environmental exposure of organophosphates and neonicotinoids on the human health in collaboration with Dr. Yoshiko Aoyama in Gunma, and published eleven academic articles.Dr. Taira is a part-time lecturer at the Department of Anesthesiology at Tokyo Women’s Medical University Medical Center East, a part-time lecturer at the Department of Environmental Education at Tokyo Kasei University, a board member of the Japanese Society of Clinical Ecology, and the chair of the Public Health working group of IUCN Task Force on Systemic Pesticides.

Abstract:

In 2004, we started to study the health effect of neonicotinoid insecticide (neonic), because we encountered many patients with unusual symptoms including chest pain with ECG abnormality after a neonic spraying application. Neonics were water systemic pesticide introduced to global market in 1990’s as alternatives of organophosphate insecticide.

 In 2006, neonic spraying application was discontinued, whereas we met a large-scale pandemic of patients with similar symptoms. All of them had became ill after consecutive intake of tea beverages and/or conventional domestic fruits. We started chemical analysis of patients’ urine from 2007, and detected some neonicotinoid metabolites in their urine.

Then we conducted a prevalence case control study prospectively, and analyzed urinary neonics and a metabolite, N-desmethyl-acetamiprid (DMAP). DMAP and thiamethoxam were more detected significantly from the group of patients with typical symptom named neo-nicotinic symptoms including 6 subjective symptoms, i.e. headache, general fatigue, chest pain or palpitation, stomachache, muscle pain or weakness or spam and cough, and 3 objective symptoms, i.e. postural tremor, recent memory loss, and fever.

 Last year, a small-scale epidemiological study in Japan revealed that the detection rate of neonics were increasing linearly in these 20 years, although the domestic shipment has not changed in imidacloprid, acetamiprid, and nitenpyram. Laboratory data show human excretion half life in urine is approx. one and half day for DMAP and imidacloprid. Animal data show neonics accumulate in brain, affect on developing neuron, and cause neurodevelopmental disorders. Acceptable dose of intake of neonics seems to be not low enough, if those data were applied.

Biography:

Inge Pauwels has a Masters Degree in Audiology and Speech Therapy from Ghent University and is head of the Audiology department at the University Children’s Hospital Brussels. Since 2012 they have developed  a Vestibular Evaluation Department for young children in this hospital and their first research was recently published in European Annals of Otorhinolaryngology.

Abstract:

An early acquired or congenital  absence of sensory input of the vestibule will lead to severe delayed posturomotor milestones. Previous studies have proven modifications and even complete ipsilateral loss of vestibular function after unilateral cochlear implantation.

The objective of this study was to evaluate whether sequential cochlear implantation has an impact on vestibular function.

Methods: Retrospective study from January 2012 to January 2015 including 26 patients. The first stage consisted of determining the vestibular status of 26 hearing impaired children who were candidates for a second cochlear implant. Three months after contralateral implantation we reevaluated the vestibular function of the same patients. The vestibular evaluation consisted of multiple tests for canal and otolith function. A complete clinical vestibular evaluation was performed, including the head thrust test. This was followed by an instrumental assessment composed of the classic bicaloric test and vestibular evoked myogenic potentials testing with tone bursts.

Results: A high prevalence of vestibular dysfunction (69%) was found in our  group of unilaterally implanted children. Three patients had a unique functional vestibule at the not yet implanted ear. Vestibular evoked myogenic potentials responses stayed present in 15 of the 19 patients with a VEMP-response before contralateral implantation. Results of the caloric test changed for 6 patients  after contralateral implantation.

Conclusions: After contralateral implantation nearly 40% of our patients manifested modifications of their vestibular status. Intrasubject comparison of bicaloric and vestibular evoked myogenic potentials testing before and after contralateral cochlear implantation showed that canal function was better preserved than saccular function.

Seeing the high prevalence of vestibular dysfunction in our test group of unilateral implanted children, sequential implantation must be preceded by a vestibular assessment to prevent complete bilateral vestibular areflexia and its potential consequences. Presence of hyporeflexia at the yet-to-be implanted ear seems to be a situation particularly at risk. 

Biography:

Benoit Devroede received his Medical Degree in 1998 from the Free University of Brussels, Belgium and has accomplished his ENT residency at the Academic Medical Centre of this University (Erasme Hospital). He is head of the Vestibular Evaluation Department at the University Children’s Hospital Brussels. His clinical and research interests include Otoneurology and Laryngotracheal stenosis treatment in children.

Abstract:

An early acquired or congenital  absence of sensory input of the vestibule will lead to severe delayed posturomotor milestones. Previous studies have proven modifications and even complete ipsilateral loss of vestibular function after unilateral cochlear implantation.

The objective of this study was to evaluate whether sequential cochlear implantation has an impact on vestibular function.

Methods: Retrospective study from January 2012 to January 2015 including 26 patients. The first stage consisted of determining the vestibular status of 26 hearing impaired children who were candidates for a second cochlear implant. Three months after contralateral implantation we reevaluated the vestibular function of the same patients. The vestibular evaluation consisted of multiple tests for canal and otolith function. A complete clinical vestibular evaluation was performed, including the head thrust test. This was followed by an instrumental assessment composed of the classic bicaloric test and vestibular evoked myogenic potentials testing with tone bursts.

Results: A high prevalence of vestibular dysfunction (69%) was found in our  group of unilaterally implanted children. Three patients had a unique functional vestibule at the not yet implanted ear. Vestibular evoked myogenic potentials responses stayed present in 15 of the 19 patients with a VEMP-response before contralateral implantation. Results of the caloric test changed for 6 patients  after contralateral implantation.

Conclusions: After contralateral implantation nearly 40% of our patients manifested modifications of their vestibular status. Intrasubject comparison of bicaloric and vestibular evoked myogenic potentials testing before and after contralateral cochlear implantation showed that canal function was better preserved than saccular function.

Seeing the high prevalence of vestibular dysfunction in our test group of unilateral implanted children, sequential implantation must be preceded by a vestibular assessment to prevent complete bilateral vestibular areflexia and its potential consequences. Presence of hyporeflexia at the yet-to-be implanted ear seems to be a situation particularly at risk. 

Biography:

Bernice Gordon-Young is a licensed clinical professional counselor (LCPC) at OSF Saint Francis Medical Center, where she counsels children in the areas of academic difficulties, adjustment disorders, Attention Deficit Hyperactivity Disorder (ADHD), mood disorders, behavior problems, anxiety, depression, and overall mental and social well-being.  She has had a dual career as a 911 dispatcher and counselor for nearly 20 years. She is a doctoral student at Walden University studying Counselor Education and Supervision with a specialization in forensic mental health.

Abstract:

There is a significant increase in the calls primary care physicians receive from parents who have actively aggressive children.  The parents are desperate for over-the-phone assistance and the availability of immediate assistance is impractical.  Training call nurses, administrative staff, and physicians to become better equipped to refer the caller and/or offer resources to existing inpatient and outpatient children can significantly reduce exacerbated behavioral problems.  Both genetic and environmental factors contribute to the development of aggressive behavior in pediatric patients. Identifying key risk factors will advance the development of appropriate clinical interventions and prevention strategies and will provide information to guide the targeting of resources to those children at highest risk. (Ercan et al., 2014).  ADHD is one of the most prevalent childhood disorders, and it is a community health problem that may result in significant psychiatric, social and academic problems if not treated. Aggression is an important associated feature of ADHD, and it is essential in understanding the impact of the disorder and its treatment (Cunningham & Boyle, 2002).  Family size, the attitude of the family toward aggression, parenting styles, low socio-economic status and family conflict influence the occurrence of aggression in ADHD.  This oral presentation will provide insight into psychiatric services for hospitalized children and also children whom outpatient services are provided.  Given the strong relation between ODD symptoms and all aggressive subtypes in psychiatrically hospitalized children (Becker et al., 2012), it appears that the co-occurrence of ADHD symptoms adds increased risk for aggression in this population. As such, attending to the co‐occurrence of such symptoms may be especially critical in this population for reducing aggressive behaviors (Gadow & Nolan, 2002). 

Biography:

Go Ichikawa has completed his PhD at the age of 33 years from Dokkyo Medical University. He is the director of Pediatrics department at Nasu Red Cross Hospital.

Abstract:

【Background】The aim of this study was to verify whether lipid emulsion treatment aggravates infection and inflammation in very low-birthweight (VLBW) infants.【Study design】Very low-birthweight (<1500 g) infants born at <32 weeks gestational age between October 2013 and October 2014 at Dokkyo Medical University Hospital (Mibu, Tochigi, Japan) were treated with or without i.v. nutrition with a lipid emulsion. Infants were excluded who had congenital abnormalities, could not receive i.v. nutrition because of poor general condition, or on physician decision. Lipid emulsion with purified soybean oil was initiated at 0.5 g/kg/day on postnatal day 1. The dose was increased to 1 g/kg/day, and then to 1.5 g/kg/day (maximum dose). Blood tests were performed before (day 1) and after (day 8) initiation of lipid emulsion treatment. Interleukin (IL)-6, IL-8, monocyte chemotactic protein 1 (MCP-1), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), total bilirubin (T-Bil), direct bilirubin (D-Bil) and insulin were measured. Changes in respiratory condition, amount of oxygen used, and phototherapy duration were investigated.【Results】A total of 17 treated and 15 untreated VLBW infants were enrolled. IL-6, IL-8, MCP-1, TNF-α, CRP, T-Bil, D-Bil and insulin on days 1 and 8; respirator or surfactant use; amount of oxygen used; and phototherapy duration were not significantly different between the two group.【Conclusions】Lipid emulsion treatment did not increase inflammatory cytokine levels or aggravate respiratory disorders. Lipid emulsions, if proven safe, could be used to treat VLBW infants soon after birth, which may prevent extrauterine growth restriction and improve intellectual development prognosis.

Biography:

Nagwa A Meguid is a Professor of Human Genetics, National Research Centre, Egypt. She is a fellow at Uppsala University, Sweden and Yale University, USA. She has authored and co-authored 100 publications. She has used her expertise to identify and describe several novel recessive genes and genetic syndromes. She is working with Neurodevelopmental disorders, where she participated in  determining the spectrum of gene mutations causing common genetic disorders in Egypt. She is a Member in Regional Bio-Ethics Society of UNESCO. She has been awarded for Africa & Middle East UNESCO/L’Oreal, 2002.

Abstract:

Although the etiology and pathology of Autism Spectrum Disorder (ASD) is still poorly understood, a number of environmental, neurobiological and genetic factors have been related to the pathophysiology of ASD. Investigations about a reliable relationship between diet and ASD are still lacking. The present study aimed at comparing dietary regimens and habits of normally developing apparently healthy children, without diagnosed ASD, with a pediatric population of individuals affected by autistic disorder. Assessments of nutritional and anthropometric data, in

addition to biochemical evaluation for nutrient deficiencies, were performed. A total of eighty children with autistic disorder and eighty healthy, normally developing pediatric individuals were enrolled in the study. Parents were asked to complete the standardized questionnaire regarding the different types of food and the proportion of a serving for their children. Biochemical analysis of micro- and macronutrients were also done. Plotting on the Egyptian sex-specific anthropometric growth chart, absolute weights as well as weight-related for age classes, were significantly higher in cases than controls. A total of 23.8% of children with autistic disorder vs. 11.3% in the healthy control group had a nutrient intake below the Recommended Dietary Allowance (RDA) of protein. Children with autistic disorder showed low dietary intake of some micronutrients; calcium (Ca), magnesium (Mg), iron (Fe) and selenium (Se) and had significantly high intake of potassium (K) and vitamin C compared to controls. Serum Mg, Fe, Ca, and vitamin B12 in autistic children were significantly low compared with healthy children. Significant positive correlations between serum Mg, Fe, Ca, vitamin B12 and their levels in food were present. These results confirmed that different nutritional inadequacy was observed in Egyptian children with autistic disorder. The evidence reported in the present study should recommend screening of the nutritional status of ASD children for nutrient adequacy to reduce these deficiencies by dietary means or by administering appropriate vitamin and mineral supplements. Nutritional intervention plan should be tailored to address specific needs.

Biography:

Daniela Prayer has completed her MD degreee at the University of Vienna/ Austria, and apent a year as a research fellow at the Departmetn of Radiology at USCF/ San Francisco. Since 2009 she is the director of the Division of Neuroradiology and Musculoskeletal Radiology at the Medical University of Vienna. One of her main scientific topics is fetal MRI.  She is the author of more than 280 scientific papers

Abstract:

One strategy to prevent or alleviate pediatric diseases is to get an early diagnosis of a pathology. From the radiological point of view, the means to get a most accurate diagnosis at the earliest time point lies in the use of MRI during fetal life. Regarding the brain, the main questions for fetal MRI comprise whether a pathology is compatible with survival, the long term prognosis for neuropsychological development, and the definition of a possible genetic background that would allow specific testing in a consecutive pregnancy. In addition to detailed morphology fetal MRI offers information about connectivity and function. Especially in malformations of cortical development, commissural agenesis, and posterior fossa pathologies these MR-applications allow most accurate answers to the questions above, from the middle second trimester onwards. In case of acquired conditions, such as cerebral haemorrhage, the underlying reason may be identified, and treatment (shunting of posthemorrhagic hydrocephalus) may be planned in a tailored scheme. With respect to spinal malformation the main challenge for prenatal MRI is to define the presence of an open or closed spinal defect. Open defects may be treated surgically already in intrauterine stages, while this option is not be indicated in closed defects. Prognostically, the spinal level of the expected palsy can also be estimated. The use of fetal MRI has increased worldwide during the last years, as early diagnosis , especially of CNS pathologies helps not only with the management of the pregnancies but also enables the development of new therapeutic strategies.

Biography:

Dong Yup Lee completed his Pediatric residency training at Severance Children’s Hospital, Yonsei University. And He earned Mast of Public Health at Graduate school of Public Health Yonsei University in 2014. He is currently working at Pyeongchang Health Center & County Hospital as a pediatric doctor.

Abstract:

Purpose: Recently, legal disputes resulting from medical accidents have been increasing annually. The purpose of this study is to determine the causes and characteristics of medical disputes brought as a result of neonatal accidents and to suggest measures to reduce the number of medical malpractice suits.

Methods: Twenty-eight medical malpractice lawsuits brought as a result of neonatal accidents between 2005 and 2009 were analyzed.

Results: The average time taken to resolve these lawsuits was approximately 4.4 years. The average gestational age and birth weight of the newborns in these cases were 35.3 ±4.2 weeks and 2,668±931 g, respectively. Twelve cases (42.9%) were concluded partially in favor of the plaintiffs, while in 10 (35.7%) cases the plaintiffs lost. In 11 of the 12 cases that were concluded partially in favor of the plaintiffs, the defendants were found guilty of violating their duty of care. Medical accidents resulted in death in 10 cases and physical disability in 18 cases, and cerebral palsy and blindness were the most common physical disabilities. The average compensation amount ordered as damages was KRW 161,389,291±12,636,454.

Conclusion: In medical litigation, the standard of judgment is whether appropriate medical practices were performed based on the patient’s symptoms. Thus, to comply with the medical treatment rules is paramount in securing patients’ safety and protecting doctors themselves. Individual effort is necessary, but not sufficient to prevent medical accidents; multilateral, systemic reform is also required if the number of neonatal medical accidents is to be reduced.

Biography:

Author is a Senior Consultant in the Department of Pediatrics at a Tertiary Care Children Hospital in South India.The author has around 40 publications in Indexed National & International Journals.Her areas of interest include Pediatric Infections,Hematology & Critical Care.

Abstract:

Skeletal tuberculosis in children can easily be missed due to their non specific presentations. The objective of our study is to review the varied presentation, pitfalls in the diagnosis of pediatric skeletal tuberculosis and treatment outcome . A retrospective review of children diagnosed with skeletal tuberculosis over a period of 3 years. A total of 19 cases were reviewed. Mean age was 5.6 years . Average duration of symptoms was 6 months with chronic pain being the most common . spine was the commonest site. Most of the cases were missed due to non specific presentation, hence delaying the diagnosis. Contact history was positive in 6 and ESR was elevated in majority of them. Diagnosis was confirmed radiologically, bacteriologically or histopathologically. All children were treated with anti tubercular drugs and surgical debridement with good prognosis. A high index of suspicion aided by confirmation using imaging or histopathology can help in early diagnosis. Treatment with anti tubercular drugs with surgical debridement has good prognosis

Biography:

Eun Joo Lee is a clinical professor at Kyungpook National University Children’s hospital in neonatology department. She has also experience as pediatric neurologist for 10 years. She completed her Pediatrics residency at Catholic University of Daegu hospital. She earned her PhD, Physiology at Kyungpook national University. She is interested in research involving neuroprotective mechanism in neonatal hypoxic-ischemic encephalopathy model.

Abstract:

Hypoxic-ischemic brain injuries influence the mechanisms of signal transduction, including mitogen-activated protein kinase (MAPK) that regulates gene expression through transcription factor activity. Several attempts have been made to use bee venom (BV) to treat neurological diseases. However, limited data are available for brain injuries such as neonatal hypoxic-ischemic encephalopathy (HIE) and neurodegenerative disorders. The purpose of this study was to investigate the neuroprotective effects by BV by determining the expression of activated MAPK pathways. We examined activation and cell viability in hypoxia (1% O₂, 5% CO₂, 94% N₂) in low glucose-treated (H+low G) neuronal cells and astrocytes in the presence and absence of BV. After they were subjected to hypoxic conditions and treated with low glucose, the cells were maintained for 0, 6, 15, and 24 hr under normoxic conditions. Extracellular-signal-regulated kinases 1/2 (ERK1/2), p38 MAPK, and stress activated protein kinase (SAPK)/Jun amino-terminal kinases(JNK) were activated in H+low G conditions. Particularly, phosphorylation of ERK1/2 was maximized 6 hr after exposure to H+low G condition. BV specifically inhibited the phosphorylation of ERK1/2. However, BV had no effect on p38 MAPK or SAPK/JNK. In addition, BV improved neuronal cell and astrocytes viability following exposure to H+low G. ERK inactivation is known to mediate protective effects in hypoxic brain injury. Taken together, these results suggest that treatment with BV may be helpful in reducing hypoxic injury in neonatal HIE through the ERK signaling pathway.

Biography:

Dr. Melnick earned his B.SC., Physics and Ph.D, Chemistry at McGill University and M.D. at Queen’s University. He completed his Pathology residency at Mount Sinai Medical Center, Miami Beach, FL and subsequently joined the Department of Pathology and Clinical Laboratories at Nicklaus Children’s Hospital where he serves as Department Chief. He directs research involving therapeutic development in cancer, immunology and metabolic disorders since 1999, published more than 85 papers in peer-reviewed journals and acquired intellectual property based on this research. He serves as an editorial board member of the Journal of Natural Products in Cancer Prevention and Therapy.

Abstract:

Pediatric nutritional status assessment, typically reserved for children with overt clinical manifestation of nutrition-based disorders require comprehensive and time-consuming clinical and laboratory evaluation. However, many more children may be at risk for these disorders; long latency periods for clinical manifestation of primary and secondary (malabsorption, autoimmune, metabolic, genetic disorders and drug side-effects) nutritional deficiencies/insufficiencies and conditions related to over-nutrition, principally obesity and associated metabolic consequences. The latter form of malnutrition is complex and overlaps with conditions related to nutrient deficiency/insufficiency. Conventional nutritional evaluation is neither appropriate nor practical for the general pediatric population who are at risk for nutrition-based disorders. Given the scope of this societal health challenge, a more practical solution for recognizing children at risk for these disorders is beneficial. Such a screening tool must be evidence-based, easily administered and informative so that children with subtle manifestations of nutritional inadequacy or those at risk can be identified and directed to precise evaluation and nutritional/lifestyle interventions. This is the basis of the nutritional status screening panel known as the TOP™ (Test-Optimize-Perform) test. The panel addresses two principle categories of nutritional status; deficiency/insufficiency and nutrient metabolism. The analytes are; vitamin B_12, folate, vitamin D, iron, ferritin, total cholesterol, HDL-c, Non-HDL-c, HbA1c, homocysteine, transthyretin, hs-CRP, GGT and ALT. The panel is designed to directly or indirectly assess nutrient or micronutrient inadequacies and nutrition-acquired metabolic disorders as suggested by analytes that reflect lipid and carbohydrate metabolism, protein status, inflammation/oxidative stress, insulin resistance and mitochondrial dysfunction. Details of the rationale are presented.

Biography:

Dr. Naveed Durrani did his post-graduation in Pediatrics from Pakistan in 2004, and MRCP from Royal College of Physicians Ireland in 2009. Currently he is doing his fellowship in Neonatal-perinatal medicine at McMaster University, Canada. His interest is in neonatal sepsis and various quality improvement projects. He has more than 10 publications in an index medical journals.

Abstract:

Background and objective: In NICU blood culture is monitored at least 48 hours before stopping antibiotic treatment in rule out sepsis.

The objective of the study is to analyze the time to positive blood cultures for rule out sepsis to estimate minimum duration of antibiotics needed. 

Methods: Retrospective observational study performed in NICU at McMaster Children hospital (January 2004 to December 2013).  Positive blood cultures identified with BacT/Alert ®3D microbial detection system were analyzed for all admitted newborns. Outcome parameter were microorganisms, hours from inoculation to positive blood culture, age at the time of culture taken. Time to positivity was evaluated for clinically important gram positive and gram negative bacteria and yeast.

Results: In 9254 babies, 7480 blood cultures were performed. 845(11.3%) were positive for organisms. 815(96%) were considered as significant organism causing disease in newborn (yeast, definite, possible pathogens) while 30 (4%) had contaminants. 54 (6.4%) blood cultures were positive in EOS (Early onset sepsis in <72hours of age) while 791(94%) were in LOS (late onset sepsis>72hours of age).

613(72.5%), 802(95%) and 43(5%) blood cultures turned positive by 24hr, 48hr and >48hrs of incubation respectively.  All gram-negative organisms in EOS and LOS were identified within 24hours except one at 26hours.

Conclusion: Probability of gram negative microorganisms growing beyond 24hours is small. Initial antimicrobials treatment can be reduced after 24hours to target only gram positive organism beyond 24hours in LOS while they may be stopped in EOS unless clinically indicated.

Biography:

Graduated from San Francisco Xavier University in Chuquisaca, Bolivia. He did a Residency in Pediatrics at Santa Cruz Hospital, Bolivia. Studies in Pediatric Endocrinology at Hospital de Clinicas. University of Sao Paulo. Brazil. Member of the Bolivian Society of Pediatrics and the Latin American Society of Pediatric Endocrinology. He works as a Pediatric Endocrinologist and Professor of Pediatrics at Santa Cruz Hospital, Bolivia. Editor of the Journal of Cruceña Society of Pediatrics and Coeditor of the Journal of Bolivian Society of Pediatrics. Author of several articles in various national and international journals.

Abstract:

Nutritional marasmus is still prevalent in developing countries. Disorders of thyroid function have been reported in patients with marasmus.

The objective of the present study is to evaluate the levels of thyroid hormones in infants diagnosed with marasmus at the time of diagnosis and after reaching a normal weight for age and sex.

Material and methods: Prospective study of patients from one to 11 months of age, diagnosed with nutritional marasmus. Plasma levels of thyrotropin (TSH), thyroxine (T4) and triiodothyronine (T3) were determined at the time of diagnosis and after reaching normal weight for age and sex, when properly fed.

Results: We studied 47 patients with nutritional marasmus; 41 (87% of the total) had altered thyroid function at the time of diagnosis: In 29 (71% of those affected), there were low T3 values, with T4 levels being normal; 12 (29%) showed low values of T3 and T4. TSH levels were normal in this group of patients. Values of T3 and T4 were normalized when patients reached a weight adequate for age and sex.

Discussion: The alterations of the thyroid function observed in infants with nutritional marasmus (the decrease in T3 and T4 levels were evidenced), do not require replacement therapy with thyroid hormone, since once the patients reach the adequate weight for the age and sex, the thyroid profile normalizes.

Biography:

Saeyoon Kim has completed his PhD at the age of 35 years from Yeungnam University and postdoctoral studies from Kyungpook National University, School of Medicine. He is the director of Division of Pediatric Neurology of Yeungnam University Hospital.         

Abstract:

A limited number of studies have examined the link between F-wave abnormalities and clinical presentation in pediatric Guillain-Barre syndrome (GBS). Further randomized controlled studies are needed to confirm the clinical significance of these findings and efficacy of treatment. Therefore, this study examined the importance of F-wave abnormalities as a prognostic factor in pediatric GBS patient.

We retrospectively evaluated the records and electrodiagnostic studies (EDS) from 70 GBS patients. Subjects were divided into two groups according to the results of EDS, including F-wave examination. Group A (n=33) presented with F-wave abnormalities, and Group B (n=26) exhibited normal findings. We compared laboratory reports, clinical features, response to treatment, and prognosis between the two groups.

The most common symptom was motor weakness in both groups. The prevalence of abnormal deep tendon reflex (DTR) was significantly higher in Group A than B (p < 0.05). Patients diagnosed with GBS had received intravenous immunoglobulin treatment: 31/33 (94%) in Group A and 15/26 (58%) in Group B. With regard to the relationship to F-wave abnormalities, significantly greater numbers of children in Group A showed H-reflex abnormalities and poor prognosis compared with Group B (p < 0.05).

This study demonstrated that F-waves are clinically important as a prognostic factor in GBS patients. Significantly more cases exhibited an abnormal DTR, and had a poorer prognosis than the normal group. Limited studies have examined the correlations between F-wave abnormalities and clinical results. Therefore further randomized controlled studies are needed to confirm the clinical characteristics and efficacy of treatments.

Biography:

1993: Graduated Hamamatsu University School of Medicine, 1993: Residency in Okayama Medical Center, 1997- : Attending Physician in Okayama Medical Center

Abstract:

In this case report, two siblings with MPS VI started enzyme replacement therapy (ERT) with weekly infusions of recombinant human ASB (Galsulfase) at 1mg/kg. Sibling 1 started ERT 5.6 years of age and Sibling 2 was 6 weeks old. The disease status in these two siblings prior to and for no less than 120 months of ERT was followed up and compared. The treatment was well tolerated by both siblings. During 120 months of ERT, symptoms typical of MPS VI including short stature, progressive dysmorphic facial features, hepatosplenomegaly, hearing impairment, corneal clouding, and dysostosis multiplex were largely absent in the younger sibling. Her cardiac functions and joint mobility were well preserved. On the other hand, her affected brother had typical MPS VI phenotypic features described above before commencing ERT at the equivalent age, of 3 years. There was significant improvement in the shoulder range of motion and hearing loss after 120 months of treatment and cardiac function was largely preserved. His skeletal deformity and short stature remained unchanged, 　but he reached the age of puberty. The results showed that early ERT initiated at newborn is safe and effective in preventing or slowing down disease progression of MPS VI including bone deformities. These observations indicate that early diagnosis and treatment of MPS VI before development of an irreversible disease is critical for optimal clinical outcome

Biography:

Graduated from San Francisco Xavier University in Chuquisaca, Bolivia. He did a Residency in Pediatrics at Santa Cruz Hospital, Bolivia. Studies in Pediatric Endocrinology at Hospital de Clinicas. University of Sao Paulo. Brazil. Member of the Bolivian Society of Pediatrics and the Latin American Society of Pediatric Endocrinology. He works as a Pediatric Endocrinologist and Professor of Pediatrics at Santa Cruz Hospital, Bolivia. Editor of the Journal of Cruceña Society of Pediatrics and Coeditor of the Journal of Bolivian Society of Pediatrics. Author of several articles in various national and international journals.

Abstract:

Nutritional marasmus is still prevalent in developing countries. Disorders of thyroid function have been reported in patients with marasmus.

The objective of the present study is to evaluate the levels of thyroid hormones in infants diagnosed with marasmus at the time of diagnosis and after reaching a normal weight for age and sex.

Material and methods: Prospective study of patients from one to 11 months of age, diagnosed with nutritional marasmus. Plasma levels of thyrotropin (TSH), thyroxine (T4) and triiodothyronine (T3) were determined at the time of diagnosis and after reaching normal weight for age and sex, when properly fed.

Results: We studied 47 patients with nutritional marasmus; 41 (87% of the total) had altered thyroid function at the time of diagnosis: In 29 (71% of those affected), there were low T3 values, with T4 levels being normal; 12 (29%) showed low values of T3 and T4. TSH levels were normal in this group of patients. Values of T3 and T4 were normalized when patients reached a weight adequate for age and sex.

Discussion: The alterations of the thyroid function observed in infants with nutritional marasmus (the decrease in T3 and T4 levels were evidenced), do not require replacement therapy with thyroid hormone, since once the patients reach the adequate weight for the age and sex, the thyroid profile normalizes.

Biography:

Abstract:

Background – breast-feeding has benefic effects in the mother and toddler, the absence of it has been implicated in numerous adverse effects.  Currently we see less patients nursing, the estimated prevalence in Mexico for 2012 was a 14.6% of exclusive breast-feeding in the first 6 months of life.

Problem – information has been documented in other countries about how socio economical status has a direct impact on the incidence of nursing. There has not such information reported in Mexico. Do differences in socio economical status have differences in the exclusivity and application of nursing in their babies?

Objective – the primarily objective of this study was to compare the duration of breast-feeding in Mexican infants younger than one year with low socio economical status versus those with medium and high socio economical status.

Methods – the design was a replicative, observational, retrospective, transversal and comparative study, without follow-up on the studied patients. The sample was a total of 1962 Mexican infants, younger than 1 year. The data was obtained at the public national health institute through the national health and nutrition survey 2012 (ENSANUT 2012) applied in 1719 houses (total of 55,008 homes surveyed), the study period was from may 2011 through may 2012, the level of significance (a) was of 95% for two tails, Z = 1.90, Z  = 1.96 with a potency of B 90% for the both. 

Results – the number of surveyed patients where 783 for low, 691 for medium and 488 for high socio economical status, representing 39.9%, 35.2% and 24.9% respectively of the total studied sample. We formed two groups of interest the low socio economical status versus the rest of the group (39.9% versus 60.1%). Studied subject medium age was 6.5 months with a Standard Deviation (SD)+- 3.5 months.  The highest number of patients nursing is during the firsts months of life, especially during the first month. The proportion of subjects that did not receive breastfeeding was higher among the group of medium and high socio economical status. The mean breastfeeding duration was 5.4 months (± 3.5 months) in the low socioeconomic status , versus 4.3 months (± 3.3 months) in the medium to high socioeconomic status. The level of significance for the test was found to have p>0.001.

Conclusion – There is a statistically significant difference in breastfeeding duration among Mexican infants younger than one year with low socioeconomic status, versus those with medium to high socioeconomic status.

Biography:

Sunil kumar Gonuguntla has completed his MD Pediatrics from Dr. NTRUHS, Vijayawada, India. He is currently working as Resident in SVRR GGH, Tirupati, India.

Abstract:

A 11 years boy is brought with complaints of abnormal movements, fever, passing mucous stools, vomitings and decreased vision in left eye of about 10 days. Boy was delivered at term vaginally. Child had blisters with erythematous base on his trunk and upper and lower limbs since the first few weeks of life. Later, hyperpigmentation developed. He received various treatments with topical medications, albeit without success. On clinical evaluation, the following clinical features of IP are observed²: CNS: Seizures (GTCS), Dental: White opaque lines seen on all labial surfaces of the teeth with retained deciduous teeth and pegged lateral incisor, partial anodontia, Eye: Cotton wool spots, Skin: Hyper pigmented hyperkeratotic plaques over lines of blaschko over thighs, both legs and axilla, lower trunk and buttocks.

Skin biopsy showed hyperkeratotic epidermis with mild acanthosis and basal cell degeneration, vacuolization and decreased pigment content. Melanophages extend into the epidermis and also into papillary dermis.

Biography:

ES Suh has completed hers PhD at the age of 32 years from Kyungbuk National University.  She is the director of department of Pediatrics, and Pediatric Neurology of Soonchunhynag University in Korea.  She has published more than 50 papers in reputed journals and has been serving as an editorial board member of Korean Journal of Pediatrics and Korean Journal of Child Neurology for more tha 10 years.

Abstract:

Isolated sphenoid sinusitis is a rare disease in children, and its symptoms are often nonspecific and confusing. Rarely, severe headache can be the first or only symptom of isolated sphenoid sinusitis. New daily persistent headache (NDPH) is a form of chronic daily headache that may have features of both migraines and tension-type headaches. NDPH is difficult to diagnose and requires a multifaceted approach. Here, we report on a 10-year-old boy and an 11-year-old girl who both presented with typical NDPH symptoms. These patients had no nasal symptoms or signs of infection. Neither non-steroidal anti-inflammatory drugs (NSAIDs) nor topiramate had any effect on the headaches. Their neurological and ophthalmological examinations were normal. The results of routine blood work, including thyroid function tests, inflammatory markers, complete blood count, tests for viral infection, and a metabolic panel, were normal. A brain magnetic resonance imaging (MRI) scan showed isolated sphenoid sinusitis. Both patients’ symptoms resolved completely after approximately 1 month of oral antibiotics for sinusitis.

Biography:

Dr.Sharayu Dighavkar has completed her undergraduate in Bachelor of Medicine and Bachelor of Surgery at the age of 21 years from D.Y Patil University School of medicne and is currently pursuing Post Graduation in Pathology from D.Y.Patil School of Medicine.   

Abstract:

Congenital pouch colon(CPC) is an anorectal malformation with highest number of reported cases in northern part of Indian Subcontinent. The cause of this unique geographical distribution has not yet been ascertained. In this anomaly an entire colon or a part of colon is repalced by a pouch like dialation, which communicates  distally with urogenital tract via a large fistula.

A 2yr old female patient had a history of anorectal malformation with passing of stools from introitus with absent anal opening since birth. Per abdominal examination fecaloma was palpable. In introitus two openings were noted urethra and vagina, and stools coming out of vagina with absent anal opening. Sigmoid stoma was done in February 2016, intraoperatively sigmoid colon was ectatic and the fecaloma was removed.

Faliure of the ectatic bowel to regress back to its normal morphology and structure even after 6 months post sigmoid stoma alerted the surgeon to the suspicion of Congenital Pouch Colon.  Sacro-abdominal pull through was performed and pouch was excised and sent for histopathological analysis.

Histopathology confirmed the diagnosis of Pouch colon. It showed chronic inflammation in the mucosa and submucosa, along with disruption of the outer longitudnal and inner circular muscle layers, hypertrophy of nerve bundle was noted and mature and few giant ganglion were noted between the ill-formed muscle layers(only 10% of all cases of CPC shows giant ganglion).

Biography:

Nada Alabdulkarim has graduated (2013) from King Saud University in Saudi Arabia with a bachelor degree of Medicine and surgery plus honor class. Nada completed two years of general pediatric training in Saudi Arabia. She has been interested in public health education and organized many events for that. Currently, she is working on research subjects including neonates of diabetic mothers and neonatal infections. In addition Nada is a member of the Saudi Pediatric society.

Abstract:

Background: The higher prevalence of diabetes mellitus during pregnancy causes perinatal and neonatal morbidities. There is a greater risk of morbidity among the infants born to diabetic mother. The study has aimed to investigate the perinatal and neonatal complications among the infants of diabetic mother. Methods: Quantitative research design was opted for the analysis of results. It has included the neonates born to diabetic mothers between July 1 2014-June 30 2015 in King Khalid University Hospital of King Saud University Medical City. A total of 279 mothers and 289 infants were enrolled in the study. The mothers were regularly checked during their gestation period and glucose levels of all the infants born to diabetic mother were monitored. Results: The potential complications causing neonatal morbidity and mortality have been highlighted in the study. The infants born to diabetic mothers were extensively observed to suffer metabolic abnormalities including hypoglycemia. Regarding the mode of delivery, majority of the diabetic mothers (61.5%) had spontaneous delivery; while others (38.5%) had induced delivery. The neonates born to diabetic mother were at risk of developing hypoglycemia (p= 0.008), hyperbilirubenemia (p= 0.014), respiratory distress syndrome (p= 0.035), admission in NICU (p= 0.005), and congenital anomalies (p= 0.024). Conclusion: The poor maternal diabetic control poses higher risk of neonatal morbidity and mortality. There is greater risk of adverse neonatal outcome among the mothers suffering gestational diabetes mellitus.

Biography:

Nada Alabdulkarim has graduated (2013) from King Saud University in Saudi Arabia with a bachelor degree of Medicine and surgery plus honor class. Nada completed two years of general pediatric training in Saudi Arabia. She has been interested in public health education and organized many events for that. Currently, she is working on research subjects including neonates of diabetic mothers and neonatal infections. In addition Nada is a member of the Saudi Pediatric society.

Abstract:

Introduction: Infection remains one of the leading causes of neonatal morbidity and mortality worldwide. Yearly 3·257 million child below 5 years old dies because of infections, 44% of them die in the neonatal period. Group B Streptococcus (GBS) is the most common pathogen particularly in infants under three months of age and it is unusual to present after that age. Neonatal GBS disease is divided into 3 categories according to the age of hospital admission; early-onset disease (EOD) (day 0–6), late-onset disease (LOD) (day 7–89), and ultra-late onset disease (ULOD) if more than 3 months (range 91–226 days). Significance of the study: To the best of our knowledge, only few cases were reported of invasive ULOD GBS outside of Saudi Arabia. In this report, we present and discuss a neonate who developed a rare invasive ULOD GBS. Patient description: Full term Afghani female was brought to the ER at 15 weeks (450 days) of age with 2 days history of fever, vomiting, poor appetite and lethargy. Blood and cerebrospinal fluid (CSF) cultures confirmed a heavy growth of streptococcus agalactiae. She developed multiple episodes of tonic-clonic convulsions of the right arm and left leg with lip smacking that lasted for few seconds. A right side facial palsy with generalized spasticity also noted, she was started on anticonvulsants. Electroencephalogram (EEG) demonstrated tendency for seizure and encephalopathy. Imaging showed bilateral extensive meningo-encephalitis and bilateral subdural fluid collection. Initial dexamethasone and empirical antibiotics were started. Her total antibiotics duration and hospital stay was ten weeks. Ptosis and spasticity improved to full recovery by her third week of admission.

Biography:

Judy Prehn completed her Physical Therapy degree from the Medical University of South Carolina. She completed her Doctoral degree in Rehabilitation Science from the University of Oklahoma Health Sciences Center. Her current research on infant transport was published in the Journal of Perinatalogy in 2015. She is a faculty member at William Carey University, where she teaches pediatric physical therapy and motor learning concepts, and continues research activities into developmentally supportive practices for infants born prematurely.

Abstract:

Premature infants with very low birth weight (VLBW) are at risk for germinal matrix (GMH) and intraventricular hemorrhage (IVH). Infants with VLBW are most vulnerable to hemorrhage during the first 24 to 72 hours following birth, which is the time they are likely to be transported from local hospitals to regional medical centers. In addition, preterm infants’ sensory systems are immature and unable to adapt or habituate to auditory and vestibular input. Premature infants respond negatively to intense sensory stimulation such as sudden, loud sound that can produce an increase in respiration and heart rates, increase in intracranial pressure and decrease in oxygenation. This study measured the effectiveness of modifications to reduce sound and vibration during ground transport of a model infant with VLBW (1368 grams) and prematurity (estimated gestational age 30 weeks). We modified the incubator mattress and found that the combination of a gel mattress over an air hambered mattress was effective in significantly decreasing vibration levels. Infant weight influenced the effectiveness of mattresses in decreasing vibration transmitted to the infant. Modifications that decreased vibration for infants weighing 2000 g were not effective for infants weighing 1368 g. Incubator cover modifications did not decrease sound levels inside the transport incubator, suggesting that sound was transmitted into the incubator as a low-frequency vibration through the incubator’s contact with the ambulance floor. Interprofessional collaboration is needed for transport redesign to protect infants born prematurely with VLBW from excessive physical strain during vulnerable periods of brain development.

Biography:

J L Mathew works at the Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. He has contributed extensively to evidence-based policy-making for several vaccines in the Indian context, especially Hepatitis B, Hib, IPV, MMR, PCV, Influenza, Varicella, acellular pertussis, HPV, Rotavirus, and typhoid conjugate vaccines. He is one of the first to identify the rapid waning of maternal measles antibodies in infancy, creating a pool of susceptible infants/children. He has nearly 200 peer-reviewed publications to his credit and delivered numerous presentations related to Vaccinology in national and international meetings.

Abstract:

Background: In India and many other developing countries, a single dose of measles vaccine is administered to infants at 9 months of age. This is based on the assumption that maternal transplacentally transferred antibodies will protect infants until that age. However, our previous data showed that most infants lose maternal anti-measles antibodies before 6 months of age, making them susceptible to measles before vaccination at 9 months.

Objective: This prospective study was designed to compare susceptibility in pre-term vs. term infants, at different time points.

Material & Methods: Following Institutional Ethics Committee approval and a formal informed consent process, venous blood was drawn from a cohort of 45 consecutive term infants and 45 consecutive pre-term infants (both groups delivered by the vaginal route); at birth, 3 months, 6 months and 9 months (prior to measles vaccination). Serum was separated and anti-measles IgG antibody levels were measured by quantitative ELISA kits (with sensitivity and specificity >95%). Susceptibility to measles was defined as antibody titre <200 mIU/ml. The mean antibody levels were compared between the two groups at the four time points.

Results: The mean gestation of term babies was 38.5±1.2 weeks; and pre-term babies 34.7±2.8 weeks. The respective mean birth weights were 2655±215 g and 1985±175 g. Reliable maternal vaccination record was available in only 7 of the 90 mothers. Mean anti-measles IgG antibody (±SD) in terms babies was 3165±533 IU/ml at birth, 1074±272 IU/ml at 3 months, 314±153 IU/ml at 6 months, and 68±21 IU/ml at 9 months. The corresponding levels in pre-term babies were 2875±612 IU/ml, 948±377 IU/ml, 265±98 IU/ml, and 72±33 IU/ml at 9 months (p>0.05 for all inter-group comparisons). The proportion of susceptible term infants at birth, 3 months, 6 months and 9 months was 0%, 16%, 67% and 96%. The corresponding proportions in the pre-term infants were 0%, 29%, 82%, and 100% (p>0.05 for all inter-group comparisons).

Conclusion: Majority of infants are susceptible to measles before 9 months of age suggesting need to anticipate measles vaccination, but there was no statistically significant difference between the proportion of susceptible term and pre-term infants, at any of the four time points. A larger study is required to confirm these findings and compare sero-protection, if vaccination is anticipated to be administered between 6 and 9 months.

Biography:

Bao shan is a MD student in Sichuan university at the age of 26 years. Her major is pediatrics, especially on neonatology. She has published several papers in reputed journals, and done a lot of researches on clinical aspects of neonates.

Abstract:

Background Neonatal infection is one of the most common disease in Neonatal intensive care unit, and is also a crucial cause of neonatal death. An effectual therapy at the very beginning of the infection can significantly reduce the mortality of neonate. Object To uncover the status of neonatal infection and current antibiotic therapeutic proposal. Method An observational, retrospective study was performed, assessing all the infants that were dead during hospitalization between 2013.1.1-2014.12.31. Analyze the clinical data,  discover the risk factors and characteristics of infection, and summarize the current precaution and therapeutic proposal. Result 40(91%) out of 44 in total infants had infective symptom, and 68% of their mothers got infective symptom too, and only 38% of these mothers received antibiotic therapy, while the drug had low sensitivity and the duration of use was not correct. 35(88%) out of 40 infected infants received antibiotic therapy, while 5(12%) infants were unable to received effective therapy due to the unobvious clinical symptom and early on set of death. The positive rate of clinical pathogen samples was 17%, most of which was Klebsiella pneumonia Streptococcus viridans and Escherichia coli. Piperacillin tazobactam sodium and Meropenem is most common used. Conclusion Infection occupies a crucial role in neonatal death, by improving maternal infection treatment and enhancing the management of infants can significantly reduce neonatal mortality.

Biography:

Nisha Agarwal has completed her M.B.B.S. in 2012 from Stanley Medical College, India. She is currently doing her Pediatrics residency at Harlem Hospital Center, New York and is in her second year. She has participated in basic science research project in 2013-2014 which has been published in premier journals like American journal of respiratory and critical care medicine. She is also involved in multiple patient and quality improvement projects at Harlem hospital currently.

Abstract:

Bronchiolitis is one of the most common diagnoses requiring hospitalization in less than 2 years old and Continuous Positive Airway Pressure (CPAP) is the most common treatment strategy for providing positive pressure ventilation (PPV)in these patients. Recently, High flow nasal cannula (HFNC) has emerged as a new modality for providing PPV. Our study attempts to compare the two modes. It is a retrospective chart review including patients less than 2 years with a clinical diagnosis of bronchiolitis and no chronic lung disease. The study compares the outcome which is defined as escalation of therapy to BIPAP or mechanical ventilation between the two groups. CPAP group is an in built control as HFNC was not available during first year of data collection. Post HFNC introduction, all the patients were started on HFNC except for some who were started on CPAP based on HFNC availability. The study included total of 63 patients based on eligibility criteria. Among 63 patients, CPAP group had 14 and HFNC group had 19. In CPAP group, 2 patients got intubated and 1 patient got escalated to BIPAP. In HFNC group, 1 patient got intubated and 4 patients got escalated to BIPAP. Overall, among CPAP group 21% worsened and required escalation and among HFNC group 26% worsened and required escalation. P-value for the above study was 0.69 which was not significant. Therefore, our study shows there is no difference between CPAP and HFNC use in bronchiolitis patients. Our study was limited due to small sample size.

Biography:

Jenelle Fernandez is currently a Pediatric Resident at the Children’s Hospital Navicent Health affiliated with Mercer University School of Medicine. She has received her BS in Biology at the University of Florida, USA. She went on to receive her Medical degree from Ross University School of Medicine

Abstract:

Despite the high accuracy, sensitivity and specificity, radio nucleotide imaging, using (99mTc) pertechnetate to diagnose Meckel’s diverticulum may result in false positive studies. Early or late appearance of the dye in relation to that of the stomach can aid in distinguishing the false-positive causes from those due to ectopic gastric mucosa on a Meckel’s scan. The accumulations of  pertechnetate due to hyperemia appear early or late in the study and tend to fade over time. Whereas in a Meckel’s diverticulum, uptake of radio-tracer occurs simultaneously, usually between 10 and 20 minutes after tracer injection and persists throughout the study, increasing in intensity parallel to the intensity of the stomach. However, pitfalls to this rule may exist requiring additional imaging. A 13-year-old female patient presented with acute onset, colicky, right lower quadrant abdominal pain since the past one day, associated with recurrent bright red, painless rectal bleeding for the past one month. There was no history of hard bowel movements or painful defecation. Other than a history of a bilateral periacetabular osteotomy for hip dysplasia a month prior, past medical and family history were not significant. Laboratory evaluation included hemoglobin of 9.7 g/dL, Hematocrit of 31.2%, MCV of 80.5. Physical examination was normal. Meckel’s scan demonstrated diffuse streaky uptake of the tracer in the right lower quadrant, more lateral in location than normal coinciding with that of the stomach. Due to the persistent concern of MD in the patient SPECT was performed. Accumulation of the 99mTc was noted in the right joint capsule ruling out a MD. Although, MD was ruled out, magnetic resonance enterography (MRE) was performed to further assess this area of increased uptake on the perfusion scan. Soft tissue enhancement was noted around the right hip, deep to the iliacus and psoas muscle. The MRE findings were thought to be most consistent with post-surgical inflammation of the right hip. Our case highlights the importance of not only concentrating on the

Biography:

Amy Issa D O is currently a Pediatric Resident at the Children’s Hospital Navicent Health affiliated with Mercer University School of Medicine. She has received her BS in Biology with a minor in Great Texts of the Western Tradition while in the Honors College at Baylor University. She went on to receive a Master of Science in Medical Science from the University of North Texas Health Science Center (UNTHSC) and received her Medical degree from Texas College of Osteopathic Medicine at UNTHSC.

Abstract:

A pre-duodenal portal vein (PDPV) is a congenital anomaly that is rare in both pediatric and adult patients. PDPV results from persistence of a primitive vitelline vein and rather than passing inferiorly and behind the pancreas, the portal vein crosses in front of the duodenum and pancreas. PDPV is usually found as an incidental finding during surgeries of the gastrointestinal tract but
can cause an extrinsic compression of the duodenum leading to intestinal obstruction. PDPV association with such a complication is extremely rare. In fact, in a 25-year retrospective study in a single center; PDPV was found only in five neonates. In all of them, the PDPV was asymptomatic and the duodenal obstruction was due to associated malformations, such as malrotation, duodenal atresia, duodenal web or annular pancreas. Most of the cases of PDPV reported have been described in association with other congenital anomalies including heterotaxia, polysplenia syndrome, situs inversus, cardiac defects, malrotation, biliary or duodenal atresia and annular pancreas. To our knowledge, out of the 100 pediatric and adult cases reported, an association with a Meckel’s diverticulum has never been described. We hereby, report a 14-month old male with a history of heterotaxy syndrome, left atrial isomerism, severe gastroesophageal reflux disease and failure to thrive with malrotation that was noted on an upper GI series. Surgical exploration revealed affixation of the midgut without volvulus without dilatation of the duodenum. A vascular structure crossing the duodenum anteriorly was noted and identified as a PDPV in association with a Meckel’s diverticulum, which was removed. The PDPV was left in place, since no signs of duodenal obstruction or inflammation were noted. Although, an incidental finding, this anomaly is of great surgical importance as it can cause unexpected surgical complications from accidental injury to the portal vein. Therefore, knowledge of this anomaly is essential for avoiding injuries during laparotomy for surgical correction of gastrointestinal anomalies such as malrotation.

Biography:

Mehrdad Modaresi currently working as an Associate Professor in the Department of Animal Science at Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran. His research fields is herbal drugs and Animal Physiology. He has been recipient of few awards and grants. His research reflect in wide range of publications in various national and international journals. He completed his PhD at the age of 29 years from Islamic Azad University,Research and Science Branch.

Abstract:

The liver has a key role in the regulation of many physiological phenomenon. Due to the use of traditional medicinal plants, in this study the effects of lavender (Lavandula officinalis) extract on tissue and liver enzymes were investigated. In this experimental study, 50 mature female mice were divided into 5 groups, each group including ten adult female Balb/C mice. The control group did not receive any extract, the placebo group received 0.5 cc normal saline every other day and 3 treatment groups received hydro alcoholic extract of lavender with 50,100,200mg/kg /2day doses that was used interperitoneal injection for 20 days..20 days later, blood samples were taken from all groups and the liver enzyme ALT, AST, and ALP were measured. Liver tissue was studied by light microscopy in all groups. Obtained data were analyzed using SPSS program (p<0.05). ALT enzyme increased significantly in 200 doses (p<0.05). AST enzyme levels at doses of 100 and 200 mg/kg compared to the control group showed a significant decrease, and ALP enzyme concentration in a dose of 200 compared to the control group showed a significant decrease(p<0.05). Observations in sections showed that the liver tissue in 50 and 100 were not significant pathological changes but obvious pathological changes of liver tissue (necrotic tissue) observed in 200 group.

Biography:

Paula Francezca C. Padua, M.D has completed her MD at the age of  27 from St. Luke’s College of Medicine, Quezon City,  Philippines, last 2013.  She is currently in her 3rd year residency training at the Department of Otolaryngology, Head and Neck Surgery  at St. Luke’s Medical Center, Quezon City Philippines.

Abstract:

Objective:

(1) To present a case of venolymphatic malformation and OK-432 as its management

(2) To discuss the mechanism of action of OK-432 in the treatment of        venolymphatic malformations

(3) To discuss the known complications of OK-432 in the treatment of venolymphatic malformations

Design:  Case Report

Setting:  Tertiary Hospital in Metro Manila

Case Report: A 4 year old male, presenting with a right facial and cervicothoracic mass, consulted and given Picibanil (OK-432) as trial treatment for 2 doses.  A local inflammatory response was observed after the first dose.  However, the patient exhibited a systemic inflammatory response after the 2nd dose.

Conclusion: Venolymphatic malformation is one of the most common types of vascular malformations with an overall prevalence of up to 1% in the general population.  Although benign, these lesions have a tendency to grow in an infiltrating manner.  OK-432, which is the most widely used alternative treatment, showed promising results of regression of malformations, systemic inflammatory response syndrome may be a possible side effect with its use.

Biography:

Bao shan is a MD student in Sichuan university at the age of 26 years. Her major is pediatrics, especially on neonatology. She has published several papers in reputed journals, and done a lot of researches on clinical aspects of neonates.

Abstract:

Biography:

Geir Ogrim is a Senior Clinical Neuropsychologist working in a Neuropsychiatric team in     Child- and Adolescent Psychiatry at Østfold Hospital Trust, Fredrikstad, Norway, combining research and clinic. His university affiliations are NTNU, Trondheim Norway and Gillberg Neuropsychiatry Centre (GNC), Gothenburg, Sweden. His PhD thesis was on, “Electrophysiology in ADHD: Diagnosis, Predictions and Treatment”. His research focuses on quantitative EEG (QEEG) and event related potentials (ERPs) in combination with neuropsychological tests as methods to be used as supplementary biomarkers in diagnosing developmental disorders and predictions of treatment outcome. He is the Head of the professional board in patient organization ADHD Norge, and a consultant at NevSom – National Resource Centre for Neurodevelopmental Disorders and Hypersomnias.

Abstract:

Millions of children and adolescents worldwide are diagnosed with ADHD and treated with stimulants. About 25% are non-responders (non-REs), and acute side effects are reported in about 30%. In search for EEG based predictors of response we applied WinEEG test procedure (www.mitsar-medical.com) making EEG registrations of 3 minutes eyes closed, 3 minutes eyes opened and a 20 minutes task condition – a cued visual go/no-go task for computing ERPs. In one study 98 ADHD patients completed a 4 weeks medication trial, and were classified as REs or non-REs based on interviews and rating scales from parents and teachers. The study reports QEEG/ERP data that predict clinical response. In another study, a similar procedure was applied to predict acute side effects. In a third study, 87 patients completed a second test on a single dose of stimulants before onset of the 4 weeks trial. The predictive power of single dose changes in ADHD related ERPs and behavioral test variables were studied. Changes in ERP component P3no-go predicted the outcome of the 4 weeks trial with a large effect size (d=1.76). A study combining all data to compute a global prediction index is in progress.

Biography:

Bao Shan is a MD student in Sichuan University. Her major is Pediatrics especially on neonatology. She has published several papers in reputed journals, and has done a lot of researches on clinical aspects of neonates.

Abstract:

Background: Chorioamnionitis is thought to be related to neonatal mortality and morbidity, but conflicting results appears in different studies influenced by different definition of chorioamnionitis and study populations. Meanwhile, the effect of different grades of histologic chorioamnionitis on neonatal diseases has not been talked before. Method:  A retrospective study was performed, analyzing the neonates who were sent to our neonatal intensive care unit and with a pathologic examination of placenta of their mom between 1^st January and 31^st December in 2014. Neonates were excluded if there were major malformations or chromosome abnormality. Complications during pregnancy, pathologic examination results of placenta and neonatal outcomes were collected and analyzed. Outcomes: A total number of 253 neonates were included, including 192 preterms (76%) and 61 terms (24%). Mothers who had chorioamnionitis accounted for 83% (209) with grade I 58% (121), grade-II 25% (53) and grade-III 17% (35). Premature rupture of membranes (P<0.001), placenta adhesion(P<0.001), mother infection(P<0.001) and scarred uterus (P<0.05) significantly increased the risk of having chorioamnionitis, while pregnancy induced hypertension, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy and hashimotos thyroiditis did not. Chorioamnionitis did not increase the risk of having intracranial hemorrhage (P=0.602), pneumonia (P=0.612), electrolyte disorder (P=0.965), hypoproteinemia (P=0.347) and retinopathy of prematurity (P=0.310) in infants. Different grades of chorioamnionitis also did not have significant effect on neonatal outcomes. Conclusion: The relevance ratio of chorioamnionitis is dramatically high in pregnancy women and premature rupture of membranes, placenta adhesion, mother infection and scarred uterus significantly increased the risk of this pathological changes. But the current data showed it does not have effect on neonates. More prospective researches are needed to reveal the impacts of chorioamnionitis on infants.

Biography:

Leonardo Cano Cevallos is an Ecuadorian medical student attending to the last year of medical school at Universidad Católica Santiago de Guayaquil, Ecuador. He is interested on research and has experience as a Teaching Assistant in Hematology for 2 years. He is a part of the research team of Respira Lab Research Group.

Abstract:

Background: Gorham-Stout Syndrome is a rare idiopathic nonmalignant disorder characterized by recurrent, progressive osteolysis. It may affect any bone, but commonly involves mandible, shoulder and pelvic girdle, each in roughly 20% of all the cases. The disease affects one or contiguous bones. Our purpose is to highlight the relevance of an extraordinary progression time in four months of massive osteolysis of the shoulder. 

Case Presentation: A 12-year-old-boy is admitted by complete loss of function of the right arm and showing a deformity at level of right clavicle. His history was characterized by progressive weakness and pain on right shoulder 4 months ago. Biopsy results showed numerous congestive capillaries surrounded by fibrous tissue and blood material, also trabecular areas with irregular edges, perivascular inflammation and atrophy signs suggestive of angiomatosis confirmed the diagnosis of the disease.

Conclusion: The time of progression of the disease in a normal pattern is at least one or two years within the beginning of suggestive symptoms. We consider that our case is particularly important, because the progression to total destruction of elements of patient’s shoulder was four months in a young patient.

Biography:

Paula Francezca C Padua, M.D has completed her MD at the age of 27 from St. Luke’s College of Medicine, Quezon City, Philippines, last 2013. She is currently
in her 3rd year residency training at the Department of Otolaryngology, Head and Neck Surgery at St. Luke’s Medical Center, Quezon City Philippines.

Abstract:

Objective: (1) To present a case of venolymphatic malformation and OK-432 as its management
(2) To discuss the mechanism of action of OK-432 in the treatment of venolymphatic malformations
(3) To discuss the known complications of OK-432 in the treatment of venolymphatic malformations

Design: Case Report

Setting: Tertiary Hospital in Metro Manila

Case Report: A 4 year old male, presenting with a right facial and cervicothoracic mass, consulted and given Picibanil (OK-432) as trial treatment for 2 doses. A local inflammatory response was observed after the first dose. However, the patient exhibited a systemic inflammatory response after the 2nd dose.

Conclusion: Venolymphatic malformation is one of the most common types of vascular malformations with an overall prevalence of up to 1% in the general population. Although benign, these lesions have a tendency to grow in an infiltrating manner. OK-432, which is the most widely used alternative treatment, showed promising results of regression of malformations, systemic inflammatory response syndrome may be a possible side effect with its use.