Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 5th International Conference on Pediatrics and Pediatric Surgery Rome, Italy.

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Scientific Program Day 1

Day :

  • Special Session on Pediatric Traumatology
Location: Olimpica 3+4

Session Introduction

Martin Kaiser

BG Hospital Bergmannstrost, Germany

Title: Age-related strategies in Pediatric Traumatology
Speaker
Biography:

Martin M Kaiser is the Clinic Director at University Medicine and Chief Physician for Child Traumatology at Bergmannstrost, Halle, Germany. Before moving to Halle, he was Senior Physician and Deputy Head of the Pediatric Surgery Clinic at the University Medical Center Schleswig-Holstein in Lübeck. He received his license to practice medicine in 1993. In 2002 he passed the specialist examination and habilitated in 2010. Since 2015 he has been an Associate Professor of Pediatric Surgery in Lübeck.

Abstract:

Dealing with Pediatric Traumatology we must care for many special things in the growing child.
First, physes with different potential concerning length-growth act as "good cops" while correcting misalignments specially in children below the age of 10 through remodelling. This positive corrective ability can often be used in conservative treatment. On the other hand they can cause serious trouble ("bad cops") with partial or total arrest leading to deviation of axis or length-discrepancy.
 
Both complications can be caused either by the lesion itself of iatrogenic by false treatment. Further on, the plasticity of bony structures creates leads to different fracture types comparted to the adult. Missing knowledge of the so-called bone centers – especially in the elbow-joint region can end up in false diagnosis. Last, but not least we treat not only different fracture types between birth and 16. Birthday and we must respect the wishes and the mentality of each child and adolescent.As many examples would clarify these topics, in this keynote speech five different locations will be discussed in detail:
 
Clavicular shaft fractures: Clear Indication for preferred ESIN-Osteosynthesis are rare cases of
bilateral fracture, open fracture and neurological damage. In adolescents we offer ESIN-Osteosynthesis with serious dislocation of the fracture and desire for immediate mobilization.
 
Proximal humeral fractures: Osteosynthesis is indicated in open fracture, neurologic lesions or complete dislocation beyond the age of 10-12 years. For adolescents we see an advantage in ESINOsteosynthesis (no K-wires) with deviation >20°and desire for immediate mobilization.
 
Femoral shaft Fractures: Below the age of three these fractures are treated in a cast, older children are provided with a 3-nail-modification of the classical 2-C-shaped ESIN osteosynthesis, while we implant a lateral femur nail in adolescents with open physes.
 
Lesions of the cruciate ligaments: In children <10 years dislocations of the eminentia intercondylaris, can often be treated conservatively, in other cases, arthroscopic or open reduction and fixation with screws or transosseal sutures is recommended. True ligamentous injuries (mostly the ACL) need a replacement with hamstring grafts.
 
Fractures of the distal Tibia: Irregularities of the joint-surface need reduction and then are preferably stabilized with screws; lesions of the open physes must be treated with special attempt to reduce the risk of partial or total growth arrest.
 
Conclusion:
 
Pediatric Traumatology is the small, but fine art to treat injuries of children and adolescents according to localisation, severity of injury and displacement, biological age and the individual desire and character of our little patients with most possible success.

  • Pediatric Psychology
Location: Olimpica 3+4

Session Introduction

Anne-Frédérique Naviaux

Summerhill Mental Health Centre, Ireland

Title: Triage of children with mental health difficulties presenting in A&E in a general hospital
Speaker
Biography:

Anne-Frédérique Naviaux is a Consultant Psychiatrist and Child Psychiatrist, who finished her Master in Psychiatry in 2004 (Universite Catholique de Louvain, Belgium). She worked in France as a ‘praticien hospitalier’ in Child Psychiatry and for the World Health Organization, before joining the Research Department in Trinity College (Dublin, Ireland) in 2011. She has been a Lecturer in France (IFSI) since 2004 but has also joined the College of Psychiatrists of Ireland in 2012. She currently works for the Health Service Executive in Ireland as Head of Service in Summerhill Adult Mental Health Centre (Wexford) and as Clinical Lead for Liaison Psychiatry in Wexford General Hospital (WGH). Since 2016, she has been developing in collaboration with the Paediatric Team in WGH and University Hospital Waterford, an out of hours emergency service for young people with Mental Health Issues.

Abstract:

In Wexford and Waterford, an “out of hours” child psychiatric service has been developed, in order to provide help when the CAMHS services are not accessible. Providing a service for under 18 years old patients with mental health issues presenting in Accident and Emergency (A&E) or hospitalised on a Ward (Paediatric, psychiatric or other), it functions with extremely limited resources (a consultant psychiatrist and a doctor in psychiatric training) and therefore needs an efficient triage procedure. Several triage tools were internationally developed for dealing with emergencies; the difficulty was to find a triage tool that would be specific enough for a paediatric population but that would also be useful for patients with Mental Health issues. The purpose of this article is to review existing triage tools, and especially the 2016 Irish Children’s Triage System (ICTS) and to discuss how we believe this triage tool could respond to our specific needs in this new ‘out of hours’ CAMHS cover for Waterford /Wexford area.

  • Pediatric Surgery
Location: Olimpica 3+4

Session Introduction

D Dean Potter Jr

Mayo Clinic College of Medicine, USA

Title: Familial adenomatous polyposis syndrome in children: Evidence based screening program and intervention
Speaker
Biography:

D Dean Potter Jr completed his MD at the University of Iowa College of Medicine. His General Surgery training was completed at Mayo Clinic Rochester, followed by a Pediatric Surgery Fellowship at the University of Colorado Denver College of Medicine. He is the Chair of Pediatric Surgery at the Mayo Clinic Rochester. He has published 48 papers in peer reviewed journals and has given many presentations both internationally and in the United States.

Abstract:

Familial adenomatous polyposis (FAP) is an autosomal dominant polyposis syndrome classically characterized by mutation in the APC gene on the long arm of chromosome 5. These mutations results in hundreds to thousands of adenomatous polyps in the colon and rectum early in life. Progression to colorectal cancer occurs by age 40-50 with rare malignancy occurring in teenagers. Thus screening protocols have been developed to reduce the risk of colorectal and other associated malignancy in these people. Review of our history with children with FAP revealed approximately 30% of children had extraintestinal manifestations including papillary thyroid cancer and hepatoblastoma. The mean age of polyp detection was 12 years; however, 37% of our patients were younger than 10 years of age when polyps were discovered. Thus we have recommended beginning screening at 7 years of age or at same age of other family members if polyps detected younger than 7 years of age. Once polyp burden is >30 or if symptoms develop, consideration for total proctocolectomy with ileal pouch anal anastomosis (IPAA) is advised. Our data shows that the mean age at IPAA is 15 years of age. Older children tend to undergo 2 stage procedures versus younger children tend to have more 1 stage procedures. Early postoperative complications occurred in 20% of patients with 10% requiring a reoperation. 20% of patients developed polyps in the rectal cuff, thus continued monitoring even after IPAA is indicated. 99% of patients has a functioning IPAA at the time of last follow up. Thus we advocate for early, routine screening for polyps in children with FAP. Once the polyp burden is high, then IPAA is the procedure of choice. Ongoing screening is required for recurrence of rectal and duodenal polyps, in addition to thyroid nodules.

Hissa Mohammed

Aberdeen University, Qatar

Title: Radiological procedures for pediatric patients with down syndrome
Biography:

Hissa Mohammed has completed her master’s degree in medical imaging at the age of 33 years from Aberdeen University. She is the Radiology supervisor in Communicable disease Centre, member of HMC. She has published 1 paper in online OMICS Journal of Radiology and member of Quality team in CDC.

Abstract:

Introduction:

Down syndrome is a condition of the chromosomes that is caused when an error occurs during cell division creating an extra chromosome 21 (Gardiner et al., 2010). People with Down syndrome especially pediatric patients may develop several health conditions that may require to be diagnosed through imaging (Bull, 2011).

Purpose:

This research was used to identify environmentally friendly methods for pediatric patients with Down syndrome. These methods are aimed at reducing the radiation dose for a patient during a radiological procedure. Additionally, the methods should be able to provide the best quality images to improve diagnosis and hasten recovery.

Method:

We used the PRISMA guidelines to perform a systematic review of the current literature obtained from various databases. We searched for several articles and found a total of 51 articles related to environmentally friendly radiological procedures. Out of the 51 articles, 17 were analyzed in detail.

Result:

Caring for pediatric patients with Down syndrome requires environmentally friendly methods to improve the quality of care. Patients may not respond well to high dosages of radiation because they sometimes cause irritations. Both patients and clinicians need improved image quality of the radiological procedures to make the diagnosis of the condition easier and hasten the process of recovery.

Conclusion:

Methods that create a friendly environment for pediatric patients with Down Syndrome during radiological procedures such as CT scans and X-rays are important in the diagnosis of disease. High radiation dosages may not suit patients sometimes thus affecting the quality of care. Improving image quality is also important in the diagnosis and management of the condition.

Chhaya Akshay Divecha

National University of Science and Technology, Oman

Title: An observational analytical study of causes, severity, risk factors and outcome of thrombocytopenia in a pediatric intensive care unit
Biography:

Chhaya Akshay Divecha has completed her Undergraduate as well as postgraduate (MD Pediatrics) from the reputed Seth G.S. Medical College & KEM Hospital at Mumbai , India.She has also obtained fellowships in Neonatal Intensive Care and Pediatric Intensive Care from the same reputed institution. She is currently Assistant Professor in Pediatrics at College of Medicine, National University of Science and Technology (formerly Oman Medical College) at Sohar, Sultanate of Oman. She has more than 10 years of teaching experience and has published many papers in reputed journals as well as contributed to chapters in four textbooks.

Abstract:

Aims and objectives:

Thrombocytopenia, commonly encountered in intensive care units, has been shown to be independent predictor of mortality and prolonged hospital stay in critically ill. We conducted a study in Pediatric Intensive Care Unit(PICU) to determine the causes and severity of thrombocytopenia as well as patient outcomes (bleeding and mortality).

Materials and methods:

Observational study was conducted in PICU of tertiary care hospital, India after ethics committee approval. Data was derived from routine examinations and investigations. Detailed information about demographic data, clinical data, length of stay (LOS), periodic platelet counts, primary diagnosis, complications, sites of bleeding (if any), use of mechanical ventilation and outcome in PICU were noted.

Results:

Occurrence of thrombocytopenia in study population (N= 491) was 60.3%. Mild, moderate, severe and very severe thrombocytopenia was seen in 27%, 32.1%, 34.1% and 6.8% patients respectively. Causes of thrombocytopenia were sepsis (27%), part of primary illness (25.7%), undetermined cause (24.7%), nosocomial sepsis (21.2%) and drugs (1.4%). 237 (48.3%) patients had bleeding during PICU stay. Maximum patients (26.1%) had respiratory system involvement. Risk factors associated with thrombocytopenia were sepsis, shock and mechanical ventilation. Patients with thrombocytopenia had longer PICU and hospital stay. Patients with infectious disease and haematological disorders had statistically significant chances of thrombocytopenia. Shock was significantly associated with increasing severity of thrombocytopenia. Presence of thrombocytopenia and increasing severity were associated with higher mortality.

Conclusion:

Thrombocytopenia is a readily available risk marker of mortality and increased PICU stay. Patients having sepsis, shock and mechanical ventilation are at higher risk of developing thrombocytopenia.

Ria Marwaha

University of Manchester Medical School, London

Title: An audit of overweight and obese children admitted for surgery: Implications for paracetamol overdose
Biography:

Ria Marwaha has completed 4 years at medical school. Currently is enrolled in a year long medical intercalation in “Urgent and Emergency Care” based at the UCLh A&E department in London.

Abstract:

Introduction:

Childhood obesity has been established as one of the most detrimental public health concerns with its prevalence increasing at an alarming rate. Addressing the risks overweight individuals face prior to surgery must be taken into consideration, such as the possibility of being administered the incorrect dosage of paracetamol medication, leading to a susceptibility to analgesic-induced toxicity The aims of this audit include:

1) To identify the prevalence of overweight and obese children admitted for elective surgery at our institution

2) The incidence of intravenous paracetamol administered according to actual body weight in overweight children.

Results include that the average paracetamol dose over prescribed was 130 mg.

Conclusion:  The audit revealed that despite the high prevalence childhood obesity children 2-16 years old, less than a 3rd of the overweight and obese children were identified. Auditing children presented to the paediatric surgical department has identified the prevalence of childhood obesity. Secondly, it has been understood that there is a misconception into how to dose overweight children with paracetamol as well as there being a lack of understanding into the susceptibility of overweight children are to being overdosed.

Vivien Marie P. Abitong

Ilocos Training and Regional Medical Center, Philippines

Title: Solid pseudopapillary neoplasm of the pancreas in a fourteen-year-old: A case report
Biography:

Vivien Marie P. Abitong has completed his Doctor of Medicine degree at the age of 25 years from the University of Northern Philippines in Vigan City, Ilocos Sur, Philippines. She is currently a 3rd year surgical resident in Ilocos Training and Regional Medical Center in San Fernando, La Union, Philippines.

Abstract:

Solid pseudopapillary neoplasm of the pancreas is a rare but disparate neoplasm previously thought of as a non-functioning islet cell carcinoma comprising about 0.13 to 2.7% of all pancreatic tumors, primarily affecting women aged twenty to thirty. Presenting features are non-specific. Its natural course is not yet fully established due to the limited studies and the indolent course of these tumors. Our case is that of a fourteen-year-old female who was admitted due to chronic abdominal pain for two months.

Ultrasonography and computed tomography showed a well-circumscribed mixed-density cystic mass within the pancreatic caput and neck. She underwent pancreaticoduodenectomy where reconstruction was done by doing a pancreatojejunostomy, cholecystojejunostomy and pyloric-sparing gastrojejunostomy. Post-operative course was unremarkable with a Clavein-Dindo Classification grade of I. She followed up four months after the procedure and was doing well. No recurrence of tumor was noted on repeat ultrasound and tomography. Histopathology report confirmed the diagnosis of solid pseudopapillary neoplasm.

Solid pseudopapillary neoplasm of the pancreas is a rare neoplasm with an excellent long-term prognosis after surgical resection. A high index of suspicion is warranted in any patient presenting with abdominal pain non-responsive to pain medications especially in females under 35 years of age. Correct preoperative diagnosis of the tumor is crucial to minimize the range of surgical ablation compared to that required for pancreatic malignancy. Surgical resection is curative with more than 95% and 100% 5-year and 10-year survival rate, respectively.

Claire Gerall

Columbia University Irving Medical Center,USA

Title: High rate ventilation as a primary rescue strategy for patients with congenital diaphragmatic hernia: a comparison to high frequency oscillatory ventilation
Biography:

Claire Gerall completed her MD at University of Texas Health at San Antonio (UTHSA) and began her general surgery residency at UTHSA as well.  Now in her fourth year of training, Claire is currently a pediatric ECMO fellow at Children’s Hospital of New York and a pediatric surgery research fellow at Columbia University College of Physicians and Surgeons.  She currently does both clinical and basic science research with focuses in congenital anomalies, prenatal interventions and pediatric oncology.

Abstract:

High frequency oscillatory ventilation (HFOV) is a common rescue strategy for patients with congenital diaphragmatic hernia (CDH).  Although shown to increase survival, HFOV can also hinder care when transport is necessary.  The purpose of this study is to establish non-inferiority of high rate ventilation (HRV) as a rescue strategy in critically ill CDH patients.  We conducted a retrospective review of patients diagnosed with CDH and treated at Children's Hospital of New York (CHONY) from 2005 until present.  Patients who utilized neither or both HRV and HFOV were excluded.  Potential confounding variables included lung to head ratio, hernia laterality, type of repair, genetic syndrome, gestational age, gender and birth weight.  

The primary outcome was survival with secondary outcomes including need for extracorporeal membrane oxygenation (ECMO), length of stay (LOS), need for nitric oxide (iNO), rate of bronchopulmonary dysplasia (BPD), and age at repair.  With single variable analysis comparing HRV to HFOV, median age at repair was lower (4 days vs 7 days, p<0.001), odds of needing ECMO were 4.35 times less (p=0.01), odds of death were 7.6 times less (p<0.001) and odds of needing iNO were 3.8 times less (p=0.01).

With multiple variable analysis, the odds of needing iNO were 6 times less with HRV compared to HFOV (p=0.008) and the odds of death were 4.22 times less with HRV compared to HFOV, although ths finding was not significant.  All other outcomes showed no significant difference however trends for each variable show improved outcomes in patients treated with HRV compared to HFOV.  Within our population, HRV has comparable outcomes to the more widely accepted rescue strategy of HFOV.  This supports the use of HRV as a primary rescue strategy, allowing for increased ability for transport and potentially improved outcomes in these critically ill patients.