Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 2nd International Conference on Neonatology London, UK.

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neonatal@meetingsnexpo.com
neonatal@meetingsnexpo.com
neonatal@meetingsnexpo.com

Scientific Program Day 1

Day :

  • Neonatology,Perinatology,Neonatal Nutrition

Session Introduction

Dr.Peter Averkiou, MD

Charles E. Schmidt College of Medicine at Florida Atlantic University

Title: Early Clinical Exposure in Medical Education: The Newborn Nursery Clinical Experience
Biography:

Dr. Peter Averkiou is a pediatrician and an Associate Professor of Pediatrics at the Charles E. Schmidt College of Medicine at Florida Atlantic University. He is the Co-Director of the four Foundations of Medicine Courses, the Director of the Service Learning Projects, the Director of the Newborn Nursery Clinical Rotation and the Director of the Synthesis and Transition Course at the medical school.

 

Abstract:

The Newborn Nursery Clinical Experience is an innovative, early exposure for medical students to the hospital setting and family medicine. Early in their second year, our medical students are immersed into the Newborn Nursery, while also experiencing the neonatal intensive care unit (NICU) and attending obstetrical deliveries. They witness, first hand, the interprofessional and interdisciplinary workings of pediatricians, obstetricians, neonatologists, anesthesiologists, nurses and other professionals. The medical students are also instructed on how to read a medical chart and on proper medical documentation and its importance. They also interact with the mother of the patient, as well as other family members that are in attendance, and long-term continuity of integrated care and the focus on the personal patient/patient’s guardian(s) - physician relationship is stressed. This experience is always well-received and highly evaluated by our medical students. It also helps to prepare them for their third-year clinical rotations in family medicine, pediatrics and Ob/Gyn.

 

Dr.Marfel Coleen Vergara

National Children’s Hospital, Philippines

Title: A Systematic review and Meta-analysis of Prophylactic Fluconazole for Invasive Candidiasis in Preterm Infants
Biography:

Marfel Coleen P. Vergara is a pediatrician from National Children’s Hospital, Philippines. She received a bachelor’s degree in cell and molecular biology from University of the Philippines, and finished Doctor of Medicine program at St. Luke’s Medical Center College of Medicine in Metro Manila, Philippines. She is currently in the Department of Health, serving a local hospital to help the needs and improve the health and wellbeing of the poor Filipino children.

Abstract:

RATIONALE: Invasive candidiasis is a serious condition that occur more commonly in vulnerable populations, such as in preterm neonates especially those in intensive care units. Antifungal prophylaxis has been suggested to decrease mortality in this vulnerable population, with fluconazole as the drug of choice because of its ability to treat more than 90% of Candida species isolates. OBJECTIVE: To determine the efficacy and safety of fluconazole in preventing invasive candidiasis in preterm infants. METHODOLOGY: Publications were searched through PubMed, Cochrane, HERDIN plus, Google Scholar, ResearchGate, ClinicalTrials.gov, medRxiv, Epistemonikos, WHO International Clinical Trials Registry, and ALIBATA, without language restriction. Randomized controlled trials that compared the effect of prophylactic oral or systemic fluconazole versus placebo in preterm infants, done from January 2000 until present, were included. The methodological quality of the studies were assessed based on the (1) randomization process, (2) deviations from intended interventions, (3) missing outcome data, (4) measurement of the outcome, and (5) selection of the reported result, and a metaanalysis was conducted using STATA. RESULTS: A total of 5 studies were included, with a total of 1084 preterm infants. Prophylactic fluconazole significantly reduced the incidence of invasive candidiasis by 60% (RR=0.40; 95% CI: 0.21, 0.77; p=0.006). The incidence of mortality (RR=0.84; 95% CI: 0.6, 1.2; p=0.324) and necrotizing enterocolitis (RR=0.94; 95% CI: 0.61, 1.44; p=0.770) did not increase among infants give fluconazole prophylaxis as compared to placebo. Fluconazole prophylaxis resulted to a higher mean length of hospital stay versus placebo (SMD=0.16; 95% CI: 0.02, 0.30; p=0.022). Decrease in the incidence of IC also did not depend on the age at first dosage, whether given at 72nd or 120th hour of life (p=0.047, p=0.035), or the dosage used, whether given at 3mg/kg or 6mg/kg (p=0.0043, p=0.0002). CONCLUSION: The use of prophylactic fluconazole decrease invasive fungal infection in preterm infants. While there is no noted increase in mortality and adverse effects, larger clinical trials with longer follow-up periods are still recommended to comprehensively assess the safety profile of fluconazole prophylaxis among preterm infants.

Dr.Niko Miguel Pasatiempo

Government hospital , Philippines

Title: INCIDENCE OF NEONATAL SEPSIS FOLLOWING PROLONGED RUPTURE OF MEMBRANES AMONG PATIENTS ADMITTED AT THE NICU OF JOSE R. REYES MEMORIAL MEDICAL CENTER
Biography:

Dr.Niko Miguel Pasatiempo underwent Pediatrics residency training in a government hospital in The Philippines wherein majority of pediatric patients are indigenous. He is passionate in taking care of well and sick children in hospital setting and mostly in community setting. Currently, he is deployed in a remote rural area of his country, providing medical service to the underserved and disadvantaged children, with regard to their health and welfare services.

 

Abstract:

Neonatal mortality is a global burden and a significant number of neonatal deaths are attributed to early onset sepsis. Prolonged rupture of membranes is an important risk factor for the development of early onset neonatal sepsis (EONS).

This is a prospective cohort study which aimed to identify the incidence of early onset neonatal sepsis following prolonged rupture of membranes among patients admitted at the NICU of Jose R. Reyes Memorial Medical Center.

Results: Out of 105 neonates with maternal history of prolonged rupture of membranes of > 18hours in this study, incidence of neonatal sepsis was reported at 39% with a total of 41 neonates; 3 of them or 7.31% had culture proven sepsis. 64 neonates did not develop clinical signs consistent with sepsis. Majority of neonates in this study were born to term (>37 weeks) pregnancy at 89%, male sex outnumbered females with ratio 2:1, the birth weight of neonates is more than 2500g at 59%, majority were appropriate for gestational age at 83%. Most neonates were delivered via normal spontaneous delivery at 71%. With regards to WBC count, 77.14% belongs to the bracket of 9,000 – 20,000 WBC count with mean WBC count of 15,839. In Neutrophil Count, 61.90% had less than 60,000 with mean neutrophil count of 53,978. In Platelet Count, majority had more than or = 150,000 with 93.33%. Bacterial isolates found in one patient, Staphylococcus epidermidis and two patients with growth of Enterobacter cloace.

Conclusion: Prolonged rupture of membranes was found out to be significantly associated among mothers with history of maternal fever. Also, low birth weight (< 2500g) neonates was found out to be significantly associated with development of sepsis among newborns with prolonged rupture of membranes. Elevated WBC and elevated neutrophil counts were found out to be significant characteristics of neonates with sepsis.

 

Dr.Rina Celestino

University of Santo Tomas Hospital

Title: A Meta-analysis on the Effect of Prone vs Supine Positioning on the Oxygen Saturation of Preterm Neonates with Respiratory Distress
Biography:

Abstract:

Background: Preterm births remains an important public health priority worldwide, with increased risks of neonatal respiratory conditions, which necessitate ventilation support. Body positioning has been used to the maintenance of good lung ventilation by optimizing oxygen transport and gas exchange. However, few studies have determined the effect of body positioning, particularly supine and prone, on the oxygen saturation in preterm neonates.

Objective: to compare the effect of prone vs. supine positioning on the oxygen saturation of preterm neonates with respiratory distress. Design: meta-analysis Results: Five studies were included. The overall mean difference was 0.98 (0.45 to 1.51). This means that patients in prone have overall higher oxygen saturation at 120 minutes than in supine.

Conclusion: Prone positioning increases oxygen saturation among preterm neonates with respiratory distress compared to supine positioning. This simple and non-invasive method can be employed to improve oxygen saturation among preterm neonates in the NICU, especially among mechanically-ventilated neonates, and to help reduce the duration of oxygen therapy.

Dr.Muhammad Rehan Akhtar

United Kingdom

Title: Are The Babies With Congenital Heart Disease Born In The Right Place At The Right Time? – Practices in Yorkshire and Humber.
Biography:

Abstract:

Authors: M R Akhtar (Leadership Fellow Yorkshire and Humber Congenital Heart Disease Network), L Miall (Neonatal Co-Lead for Yorkshire and Humber Congenital Heart Disease Network).
 
Institutions: Leeds Teaching Hospitals, Yorkshire and Humber Congenital Heart Disease Network.
 
Background: 
Advances in prenatal screening have enabled earlier identification of congenital heart disease (CHD). This enables planned deliveries at hospitals with specialized cardiac and neonatal care, improving neurodevelopmental outcomes in neonates. In October 2021, the Yorkshire and Humber Congenital Heart Disease Network developed a guideline aimed at providing guidance on the timing and location of delivery for babies with antenatal diagnosis of CHD. We aimed to assess compliance with the guideline and evaluate the extent of improvement in delivery practices that have been implemented in accordance with the guideline.
 
Methods: 
We conducted a retrospective audit analyzing data for infants born between May 2021 and April 2022, specifically examining a period of 6 months before and 6 months after the guideline publication. 
This review was carried out in the cardiac centre using electronic patient records (PPM+ and Badger Net) and the local data provided by regional paediatricians with expertise in cardiology. 
 
Results:
There were 166 live births of babies with CHD in the region during the study period.
 
Before the guideline: 
- Cardiac Centre: median gestational age was 38+2 (30+6 – 40+0). 
- Local: median gestational age was 38+0 (32+4 – 41+0). 
- 8% of babies were delivered outside their planned delivery destination. 
- All planned palliative care was achieved in local hospitals. 
 
After the guideline: 
- Cardiac Centre: median gestational age was 38+3 (27+0 – 40+1). 
- Local: median gestational age was 38+1 (26+5 – 40+4). 
- 5% of babies were delivered off-pathway. 
- 80% of planned palliation was achieved locally.
 
Conclusion:
There was a 1-day increase in median gestational age at birth across the region and a slight improvement in the number of babies born off-pathway following the guideline. Obstetric emergencies and parental wishes were drivers of off-pathway deliveries. Good communication between professionals and institutions, parental counselling and reassurance could improve off-pathway deliveries. 
 

Dr.Muhammad ali

United Kingdom

Title: An usual case of vomiting in a premature baby
Biography:

Abstract:

Background:
We are reporting a case of pyloric stenosis in an extremely preterm male baby of 27 weeks gestation, discovered in the 7th week of life. To our knowledge, pyloric stenosis has not been reported previously in a preterm baby of 27 weeks of gestation or less.
The presentation of pyloric stenosis in preterm babies is atypical and diagnosis is often delayed. 
 
Case Presentation:
A male baby was born via vaginal delivery at 27 weeks. He had smooth neonatal journey requiring respiratory support.
 
His feeds were commenced and built up with preterm formula according to local guidelines. He reached full feeds on day 10. 
 
On day 13, he showed signs of feed intolerance with vomiting and distended abdomen. He was treated for suspected sepsis and septic ileus. 
 
On day 44 (33+1 CGA), he developed persistent vomiting. Several management strategies were tried including nasogastric tube replacement, gravity feeding and decreasing feed volume.
He continued to be clinically well with normal abdominal examination.
 
On day 45, he was placed NBM and treated for possible NEC. 
His blood gas at that time showed pH 7.4, CO2 8.7, HCO3 36.6, BE 16.3,Na 138 , K 3.2 ,Cl 92
 
Investigations:
His D45 plain Abdominal film showed non-specific bowel gas pattern, dilated stomach bubble but no signs of NEC (Fig:1) and  abdominal ultrasound showed appearances in keeping with pyloric stenosis. The pyloric muscle was thickened with pyloric length of 1.9 cm muscle thickness of 4 mm (Fig:2). 
 
Treatment:
He underwent pyloromyotomy and recovered fully afterwards.
 
Discussion:
 
The blood gas did show the textbook hypokalaemic hypochloraemic metabolic alkalosis although more subtly than usually described.
• Pyloric stenosis should remain a differential diagnosis in preterm neonates with persistent vomiting and feed intolerance.
• A contrast study may be needed in order to confirm diagnosis if ultrasound findings remain inconclusive
 

Dr.Quratulain Aslam

United kingdom

Title: NECTAR Project: an initiative to maintain normothermia for the preterm infant in a tertiary care centre in UK.
Biography:

I am Quratulain Aslam. I have expertise in Paediatrics and neonates. I am an international doctor and currently working in one of the biggest neonatal unit in the United Kingdom. We aim to provide the best care to babies born in our unit and keep on taking steps aiming to provide quality care to the babies.

 

Abstract:

Background:
Normothermia (36.5°C to 37.5°C) is vital in neonatal resuscitation. Admission temperatures in preemies inversely correlate with mortality, every 1°C drop below the range increases mortality by 28%1. It also increases the risk of sepsis, intraventricular hemorrhage, hypoglycemia, Necrotizing enterocolitis  and death.2,4,5
 
Aim & Objectives:
To improve normothermia rates in preterm admissions <32 weeks promoting better outcomes.
 
Methods:
The project commenced in 2019 with planned 6 monthly cycles coinciding with the rotation of junior doctors. Focusing on pre-birth, birth and post-birth areas, interventions were put in place to optimize preterm stabilisation.
 
Results:
Audit cycles demonstrated inconsistencies in using thermoregulation procedures, variations in the timing of temperature checks from the delivery suite to the neonatal unit and suboptimal delivery room temperatures. A thermoregulation flowchart was devised and an education initiative with bedside training was rolled out. Timing of temperature check was standardised and steps to establish normothermia before mobilising the baby to the neonatal unit were put in place.
To achieve the best results, a multidisciplinary approach was adopted in subsequent cycles. The training was more robust with posters, and e-learning packages including videos. Representatives from midwifery, neonatal medical and nursing were appointed to tackle issues from pre-birth, during birth and post-birth angles. Debrief forms were used to recognise and solve the hurdles in real-time.
Significant improvements were reflected in various areas of this project. Regular meetings between the multidisciplinary champions ensured that progress was maintained. We introduced continuous temperature monitoring probes with teaching packages to further optimise thermoregulation rates.
 
Conclusion:
The project showed significant improvement in the overall normothermia rates in preterm stabilisation reflecting the importance of a multi-disciplinary approach and robust interventions.