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NMC Royal Hospital DIP, UAE
Brankica Vasiljevic is the Head of Maternity and Child Health Services in NMC Royal Hospital DIP in Dubai, UAE. After completing her MD, she had completed her clinical postgraduate education (Pediatric and after that Neonatology fellowship) and academic postgraduate education (MSc in Pediatric and Ultrasonography field and PhD in Neonatology field) at Belgrade University School of Medicine in Belgrade, Serbia. She also completed Safety, Quality, Informatics and Leadership Program at Harvard Medical School in Boston, USA. She had won the ESPNIC Educational Grant at 5th World Congress on Pediatric Intensive & Critical Care in Geneva Switzerland (2007). She was a local coordinator for International Neonatal Immunotherapy Study-INIS for Serbia and Montenegro and participated in SIOP 93-01 Study, ITP Study and Twin Birth Study. She has published more than 35 international publications in international indexed journals (100 citations), 5 chapters in various fields of neonatal medicine and has more than 30 presentations in international conferences. She is a Member of Editorial Board of different international journals.
Introduction: Kangaroo Care (KC) or Kangaroo Mother Care (KMC) was introduced more than 25 years ago in Bogota, Colombia, as an alternative to conventional Neonatal Intensive Care Unit (NICU) care for low-birthweight infants in resourcelimited settings. In developing countries, KC for low-birthweight infants has been shown to reduce mortality, severe illness, infection and length of hospital stay. Practice of skin-to-skin contact between the preterm infant and parent KC has been adopted in many NICUs, initially as a means of promoting maternal-infant bonding and breastfeeding. KC is most often offered for stable preterm infants who are 30 weeks’ gestational age at birth, but nowadays KC is offered also to infants on ventilator and extreme preterm infant 26 weeks’ gestational age at birth.
Aim: To examine first the literature and guidelines for KC in very premature infants (<32 weeks) in NICU and after that application and barriers of KC in our NICU.
Result: KC in preterm and sick infants in NICU has benefit in physiological stability (thermoregulation, cardiorespiratory) stability, behavioral (sleep, breastfeeding duration and degree of exclusivity) domains, better nutrition, earlier discharge from hospital and increase parental satisfaction. Barriers to implementation of KC include lack of staff and time, poor knowledge and inadequate training staff and parents, medical concerns including the unstable clinical condition of the newborn or mother, lack of privacy and parental reluctance.
Conclusion: KC facilitates bonding and may improve infant nutrition and neurodevelopment and reduced neonatal morbidity and mortality and decrease length of hospital stay and should therefore be encouraged in clinical practice. Identification of barriers to implementation KC is an important step in the successful implementation.
Saint Mary’s Hospital, UK
Anupam Gupta is a Consultant Neonatologist at Saint Mary’s Hospital, Manchester UK. He have trained and worked in world famous and prestigious pediatric and neonatal centres in India and UK and developed an expertise in neonatal ventilation and research. He was awarded his PhD by Durham University and he has carried out award winning projects and presented in prestigious international conferences like PAS, EAPS, ESPID, UENPS and helped to organize neonatal conferences here in the UK.
Introduction: Preterm infants often require mechanical ventilation. Volume targeted ventilation has been shown to reduce both complications and the duration of mechanical ventilation. Recommended tidal volume varies from 4-8 mL/kg, but the optimal tidal volume remains elusive.
Aim: To compare a lower (4-5 mL/kg) to a higher (7-8 mL/kg) tidal volume during Volume Guarantee ventilation (VG) of Respiratory Distress Syndrome (RDS) in very preterm infants.
Method: The randomized trial was conducted at North Tees Hospital from 2013-2016. Babies <32 weeks’ gestation or <1500 grams birthweight and requiring mechanical ventilation within 12 hours of life from RDS were included in the study. Babies were randomized to receive lower (4-5 mL/kg) or higher (7-8 mL/kg) tidal volume using VG. The dead space was kept consistent by using standardized trimming of the ET tube. Subjects all received surfactant and were managed by a strict protocol with rescue by high frequency ventilation for defined criteria. The primary outcome was the time to achieve a 25% reduction from the initial Peak Inspiratory Pressure (PIP). Secondary outcomes included the duration of mechanical ventilation, as well as respiratory and nonrespiratory complications. The data were analyzed using SPSS® version 20.0.
Result: During the study period, 70 of 97 (72%) eligible infants were enrolled. The groups were similar (Table 1). The primary outcome, time to reduce PIP (median [IQR]) were 13.6 (8.8-25.2) hours and 17.4 (7.7-27.8) hours, respectively, for higher and lower Vt (p=0.678). The total duration of ventilation (median [IQR]) on higher vs. lower tidal volume was 33.3 (22-368.8) and 61.8 (15.4-177.5) hours, respectively (p=0.959). There were no differences between the two groups for respiratory and non-respiratory complications of prematurity (Table 2).
Conclusion: This study failed to find differences in lower versus higher tidal volume delivery in a small population of infants with RDS. It is possible that both tidal volume ranges selected for study are at functional residual capacity.
Sheikh Khalifa Medical City, UAE
Keynote: Lung ultrasound in pediatrics
Nasser Ezzat Elshahat Mohamed has almost 30 years of experience as Neonatologist and Pediatric intensivist. He has graduated with MBBCh in 1989 from Zagazig University, Faculty of Medicine Egypt. He has obtained his Master’s degree of Pediatrics in 1994, Egypt then was moved to work in Kuwait where he spent 20 years working between NICU and PICU, Mubark Al-Kabeer University Hospital. In 2015, he joined Sheikh Khalifa Medical City, PICU managed by Cleveland Clinic in Abu Dhabi as Pediatric Intensivist. He has completed MRCPCH degree in UK and now having Membership of Royal College of Pediatric and Child Health from 2016. He is currently a Senior Consultant of Pediatrics in Egypt.
Ultrasound techniques have been developed since the past century and are becoming more useful in different areas of medical knowledge. More recently, lung ultrasound gained importance throughout artefact analysis to help clinical evaluation at bedside and became subject of interest in the pediatric intensive care and emergency department settings for both procedural and diagnostic purposes. The normal pattern of lung ultrasound is defined by the presence of lung sliding associated with A-lines whereas B-lines may be representative of pathology findings. This review focuses on some of the most common pulmonary conditions, their respective sonographic features and clinical implications in the emergency department and pediatric intensive care unit. There have been a number of recent advancements in the field of point-of-care ultrasound, including lung ultrasound for pediatric populations. Evidence-based guidelines on the use of point-of-care lung ultrasound have been published. Lung ultrasound is superior to chest radiography in diagnosing several disorders. Before performing lung ultrasound, it is important to note that the position of the patient could affect the findings, as air increases and liquid sinks under the influence of gravity, lung ultrasound is usually performed with the patient in the supine position. While lung consolidation or pleural effusion is predominantly found in dependent and dorsal lung regions, pneumothorax is primarily found in the anterior chest.
- We aim to review the application of lung ultrasound in bedside clinical medicine and introduce it as an adjunct to the stethoscope in physical examination.
- We review the basic points required to introduce lung ultrasound to physicians.
- We also aim to review the utility and application of lung ultrasound in pleural and parenchymal lung pathologies and also cover the use of ultrasound in thoracic procedures.
- To identify lung US artifacts in normal and abnormal thoracic examination
- To review and evaluate pneumothorax.