Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 15th International Conference On Pediatrics and Pediatric Cardiology Paris, France(Holiday Inn Paris – Marne La Vallée Noisy-le-grand).

Day 1 :

Keynote Forum

Luca Brunelli

University of Nebraska Medical Center and Children’s Hospital & Medical Center, USA

Keynote: 14-3-3epsilon Controls Multiple Developmental Processes in the Mouse Heart

Time : 10:00-10:45

Pediatric Cardiologists 2018 International Conference Keynote Speaker Luca Brunelli photo
Biography:

Dr. Luca Brunelli, MD, PhD has completed his MD at the University of Genoa Medical School at the age of 25 years and his PhD at the University of Turin at the age of 39. He is an Associate Professor of Pediatrics, and Genetics, Cell Biology and Anatomy at the University of Nebraska Medical Center, and the Division Chief of Neonatology at the University of Nebraska Medical Center and Children’s Hospital & Medical Center in Omaha, Nebraska. He has published more than 20 papers in reputed journals, including Circulation Research, Molecular and Cellualr Biology, and Nature Methods.          

Abstract:

14-3-3ε plays an important role in the maturation of the compact ventricular myocardium by modulating the cardiomyocyte cell cycle via p27kip1. However, additional cardiac defects are possible given the ubiquitous expression pattern of this protein. Germ line deletion of 14-3-3ε led to malalignment of both the outflow tract (OFT) and atrioventricular (AV) cushions, with resulting tricuspid stenosis and atresia, mitral valve abnormalities, and perimembranous ventricular septal defects (VSDs). We confirmed myocardial non-compaction and detected a spongy septum with muscular VSDs and blebbing of the epicardium. These defects were associated with abnormal patterning of p27kip1 expression in the subendocardial and possibly the epicardial cell populations. In addition to abnormal pharyngeal arch artery patterning, we found deep endocardial recesses and paucity of intramyocardial coronary vasculature as a result of defective coronary plexus remodeling. The malalignment of both endocardial cushions provides a new explanation for tricuspid and mitral valve defects, while myocardial non-compaction provides the basis for the abnormal coronary vasculature patterning. These abnormalities might arise from p27kip1 dysregulation and a resulting defect in epithelial-to-mesenchymal transformation. These data suggest that 14-3-3ε, in addition to left ventricular non-compaction, might be linked to different forms of congenital heart disease

Keynote Forum

Megan L Ringle

Stanford University School of Medicine, USA

Keynote: Functional, quality of life, and neurodevelopmental outcomes after congenital cardiac surgery

Time : 11:00-11:45

Pediatric Cardiologists 2018 International Conference Keynote Speaker Megan L Ringle photo
Biography:

Megan L Ringle received her medical training at St. George’s University School of Medicine and completed her Pediatric Residency at Miami Children’s Hospital in Miami Florida. She is currently a neonatal- perinatal fellow at Lucile Packard Children’s Hospital, Stanford University School of Medicine. Her clinical interests include the ICU care of newborns with critical congenital heart disease and the neurodevelopmental outcomes and follow up of premature infants and neonates with congenital heart disease.

Abstract:

Throughout the past few decades, advances in cardiology, neonatal intensive care, and surgical techniques have resulted in a growing cohort of thriving school-aged children with previously lethal complex congenital heart diseases. While survival has increased, there remains significant morbidity following repair including neurodevelopmental sequelae. Compared to children with a structurally normal heart, these infants and children have a higher frequency of abnormalities in tone, feeding, and delayed developmental milestones, as well as challenges with speech and learning disabilities, while a higher proportion of adolescents suffer from problems with processing speed, executive function, and a unique set of medical hardships related to exercise intolerance and obesity, medication burden, and mental health comorbidities. Innovative perioperative techniques and early psychosocial intervention in these young survivors has shown that despite the obstacles, the majority of these children can grow to have fulfilling lives with intelligence and social skills in the normal range. Additionally, a comprehensive medical home aids in optimizing the quality of life for these children and their families.

  • Special Session
Speaker
Biography:

Jean AMIRAL, PhD, has been working for 40 years in the coagulation area, first as scientific director of Diagnostica Stago (until 1998), then as the founder of HYPHEN BioMed and its scientific and research director (until 2012), and is now scientific and technical consultant for HYPHEN BioMed and Sysmex. He developed many assays for hemostasis and thrombosis, and participate to many studies. He discovered PF4, when complexed with heparin, as the target for heparin induced antibodies.

Abstract:

Prophylaxis of Hemophilia, identified early in life, is becoming an important requirement from affected patients and society, in all countries demanding treatments for managing hemorrhages. Such a therapeutic modality highly improves hemophiliacs’ quality of life, through a dramatic reduction of severe bleeding events and disease burdens. Availability of recombinant proteins has introduced an abundant offer of therapeutic products, and overwhelms limitations of blood extracted products. The recent introduction of long-acting products reduces the frequency and constraints of prophylaxis therapy, but there is an important cost for public health, and individual monitoring of drug kinetics in treated patients allows optimizing the associated costs, as conventional clotting assays are APTT based methods, prerequisite FVIII or FIX deficient. New recombinant and long-acting products (Glyco-pegylated, Fc or Human Albumin fusion proteins) can present huge differences with the different APTT reagents, and drug-specific calibrators can be needed. Availability of multiple drugs, which present different behaviors in the assays, renders APTT based clotting assays inappropriate for monitoring drug kinetics in treated patients. Chromogenic assays are now available for overcoming these inconveniences: all blood extracted, recombinant, or long-acting products generate the same dose-response curves for a same product potency. We have experience with Biophen™ Factor VIII and Biophen™ Factor IX chromogenic assays, which can be calibrated using plasma calibrators with assigned FVIII or FIX concentrations, and can be used for all drugs. Dynamic ranges cover all concentrations from < 10% to > 200% FVIII or FIX activity, and low range protocols are available for concentrations down to 0.1%. Assays are automatable on all coagulation platforms, and can be used with the micro-Elisa plate format for high throughput testing. Multicentric studies have demonstrated the robustness of these chromogenic assays, with good reproducibility and accuracy, and high reliability between centers. These assays are now widely used for the various FVIII or FIX drug potency value assignment in pharmaceutic industry. Internal standards are available. They are established against the WHO International Standards, for FVIII or FIX concentrates, and they are prepared and supplied by NIBSC (Potters Bar, UK).

  • Pediatric Congenital Heart Disease |Pediatric Heart Murmurs |Fetal Cardiology |Pediatric Pericarditis

Session Introduction

Jerard Segatchian

International Consultancy in Blood Components Quality/Safety Improvement & DDR Strategies AJDIT/Inspection, London, UK

Title: GLOBAL REFLECTIONS ON IMPACT OF NEWER DDR STRATEGIES ON PEDIATRIC TRANSFUSION: Where we were, where are we now, and where are we going!

Time : 13:30-14:00

Speaker
Biography:

Jerard Seghatchian the senior longstanding editor of Transfusion Apheresis Science [TRASCI] and international consultant in transfusion and transplant. . He is presently a senior member of both Best Collaborative and ISTH. He has published more than 390 papers in peer reviewed reputable journals and coedited 5 books in various quality and safety transfusion aspects. He has been serving as an editorial board member TRASCI and section senior editor of the journal.

Abstract:

This commentary encompasses, as a preamble, the current views on the laboratory and clinical aspects of pediatric transfusion, cellular therapy and apheresis emergencies, all appearing as theme in TRASCI , appering in April 2018{1}.

In brief, the key areas of this presentation embody: firstly, the newer insights into pediatric apheresis including, hematopoietic progenitor stem cell collection, challenging dynamics of progenitor cell recruitment, individual adaptation of procedural parameters and vigilant evaluation of risk factors/adverse effects: secondly, the essentials in pediatric transfusion with innovative DDR questions in screening, manufacturing processes/procedures, quality assurance, and opportunities for standardization of personalized clinical practices.

IN RESPECT TO WHERE WE WERE AND WHERE ARE NOW:

One of the most important challenges in transfusion practice is to provide factual reflections and evidence-based recommendations on pediatric transfusion, a highly complex area of transfusion science and medicine, covering a broad range of patients from intrauterine life to young adults. In clinical pediatric practice an effective transfusion embodies enormous opportunities & challenges at all levels; for laboratories to be upgraded continuously with validated newer and safer technologies; for suppliers to produce the safest and highly specialized components; for physicians to select applicable components or alternatives while balancing the risks and benefits. A high quality research and development strategies are still needed on which the guidelines should be based.

IN RESPECT TO WHERE WE ARE GOING!

Continual efforts are directed in developing many innovative approaches to this multidisciplinary field by key opinion holders to provide a collective platform for TRASCI readers in line with our future plan (1). This is of particular relevance to current situation as we are witnessing the newer products/processes being introduced to the pediatric fields. 

Speaker
Biography:

Elie Ghoussoub is a Lebanese Medical Doctor practicing Neonatology. He currently serves as a Neonatal Fellow at CHI-André Grégoire, Montreuil-France where he has worked since June 2017. He completed his residency in Pediatrics at CHU-NDS, Jbeil-Lebanon and Rafic Hariri University Hospital, Beirut-Lebanon. He has special interest in Neonatal Cardiology. His practice focuses on extreme prematurity and patent ductus arteriosus. 

Abstract:

Pulmonary hemorrhage is frequently associated with hemodynamically-significant Patent Ductus Arteriosus (hsPDA) especially in premature infants, and considered a major risk for mortality and morbidities in this population. We have studied pulmonary hemorrhage incidence in extreme premature infants after the implementation of a new protocol of early ultrasonographic diagnosis followed by ibuprofen-based treatment. In 2016, a new protocol was introduced for early diagnosis and treatment within the first 24 hours of life of premature infants born less than 26 weeks of gestation and/or less than 1000 grams. Three of the 4 criteria present on cardiac ultrasound (12 to 24 hours of life) were needed to confirm hsPDA: Left atrium/Aorta ratio > 1.5 mm, Ductus arteriosus diameter > 1.5 mm, Transductal flow velocity < 2 m/sec and mean left pulmonary artery velocity > 0.2 m/sec. We realized a study divided into 2 parts. The first one was retrospective of children born from September 2015 to August 2016 (PDA-1) and the second prospective of children born from September 2016 to May 2017 (PDA-2). 55 premature infants were illegible for the study: 31 in PDA-1 cohort and 24 in PDA-2 group. We noticed a tendency to a reduction in the incidence of pulmonary hemorrhage in PDA-2 compared to PDA-1 cohort (4.3% vs. 29.1% respectively; p = .055) but not statistically significant. The survival rate was increased by third in PDA-2 group (91.5% vs. 67.7%; p=.033). Screening and early-treatment of a hsPDA did not show a significant reduction of pulmonary hemorrhage incidence, but increased the survival rate of infants born less than 26 weeks of gestation and/or less than 1000 grams by third.

 

Speaker
Biography:

Oberhuber R D works as a Clinical Health Psychologist at the Kepler University Hospital in Linz, Children’s Heart Center, Austria, as well as working in private practice and teaching as Professor of Psychology at the University of Education of Upper Austria. As a heart patient (CHD) himself, and as a Scientist he is uniquely able to empathize and communicate with heart patients and their families and to provide them with expert professional care.

Abstract:

Introduction: Neurological and radiologic research results show an abnormal cerebral micro-structure as well as abnormal neurodevelopment in patients treated for hypoplastic left heart syndrome. The aim of this study was to assess the varying cognitive performance these children have developed in dependence upon prenatal diagnosis, surgical techniques, surgical learning effects, anatomy, perfusion techniques, gender, pedagogic and sociodemographic parameters in comparison to age-adjusted normative values.

 

Methods: School-age children (6.3-16.9 years) with hypoplastic left heart syndrome, who were treated at the Children’s heart Center Linz between 1997 and 2009, (n=74), were surveyed about cognitive achievements. 43 patients were examined prospectively by psychologists using the Wechsler Intelligence Scale for Children IV to determine the respective total intelligence quotient index for each child’s developmental stage.

Results: The mean index was 84.5 (percentile rank 26.4). The statistical spread and standard deviation ranged from a minimum of 40 to a maximum of 134±20.8. The results for verbal comprehension, perceptual reasoning, and processing speed corresponded with total index results and were thus lower than the mean value of the normative values. The assessment of working memory showed results in the average. Prenatal diagnosis, type of lung perfusion, anatomy, and various cerebral perfusion techniques did not significantly affect the cognitive results of the patients.

Conclusion: The results show that hypoplastic left heart syndrome patients can be successfully tutored formally as well as personally in cognitive areas, although when compared to healthy children, they showed lower results for intellectual area parameters.

Speaker
Biography:

Kaddoum R N joined AUBMC in 2011 as Assistant Professor at the Department of Anesthesiology from St. Jude Children’s Research Hospital in Memphis TN where he worked from 2008 till 2011. He conducted clinical Research at St. Jude and his main interests were the management of chronic pain in children with cancer, pediatric regional anesthesia, and pediatric airway management in children with mediastinal masses. He is currently Director of Pediatric Anesthesia and Director of the Operating Room at the American University of Beirut Medical Center. He has also been recently promoted to Associate Professor of Clinical Anesthesiology. His main focus at AUBMC is pediatric open-heart anesthesia.

Abstract:

Background: Percutaneous cannulation of the femoral artery in the pediatric age group can be technically challenging, especially when performed by residents in training.

Objective: We examined whether the use of real-time ultrasound guidance is superior to a palpation landmark technique for femoral artery catheterization in children undergoing heart surgery.

Methods: Patients were prospectively randomized into two groups. In the palpation group, the femoral artery was cannulated using the traditional landmark method of palpation of arterial pulse. In the ultrasound group, cannulation was guided by real-time scanning with an ultrasound probe. Ten minutes were set as time limit for the resident's trials during which the time taken for attempted cannulation (primary outcome), number of attempts, number of successful cannulations on first attempt, and success rate were compared between the two groups. Adverse events were monitored on postoperative days 1 and 3.

Results: A total of 106 patients were included in the study. The time taken for attempted femoral artery cannulation was shorter (301±234 vs. 420±248 s; difference in mean: 119; 95% confidence interval (CI) of difference: 26-212; P=0.012) and the number of attempts was lower [1 (1-10) vs. 2 (1-5); difference in median: 1, 95% CI of difference: 0.28-1.72; P=0.003] in the ultrasound group compared with the palpation group. The number of successful cannulations on first attempt was higher in the ultrasound group compared with palpation group [24/53 (45%) vs. 13/53 (25%); odds ratio (OR): 2.54, 95% CI: 1.11-5.82; P=0.025]. The number of patients who had successful cannulation was 31 of 55 (58%) in the palpation group and 40 of 53 (75%) in the ultrasound group (OR: 2.18, 95% CI: 0.95-5.01; P=0.06). None of the patients had adverse events at days 1 and 3.

Conclusions: Ultrasound-guided femoral arterial cannulation in children when performed by anesthesia residents is superior to the palpation technique based on the reduction of the time taken for attempted cannulation and the number of attempts, and improvement in first attempt success

 

YoungAh Youn

Seoul St. Mary’s Hospital - The Catholic University of Korea, South Korea

Title: Long-term postnatal steroid effect in very low birth weight infants

Time : 15:30-16:00

Biography:

YoungAh Youn MD, PhD has completed her PhD in Pediatrics at 2012 from the Catholic Medical College at Seoul, Korea. As a Neonatologist, she is working at Neonatal Intensive Care Unit (NICU) in Seoul St. Mary’s Hospital. She has earned many medical experiences on the care of extremely low birth weight infants and working as an active member of Korean Neonatal Society. She also published more than 20 papers in reputed journals and has been serving as a vice chief of NICU which holds 50 intensive care beds.

Abstract:

Since corticosteroids are broadly administered, particularly on neurological outcomes, remain a concern. Hypotension and shock within the first week of life for VLBWI are the first indications of circulatory collapse that might require treatment with steroids. Postnatal administration of dexamethasone in preterm infants has been adopted with caution due to its adverse long-term outcomes. Since 2012, our unit has only used hydrocortisone as an alternative to dexamethasone in an attempt to minimize negative long-term neurological outcomes. We examined whether hydrocortisone exposure ≤ 1week in very low birth weight infants (VLBWI) was associated with poor neurodevelopmental outcomes at corrected 18 months. Of a total of 191 VLBWI, 115 (60.2%) infants were exposed to early postnatal hydrocortisone ≤ 1 week of life in our NICU of Seoul St. Mary’s Hospital, The Catholic University of Korea between December 2012 and December 2014. The morbidities were significantly higher in the group with early hydrocortisone exposure group. At corrected age of 18 months, 183 (95.8%) infants in the early hydrocortisone exposure group had significantly lower scores in all three (cognitive, language and motor) composites of Bayley Scales of Infant and Toddler Development III. The multivariable logistic regression analysis showed that periventricular leukomalacia (PVL) is consistently associated with poor long-term outcomes. Our results suggest that early hydrocortisone exposure ≤ 1week in VLBWI may not increase the risk for poor long-term outcomes compared to those not exposed. Only PVL is considered as a risk factor for poor long-term neurodevelopmental outcomes.

 

Debadatta Mukhopadhyay

Medical College, Kolkata - West Bengal University of Health Sciences, India

Title: Myocarditis revisited: few unusual cases of myocarditis – experience in an Indian tertiary care centre

Time : 16:00-16:30

Biography:

Debadatta Mukhopadhyay has completed her MBBS with Honours from Medical College, Kolkata. After completing her DCH from Institute of Child Health, Kolkata she completed her MD and then MRCPCH. She has trained in Paediatric Intensive Care and is also a BPICC instructor. She has trained in Paediatric Cardiology in RN Tagore International Institute of Cardiac Sciences, Kolkata and as Fellow Paediatric Cardiology at University Hospital, Southampton, UK. Currently, she is working as Assistant Professor, Paediatrics, Medical College, Kolkata, India where she also runs Paediatric cardiology services. Her special interest are complex congenital heart diseases and fetal echo.

Abstract:

Introduction: Myocarditis is a known complication of various febrile illnesses of infective and noninfective etiology. Here we describe some atypical causes of myocarditis, their clinical profile and outcome.

Case 1: A two-year-old girl presented with low grade fever and respiratory distress for three days. Significant clinical findings were cardiomegaly, gallop rhythm and tender hepatomegaly. Diuretics and inotropes as Dobutamine and Milrinone were commenced. Echocardiography revealed gross dilatation of LV and severe systolic dysfunction (EF 31%) (Fig1a). Absolute eosinophil counts dramatically reduced to 288 after 10 days. There was also improvement of cardiac function (EF-42 %) (Fig 1b). On follow up, LV dilatation and mild to moderate dysfunction persisted.

A five month old child was brought to the A and E with incessant crying. She had tachycardia (HR 198/min, sinus rhythm), High BP (97th centile) and cardiomegaly. She had been bitten by a scorpion two hour back. There was LV dilatation and severe cardiac systolic dysfunction (EF 33%). CPK MB and Trop T levels were raised as were the inflammatory markers like ESR and CRP. The tachycardia and hypertension settled gradually after starting oral Prazosin and intravenous Labetalol infusion. After few days the cardiac function improved and normalized on follow up with cardiac chambers resuming their normal size.

Case 2: Myocarditis is a known complication of Dengue fever in the tropical countries, characterized by LV dilatation and dysfunction. A six year old boy presented with shock with history of fever for last five days. Patient received adequate fluids and inotropes including Milrinone and Levosimendan. Later, IVIg was also given which led to marked improvement in function. There was Leukocytosis, thrombocytopenia and Dengue serology (IgM and IgG) was positive. In addition to severe systolic dysfunction (EF 33%), pericardial effusion, echocardiography also showed unusual hypertrophy of the interventricular septum (IVSd 1.3cm: >4 z scores, LVPWd = 1cm, >4 z scores) (Fig2a, b and c). On D6 PICU stay, LV Ejection fraction was found to have significantly increased to 60% (Fig 3a and 3b).

 

 

Speaker
Biography:

Peter Benn completed his undergraduate degree at the University of St Andrews, Scotland, received a PhD from the University of Birmingham, England, and post-doctoral training at the University of Pennsylvania.  He also holds a DSc degree from the University of St Andrews.  For the past 25 years, he has been at the University of Connecticut Health Center and is currently Professor Emeritus in the Department of Genetics and Genome Sciences. Clinical responsibilities have included oversight of the cytogenetics and prenatal screening laboratories.  His research interests have focused on prenatal testing and diagnosis, most recently involving the introduction of non-invasive prenatal testing

Abstract:

The 22q11.2 Deletion Syndrome (22q11.2DS) Is associated with a variably expressed complex phenotype that includes cardiac abnormalities that are present in approximately 74% of cases.  A high proportion of conotruncal and right aortic arch malformations are attributable to 22q11.2DS.  Prenatal prevalence may be as high as 1 in 1000 fetuses.We developed a non-invasive prenatal screening test for 22q11.2DS and 4 other clinically significant microdeletion syndromes based on analysis of single-nucleotide polymorphisms in maternal cell-free DNA.  In 80,449 pregnancies screened for 22q11.2 deletions, we found 263 (0.39%) at high-risk for fetal deletion and 6 (1 in 13,408) maternal carriers. Pregnancy outcome information was available in 153 pregnancies at high-risk for a fetal deletion of which 24 were true-positive.  The testing had a positive predictive value of 15.7%, a false-positive-rate of 0.33%, and the estimated prevalence of 22q11.2DS was 1/1255 in the referral population.  Of the 24 true-positives, 21 showed prenatal ultrasound abnormalities including 10 with Tetralogy of Fallot, 3 unspecified cardiac malformations, 1 truncus arteriosis, 1 double outlet right ventricle and 1 VSD.  A screening enhancement has reduced the false-positive rate to 0.07% and increased the positive predicative value to 44.2%.Screen-positive pregnancies need to be confirmed by chromosome microarray, either on a prenatal sample (amniotic fluid or chorionic villus) or at birth (blood). Prenatal screening provides an opportunity to reduce adverse sequelae in 22q11.2DS through delivery at a tertiary medical center, the earliest possible management of cardiac, velopharyngeal, and other malformations, seizure management, and additional specialty consultation.