Day 1 :
- Pediatrics & Neonatology
Session Introduction
Chirag Saluja
Chirag Saluja(Post Graduate,Department of Pediatrics, Safdarjung Hospital New Delhi,India)
Title: Prevalence of meningitis in the first episode of febrile seizure in children aged between 6 to 18 months.
Biography:
Chirag Saluja finished his MBBS from Vardhaman Mahavir Medical College and Safdarjung Hospital , New Delhi in the year 2017 at the age of 24.Now he is pursuing his post graduation in the field of paediatrics from the above mentioned institute.
Abstract:
Background : Febrile seizures (FS) are the most common type of childhood seizures, affecting 2–5% of children older than 1 month and most commonly from 6 months–5 years old. It is a major cause of paediatric admissions worldwide. In India, AAP 2010 guidelines are followed for performing Lumbar Puncture(LP) in first episode of febrile seizure despite India having wide difference in the epidemiology of meningitis and immunisation coverage as compared to USA. This study has been done to find out whether AAP guidelines are applicable in India also or there is a need for our own guidelines.
Aims and objectives :
Primary Objective-To find out the prevalence of meningitis in first episode of febrile seizure in children aged 6 to 18 months.
Secondary Objective-To find out predictors of meningitis in in children with first episode of febrile seizure
Materials and Methods: A cross-sectional study over a period of 18 months was carried out in paediatric wards of Safdarjung Hospital. LP was performed and results analysed for meningitis as per guidelines.
Results: 200 cases were analysed. The prevalence of meningitis in children aged 6 to 18 months presenting with first episode of Febrile Seizure was 16%.Bacterial Meningitis was seen in 3%.The independent predictors of meningitis were high TLC(>16500/mm3),positive CRP and prematurity. High grade fever(>102ËšF),high seizure duration(>12 minutes),low MCV(<75fl),malnutrition(lesser weight for age) and longer post ictal state duration(>14 minutes) were seen as predictors of meningitis but after logistic regression they were not found to be independent predictors. Streptococcus pneumoniae was the most common organism isolated in the blood(42.8%) as well as the CSF(50%) of the cases taken. Most common type of cell seen were monocytes which were alone seen in 56.2% of the meningitis cases.
Conclusion: India needs its own guidelines for performing LP in cases of first episode of FS. Meningitis can be predicted in those with high TLC(16500/mm3), CRP positive and who are prematurely born.
K. M. Yacob (Chief Physician)
K. M. Yacob (Chief Physician). Marma Heatth Centre,Kochi ,Kerala,India
Title: The Purpose of Temperature of Fever
Biography:
A practicing physician in the field of healthcare in the state of Kerala in India for the last 30 years and very much interested in basic research. My interest is spread across the fever , inflammation and back pain,. I am a writer. I already printed and published nine books in these subjects. I wrote hundreds of articles in various magazines.
After scientific studies we have developed 8000 affirmative cross checking questions. It can explain all queries related with fever
Abstract:
When the disease becomes threat to life or organs blood circulation decreases, Temperature of fever will emerges to increase prevailing blood circulation. And it acts as a protective covering of the body to sustain life.
When blood flow decrease to brain, the patient becomes fainted-delirious .If we try to decreases temperature of fever, the blood circulation will further reduced. Blood circulation never increases without temperature increase. Delirious can never be cured without increase in blood circulation.
The temperature of fever is not a surplus temperature or it is not to be eliminated from the body. During fever, our body temperature increases like a brooding hen`s increased body temperature.
The actual treatment to fever is to increase blood circulation. Two ways to increase blood circulation. 1. Never allow body temperature to lose 2. Apply heat from outside to the body. When the temperature produced by body due to fever and heat which we applied on the body combines together, the blood circulation increases.
Then body will stop to produce heat to increase blood circulation. And body will get extra heat from outside without any usage of energy.
How can we prove that the temperature of fever is to increase blood circulation?
If we ask any type of question related to fever by assuming that the temperature of fever is to increase blood circulation we will get a clear answer. If avoid or evade from this definition we will never get proper answer to even a single question
If we do any type of treatment by assuming that the temperature of fever is to increase blood circulation , the body will accept, at the same time body will resist whatever treatment to decrease blood circulation.
No further evidence is required to prove the temperature of fever is to increase blood circulation.
Ms Lana Al-Nusair
317 St Albans road west haftield AL10 9RJ
Title: Prevalence of meningitis in the first episode of febrile seizure in children aged between 6 to 18 months.
Biography:
Abstract:
Background: Social media use is now a common use of mobile phones among teenagers. With adolescent smartphone ownership having risen sharply, with 71% of 11 year olds now owning a smartphone, the WHO recommends research on mobile phone use on all aspects of children’s health as a high priority. While previous research demonstrates an increase in BMI in children when exposed to conventional media-based behaviours (e.g. television), there is little research on the impact of social media on adolescent BMI.
Methods: We investigated the effects on time spent on social media on mobile phones, as well as all other devices, on BMI z-scores. 238 secondary school students were recruited and underwent biometric measurement and completed a computerised assessment and questionnaire. Age and sex-specific BMI z-scores were calculated. A linear relationship existed between BMI z-scores and time spent on social media, therefore a linear regression model was used for analysis.
Results: For both social media use on mobile phones and on all other devices, a decrease in BMI z-score was found between 1 and 30 minutes, with an increase in z-score seen after 31 minutes of social media usage. The largest increase in BMI z-score was seen with 31-59 minutes of social media usage across all device types.
Conclusions: We found no significant association and no evidence of an increasing trend between social media use and BMI z-scores. However, there is a suggestion of an increase in BMI in higher social media use in mobile phones and other devices.
Dr Pei Sen Tee
Dr Pei Sen Tee, Dr Amanda Ogilvy-Stuart Department of Neonatology, Rosie Hospital, Cambridge
Title: Audit Of Antibiotic Administration In Suspected Early Onset Neonatal Sepsis
Biography:
Abstract:
Background: Sepsis remains a major cause of morbidity and mortality1 . NICE guidance stated that there should not be any delay in starting antibiotics, pending test results. Aim: To assess compliance with NICE guidelines on antibiotic administration for babies with suspected EONS on postnatal ward and delivery unit (DU) Method: • Audit of antibiotic administration in babies with suspected EONS born in the month of December 2018 in Rosie Hospital, Cambridge. • Babies admitted to NICU before antibiotic administration were excluded. • The process from decision to treat to antibiotic administration was mapped in order to identify areas where compliance might be improved. Standards: NICE guidance CG1492 “Neonatal infection (early onset): antibiotics for prevention and treatment”: -100% of newborns with suspected EONS receive antibiotics within 1 hour of decision to treat. Results: 61 babies with suspected EONS in the postnatal ward/DU were started on antibiotics in December 2018. 13 had unclear documentation of the time of decision to start antibiotics and were excluded. Time from decision to treat to antibiotic administration: -Compliance with antibiotic administration <1 hour from decision to treat: 17% -Longest time: 7 hours 54 mins -Shortest time: 33 mins -Average time: 2 hours 15 mins Conclusion: • The target timeframe for antibiotic administration in most cases of suspected EONS of babies on the postnatal wards and DU is not being achieved. • Process mapping identified that most delay arises during transfer of the baby to the neonatal unit for the infection screen and lack of immediate availability of neonatal nurses for antibiotic administration. Action Plan: 1. Raise awareness of the importance of prompt antibiotic administration to medical, midwifery and nursing staff 2. Involvement of midwifery and neonatal nursing team leads to change practice: i. Introduction of “septic screen pack” containing essential equipment required for septic screen so screen can be performed on delivery suite ideally beside the mother ii. Training of midwifery staff to administer antibiotics
Dr SUMUDU WANIGASURIYA
SUMUDU WANIGASURIYA N0.66/B NAPAGODA NITTAMBUWA SRI LANKA
Title: Neonate: Absence of femoral pulses is not always Coarctation of Aorta
Biography:
Abstract:
Introduction Thrombotic disease is an uncommon entity in the newborns but can significantly contribute to morbidity and mortality. New avenues of research may help to achieve new treatment modalities of treatment. Case report A newborn term, baby girl, delivered by LSCS with B.Wt of 3300g and normal APGAR score was found to have cyanosed lower limbs at the sixth hour of life. On examination, her femoral pulses were not felt and had a saturation of 60% on air bilaterally. Her hematological investigations revealed no abnormality apart from low platelet count (101000/L). Her bleeding and clotting profiles were also normal. Hence, an urgent 2D echocardiography was arranged in view of coarctation of aorta but revealed only a small ostium secundum with no patent ductus arteriosus. Then a Doppler flow study revealed an extensive, acute thrombosis below the renal artery at the level of abdominal aorta with minimal distal reformation of flow via left external Iliac artery. At the twentieth hour of life she was administered antithrombolytic agent, reverse tissue plasminogen activator (rTPA) with intravenous heparin for three days followed by intravenous heparin alone for two weeks and subcutaneous enoxaparin to be followed for six weeks. A repeat Doppler flow study on the day three of life revealed normal flow on both lower limbs with no residual thrombosis. Parental screening for possible abnormal anticoagulant revealed reduced protein S level in the mother with total protein S -50%. ( Ref range 60-150%, free protein S 45%. Ref range 50-130). Child recovered without any complication. Conclusion Administering antithrombolytic agents at the earliest would save life with minimal or no complication.