13.00 – 13.40
Patent ductus arteriosus (PDA) is a common diagnosis in preterm infants, especially, in extremely preterm infants. PDA is extremely important during the fetal life. After birth, functional closure of this vessel occurs during the first 72 hours in majority of the late preterm and term infants. However, in preterm infants, due to higher sensitivity to prostaglandins, predominance of vasodilator receptors in the ductal tissue, and lack of vasa vasorum, ductus arteriosus (DA) may not close spontaneously or often remains patent for weeks. Incidence of PDA correlates inversely with gestational age. Routine use of echocardiography in the neonatal intensive care unit has led to increase in the diagnosis of even small or hemodynamically non-significant PDA.
Hemodynamic effects of a PDA depend on several factors, such as, size and direction of shunt across the DA, extent of steal phenomena, adequacy of compensatory mechanisms and duration of patency of DA. Prolonged patency of DA has been shown to be associated with several morbidities, like, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and increase in mortality.
Typically, clinicians tend to treat “hemodynamically significant PDA” (hsPDA) with non-selective cyclooxygenase inhibitors, like, ibuprofen or indomethacin, or peroxidase inhibitor, paracetamol. Success with any of these drugs is about 70%. When medical treatment fails, surgery is often used to close the PDA. Surgical ligation of PDA is associated with post-ligation cardiac dysfunction, and pulmonary dysfunction leading to increase in oxygen and ventilatory requirements. Furthermore, surgical ligation has been associated with vocal cord paralysis, phrenic nerve injury, and abnormal neurodevelopmental outcomes. In the present era, transcatheter closure of PDA is increasingly being evaluated in many leading centers to minimize complications associated with surgical ligation. Assessment using multiple echocardiographic indices including organ blood flow by Doppler rather than just the size of DA is much more helpful in making a decision to treat or just follow the PDA. In cases of hsPDA that failed to respond to medical interventions, device closure should be considered first if patients meet the eligibility criteria for device closure before surgical ligation.
Rangasamy RAMANATHAN
Division Chief, Division of Neonatal Medicine, LAC+USC Medical Center
Good Samaritan Hospital
Director, NPM Fellowship Program and NICU
Director, Neonatal Respiratory Therapy Services
Keck School of Medicine of USC
Los Angeles, California, USA
13.40 – 14.25
Rangasamy RAMANATHAN
Division Chief, Division of Neonatal Medicine, LAC+USC Medical Center
Good Samaritan Hospital
Director, NPM Fellowship Program and NICU
Director, Neonatal Respiratory Therapy Services
Keck School of Medicine of USC
Los Angeles, California, USA
Boris KRAMER
Neonatologist, Professor of Experimental Perinatology
Director of Pediatric Research
Maastricht University Medical Center
Maastricht, Netherlands
Adriana Mihaela Dan
Bucharest, Romania
Ivanna Natalich
Kyiv, Ukraine
Andra Pirnuta
Bucharest, Romania
14.25 – 14.35
14.35 – 16.00
High risk pregnancies should be treated in specialized perinatal centers.
Effective collaboration between obstetrics and neonatology can optimize outcomes for both mother and baby and improve the work flow in each department.
We will discuss in this workshop:
Andrew COMBS
Patient Safety & Quality Committee, SMFM
Women’s Services Safety & Quality Committee, GSH
Obstetrix Medical Group, an affiliate of Mednax
Campbell, California, USA
Boris KRAMER
Neonatologist, Professor of Experimental Perinatology
Director of Pediatric Research
Maastricht University Medical Center
Maastricht, Netherlands
13.00 – 13.40
Every year 30 million babies are born prematurely, small or sick; more than 7000 of these babies die each day. Neonatal deaths account for nearly half of all deaths in children under five. The quality of neonatal care is receiving increased attention from policy makers including the WHO and UNICEF.
This talk will review the recently published evidence, reports and recommendations to improve neonatal care. Data and recommendations relevant to countries participating in the conference will be reviewed and the important roles individuals can play in improving neonatal outcomes will be highlighted.
Karen WALKER
Clinical Associate Professor, University of Sydney
President, Council of International Neonatal Nurses
Australian Program Manager, Global Women’s Health
The George Institute for Global Health
Sydney, Australia
13.40 – 15.20
The aim of the workshop is to introduce the concept of brain-focused neonatal intensive care. There are presented the seven steps of this strategy: prenatal history with focus on the maternal-placental-fetal unit; neurologic assessment; neuro-monitoring and neuro-imaging; neuro-protection; involvement of the parents in the frame of the family-centered care; follow-up of the patients and care for the team: training and emotional and psychological support.
The clinical cases presented will emphasize the most important aspects of neuro-monitoring and neuroimaging in the frame of brain-focused neonatal care. The cases will illustrate both patients with primary neurological conditions but also patients with medical conditions with secondary involvement of the brain. There will be also presented the benefits of the family-centered care on neuroprotection and neurodevelopment.
Moreover, this workshop wants to underline the importance of assessment of neurodevelopmental outcome of preterm infants. An update on recent international outcome data will be given. Different options of assessment and follow-up schedules should be discussed. Influence of the most important morbidites of prematurity on neurodevelopmental outcome will be demonstrated. National and international outcome data, different definitions and reference values and hence difficulties in comparability of these results will be discussed.
Katrin KLEBERMASS-SCHREHOF
Deputy Head, Department of Neonatology, Pediatric
Intensive Care and Neuropediatrics
Medical University Vienna
Vienna, Austria
Adrian Ioan TOMA
Head of Neonatology Department, Life Memorial Hospital
Unviersity ”Titu Maiorescu”, Faculty of Medicine
Bucharest, Romania
Virgilio CARNIELLI
Professor of Neonatal Pediatrics
Director of the Division of Neonatal Medicine
G. Salesi Hospital and Polytechnic University of Marche
Ancona, Italy
15.20 – 15.30
15.30 – 16.00
Katrin KLEBERMASS-SCHREHOF
Deputy Head, Department of Neonatology, Pediatric
Intensive Care and Neuropediatrics
Medical University Vienna
Vienna, Austria
Adrian Ioan TOMA
Head of Neonatology Department, Life Memorial Hospital
Unviersity ”Titu Maiorescu”, Faculty of Medicine
Bucharest, Romania
Boris KRAMER
Neonatologist, Professor of Experimental Perinatology
Director of Pediatric Research
Maastricht University Medical Center
Maastricht, Netherlands
Karen WALKER
Clinical Associate Professor, University of Sydney
President, Council of International Neonatal Nurses
Australian Program Manager, Global Women’s Health
The George Institute for Global Health
Sydney, Australia
Nurgul Junussova
Uralsk, Kazakhstan
Ligia Blaga
Cluj, Romania
13.00 – 13.40
CPAP is first-line in preterm infants who need respiratory support, with surfactant replacement used second-line on CPAP failure (CPAP-F). We analyzed the incidence and factors associated with CPAP-F in preterm infants with RDS. This is a Single center, retrospective database analysis (January 2004-December 2017) of inborn infants, gestational age (GA) 24+0/7 to 31+6/7 weeks, not intubated on admission to the neonatal intensive care unit, managed with CPAP. CPAP-F was defined as need for intubation and surfactant administration in the first 72 hours of life; CPAP success (CPAP-S) was CPAP alone without need for additional RDS treatments. Demographic, respiratory and clinical data associated with CPAP-F were studied using logistic regression analysis.
Results: More than 500 infants were studied. 45% were CPAP-Failures and 55% were CPAP-Success. Neonates with CPAP-F were smaller and younger, were less likely to have received antenatal steroids and less vaginal births. We found that and FiO2 as low as 0.23 after stabilization was highly predictive of CPAP-F regardless of gestational age. Additional data from the cohort will be discussed.
Virgilio CARNIELLI
Professor of Neonatal Pediatrics
Director of the Division of Neonatal Medicine
G. Salesi Hospital and Polytechnic University of Marche
Ancona, Italy
13.40 – 15.20
In this session we will discuss strategies for the prevention of lung injury in preterm infants.
We decided to split into three parts:
In the first part we will discuss delivery room strategies to prevent lung injury. Methods for assisting gentle early lung inflation in babies with respiratory insufficiency, striking a balance between effective ventilation and avoidance of lung injury. The relative merits of initiation of respiratory support with CPAP vs. Intubation and High Flow vs. CPAP at birth will be discussed.
The second part will cover the basic mechanisms of lung injury during conventional ventilation as well as the influence of several new ventilation modalities such as Volume Targeted Ventilation, NAVA, non-invasive NAVA in the prevention of lung injury. We will discuss the evidence of protective role of HFOV for the immature lungs.
During the third part we will talk about pharmaceutical prevention and treatment of lung injury. We will talk about role of caffeine to promote extubation, role of prophylactic vitamin A as antioxidant, role of low dose dexamethasone and hydrocortisone to facilitate extubation and role of nebulised budesonide and azithromycin in evolving BDP. And, of course surfactant as an important medicine to prevent lung injury.
David SWEET
Consultant Neonatologist
Royal Maternity Hospital, Belfast
Northern Ireland, United Kingdom
Oleg IONOV
Head of NICU named by Prof. A.G. Antonov
“National Medical Research Center for Obstetrics, Gynecology and Perinatology named by V.I. Kulakov”
Ministry of Health
Moscow, Russia
Mark PRUTKIN
Head of NICU, Regional Perinatal Center, Regional Children Hospital #1
Director of Medicos Ltd. Ekaterinburg, Russia
Ekaterinburg, Russia
15.20 – 15.30
15.30 – 16.00
Virgilio CARNIELLI
Professor of Neonatal Pediatrics
Director of the Division of Neonatal Medicine
G. Salesi Hospital and Polytechnic University of Marche
Ancona, Italy
David SWEET
Consultant Neonatologist
Royal Maternity Hospital, Belfast
Northern Ireland, United Kingdom
Oleg IONOV
Head of NICU named by Prof. A.G. Antonov
“National Medical Research Center for Obstetrics, Gynecology and Perinatology named by V.I. Kulakov”
Ministry of Health
Moscow, Russia
Mark PRUTKIN
Head of NICU, Regional Perinatal Center, Regional Children Hospital #1
Director of Medicos Ltd. Ekaterinburg, Russia
Ekaterinburg, Russia
Mariana Martian
Bucharest, Romania
Timea Brandibur
Timisoara, Romania
13.00 – 13.40
Respiratory distress syndrome (RDS) remains one of the causes of morbidity and mortality among preterm babies. Short and long term outcomes very much depend on initial and appropriate respiratory support at the delivery room. Timely and optimal surfactant administration, rational oxygen therapy with optimal oxygen saturation targets during the first minutes of life are vital in improving of survival and deceasing morbidity of very low birth weight and extremely low birth weight babies.
Arunas LIUBSYS
Director of Neonatal Centre of Vilnius University
Children‘s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos
Vilnius, Lithuania
13.40 – 15.10
Overall, AHA 2020 guidelines confirm previous recommendations that in this edition are based on more robust evidence (i.e. management of non-vigorous infants born through meconium stained amniotic fluid, delayed cord clamping) and add very few news. They include i) the milking that is not recommended in infants born at less the 28 weeks of gestation, ii) the use of a 3-lead ECG that should be used when providing chest compressions (expert opinion), and iii) the cessation of resuscitation efforts around 20 minutes after birth after discussion with the team and the family. This presentation aims to discuss the methodology followed by the ILCOR neonatal task force, the evidence behind each recommendation treatment, the news, and the gaps of knowledge to be considered for future studies.
Moreover, in this session we aim to provide participants with the latest knowledge on caffeine to use it effectively in their clinical practice. We will therefore review the use of caffeine in clinical care, the pharmacology in the newborn infant and how caffeine may influence important clinical outcomes such as BPD and neurodevelopmental outcomes. We will present some clinical scenarios when to use, increase, reduce and stop caffeine treatment based on the latest evidence.
Daniele TREVISANUTO
Department of Woman’s and Child’s Health
University of Padova
Padova, Italy
Peter REYNOLDS
Consultant Neonatologist and Specialty Lead
NICU, St. Peter’s Hospital
Honorary Senior Lecturer, Royal Holloway University of London
Clinical Lead (Joint) South East Coast Neonatal Network
London, United Kingdom
15.10 – 15.20
15.20 – 16.00
Boris KRAMER
Neonatologist, Professor of Experimental Perinatology
Director of Pediatric Research
Maastricht University Medical Center
Maastricht, Netherlands
Daniele TREVISANUTO
Department of Woman’s and Child’s Health
University of Padova
Padova, Italy
Peter REYNOLDS
Consultant Neonatologist and Specialty Lead
NICU, St. Peter’s Hospital
Honorary Senior Lecturer, Royal Holloway University of London
Clinical Lead (Joint) South East Coast Neonatal Network
London, United Kingdom
Arunas LIUBSYS
Director of Neonatal Centre of Vilnius University
Children‘s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos
Vilnius, Lithuania
Oana Boantă
Sibiu, Romania
Ksenia Pavelko
Zaporizhzhya, Ukraine
Diana Arnautu
Constanţa, Romania
13.00 – 13.40
Achievement of proper postnatal growth is crucial in preterm infants. It has been shown that there are critical time windows of brain growth and that missed opportunities may lead to suboptimal neurodevelopmental outcomes in later life. There is also a risk for early onset of adult neurological, metabolic and cardiovascular diseases if improper postnatal growth and body composition is achieved.
This course reviews what appropriate postnatal growth trajectories will look like and how growth can be monitored. Also the role of parenteral nutrition will be discussed and the essentials of the recently updated ESPGHAN guidelines will be presented.
The third part of this lecture will be devoted to enteral nutrition. The role of different dietary sources (preterm formula, breast milk, donor milk etc) and that of optimized fortification strategies will be reviewed. Guidelines on practical aspects of how to feed preterm infants will be presented.
It is also the aim of this course to provide insight into future areas of clinical nutritional research in neonatal medicine.
Christoph FUSCH
Head, Department of Neonatology, Children and Adolescents
General Hospital Nuremberg
Paracelsus Medical Private University
Nuremberg, Germany
13.40 – 15.10
Now, even more, around the world neonatal units are struggling with lack of staff, lack of education and lack of support. Naturally, this has a huge impact on neonatal survival and morbidity. Neonatologists have a pivotal role but they cannot do it alone. Nurses make up the majority of health care practitioners in neonatal units so it makes sense for doctors and nurses to respect each other, their individual strengths and the value of working and learning together. No unit will function without both doctors and nurses.
Objectives:
Merran THOMSON
Honorary Consultant Neonatologist
The Hillingdon Hospital
London, United Kingdom
Karen WALKER
Clinical Associate Professor, University of Sydney
President, Council of International Neonatal Nurses
Australian Program Manager, Global Women’s Health
The George Institute for Global Health
Sydney, Australia
15.10 – 15.20
15.20 – 16.00
Merran THOMSON
Honorary Consultant Neonatologist
The Hillingdon Hospital
London, United Kingdom
Karen WALKER
Clinical Associate Professor, University of Sydney
President, Council of International Neonatal Nurses
Australian Program Manager, Global Women’s Health
The George Institute for Global Health
Sydney, Australia
Christoph FUSCH
Head, Department of Neonatology, Children and Adolescents
General Hospital Nuremberg
Paracelsus Medical Private University
Nuremberg, Germany
Rangasamy RAMANATHAN
Division Chief, Division of Neonatal Medicine, LAC+USC Medical Center
Good Samaritan Hospital
Director, NPM Fellowship Program and NICU
Director, Neonatal Respiratory Therapy Services
Keck School of Medicine of USC
Los Angeles, California, USA
Sarbas Ainurym
Almaty, Kazakhstan
Anna Leniushkina
Moscow, Russia