NPMF 2021

12th of April 2021

13.00 – 13.40

Patent Ductus Arteriosus (PDA): To Treat or Just Ignore It?

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

Q&A

13.40 – 14.25

Present Your Own Case!

Moderated by:

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

Intratautrine Hemorrhagic Stroke-Postnatal Outcomes

Adriana Mihaela Dan
Bucharest, Romania

Totally Hypothermia in Treatment of Asphyxia of Newborn Babies: Experience of Kyiv Perinatal Center, Ukraine

Ivanna Natalich
Kyiv, Ukraine

Diagnosis and Management Challenges in Extreme Prematurity Associated with Unknown Etiology Hydrops Fetalis

Andra Pirnuta
Bucharest, Romania

14.25 – 14.35

Break

14.35 – 16.00

Perinatal Approach to High Risk Pregnancy- Collaboration between Obstetrics and Neonatology

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:

  • Maternal transport
  • Maternal medication for fetal/neonatal benefit (Antenatal steroids, tocolytics, antibiotics, MgSO4)
  • Delayed cord clamping (DCC)
  • Hypothermia prevention
  • Discordant choices for maternal versus neonatal care

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

13th of April 2021

13.00 – 13.40

Global Challenges in Neonatal Care

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

Q&A

13.40 – 15.20

Brain-Focused Neonatal Intensive Care and Neurodevelopment Outcome of Preterm Infants

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

Break

15.30 – 16.00

Present Your Own Case!

Moderated by:

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

Congenital Bilateral Choanal Atresia

Nurgul Junussova
Uralsk, Kazakhstan

Complex Hepatic Arteriovenous Malformation – Diagnostic Pitfalls

Ligia Blaga
Cluj, Romania

14th of April 2021

13.00 – 13.40

Early Predictors of CPAP Failure from the ANCONA COHORT

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

Q&A

13.40 – 15.20

Lung Protection Strategies from Delivery Room to Discharge

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

Break

15.30 – 16.00

Present Your Own Case!

Moderated by:

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

Bronchopulmonary Dysplasia - Still an Unsolved Problem

Mariana Martian
Bucharest, Romania

Cholestasis Syndrome at Newborn with Early Onset

Timea Brandibur
Timisoara, Romania

15th of April 2021

13.00 – 13.40

Surfactant, Oxygen and Target Oxygen Saturation in Preterm Infants

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

Q&A

13.40 – 15.10

2020 Guidelines on Neonatal Resuscitation: News and Gaps of Knowledge and the Role of Caffeine in Modern Newborn Care

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

Break

15.20 – 16.00

Present Your Own Case!

Moderated by:

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

Use of a Clinical Score to Predict Immediate Outcome after Neonatal Transport

Oana Boantă
Sibiu, Romania

Clinical Management in Newborns with Chylothorax and Chyloperitoneum

Ksenia Pavelko
Zaporizhzhya, Ukraine

Important Right Pulmonary Hyperinflation Associated with Bronchopulmonary Dysplasia and Left Atelectatic Lung

Diana Arnautu
Constanţa, Romania

16th of April 2021

13.00 – 13.40

How to feed a Preterm Neonate?

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

Q&A

13.40 – 15.10

Educate, Collaborate and Invest for a Sustainable Neonatal Workforce

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:

  • Understand the need for collaboration and investing in education for neonatal medical and nursing staff
  • Reflect on the challenges to ensure the sustainability of the workforce

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

Break

15.20 – 16.00

Present Your Own Case!

Moderated by:

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

Congenital Cutaneous Aplasia

Sarbas Ainurym
Almaty, Kazakhstan

Congenital Heart Block due to Neonatal Lupus in a Very Premature Baby

Anna Leniushkina
Moscow, Russia

Bulgaria, Burgas, community Nesebar, VSG Siyana south, Svety Vlas st. 8256

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