Neonatology: The Sick Newborn

Transcription

1 2013 Continuing Education 35th Annual Neonatology: The Sick Newborn Including STABLE, PICC Line and Pediatric Neonatal Vascular Ultrasound Workshops September 20-22, 2013 Kiawah Island, South Carolina Presented by Medical College of Georgia at Georgia Regents University and Division of Continuing Education

2 PURPOSE This conference will update neonatal health care professionals on basic and complex neonatal issues. Workshops on PICC lines, STABLE, and Pediatric Neonatal Vascular Ultrasound are featured. The conference will benefit both the health care professional new to neonatal-perinatal medicine and the experienced practitioner. OBJECTIVES This conference should enable participants to: Set improved goals for preterm infant growth using newer comparable-age fetus based growth charts Categorize neonatal heart disease, recognize urgent heart lesions, and respond early to reduce morbidity and mortality Promote optimal outcomes (and avoid adverse outcomes) by implementing early and aggressive feeding strategies Be an advocate for human milk by knowing when to use donor milk and when and how to fortify human milk Recognize and prepare patients with surgical emergencies for surgery or for transport Improve perinatal communication for better delivery outcomes Make informed decisions based on the current practices of ethics and limits of viability Extrapolate from the 6th Ed. NRP guidelines to improve long-term outcomes starting in the first minutes of life Provide optimal and efficient care to our smallest patients while reducing costs Address the question of Just because we can, should we? through 2 case presentations CREDIT The general session of this activity includes a maximum of hours of instruction and is approved by the Medical College of Georgia at Georgia Regents University for continuing education credit hours. For nurses: The Georgia Regents University Division of Continuing Education is an approved provider of continuing nursing education by the Georgia Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation Contact hours. Accreditation: The Medical College of Georgia at Georgia Regents University is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Designation: The Medical College of Georgia at Georgia Regents University designates this live activity for a maximum of AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending. Note: Optional PICC I and II workshop includes 8 AMA PRA Category 1 Credits and 8 contact hours. Optional STABLE workshop includes 8 AMA PRA Category 1 Credits and 8 contact hours. Optional Pediatric Neonatal Vascular Ultrasound Workshop includes 2 AMA PRA Category 1 Credits and 2 contact hours. SPECIAL NEEDS The Georgia Regents University Division of Continuing Education complies with the Americans With Disabilities Act. If you require special services, facilities, or dietary considerations (vegetarian or otherwise) to support your participation in this continuing education program, contact the conference coordinator at or

3 GUEST FACULTY Debbie Elder, R.N., B.S.N., C.R.N.I., V.A.-B.C. Debbie Elder has been with Bard Access System since 2006 as the Clinical Nurse Educator for all Vascular Access Devices. Prior to Bard, Debbie was with Piedmont Hospital in Atlanta, GA as a staff nurse in medical surgery and IV therapy. Tanis Fenton, M.D. Dr. Tanis Fenton is a Dietitian and an Epidemiologist, with 18 years of clinical experience in neonatal intensive care. Dr. Fenton is best known for her work on developing growth charts for preterm infants. Currently an adjunct assistant professor at the Faculty of Medicine, University of Calgary, Tanis is an invited member of the Canadian Expert Panel for Canadian Nutrient Requirements and Feeding of the Preterm Infant, and was selected by Dietitians of Canada to be Liaison to the Canadian Pediatric Society Nutrition Committee. Tanis was recently invited to be a member of the Oxford-based INTERGROWTH team to develop a growth standard for preterm infants. Tanis main research areas include critical appraisal in nutrition, neonatal nutrition and growth. Tanis recently revised the Fenton Preterm Growth chart, which is being widely used worldwide. This growth chart has been recommended in 16 textbooks. Anjali Parish, M.D. Dr. Anjali Parish joined the Family Ties Birthing Center staff at Coliseum Health System and the Medical Center of Central Georgia in Macon, Georgia, in the fall of She specializes in Neonatal-Perinatal Medicine. Board certified, Dr. Parish has over 15 years of pediatric experience. Dr. Parrish received her Doctor of Medicine from the University of Mississippi before training at the Medical College of Georgia in Augusta. Linda Sacks, M.D. Dr. Linda Mann Sacks, a native of Philadelphia, is a magna cum laude graduate of the University of Pennsylvania, College for Women. She received her medical degree from the College of Physicians and Surgeons of Columbia University in New York City in Dr. Sacks took five years to complete her degree, taking a year off between third and fourth year studies to give birth to her first child, the first female student at P&S to ever do so outrageous a deed. There were twelve women in her 120 member graduating class. After internship and residency in Pediatrics at the Children s Hospital of Philadelphia, she completed a two year fellowship in Neonatal-Perinatal Medicine at the University of Pennsylvania. Dr. Sacks is Board Certified in Pediatrics and Neonatal-Perinatal Medicine. Following a (thankfully) short career in academic medicine at the University of Pennsylvania where she specialized in measuring calcium uptake from brain and heart mitochondria harvested from oxygen deprived lambs and rats, she moved to Savannah, Georgia where she has practiced clinical neonatology since Dr. Sacks is Associate Clinical Professor of Pediatrics on the faculty at Mercer University School of Medicine and the Medical College of Georgia. She is currently the Medical Director of a seven physician, six nurse practitioner group and oversees a neonatal intensive care unit that admits 800 medical and surgical patients a year. Kris Sekar, M.D. Dr. Sekar, Professor of Pediatrics at the University of Oklahoma Health Sciences Center, completed a pediatric residency and neonatology fellowship at the Georgetown University Medical Center. He is the Medical Director of the Oklahoma University Children s Hospital Neonatal Intensive Care Unit and Pediatric Sleep Laboratory. He studies pulmonary physiology and infant breathing and has participated in National Institutes of Health studies involving nitric oxide, surfactants and noninvasive ventilation. He has contributed to over 80 peer-reviewed papers in journals including Pediatrics, the Journal of Perinatology, the American Journal of Perinatology, Pediatric Pulmonology, and Biology of the Neonate. John Zupancic, M.D. Dr. Zupancic received his Bachelor of Science degree from Victoria College at the University of Toronto, where he was awarded the G. A. Cox Gold Medal in Life Sciences upon graduation. He undertook his undergraduate medical training and pediatrics residency at McMaster University and completed his fellowship in neonatal-perinatal medicine in the Joint Program in Neonatology at Harvard Medical School. Concurrent with his neonatology fellowship training, he was awarded a Doctorate in Health Policy, with concentrations in Decision Science and Economics, from the Harvard School of Public Health. He is currently Assistant Professor of Pediatrics at Harvard Medical School and Director of the Harvard Neonatal-Perinatal Medicine Fellowship Program. Alongside his research contributions, Dr. Zupancic has a strong commitment to methodological and clinical teaching, research mentoring, and career development. As Director of one of the largest neonatology fellowship programs in the United States, he has primary responsibility for the clinical and scholarly education of trainees as they rotate through the four main Harvard teaching hospitals, numerous research laboratories, and ancillary research fellowships. He has regularly mentored fellows in health services research projects and is the recipient of both the Merton R. Bernfield Mentoring Award from the Fellows of the Harvard Neonatal- Perinatal Medicine Fellowship Program and the national John M. Eisenberg Excellence in Mentorship Award from the Agency for Healthcare Research and Quality.

4 CO-COURSE DIRECTORS Jatinder Bhatia, M.D., Professor of Pediatrics and Chief of Neonatology Amy Gates, R.D., C.S.P., L.D., Board Certified Pediatric Nutrition Specialist GRU FACULTY Triven Bashambu, M.D., Assistant Professor of Pediatrics Paul C. Browne, M.D., Associate Professor of Obstetrics and Gynecology, Chief, Maternal Fetal Medicine Marcus Dye, R.N., Pediatric Vascular Access Team, Children s Hospital of Georgia Teresa Dye, R.N., Pediatric Vascular Access Team, Children s Hospital of Georgia Pat King, Program Coordinator William A. Lutin, M.D., Ph.D., Professor of Pediatrics Jason Parker, M.D., Fellow, Neonatal- Perinatal Medicine Walter L. Pipkin, M.D., Assistant Professor of Surgery Deborah A. Wall, R.N.C.-N.I.C., C-N.P.T., Neonatal Nurse Clinician; Neonatal ECMO/Transport; PICC Trainer Johnny Wilson, R.N., Neonatal Specialist/Outreach Educator Leann VanLandingham, R.N., M.S.N., Clinical Nurse Educator, Neonatal Intensive Care Unit, Children's Hospital of Georgia KIAWAH ISLAND RESORT Located on the Atlantic Ocean only 21 miles from historic Charleston, Kiawah Island has been developed into one of America s finest resorts while preserving the environmental richness of its barrier island setting. Kiawah s natural beauty and bountiful wildlife have been carefully preserved amid golf courses referred to as the Pebble Beach of the East Coast and a tennis program ranked among the top 10 in the United States. Ten miles of broad, sparkling beach ranked the Second Most Romantic Beach in America invite you to explore all the opportunities that Kiawah offers for recreation, education and renewal. During free time, you and your family can enjoy the unspoiled beach, large, cool swimming pools, and the spa with therapeutic massage, saunas, and hot tubs. Golfers will enjoy the challenge of Kiawah s five championship golf courses. Imagine the thrill of testing your skills on the course that hosted the 1991 Ryder Cup, 2007 Senior PGA, 2012 PGA Championship or walking the course that was the setting for the movie, Bagger Vance. Avid tennis players can easily find a game or a lesson at the two nationally known tennis centers. Parents and kids appreciate well-organized children s and teen recreation programs, and evening children s activities enable parents to enjoy a quiet evening together at one of the resort s restaurants. In addition, the shops and culture of the historical city of Charleston are nearby for you and your family to explore and enjoy. HOTEL RESERVATIONS For reservations, contact the Reservations Department, Kiawah Island Resort, 1 Sanctuary Drive, Kiawah Island, SC If calling , identify your group as Georgia Regents University and/or group booking number You may fax reservations to Deadline for reservations is August 18, Reservations received after this date will be filled on a space-and-rate available basis. Check-in time is 4 p.m. with checkout time at 10:30 a.m. Room rates (scenic view villa): $179 one bedroom, $219 two bedrooms.

5 CONFERENCE SCHEDULE THURSDAY, September :00 Early Registration, East Beach Conference Center FRIDAY, September 20 7:00 Registration and Continental Breakfast 7:45 Welcome and Introductions Dr. Jatinder Bhatia 8:00 Growth Goal for the Preterm Infant Dr. Tanis Fenton The fetus grows at an astounding rate to achieve a birthweight of 7 to 8 pounds (about 3,500 grams) by term. Key guideline groups, including the American Academy of Pediatrics recommend that preterm infant growth mimics the growth of the fetus. Thus, we need to look at intrauterine growth assessments to develop growth goals for infants born prematurely. Perhaps the best available source of intrauterine growth data is from recent data from developed countries, with gestational age assessments or corrections for inaccurate gestational age estimates. The PreM Growth study (Preterm Multicentre Growth study) provides a comparison of recent preterm infant growth for comparison with fetal growth estimates. 8:45 Cardiac Emergencies Dr. William Lutin Congenital heart disease presents in benign and aggressive forms. Recognizing serious lesions as soon as they start presenting could aid in minimizing morbidity and mortality. 9:30 Panel for Questions 10:00 Break 10:15 Nutrition in the Premature Infant: Why and How Dr. Jatinder Bhatia The increasing survival of premature infants and the global burden of prematurity and low birth weight makes this cohort of infants an important public health concern. These infants are at high risk for extra uterine growth restriction, infections, developmental delay, chronic lung disease, and mortality. Among premature infants, it is well recognized that early aggressive parenteral nutrition and early initiation of enteral nutrition can minimize the time to return to birth weight and potentially reduce the burden of growth restriction. Utilizing appropriate feeding strategies and promoting the best growth possible has demonstrated multiple benefits: infants growing at the highest quartiles demonstrate less neurocognitive adverse effects and incidence of chronic lung disease than infants growing at the lower quartiles. In this presentation, rationale for early nutrition, strategies of parenteral and enteral nutrition both for in hospital and post hospital will be emphasized. 11:00 Breast is Best: Using Human Milk to Improve Outcomes Amy Gates It has long been acknowledged that human milk is the best feeding for all infants. Human milk offers a unique protection for the premature infant. Human milk has been shown to improve outcomes such as length of stay, days on parenteral nutrition, and infection rates. Despite this understanding, there are challenges to feeding human milk in the Neonatal Intensive Care Unit [NICU]. The long separation of mother

6 Neonatology: The Sick Newborn and baby negatively effects mother s milk supply, creating a need for supplementation with infant formula or donor human milk. Fortification of human milk is necessary to ensure adequate levels of nutrients to promote growth. Amy Gates will outline the benefits of human milk, the appropriate use for donor milk, and how to adequately and safely fortify human milk. 11:45 Panel for Questions Noon Adjourn Afternoon Session (1 5 p.m.) Simultaneous Workshops (Lunch provided for workshop participants) 1:00 STABLE Johnny Wilson S.T.A.B.L.E. is the most widely distributed and implemented neonatal education program to focus exclusively on the post-resuscitation/pretransport stabilization care of sick infants. Based on a mnemonic to optimize learning, retention and recall of information, S.T.A.B.L.E. stands for the six assessments and care modules in the program: Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support. A seventh module, Quality Improvement, stresses the professional responsibility of improving and evaluating care provided to sick infants. 1:00 PICC Line Course Debbie Wall This two-day program is designed to fulfill the didactic and practicum components of instruction for insertion, use, and care of PICC catheters. The didactic portion of this program will include many topics of discussion including the insertion procedure and care and maintenance. Following the didactic portion of the class, each workshop participant will be required to demonstrate a PICC insertion in the classroom setting. They will receive a certificate of program participation and 8 continuing education credits. The course instructors will be available for supervision and support during the practicum portion of the class. SATURDAY, September 21 7:00 Registration and Continental Breakfast 7:45 Welcome and Introductions Amy Gates 8:00 Neonatal Surgical Emergencies Dr. Walter Pipkin Almost all surgical lesions that call upon the medical team for urgent attention are diagnosed prior to birth. In this session, commonly presenting lesions that are surgical emergencies and immediate steps that need to be taken prior to either transport or surgical consultation will be outlined. 8:45 Art Hardy Memorial Lecture NIPPV: It s Day has Come Dr. Kris Sekar An infant who is not intubated usually does not develop chronic lung disease! As more evidence becomes available, early recognition of RDS and treatment with surfactant or CPAP and the use of NIPPV will be highlighted in this lecture. 9:30 Panel for Questions 10:00 Break 10:15 Optimizing Neonatal Care before Delivery Dr. Paul Browne As prenatal diagnosis and OB care has advanced, there is a wealth of

7 September 20-22, 2013 information about fetal health which translates to neonatal care. Prenatal diagnosis is not only about detecting birth defects. Technology exists to assess failure to thrive (IUGR), fetal obesity (macrosomia), fetal health (BPP), placental health (Doppler velocity studies), fetal anemia (MCA Dopplers), twin discordance, etc. Accurate prenatal diagnosis and appropriate communication to neonatal providers optimizes the transition from fetal life to neonatal life. This lecture will discuss technology and perinatal communication strategies to improve neonatal outcomes. 11:00 Limits of Viability Dr. Linda Sacks The current consensus is that infants born prior to 23 weeks gestation are considered non-viable. However, the best estimate of gestational age is the obstetrician s estimate of gestational age. Further, neonatologists can estimate gestational age to within two weeks, but whether an infant is viable or not cannot be determined just based on visualization except in extreme cases. Limits of viability and problems with survival are the focus of this discussion. 11:45 Panel for Questions Noon Adjourn Afternoon Session (1 5 p.m.) Simultaneous Workshops (Lunch provided for workshop participants) 1:00 STABLE, Part Two 1:00 PICC Line Course, Part Two 6:00 Reception at Mingo Point 7:00 Dinner at Mingo Point SUNDAY, September 22 7:00 Continental Breakfast 7:45 Welcome and Introductions Amy Gates 8:00 The First Hour Dr. Triven Bashambu Delivery room personnel during the first moments of life have an opportunity to impact not only the immediate success of the newborn, but also longterm outcomes such as developmental delay and even death. Efficient team management, minimizing oxygen exposure, and optimizing lung recruitment are just some of the challenges faced during this transitional period. The focus of this presentation will be to discuss these challenges and the latest evidence-based recommendations for delivery room management of the newborn. 8:45 The NRP and Beyond: Do s and Don ts Dr. Anjali Parish With the ever-changing landscape in neonatology, this lecture will focus on the best evidence available about monitoring limits, use of therapies including oxygen. 9:30 Panel for Questions 10:00 Break and check out 10:45 Debbie Matthei Memorial Lecture What Do We Know? Twenty Years of Trials in Neonatology Dr. John Zupancic In this era of constricting resources, we are all called upon to provide health care more efficiently, at a lower cost, and with better outcomes. This discussion will focus on various issues in this area.

8 11:30 Case Presentations and Questions in the New Era of Health Care Dr. Jatinder Bhatia In the uncertain times ahead of us, there will be new questions raised about treatment modalities that may be humanely justified, but not evidence-informed. In other parts of the world, such restrictions on treatment are applied, and withdrawal of care is also performed if the parents/family do not have an ability to pay. In these case presentations, we will review two cases where infants were placed on extracorporeal membrane oxygenation. Questions that we will explore together are: 1. Were the decisions ethically sound? 2. Did the cost justify the means? 3. Did we do the right thing? 12:15 Panel for Questions 12:30 Adjourn Afternoon Session (12:30 2:30 p.m.) - Workshop (lunch provided for workshop participants) Pediatric Neonatal Vascular Ultrasound Course Debbie Wall, Marcus Dye, Teresa Dye, and Debbie Elder This is a step-by-step Ultrasound Guided PICC Insertion Training program that introduces the clinician to the use of ultrasound for vessel identification, visualization, and as an aid in needle access during PICC placement. Steps for and use of modified seldinger technique for the neonatal and pediatric population will be included. It is recommended that the applicant already be PICC trained or be registered in the PICC class provided at this conference. 2:30 Adjourn MINGO POINT Low Country Oyster Roast Join us Saturday night for an authentic Low Country Oyster Roast reception with specialty beverage. Dinner includes a whole pit roasted pig, Carolina Pork Spareribs, and all of the Southern side dishes you would expect. Network with other neonatal professionals as you enjoy music and the beautiful waterfront scenery of Mingo Point. Tickets are $25 per adult and $15 for children 5-12, under 5 free. Tickets include two bar tickets for wine, beer, or soft drinks. Pre-registration Required Registration Fee The registration fee includes attendance to the conference, continental breakfasts, refreshments, and access to a website to download copies of handouts prior to the conference. Optional workshops (PICC I & II, STABLE, and Vascular Ultrasound) are available for additional fees. A hard copy of the syllabus is available for an additional fee of $35. Order your copy when you pre-register for the conference. Handouts received prior to our print deadline will be included in the syllabus. Handouts not in syllabus may be downloaded from web link.

9 REGISTRATION FORM Neonatology The Sick Newborn September 20-22, 2013 Course Registration Fees $350 Physicians (entire conference) $200 per day $235 All others (nursing, residents, and fellows) $100 per day Workshops Optional PICC I and II (limited number of participants / lunch included) $100 if registered for entire conference $125 PICC workshop only STABLE certification/recertification (limited number of participants / lunch) $100 if registered for entire conference $125 STABLE workshop only Pediatric Neonatal Vascular Ultrasound* (limited number of participants / lunch) $100 if registered for entire conference $125 PNVU course only *Recommended you are PICC trained to attend Mingo Point Reception Number attending $25 per adult Number attending $15 per child 5-12 under 5 free q Hard copy of syllabus ($35 fee required) $ My check payable to Georgia Regents University is enclosed or please charge $ to my q VISA q MasterCard q American Express q Discover Account no. Three- or four-digit security code Name Street Expiration date City State Zip Telephone no. Last four digits of Social Security number M.D., R.N., other Previously attended this course q Yes q No address Fax Position/specialty The registration fee, less a $75 administrative charge, is refundable if notification of cancellation is received by September 1, We reserve the right to cancel the program if necessary. Full registration fees will be refunded for canceled programs. Georgia Regents University cannot be responsible for reimbursement of airline or other transportation fares, hotel, or rental car charges, including penalties. Register ( before June 29 to be placed in a raffle for a chance to win a FREE registration. Drawing to be held at the conference September 22, Send registration form to: Division of Continuing Education Georgia Regents University th Street, FI-1066, Augusta, Georgia Phone: or Fax registration with payment by credit card to

10 NEW Georgia Regents University Medical College of Georgia Division of Continuing Education 112o 15th Street, FI-1066 Augusta, GA An Affirmative Action/Equal Opportunity Educational Institution 35th Annual Neonatology: The Sick Newborn Including STABLE, and PICC Line and Pediatric Neonatal Vascular Ultrasound Courses September 20-22, 2013 Kiawah Island, South Carolina Mingo Point Reception Sept. 21, 2013 Check details! Non-Profit Org. U.S. POSTAGE PAID Augusta, Georgia Permit No. 210