Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 2nd International Conference on Pediatrics, Neonatology and Healthcare Amsterdam, Netherlands.

Day 1 :

Conference Series Pediatric Healthcare 2020 International Conference Keynote Speaker Maria Bertha Romo Almanza photo

Pediatrician Neonatologist with 11 years of experience in the field, antecedent of being Cheaf in charge in Neonatal Care Intensive Unit in Hospital Star Médica Luna Parc (until 2015) and the last 5 years. Cheaf in Charge of NICU at HMI Guadalupe Victoria Atizapan, (Actually).  subspecialty of neonatology at the National Institute of Perinatology, (INPER) Graduated from UNAM, professor of advanced breastfeeding diploma APROLAM section of Neonatology, Instructor of Neonatal Resuscitation Course, Private Clinical Clinical Researcher 11 years of experience. Certified by the National Council of Neonatology in Mexico, Member of Association of Neonatologists of the State of Mexico (ANEM) and Mexican Society of Pediatrics (SMP) Publications various.



In recent decades, advances in medicine and its neonatal approach have allowed an increase in the survival of critically ill newborns hospitalized in NICU.

In 2018  Mexico registered  a total of 2,162,535 births, of which 50.8% correspond to the male sex and 49.2% to the female (Dates obtained by the INEGI: National Statistics Institute) with a  birth rate   17.8% (2017), Specialized Care Centers have been created in the management of newborns with some type of pathology, the challenge being now the decrease in associated comorbidity, as well as decrease hospital stay  time.

Objective:  To analyze how the maternal breastfeeding roll, kangaroo breast program and the hand washing strategies, help to reduce morbi - mortality and hospital stay in the NICU

Therefore, strategies have been sought: such as greater contact of the mother-child binomial through starting the kangaroo mom program as soon as the patient's conditions allow it, this in addition to the generated emotional bond, generates adequate microbiota presence by skin-to-skin contact. In addition to improving the weight increase day by day. Start of early feeding with human milk, through homologous donation of milk, with full support for breastfeeding, as well as pasteurization of donated human milk, and certify as a Child and Mother Friendly Hospital,

Results: During the year 2018 there were a total of 3585 births of which 8.89% (n = 319) required hospitalization The main reason for hospital admission was and is currently : prematurity, and one of its comorbidities  associated is sepsis, so another strategy that has been taken is 100% continuous training and reminders of it , to both the staff in charge of the babies, as well as the their parents, which has had a positive impact on reducing nosocomial infections,  and  a home delivery is allowed earlier. 

Conference Series Pediatric Healthcare 2020 International Conference Keynote Speaker Pedro Ivan Barrera Martinez photo

Pedro Ivan Barrera Martinez is the Head of the Neonatal Intensive Care Unite Private children´s Hospital Mexico.


Introduction: One of the biggest hits of neonatology in recent years has been the progress made in the preterm newborn care, however, prematurity remains the main problem of contemporary neonatology. In premature infants, is of great importance, due to its morbidity, the group of ventilated infants. Ventilation has been a neonatal intensive care technology that has contributed to the decline in infant mortality, especially in very low birth weight infants. However, changes in long-term neurodevelopmental not descend.  One possible explanation is that ventilatory practices as useful when used in a proportionate and appropriate can damage the developing brain when used excessively (eg. hypocarbia, hyperoxia). So, the question is: what can we do to protect the developing brain?

Objective: Demonstrate abnormal neurodevelopment in premature infants weighing less than 1500 grams that showed changes in levels of CO2 and O2 by ventilation.

Methods: Performing a case-control study at the National Institute of Perinatology to assess the association between neurodevelopmental disorders and CO2 and O2 by ventilation. The study was conducted with 249 infants (100%) receiving mechanical ventilation and monitoring neurodevelopmental Pediatric tracking service, with 124 cases (abnormal neurodevelopment) and 125 controls (normal neurodevelopment) which assesses the neurodevelopment at 3 years patients age infants less than 1500 grams who required ventilatory assistance at birth and showed changes in CO2 and O2 related.

Results: We analyzed the cases and controls found no statistically significant differences in terms of demographic variables (sex, weight, gestational age, length of stay, days of ventilation and minute Apgar) Table 1. In descriptive statistics found a sex distribution of 134 (53.8%) female and 115 (46.2%) male, mean gestational age of 28.81 weeks and a mean weight of 967.18 grams.

Tracking neurodevelopmental assessment was performed with the Terman-Merril, Bayles II, Amieltison, and ultrasound transfontanelar (UST). Diagnosis was altered neurodevelopment according to Terman Merrill test, normality found in 125 (50.2%). According to the result of UST were reported normal 128 (51.4%), with Grade I hemorrhage in 23 (9.2%), Grade II 48 (19.3%) and 50 (20%) with periventricular priventricular. The Bayley Scale of development, the mental scale 76 (30.5%) had less than 69 points scoring with significant delay, 69 (27.7%) were 70 to 84 points qualifying slight delay, 95 (38.2%) with a score between 85 and 114 reported normal development and 9 (3.6%) were rated with a score higher than 115 estimating accelerated development. As for the motor scale 103 (41.4%) had less than 69 points scoring with significant delay, 63 (25.3%) were 70 to 84 points qualifying slight delay, 82 (32.9%) with a score between 85 and 114 reported development normal and 1 (0.4%) were rated with a score higher than 115 estimating accelerated development. Valuing Amiel-Tison reported abnormality in 177 infants (71.1%) and was normal in 72 infants report (28.9%). In motion abnormalities 40 (20%) patients had PCI.

To qualify hypocarbia association was identified (Figure 1), hypercarbia (Figure 2), hypoxia (Figure 3) and hyperoxia (Figure 4) with normal and abnormal neurodevelopment, with statistical significance for hypercarbia (OR 9061, IC 95% 4.895-16.775, p 0.0001), hyperoxia (OR 4820, IC 95% 2.642-8.794, p 0.0001). Following the methodology outlined in Table 2 presents the results of the estimation using bivariate logistic regression, after removal of non-significant variables. First, it is noteworthy that the statistic applied to evaluate the validity of the model as a whole indicates that there are sufficient reasons to accept its validity (omnibus test of the model shows the following results: Chi Square: 146.452,   p: 0.0001), we can say the altered levels of oxygen and carbon dioxide explain abnormal neurodevelopment. In addition, Table 3 presents the results another tests commonly used to assess the goodness of fit of a logistic regression model (called Hosmer and Lemeshow). From the results it is interesting to note the high ability of the model to correctly classify infants studied. Thus, 84.3% of cases globally considered, was well rated. And there are differences between the percentages for normal children and children 86.2 82.5 abnormal.

Conclusions: The neurodevelopmental be assessed routinely in the neonatal intensive care hospital units, with strict criteria for monitoring and assessment programs established. Alterations CO2 y O2 predict positive and statistically significant association with a population-attributable risk for neurodevelopmental disorders in both OR and in the logistic regression. The neurological assessment should be used early for timely intervention. Valuing Bayley II supports reports in the literature most affected motor scale than mental. Since its initial use neonatal ventilatory support has contributed to the increased survival in the newborn and is currently a priority need for effective strategies gentle ventilation characterized by low tidal volumes, permissive hypercarbia and hypoxemia that impact short long term care and the evolution of lung neonatal neurodevelopment.

  • Pediatric Case Reports

Session Introduction


Rajiv Gandhi Government Post-graduate Ayurvedic College and Hospital Himachal Pradesh, India

Title: Geriatric health care-impact area of Ayurveda

Y K Sharma obtained his BAMS (Gold Medalist), MD (Ay), Dip. Yoga, Ph.D. (Geriatrics). And also former Dean/Principal from Rajiv Gandhi Government Post-graduate Ayurvedic College and Hospital, Paprol, Himachal Pradesh, India.



The World population of the elderly is increasing and by the year 2050, adults older than 65 years will comprise 1/5th of the global population. This growing population percentage of Old People in World is a serious challenge to existing health care structure of World especially in Developing and Underdeveloped countries.  This shall have huge economic liability and is with potential to choke the hospitals of tertiary care in these countries which are already overloaded with patient care of other ailments of younger population with recoverable ailments. Thus it is desired that people live long, healthy and productive life without much burden on family and society. The health policies world over related with geriatric care should enable and support voluntary and non-governmental organizations as well as Alternative Systems of Medicines to supplement the care provided by the family and provide health care and protection to vulnerable elderly people. The main objective of such policies should be to make older people fully independent citizens. The biggest challenge with geriatric health problem is that in most of the cases the condition cannot be attributed to a single cause and action for their origin or management. In certain conditions like neuro-psychiatric disorders (Senile dementia, Alzheimer’s depression), the structural cause is unknown and senescence is attributed as major factor behind the degradation of physical and mental health as well as capabilities of old peoples. Ayurveda the ancient science of life with comprehensive approach for health management by promotion of health and disease management of individuals have always been looked for providing long and healthy life. Its concept of Rasayana has widely been propagated as a specialty for arresting the process of aging and assuring old age which is sickness free and productive. Various Ayurvedic therapeutics like Rasayans, Panchkarma, Herbal Formulations, etc  have been thought to improve physical, immunological, psychological, cognitive potentials of individuals the progressive loss of which is core to the ailments of old age. The  leading causes of morbidity and mortality among aged people comprise respiratory problems, heart diseases, cancer and stroke besides common age related functional disorders like lowered appetite, poor digestion, anemia, decreased colonic motility  leading to  constipation and impaction of stools,  increased frequency of urine to   retention, incontinency of urine,  BPH, etc.  Decreasing musculo-skeletal – power and tone leading to falls and fracture, as well as in-coordination of gait. Degenerative changes in Nervous system lead to dementia, delirium and depression, termers, ataxia and many other psychological ailments. Frequent lung infections, osteoarthritis etc are the other common old age related health problems.  Author feels that working with these regressing features of old age is real impact area of Ayurveda practices.  Further Ayurveda can also identify its impact area in Social, Psychological as well as Spiritual care of old people.



Sujata Sai is a resident in surgery at Manipal Hospital, Bangalore. She is passionate about saving and changing lives. She also enjoys blogging about her experiences as a surgical resident. She has consistently done excellently academically, and has excelled in multiple extracurricular activities as well – She has given the Trinity College of Music Piano exams, is a part of several volunteer organizations for social service and participates in several sports as well.



Background: Extensive vascular lesions can endanger the life of a child by their virtue of consumptive coagulopathy or cardiac failure. A conservative surgical approach is difficult and can be life-threatening due to uncontrolled bleeding. We report successful limb salvage in an infant despite an extensive and infected arterio-venous malformation of upper limb, complicated by severe consumptive coagulopathy

Case: A term male, 3.2kgs, presented with a swelling over left arm detected antenatally. Antenatal scan- soft tissue swelling 10.8 x 6.8 x 5.4cm from left shoulder to elbow with heterogeneous cystic spaces and minimal vascularity.O/E- non compressible, no bruit heard. 

Investigations: Doppler – hypoechoic lesion+ heterogeneous echotexture, numerous cystic spaces, weak color Doppler signal- S/O- Hemangioma. MRI- lobulated soft tissue mass 17 x 16 x 9.5cm with an intensive enhancement, necrotic and hemorrhagic areas, involving flexor and extensor muscles of the arm. Supplied by branches of axillary and brachial arteries.Diagnosed as- Hemangioma , hence was started on propranolol 0.5 mg/kg/ day. At 4 months of age surgery became an imperative lifesaving mode of treatment.  

Operative procedure: Planned for amputation/ disarticulation. Axillary vessels identified and controlled Tumor excised into Flexor and extensor muscles preserved as much as possible. Radial nerve through the tumor was divided and re-anastomosed. Disarticulation was hence avoided. Arm and hand movements preserved at 10mth follow-up. 

ConclusionA conservative limb salvage surgery is possible even in case of an extensive vascular anomaly. A good vascular control is a must to prevent life threatening hemorrhage in a conservative surgery.


Dr Chhaya Akshay Divecha has completed her Undergraduate as well as postgraduate (MD Pediatrics) from the reputed Seth G.S. Medical College & KEM Hospital at Mumbai , India.She has also obtained fellowships in Neonatal Intensive Care and Pediatric Intensive Care from the same reputed institution. She is currently Assistant Professor in Pediatrics at College of Medicine, National University of Science and Technology (formerly Oman Medical College) at Sohar, Sultanate of Oman. She has more than 10 years of teaching experience and has published many papers in reputed journals as well as contributed to chapters in four textbooks.


Aim and objectives: Thrombocytopenia, commonly encountered in intensive care units, has been shown to be independent predictor of mortality and prolonged hospital stay in critically ill. We conducted a study in Pediatric Intensive Care Unit(PICU) to determine the causes and severity of thrombocytopenia as well as patient outcomes (bleeding and mortality).

Materials and methods: Observational study was conducted in PICU of tertiary care hospital, India after ethics committee approval. Data was derived from routine examinations and investigations. Detailed information about demographic data, clinical data, length of stay (LOS), periodic platelet counts, primary diagnosis, complications, sites of bleeding (if any), use of mechanical ventilation and outcome in PICU were noted.

Results: Occurrence of thrombocytopenia in study population (N= 491) was 60.3%. Mild, moderate, severe and very severe thrombocytopenia was seen in 27%, 32.1%, 34.1% and 6.8% patients respectively. Causes of thrombocytopenia were sepsis (27%), part of primary illness (25.7%), undetermined cause (24.7%), nosocomial sepsis (21.2%) and drugs (1.4%). 237 (48.3%) patients had bleeding during PICU stay. Maximum patients (26.1%) had respiratory system involvement. Risk factors associated with thrombocytopenia were sepsis, shock and mechanical ventilation. Patients with thrombocytopenia had longer PICU and hospital stay. Patients with infectious disease and haematological disorders had statistically significant chances of thrombocytopenia. Shock was significantly associated with increasing severity of thrombocytopenia. Presence of thrombocytopenia and increasing severity were associated with higher mortality.

Conclusions: Thrombocytopenia is a readily available risk marker of mortality and increased PICU stay. Patients having sepsis, shock and mechanical ventilation are at higher risk of developing thrombocytopenia.

  • Pediatric Urology and Nephrology

Beatriz Gonçalves Teixeira has completed her Undergraduate Degree from the Faculty of Nutrition and Food Science of the University of Porto, Portugal. She has enrolled on the Clinical Nutrition Master Degree at the same university in 2018. She is collaborating with the Basic and Clinic Immunology department of the St. John's Hospital Center, Porto, Portugal, in order to produce the present investigation. She has done two nutrition internships at the St. John's Hospital Center, Porto, Portugal, at the gastrointestinal surgery department. She has published an audio book related to food allergies (2016).



Introduction: Obesity is one of the most prevalent chronic diseases in childhood, being an important public health issue. Excess weight has been associated with autonomic dysfunction but the evidence in children is scarce. Therefore, this study aimed to assess the effect of overweight and obesity on the autonomic nervous system activity in children.

Methods: Data were collected from a cross sectional study including 916 children (7 to 12 years), from 20 primary schools in Porto, Portugal. Anthropometric measurements and bioelectrical impedance analysis were performed to assess body mass index (BMI) and characterize body composition - body fat percentage, body fat mass and total body water. BMI was classified according to age- and sex-specific percentiles defined by the World Health Organization, the US Centers for Disease Control and Prevention and the International Obesity Task Force. Pupillometry was performed to evaluate autonomic activity. Mann-Whitney, the chi-square, and Kruskall-Wallis tests were used as appropriate.

Results: Final analysis included 858 children, 50.6% boys, with a prevalence of obesity ranging between 7.5% and 16.2% according to the International Obesity Task Force and percentage of body fat criteria, respectively. The average dilation velocity was significantly higher among children with obesity, regardless of BMI criteria.

Conclusions: Our results suggest that obesity in children is associated with a dysautonomia in autonomic nervous system, namely with changes in sympathetic activity. Moreover, these findings provide support for the role of the autonomic nervous system in the interaction between lifestyle, diet and the BMI in children.



Paul Patrick Rega is from the Department of Public Health and Preventive Medicine (PPR, SK) and the Department of Health and Recreation Professions (SMR, DB, CR), University of Toledo, Toledo, OH; and the Department of Emergency Medicine, University of Toledo Medical Center (PPR, KB), Toledo, OH.



Background:  Children are frequently victims both intentionally and as collateral damage in mass shootings, gang violence, and global conflict.  Increasingly, hospitals, previously considered inviolate, have also been targeted.  Their personnel also.  Examination of these incidents at our institution led to the development of educational strategies to improve the survivability of these innocent victims.


Methodology:  Over the course of five years, educational initiatives were developed, evaluated, and taught at our academic center to provide this training, not only to healthcare personnel and students, but also to vulnerable civilian populations both locally and across the country.  The initiatives include training in triage, tourniquet application (including improvisational), active shooter drills, emergency hospital evacuation, and active shooter “gaming.”


Results:  The types of educational activities over the course of five years and approximate number of attendess are listed:  Triage (200 multidisciplinary healthcare students and residents); Tourniquet skills (2500 multidisciplinary healthcare students, residents, law enforcement, faculty); Extramural tourniquet skills (30 under-privileged children in Arizona; 50 New York high school students; 50 children and families in Toledo health fairs and libraries); Active Shooter Exercises (500 healthcare students); Emergency Hospital Evacuation drills (300 healthcare students); Active Shooter gaming (70 healthcare students, pediatric residents, and nurses at a Pediatric Educational symposium).  Pre- and post-activity surveys revealed statistically significant satisfaction and competency scores in more than 95% of the attendees.


Segen Gebremeskel Tassew has completed her B. pharm from Mekelle University and her MSc from Addis Ababa University, Ethiopia. Currently, she is serving as a Lecturer in Clinical Pharmacy Unit, Mekelle University, Ethiopia. She is a young Researcher she have won a grant for young researcher of the year funded by Mekelle University and she have three papers under review.



Background: Hospital-Acquired Infections (HAIs) are acquired when the patient is hospitalized for more than 48 hours. In Ethiopia data are scarce in management appropriateness of HAIs. Hence, this study was aimed to assess the prevalence and management of HAI among patients admitted at Zewditu Memorial Hospital.

Method: This study was conducted from March 1, 2017 to August 30, 2017. Samples were proportionally allocated among medical, pediatrics, gynecology and obstetrics and surgical wards. Data were collected using data abstraction format and supplemented by key informant interview. Management appropriateness was assessed using Infectious Disease Society of America guideline and experts opinion. A multivariate logistic regression was used to identify factors associated with HAIs.

Result: The prevalence of HAI was 19.8%. Surgical Site Infection (SSI) and pneumonia accounted for 20 (24.7%) of the infection. Of the 81 patients who developed HAIs, 54 (66.67%) of them were treated inappropriately. Physicians’ response for this variation was information gap, forgetfulness, affordability and availability issue of first line medications. Younger age (AOR (Adjusted odds ratio) = 8.53, 95% CI: 2.67-27.30); male gender (AOR=2.06, 95% CI: 1.01-4.22); longer hospital stay (AOR= 0.17, 95% CI: 0.06-0.51); and previous hospital admission (AOR=3.22, 95% CI: 1.76- 5.89); were independent predictors of HAIs.

Conclusion: Prevalence of HAIs and inappropriate management were substantially high in this study. Locally conformable guidelines could help to correct inappropriate management.



Sujata Sai is a Resident in Surgery at Manipal Hospital, Bangalore, India. She is passionate about saving and changing lives. She also enjoys blogging about her experiences as a Surgical Resident. She has consistently done excellently academically, and has excelled in multiple extra-curricular activities as well. She has given the Trinity College of Music Piano exams, is a part of several volunteer organizations for social service and participates in several sports as well.



Background: Splenogonadal fusion (SGF) is a rare congenital anomaly which occurs due to an abnormal fusion of splenic tissue with the derivatives of the perimesonephros. It usually presents as an inguinal hernia, testicular mass or undescended testis. To the best of our knowledge, this is the first time, SGF presented as a strangulated inguinal hernia.


Case Report: A six years old boy with an acute painful left inguinal swelling since that morning. General examination- tachycardia. Groin exam- A tense, tender, irreducible left inguinal swelling with normal bilateral descended testes. USG- A soft tissue swelling as the content of the hernia with reduced vascularity. DDx- ? torsion of supernumerary testis


Intra operative findings: Left indirect inguinal hernia, no omentum/ bowel, but a purplish mass connected distally to upper pole of the left testis and proximally entering the peritoneum through a fibrous cord. Fibrous cords – 360° torsion → early gangrenous changes. Histopathology revealed a fibroelastic capsule covering a tissue comprised of red pulp, white pulp, dilated sinusoids; consistent with an ectopic spleen. SGF is a rare entity - less than 200 cases reported till date.The etiology is unknown. Treatment of choice-Complete excision of the splenic tissue with preservation of gonad. Unfortunately, 37% of the reported cases underwent unnecessary orchidectomy as many surgeons were unfamiliar with SGF.


Rodrigo Medorio

Children's Hospital of Mexico Federico Gómez

Title: Pediatric Hydronephrosis. What to do?

Rodrigo Medorio is a medical doctor whit specialty in pediatrics, pediatric surgery and pediatric urology. Focused for the last 10 years mostly to the practice of pediatric urology and got his experience in one of Mexico´s biggest pediatric hospital where part of activities carried out was en resident training. Currently collaborating in his hometown community as a pediatric surgeon and urologist as part of the social health system and private practice.



Introduction: 1-5% of obstetric ultrasound will show some degree of hidronephrosis and a high percentage of them will persist during the first decade of life or require surgical management. Prenatal hydronephrosis is define by an anterior-posterior diameter of the renal pelvis greater then or equal to 4mm at less then 33 weeks of gestation and 7mm at greater than 33 weeks gestation. In older children it is define as renal dilation with urine accumulation. Although a great number are considered transient or physiologic, the most common etiologies are ureteropelvic junction obstruction, vesicoureteral reflux and non-refluxing primary megaureter.

Objective: The purpose is to share a time saving evaluation and to optimize referral of patients detected with hidronephrosis so they may have an optimal etiological diagnosis and treatment.

Methods: A review of literature has been done to create a first line fallow-up algorithm for pediatric healthcare personnel. We reviewed literature from the last ten years selecting articles referring to diagnosis, classification and fallow-up. We excluded the ones focused on surgical treatment and management outcomes.

Results: It has been established an evidence based study algorithm for pediatric patients diagnosed with hydronephrosis and found that ultrasound is the corner stone in decision making for first line fallow-up of hydronephrosis and also marks the next step to take.

Conclutions: All patients diagnosed with hydronephrosis need to be monitored. Ultrasound is always the first exam in the decision making algorithm in the study of a hydronephrotic patient. Being the first line contact, it is imperative for pediatric health care professionals to have a knowledge of how to monitor this patient for an optimal referral.

  • Child Abuse and Prevention

Seline Ismail-Sutton is pursuing her Medicine at Cardiff University, United Kingdom. She is extremely passionate about Paediatric Mental Health. She has been fortunate to be part of the Cardiff ECHO study researching 22q11.2 Deletion Syndrome. The study has followed up children and adolescents with this syndrome. The study has found a high rate of mental health conditions including anxiety, ADHD and psychotic symptoms in this cohort. She has researched how these psychotic and pre-psychotic symptoms are related to environmental factors. She believes research into genetic syndromes and mental health is crucial, enabling early intervention to be conducted and subsequently reduce the incidence of mental health disorders.



Background: The 22q11.2DS (22q11.2 deletion syndrome) is a model of both genetic vulnerability and early traumatic experiences, yielding a varied phenotype, including a high prevalence of psychotic disorders. The factors leading to only a proportion developing prodromal psychotic symptoms are largely unknown, despite the prodromal phase being hailed as a key time for intervention. We investigated the relationship between: stressful and positive life events (SLEs and PLEs), family environment, socioeconomic background, birth order and season, and prodromal and psychotic symptoms.


Method: Variable and prodromal/ psychotic symptom data was collected using questionnaires created by Cardiff University ECHO study and the SIPS (structured interview for prodromal symptoms), and subsequently analyzed using SPSS.  The sample size was between 22-48 individuals for different variables, mean age: 15.7, 54.2% females. 


Results: Individuals with prodromal psychotic symptoms had significantly lower: PLEs, cohesion, conflict and family environmental scores (corresponding to better cohesion and family functioning and less conflict): M:26.93, SD:3.86 and M:32, SD:1.92, p=0.002, M:54.53, SD:7.94, M:65.43, SD:3.46, p=0.003 and M:27.6, SD:4.72, M:33.43, SD:2.070, p=0.006, M:1.04, SD:1.72 and M:1.71, SD:1.31, p=0.016. Individuals with prodromal psychotic symptoms had non-significantly higher SLEs and deprivation index: M:1.87, SD: 1.73 and M:6, SD:2.75, M:6.92 SD:1.83, p=0.239. A non-significantly increased relative risk was present for spring/winter births, relative to autumn/summer: RR:1.21, CI:0.79-1.86, p=0.364. No significant differences were found for self-esteem and birth order.


Conclusion: Our findings demonstrate the interplay between environmental factors and genetic vulnerability in the development of prodromal psychotic symptoms. Thus, providing potential opportunities for early intervention to create a more supportive developmental environment.

Liana Hill

Crisis Services of North Alabama, USA

Title: Refeeding Syndrome – The Caring Abuse

Liana Hill MSC, RN FNE, SANE-A SANE-P, is Forensic Nurse Examiner Program Director for Crisis Services of North Alabama. She provides direct services to victims of assault. She began the first Domestic Violence Nurse Examiner program in the state of Alabama.  Under her guidance and passion, the program now provides sexual assault, child physical abuse, domestic violence strangulation, elder abuse and suspect examinations to assist in civil and criminal cases and provide medical care to patients. She is 1 of 4 nurses in Alabama that holds both her SANE-A and SANE-P certifications.


This case study will follow the child abuse history of a 5 year old boy. In 2016 he was examined by a forensic nurse for physical abuse injuries, in 2017 he returns to school after his summer vacation looking gaunt with significant weight loss. What would you do as a teacher, social worker, child protective services worker or medical professional in seeing this child? Most would feed the child, most would do this due to concern and caring, not realising how serious this would become for the small boy.

He was again referred to the forensic nurse team for documentation of his injuries, where his condition was questioned further than the initial providers.

Now 6 year old boy was subsequently diagnosed with refeeding syndrome. First recorded during the second world war, when prisoners were released from concentration camps, after being starved, many ate too much often, quickly, and then died.

The presentation will discuss the sign and symptoms of this syndrome, including the metabolic abnormalities that occur when a malnourished person begins to feed again. It will include the treatment and recovery program for the child. The outcome of the case from a criminal disposition and education of the multi-disciplinary team, so that caring would not put another child at risk.