30^th Global Summit on Pediatrics and Neonatology August 20-21, 2020 Prague, Czech Republic

Neonatology is a division of paediatrics that specifically deals with medical care of newborn infants, especially the premature or preterm or ill. Neonatology is a specialized sub-discipline of paediatrics since neonatologists have to be trained specifically to handle the most complex and high-risk complications. Perinatology is concerned with the medical care of the mother as well as the fetus at higher-than-normal risk for complications. A high-risk infant might be cared for by a perinatologist before birth and by a neonatologist after birth.

Pediatric and neonatal genetics provides comprehensive care in the diagnosis, treatment and prevention of birth defects, structural abnormalities, inherited diseases, chromosomal abnormalities and mental retardation. Pediatric and neonatal geneticists treat genetic diseases, analyze chromosomes, perform amniocentesis for prenatal diagnosis, conduct molecular and DNA diagnostics, and provide genetic counseling. Some of the Conditions evaluated Pediatric Geneticists include autism, birth defects and congenital anomalies, cardiac genetics, craniofacial genetics (irregularity of the face and skull), cystinosis (excess amounts of the amino acid cystine in the cells, affecting kidneys and eyes), Down syndrome, ehlers-danlos, osteogenesis imperfecta and marfan syndromes (disorders of connective tissue, including skin and joints), fragile x syndrome (inherited mental impairment), neurofibromatosis (nervous system disorder that can affect skin and bone), skeletal abnormalities and limb defects, urogenital malformation (defects in urinary system or genitalia), among others.

The nutritional requirements of babies and young adolescents differ from that of adults in a number of aspects due to their energy expenditure (i.e., basal metabolism, high physical activity and metabolic response to food), rate of growth, body composition, and physiological changes (puberty, for instance). Due to the high nutritional needs of infants and adolescents, there is an increased risk for nutritional disturbances (i.e., undernutrition and overnutrition). This risk may become more complex by a lack of knowledge and/or awareness of signs and symptoms on the caregiver’s end. A pediatrcian can make a good nutritional assessment, which includes family history, developmental assessment, medical history (including growth history), and physical examination, especially growth parameters and anthropometrics.

Allergy symptoms commonly occur in children. Atopy is a tendency of exaggerated IgE antibody production and is defined by the presence of specific IgE in vivo or in vitro. Atopy represents a predisposition to atopic or allergic diseases including asthma, eczema, allergic rhinitis and food allergy. Scientific evidence of the systemic link between all of the atopic diseases has increased greatly. The atopy march starts early in life and it is widely believed that the fetal environment may be important for both the development of subsequent sensitization and disease manifestation. Early events under the influence of a variety of environmental factors, such as exposure to environmental endotoxin, allergens, infections, and variations in nutrient intake, affect the expression of the atopy genotype. The age of onset of every atopic disease is different and may be influenced by the aforementioned factors. Typically, atopic dermatitis and food allergy are commonly seen in young infants; while asthma usually starts after the age of 3 years, and allergic rhinitis develops at a later stage in childhood.

The subspecialty of pediatric infectious diseases includes both pediatrics and infection. Bacterial, fungal, parasitic or viral infections are all infectious diseases that are reason for concern. These illnesses need to be treated by specialists who are committed to preventing and treating acute and chronic infectious diseases. These include Lyme disease HIV/AIDS, pneumonia, osteomyelitis, tuberculosis, persistent fever or fever of unknown origin, lymphadenopathy, recurrent infections, complicated methicillin-resistant staphylococcus aureus (MRSA) infection.

Paediatric cardiology is an academic as well as clinical specialty and the paediatric cardiologist has a major role in the education of students, doctors, primary health care specialists, nurses and paramedical personnel. Close liaison with paediatrics, paediatric subspecialties, cardiothoracic surgery, adult cardiology, obstetrics, radiology and pathology is required.

Pediatric and Neonatal pulmonology is the study of lung diseases in infants and children. Pediatric pulmonologists are committed to provide special care for children with asthma, cystic fibrosis, and other chronic lung diseases. Pediatric pulmonology also emphasizes the importance of understanding respiratory physiology and paying detailed attention to the relevant physical exam. Pediatric pulmonology is also associated with providing care to patients with complex aerodigestive disorders, those undergoing lung transplantation, and patients with tracheostomies who may or may not be technology dependent.

Pediatric and neonatal gastroenterology and hepatology encompasses the diagnosis and treatment of children and teenagers with diseases of the digestive tract, liver and pancreas as well. Gastrointestinal (GI) problems in children may be quite different from those of adults, not only in presentation but also in types of diseases. The most prominent ailments that pediatric gastroenterology is concerned with are acute diarrhoea, gastritis, persistent vomiting, and problems with the development of the gastric tract. Although a pediatrician can provide treatment to many gastric diseases, but chronic diseases, related with the nutrition of the children, the pancreas or the liver needs to be treated by a pediatric gastroenterologist.

Traumatic wounds are a common reason for presentation to the emergency department. A wound could be defined as a physical disruption of tissue from trauma. They can be accidental as a result of trauma or intentional from surgery. Generally, wounds include abrasions, burns, lacerations, punctures, and larger wounds. Effective management of wounds requires a basic understanding of the physiologic process of wound healing. Pediatric and neonatal surgery may also be required for the surgical care of birth defects in a child or because of an injury or trauma. These may include pediatric cardiothoracic surgery, pediatric nephrological surgery, pediatric neurosurgery, pediatric urological surgery, pediatric emergency surgery, pediatric hepatological  and gastrointestinal  surgery, pediatric orthopedic surgery, pediatric plastic and reconstructive surgery, pediatric oncological  surgery, surgery involving fetuses or embryos and surgery involving adolescents or young adults.

Although only 1% of all cancers occur in children (<19 years of age), it is the second leading cause of childhood death. Early detection and prompt therapy have the potential to prolong survival and frequently cure the disease. Many factors are considered in determining the treatment goals for an individual patient: the type of cancer, its stage of growth, the patient's age, and family members' wishes. The discipline of Pediatric Hematology and Oncology has continued to expand in both the clinical and basic science arenas over the last several decades. Discoveries of dominant oncogenes, tumor suppressor genes, gene transfer technology and hematopoietic growth factors have opened new areas of clinical and basic research, as well as provided new potential therapies for patients. Both the demonstrated improvement in care for pediatric patients with hematologic-oncologic disorders as well as the scientific excitement generated through research directed toward understanding of these disorders ensures that the discipline of Pediatric Hematology/Oncology will continue to be an exciting part of pediatric medicine and science in the future.

Pediatric nephrology deals with the diagnosis, investigation and management of chronic and acute kidney ailments, including the provision of dialysis and renal transplantation. Paediatric nephrology also encompasses all aspects of renal physiology, including fluid management and disturbances in electrolytes and acid-base balance. A paediatric nephrologist is skilled in the management of acute kidney injury (AKI), which may be managed conservatively or with renal replacement therapy (RRT), including haemodialysis (HD), peritoneal dialysis (PD), and continuous venovenous haemodialysis (CVVHD) and continuous venovenous haemodiafiltration (CVVHF). They are also committed to the management of chronic kidney disease (CKD), including the pre-dialysis phase, peritoneal dialysis, haemodialysis and transplantation.

Children account for only a small percentage of pre-hospital emergency patients but are a special challenge for the treating physician. The broad spectrum of diseases, the wide age range with the physiological and anatomical changes that occur in it, and the special psychological, emotional, and communicative features of children make pediatric emergencies a special challenge for emergency physicians. A mastery of basic emergency techniques including clinical evaluation of the child, establishment of venous access, airway management, resuscitation, and drug dosing is essential for the successful emergency treatment of children. The common non-traumatic pediatric emergencies can be classified into four cardinal manifestations: respiratory distress, altered consciousness, seizure, and shock.

Pediatric ophthalmology is a sub division of ophthalmology which is committed to the care of children’s eyes, and has the greatest knowledge of possible conditions that affect the pediatric patient and his/her eyes.  Neurologic development of vision occurs up until the age of 12 years. Misalignment of the eyes (strabismus), uncorrected refractive error (myopia, hyperopia, and astigmatism), and asymmetry of refractive error (anisometropia) between the two eyes can negatively affect this development and cause amblyopia (“lazy eye”).  If these conditions are diagnosed and treated early, good vision can develop and can be maintained.  Certain diseases elsewhere in the body, such as diabetes, can affect the eyes, and the pediatric ophthalmologist addresses these, as well.

Pediatric endocrinology is a specialty concerned with the endocrine systems of infants, children, adolescents, and young adults.  Because of the complexity of the endocrine system, a number of diseases and conditions can be traced to problems in this system. Pediatric endocrinology provides diagnostic and therapeutic services for infants and young adolescents with Diabetes mellitus, Type 1 and Type 2, hypoglycemia and disorders of physical growth, disorders of puberty (including precocious puberty and delayed puberty) and sexual maturation, Hyperthyroidism and Hypothyroidism, short stature, pituitary function, Congenital Adrenal Hyperplasia (CAH), Turner Syndrome, and calcium and phosphorous metabolism- calcium disorders include hypercalcemia, hypocalcemia and juvenile osteoporosis).

Pediatric neurology or child neurology deals with the diagnosis and management of neurological conditions in neonates, infants, children and adolescents. The discipline of child neurology encompasses diseases and disorders of the spinal cord, brain, peripheral nervous system, autonomic nervous system, muscles and blood vessels that affect individuals in these age groups. A pediatric neurologist has the specialist training and knowledge to assess, diagnose and treat a child with problems that involve the nervous system. The conditions that pediatric neurologists deal with, vary considerably, from relatively simple disorders such as migraine or cerebral palsy through to more complex and rare conditions such as metabolic disease or neurodegenerative disorders.

Pediatric orthopaedics is a specialty that deals with the evaluation and management of musculoskeletal problems including the growing bones, joints, or muscles in children (newborns to young adolescents).Musculoskeletal problems and their evaluation/treatment in children differ from those of an adult. In children, musculoskeletal problems arise due to growth which does not occur in adults. The complex musculoskeletal disorders in children are best treated by a medical-surgical approach by a pediatric orthopaedic doctor. Some of the common conditions treated by pediatric orthopaedic doctors include deformities of the limb and spine, present at birth or later, such as limb length discrepancy, scoliosis, and club foot; abnormalities in gait/limping; fractures; infections or tumors in the bone or joint. Depending on the condition, pediatric orthopaedists provide appropriate non-surgical or surgical treatments to address the problems.

Pediatric dermatology focuses on the treatment and management of children’s skin, hair and nail conditions. These conditions can develop as children grow, or they can be present from birth. Pediatric dermatology focuses on children from infancy through adolescence. Pediatric dermatology deals with the skin problems, which may or may not require treatment, like acne, birthmarks, cysts, hives, lesions, moles and warts. Conditions in children where treatment is necessary include albinism, alopecia, atopic and contact dermatitis, eczema, epidermolysis bullosa, ichthyosis, hemangiomas, psoriasis, neurofibromatosis and vitiligo.

Pediatric nursing deals with the issue of child welfare and the health care of children. The definition of child welfare is simply the issues related to children faring well in a nation, a society, or throughout the world. Essentially, it is the promotion of child well-being and the protection from harm. Children may be vulnerable for a variety of reasons and need the advocacy of adults in order to grow and thrive. The pediatric nurse is in the key position to identify the needs of children, assess children's vulnerabilities, advocate for their rights, and ensure public protection. The role of the nurse in child welfare issues is to be aware of the vulnerability of children affected by social issues and to advocate and champion for those needing protection.

Neonates and young infants are less protected against life-threatening diseases due to lack of vaccines or late administration. Almost all vaccines work through induction of serum or mucosal antibodies, especially in young infants where the lack of previous antigen exposure limits the effectiveness of T cell responses. Cellular immunity is also required for protection against disseminated disease and recovery from measles and smallpox. Effective neonatal vaccination would be ideal especially for less privileged infants, for whom birth is often the only contact with health care systems. Neonatal vaccination therefore has the potential to improve vaccine coverage and confer protection before initial exposure to vaccine-preventable viral and bacterial infections. Alternative, indirect strategies include vaccination of the pregnant mother and/or other family members so as to “cocoon” the neonate against exposure to pathogens, but these strategies have shortcomings.

The important causes of neonatal mortality are congenital malformations, birth trauma, neonatal infections, and respiratory, metabolic and heart diseases. Although many of the neonatal problems are benign, self-limited and treatable, some are life-threatening and a direct cause of disability and death. Professionals who provide care for children must be aware of these problems, their natural history, their impact on children's heath and their treatment. Birth marks are common and often harmless, but parents need explanation and reassurance. Follow-up appointments are often necessary to ensure the general wellbeing of the affected children. Birth trauma, such as intracranial haemorrhage or arm paralysis, may occur during delivery, and treatment at a specialised unit is usually required. The prognosis of neonatal infections is generally poor, with high mortality unless treatment is started promptly and adequately. Respiratory diseases occur mainly in low birth-weight infants who may require mechanical ventilation. Metabolic and heart diseases are rare, but early detection is essential to ensure a high survival rate.

The human genome is often referred to as a "blueprint" and contains all of the information and instructions necessary for defining a human being. Most genes contain the information needed to make a protein, or molecules that carry out all of a cell's vital activities. Therefore, slight variations in genes lead to slight changes in a protein. Although some human diseases are explained by alterations in a single gene or of a single chromosome, most are complex and may involve multiple genes and protein pathways. A myriad of genes, as well as environmental factors, are believed to control the complex and integrated processes necessary for fetal development. When one or more of these processes goes awry, it can result in the birth of an individual with a genetic alteration. Scientific studies, often those that use other organisms as a model, will provide information about biological and regulatory processes involved in human development and will identify critical pathways in which genetic changes result in disease.

Cord blood is contained in the umbilical cord and placenta of a new born child. Cord blood contains blood (haematopoietic) stem cells, which can produce all the other cells found in blood, including cells of the immune system. Transplants of haematopoietic stem cells (HSCs) from cord blood can be used to treat several different blood diseases, such as leukaemia. Compared to HSCs from bone marrow donors, transplants of HSCs from cord blood appear to lead to fewer immune system incompatibilities, such as graft-versus-host disease. A limitation of cord blood is that it contains fewer HSCs than a bone marrow donation does; meaning adult patients often require two volumes of cord blood for treatments. Researchers are studying ways to expand the number of HSCs from cord blood in labs so that a single cord blood donation could supply enough cells for one or more HSC transplants. Some controversial studies suggest that cord blood can help treat diseases other than blood diseases, but often these results cannot be reproduced. Researchers are actively investigating if cord blood might be used to treat various other diseases.