Programme

This talk will introduce on behalf of ESPID the Antimicrobial Resistance and Prescribing in European Children project. This is a new initiative aimed at improving the evidence base for antibiotic prescribing. The first phase of the project is a systematic data collection across the EU on the variation in paediatric and neonatal antimicrobial prescribing in the community and hospital, antimicrobial resistance in paediatric bacteraemia and hospital and community based prescribing guidelines.

The main topics will be an up-dated analysis of epidemiology of perinatal infection in industrialised and developing countries, the model of the Italian register for HIV Infection in Children, risk factors for mother-to-child transmission; strategies, advances and failures in prevention, peculiarities of paediatric HIV-1 infection as compared to adults, clinical outcome of infected children (the past and the present), use of antiretroviral drugs, immunisation in HIV-1 infected children.

Since its inception in 1993, The Cochrane Collaboration has grown to include 16,000 members from more than 100 countries throughout the world. Today over half the world's population has access to The Cochrane Library and a Cochrane review is viewed every 7 seconds of every minute of every day. What is the role of Cochrane systematic reviews in closing the gaps exist between clinical practice guidelines and research evidence? This workshop will discuss the principles on which the Collaboration is based and the mechanisms used to make timely, accurate information about the effects of health care readily available in regularly updated systematic reviews. In addition, I will challenge The Cochrane Collaboration for its sometimes too zealous work and will propose new opportunities and commitments to substantially improve Cochrane reviews supporting the lifelong information and learning needs of the health professionals.

Objectives and Main Points:
1. Overview of intensive insulin therapy in the management of Type 1 Diabetes (T1D)
2. Insulin Pumps and the delivery of subcutaneous insulin
3. Review of evidence of effectiveness of insulin pumps in young people
4. Current evidence on the outcome of modern blood glucose monitoring systems used with insulin pumps
5. Using pump therapy as part of a management strategy for the delivery of care for diabetes in the young

The aim of this session is to use case-based discussion around examples of obstructive and central sleep related breathing disorders to understand the pathophysiology, clinical consequences, diagnosis and treatment of this group of conditions.
Delegates will be given an overview of sleep disordered breathing in children and review available tests used to diagnose these disorders. Indications for sleep studies in children will also be reviewed.

This presentation will highlight current consensus opinion regarding the evaluation of the child with a global developmental delay. A paradigm for the diagnostic approach and the appropriate selection of laboratory investigations will be highlighted. The presentation will also touch on emerging novel genetic investigations such as comparative genomic hybridisation and assess the role of these new technologies in our current evaluation of the child with a developmental delay.

There is great scope for genome sequencing to generate diagnoses and to guide therapeutics in the future. There is much disagreement, however, about the pace at which this will occur as our ability to interpret the results is lagging behind. Sequence information is likely to be helpful within the next decade in relation to the treatment of cancers and numerous single gene disorders and establishing diagnoses in developmental and psychiatric disorders.

The recurrent abdominal pain (RAP) is the most common gastrointestinal disease in children and adolescents. It is possible to distinguish an organic RAP and a functional RAP.
Recent clinical and experimental evidence that a mild degree of gut inflammation exists in IBS will be shown. This will help our understanding of the pathophysiology of IBS and will give a rationale for an immune-modulatory therapy in this disorder.

Mild renal pelvis dilatation (RPD) occurs commonly on antenatal ultrasound, and we performed a systematic review and meta-regression of the risks of postnatal dilatation, obstruction and Vesico-Ureteric Reflux (VUR).
Risk of postnatal dilatation rose with presentation RP size and gestation: RPD doubled per mm increase, and decreased by 16-18% each gestational week. A striking feature was low risk of obstruction/VUR. This leads us to question over investigation of mild dilatation?

Though rare, inborn errors of metabolism should be included in the differential diagnosis of almost all clinical signs and symptoms at any age. However, the perceived complexity of metabolic diseases and their diagnostic workup often precludes this, frequently resulting in misdiagnoses, obstructing both therapeutic interventions as well as appropriate counseling.
During this highly interactive meeting practical diagnostic algorithms will be discussed, based on video presentations of actual case histories.

In 1990 ESPGHAN has revised its former diagnostic criteria laid down in 1970. The criteria are still focused on the demonstration of jejuna mucosa alterations. However, in a situation where jejunal histology has lost specificity, and with the growing contribution by serology, and to a less extent by HLA, many propose to move to a new diagnostic approach mainly based on antibodies and genetics. At the moment the treatment for coeliac disease (CD) remains a life‑long strict gluten free diet (GFD) with exclusion of gluten from wheat, rye, and barley. However, significant progress has been made in recent years in the understanding of the cellular and molecular basis of CD and in the consequent identification of possible targets for therapy. Any alternative approach to gluten-free diet will need to have a safety profile equivalent to that of the gluten-free diet, but with the advantage of increased compliance.

The present talk will focus on some of the more common disorders seen by pediatric rheumatologists approaching a child whit a swollen joint. Eventually, a clinical flow-chart for this setting is proposed. Aim is to first get to appreciate the many above conditions that make up this challenging differential diagnostic universe.

This presentation is aimed at defining the aetiology of diffuse and nodular thyromegaly in childhood and adolescence and how to target further investigation according to a differential diagnosis and a cascade of investigations, including clinical history, thyroid hormone biochemistry, autoimmune markers, imaging and free needle aspiration. Definitive therapy and its duration depend on aetiology and symptoms, the likelihood of spontaneous remission, success or failure of medical therapy and individual risk-benefit profile.

The atherosclerotic process begins early in life and is progressive. Dyslipidemia is an important risk factor for atherosclerotic heart disease and stroke. The pediatric approach to dyslipidemia includes both a population and a high risk strategy. The population strategy aims to improve the diet, physical activity and lipid levels of all children. The high risk strategy includes identification and treatment of children and adolescents with the highest levels of cholesterol.
Learning objectives of this session:
1. Understand the epidemiology of lipid abnormalities in children.
2. Describe the approaches to screening and evaluation of lipid abnormalities in children.
3. Identify treatment approaches to lipid abnormalities in children.

Caloric reduction is the sine qua non of weight loss. The combination of dietary advices and physical activity appears to provide the most beneficial improvements in obesity and its metabolic complications. Although some clinical trials on the oral medications have been performed, they have not been able to demonstrate that pharmacological treatment can substitute lifestyle interventions.

Epidemiology, pathogenesis, clinical manifestations, diagnosis and management of GERD will be analyzed in a critical fashion, with an emphasis on the natural history of the disease, the identification of at-risk patients and the conditions posing major diagnostic and therapeutic problems.

The object of this presentation is for General Pediatricians to be comfortable in the proactive diagnosis of Innocent Murmurs and to differentiate them from congenital heart disease. We will also focus on the common causes of chest pain which are primary non-cardiac. The presentation will also evaluate the patient with syncope differentiating normal physiological causes of syncope from some serious Cardiac disorders.

Infantile hypotonia remains a common but often challenging diagnosis for the general paediatrician. This workshop will focus on how a final diagnosis can be reached by putting together the clinical findings and requesting the appropriate investigations based on the comprehensive evaluation of the central and peripheral nervous system. Management strategies will also be discussed.

Objectives:
1. To discuss the principles of pediatric injury care through a complex case
2. To confirm priorities of care
3. To discuss the short and long term outcome of childhood injury