Abstract Book: the Abstract Book Is Prepared in an Electronic Form

1 WELCOME MESSAGE

The Royal College of Pediatricians of Thailand and the Pediatric Society of Thailand are delighted to welcome you to the 1st Bangkok International Pediatrics Update (BIPU 2017) to be held at The Sukosol Bangkok, Thailand during November 29 – December 1, 2017. The conference will provide state-of-the-arts knowledge as well as advanced medical technologies in Pediatrics from international experts. Topics will include the evidence-based information on infectious diseases, neonatology, nutrition, allergy, gastroenterology child development, and more. Besides, participants will have a great opportunity to establish or further professional or research network with Asian and international academia.

Bangkok, the venue of BIPU 2017, is one of the World most favorite tourist destination. It is the cultural, culinary, and spiritual capital of Thailand. Bangkok features both old-world charm and modern convenience, always with a gracious smile, and there are so many for you to visit and experience.

On the behalf of the organizing committee, I would like to welcome you all to BIPU 2017.

Pipop Jirapinyo Congress President BIPU 2017

2 COMMITTEE

Advisory Board Scientific Program Somsak Lolekha Ladda Mo-Suwa Prasobsri Ungthavorn Nalinee Chongviriyaphan Usa Thisyakorn Aroonwan Preutthipan

President Treasurer, Registration Pipop Jirapinyo Vandee Ningsanond

Vice President Facilities Maj.Gen.Rudiwilai Samakoses Chalerat Direkwattanachai Vinadda Piyasil Paiboon Eksaengsri Wasu Kamchaisatian Secretary General Srisupalak Singalavanija

Deputy Secretary Narumon Densupsoontorn

Public relations Auchara Tangsathapornpong Wanatpreeya Phongsamart

3 GENERAL INFORMATION

Conference: 1st Bangkok International Pediatrics Update (BIPU 2017)

Date: November 29 – December 1, 2017

Venue: The Sukosol Bangkok

Registration: November 29 – December 1, 2017 07.30 – 17.00 hr.

Exhibition: November 29, 2017 09.00 – 18.30 hr. November 30, 2017 08.30 – 18.00 hr. December 1, 2017 08.30 – 16.00 hr.

Speaker Ready Room: November 29 – December 1, 2017 07.30 – 17.00 hr. (Kingkamol Room)

Certificate of Attendance: Provided in the conference bag

Social Program: Opening Ceremony November 29, 2017 (9.30 - 10.00) Room Kamolthip 1-2

Welcome Reception November 29, 2017 (17.30 - 19.00) Kamolthip Ballroom Foyer

Speaker’s Night November 30, 2017 (19.00 - 21.00) Rattanakosin Room (Invited only)

Internet Cafe: Located in the foyer

Abstract Book: The abstract book is prepared in an electronic form.

Evaluation form: We would like to request your collaboration in evaluating our conference management. Your evaluation will help us to improve our future program.

Oral presentation: Room 1 (Kamolthip 2) Room 2 (Kamolthip 1)

4 FLOOR PLAN

5 PROGRAM

6 ORAL PRESENTATION

30 November, 2017

Room 1: Kamolthip 2 Room 2 : Kamolthip 1 Time 16.00-16.30 hr. 16.00-16.30 hr.

O-01 Reliability and validity of different O-03 High prevalence of hepatitis B pediatric triage systems in the antibody loss and de novo hepatitis B virus 16.00 - 16.10 hr. emergency department (HBV) infection in a child with living-donor Presenter: Kanokwan Aeimchanbanjong, liver transplantation Uthen Pandee Presenter: Palittiya Sintusek

O-02 Factors associated with induction O-04 Correlation of Quantiferon-TB Gold, remission in childhood high risk ALL T-Spot.TB and Tuberculin skin test in children 16.10 - 16.20 hr. Presenter: Roro Rukmi younger than 5 years with tuberculosis exposure or tuberculosis disease Presenter: Keswadee Lapphra

O-05 Clinical manifestation, treatment outcome and prognostic factor of pediatric 16.20 - 16.30 hr. anti-NMDA encephalitis Presenter: Napa Pruetarat

7 POSTER PRESENTATION

ID TITLE Antimicrobial susceptibility of S. pneumoniae causing invasive disease in central P001 Thailand, 2012-2016

P002 The results of adenoid tissue culture of children receiving adenoidectomy

P003 Food sensitization in young Thai children with atopic dermatitis

P004 Prevalence of iron deficiency in infants of diabetic mother at the age of 6-12 months

P005 Clinical feature and outcomes of bcgosis following neonatal BCG immunization

Diagnostic value of abdominal X-ray for children with clinical suspected P006 intussusception at King Chulalongkorn Memorial Hospital Predictors of adverse outcomes following central line-associated bloodstream P007 infection in children Gastrointestinal manifestations and clinical outcome of henoch-schönlein purpura in P008 pediatric patients in King Chulalongkorn Memorial Hospital

P011 A single center study on prevalence of neonatal anemia in well-appearing term infants

“Smoke-free home” campaign and prevalence of hoursehold exposure to secondhand P012 smoke in children Performance of the “next generation sequencing” in the detection of potential P013 pathogens isolated in critically ill children with persistent fever unresponsive to broad-spectrum antibiotic Efficacy of breast milk application on skin integrity in preterm infant: A randomized P015 controlled trial

POSTER ROUND

Poster round session on November 29, 2017 – at 15.30 – 16.00 hr. ID TITLE Antimicrobial susceptibility of S. pneumoniae causing invasive disease in central P001 Thailand, 2012-2016

P002 The results of adenoid tissue culture of children receiving adenoidectomy

P003 Food sensitization in young Thai children with atopic dermatitis

8 SPEAKER PANEL

Ampaiwan Chuansumrit, Thailand

Prof. Ampaiwan Chuansumrit is the Director of the International Hemophilia Training Center-Bangkok, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand. She is on the Editorial Board of Siriraj Medical Journal, Srinagarind Medical Journal and Haemophilia of the World Federation of Hemophilia. She has authored or co-authored of more than 200 articles and book chapters.

Chalermthai Aksilp, Thailand

Specialty Procedure: Pediatric Respiratory diseases Sleep - Disordered Breathing in Children Queen Sirikit National Institute of Child Health Qualification • MD.Cert. by The Thai Board of Pediatric sub board Pediatric Chest • Thai Board of Pediatrics, Chulalonkorn University 1994 • Thai Board of Pediatric Pulmonary Medicine and Critical care medicine 1999 • MD.Cert. by The Thai Board of Pediatric sub board Pediatric Chest • Certificates in Pediatric Critical Care Great Ormond Street Children Hospital London UKl • Certificates in Pediatric Pulmonology & Sleep Medicine Weil Cornell Medical College NYUSA

Chalerat Direkwattanachai, Thailand

Division of Allergy and Immunology, Department of Pediatrics Ramathibodi Hospital, Mahidol University Rama VI Rd., Bangkok, 10400 Thailand Expertise in Respiratory Medicine, Pulmonology, Allergology, Ramathibodi Hospital. Current Position: President of Allergy, Asthma and Immunology Association of Thailand (AAIAT)

9 Christoph Licht, Canada

I am Associate Professor of Paediatrics at the University of Toronto and Staff Physician in the Division of Nephrology, The Hospital for Sick Children (Sick- Kids). In addition, I am Senior Associate Scientist in the Cell Biology Program of the SickKids Research Institute. I am also cross appointed as Associate Member to the Institute of Medical Science (IMS) and Laboratory Medicine and Pathobiology (LMP) of the University of Toronto. My research focuses on complement-mediated renal diseases such as atypical hemolytic-uremic syndrome (aHUS) and membranoproliferative glomerulonephritis (MPGN) / C3 glomerulopathy (C3G). My research has translational character and includes both clinical and basic research: I have established an international registry with biorepository (www.kidcom.ca). In addition, I have also established a basic research program focusing on the pathogenesis of complement-mediated thrombotic microangiopathy (TMA). In particular, I am investigating the consequences of complement activation on endothelial cells, platelets and neutro- phils, and the interaction of these cells in TMA pathogenesis. The results of my research can change our understanding of the pathophysiology of aHUS and may ultimately allow for the development of new treatment strategies not only for aHUS but also other complement-mediated diseases.

Duantida Songdej, Thailand

• A lecturer in Pediatric Hematology-Oncology and a leader of thalassemia clinic, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand (current) • Doctor of Philosophy in Molecular Haematology (Thesis majoring in alpha- thalassemia), Institute of Molecular Medicine, University of Oxford, UK (2012-2015) • Pediatric residency and Hematology-Oncology fellowships training at Department of Pediatric, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand (2005-2010) • Doctor of Medicine (First class honor, Gold medal), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

10 Elizabeth Ashley, Myanmar

Elizabeth Ashley is an Infectious Diseases Physician and Microbiologist working in Myanmar. She worked in clinics along the Thailand-Myanmar border for several years evaluating the efficacy and safety of artemisinin-based combination treatments for the treatment of malaria in clinical trials and more recently on a large multicentre trial describing the spread of artemisinin resistance.

Fiona Russell, Australia

Associate Professor Fiona Russell is a paediatrician and epidemiologist. She is Director of Research Higher Degree Training and Principal Research Fellow with the Centre for International Child Health (WHO Collaborating Centre), Department of Paediatrics, The University of Melbourne; and Team Leader of Clinical and Epidemiological Research, Pneumococcal Group, Murdoch Childrens Research Institute. Her research interest is in providing evidence for new vaccine introduction in low- and middle-income settings.

Hugo Van Bever, Singapore

Hugo Van Bever is Professor in Pediatrics, Pediatric Allergy and Immunology, in the Department of Pediatrics, National University Singapore (NUS). His main research interest areas are pediatric allergy, pediatric asthma and pediatric respiratory infections. His current research is focused on eczema, sublingual immunotherapy (SLIT), and on primary prevention of allergy. He has published more than 300 papers in national and international journals.

Jarin Vaewpanich, Thailand

Jarin Vaewpanich, MD Position : Instructor at Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University Specialty: Pediatric Critical Care Education: • Thai Board of Pediatrics 2008 • Thai Board of Pediatric Pulmonary Medicine 2010 • Advanced Clinical and Research Training in Pediatric Critical Care Medicine, Duke Children’s Hospital, Duke University, USA 2015 • Research Fellow in Pediatric Critical Care Medicine, Texas Children’s Hos- pital, USA 2016 Area of Interest: Mechanical Ventilation, Sepsis

11 Jiraporn Arunakul, Thailand

Jiraporn Arunakul, M.D. Adolescent Medicine Specialist Department of Pediatrics Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand Founder of Gender Variation Clinic (Gen-V clinic), First Comprehensive Care Clinic for Gender Variation Youths in South East Asia Committee of Thai Adolescent Health Association

Jiraporn Laothamatas, Thailand

Deputy Dean for Centers of Excellence and Center for Mission Financial Support, Faculty of Medicine Ramathibodi Hospital, Mahidol University Education: • 2010 Thai Board in Diagnostic Radiology, • 2004 Thai Board in Diagnositic Neuroimaging Fellowship • 1990 Certificate, Fellowship in Diagnostic Neuroradiology, Hahnemann University Hospital, Philadelphia, USA • 1989 American Board in Diagnostic Radiology, Columbia University, New York, USA • 1981 Medical Doctor: Chulalongkorn University, Bangkok, Thailand

Kulkanya Chokephaibulkit, Thailand

Kulkanya Chokephaibulkit, MD Professor of Pediatric, Chief, Division of Infectious Diseases Department of Pediatrics Faculty of Medicine Siriraj Hospital Mahidol University Areas of interest: HIV/AIDS, Vaccination, TB

12 Ladda Mo-Suwan, Thailand

Department of Pediatrics, Faculty of Medicine Prince of Songkla University Hat Yai, Songkhla 90110, Thailand Dr Ladda Mo-suwan’s research interest includes childhood obesity and effect of early nutrition on health later in life. She co-founded the Prospective Cohort study of Thai Children which has been following a group of birth cohort since November 2000. She participated in the National Health Examination Survey IV and V. She chaired the Technical Working Group to develop the resolution on the control of overweight and obesity for the 2nd National Health Assembly in 2009 and the resolution on school catering system management for the 6th National Health Assembly in 2013.

Lalida Kongkiattikul, Thailand

Lalida Kongkiattikul, MD Division of Pediatric Critical Care King Chulalongkorn Memorial Hospital

Magnus Domellöf, Sweden

Magnus Domellöf is Professor and Head of Pediatrics at Umeå University and Senior consultant in Neonatology at Umeå University Hospital, Sweden. He received his PhD degree at the university hospital in Umeå in collaboration with the University of California, Davis. He is currently leading several large research projects related to neonatal and pediatric nutrition and has more than 120 publications in the field. He is President of the Swedish Neonatal Society, is a member of the Committee of Nutrition of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, advisory board member of the Swedish Food Agency and board member of the nutrition section of the European Society for Paediatric Research.

13 Marc Benninga, the Netherlands

Professor Marc Benninga studied medicine at the University of Amsterdam, the Netherlands. After receiving his Medical degree he worked as a research fellow at the department of paediatric gastroenterology and nutrition at the Academic Medical Centre in Amsterdam with Jan Taminiau and Hans Büller. He performed extensive research on constipation and faecal incontinence in childhood. Subsequently he was trained in paediatrics at the Wilhelmina Children’s Hospital in Utrecht, The Netherlands. After his paediatric training he performed research at The Women’s and Children’s Hospital, Adelaide, Australia with Geoff Davidson and Taher Omari. During his stay in Adelaide his research focussed on maturation of upper gastrointestinal motility in very young infants. In 1999 he became a staff member in the Academic Medical Centre in Amsterdam and currently he is the head of the department paediatric gastroenterology & Nutrition. The focus of his current clinical and research work is gastro-oesophageal reflux disease, recurrent abdominal pain, constipation, functional non-retentive faecal incontinence and inflammatory bowel disease in childhood. He played in the Dutch National hockey team and competed at the Olympics in 1988, Seoul.

Montida Veeravigrom, Thailand

Pediatric, Neurology Department of Pediatric, Faculty of Medicine, Chulalongkorn University • Appointment: Lecturer • Specialty: Pediatric Neurology • Qualification & Education: Doctor of Medicine, Chulalongkorn University 1999 Thai Board of pediatrics, pediatric neurology 2005,2007 American Board of Psychiatry and Neurology specified child neurology 2012 American Board of Sleep Medicine 2013 • Area of Interest: Sleep Medicine

Nicholas White, Thailand

Professor Sir Nicholas White FRS Professor of Tropical Medicine, Mahidol University and Oxford University Chairman: Wellcome Trust South-East Asian Tropical Medicine Research Programmes

14 Pantipa Chatchatee, Thailand

Allergy&Immunology Division Department of Pediatrics Chulalongkorn University King Chulalongkorn Memorial Hospital Bangkok, Thailand

Pat Mahachoklertwattana, Thailand

Deputy Chairman, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Education: • 1981 B.Sc., Mahidol University, Bangkok, Thailand • 1983 M.D., Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand • 1989-1991 Fellow in Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok. • 1991-1994 Fellow in Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, University of California San Francisco, San Francisco, CA, USA. • 2011 School of Hospital Management, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok

Pimlak Charoenkwan, Thailand

Division of Hematology and Oncology, Department of Pediatrics Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Dr. Pimlak Charoenkwan graduated in 1995 from the Faculty of Medicine, Chiang Mai University, following which she completed the Pediatric Residency Program at Chiang Mai University Hospital and a fellowship training in Pediatric Hematology/Oncology at the Hospital for Sick Children, Toronto, Canada. Her career interest lies in the field of red blood cell disorders, thalassemias and hemoglobinopathies, a condition that is highly prevalent and is a major health problem in Thailand. Her research work involves molecular genetics, pathophysiology, treatment, prenatal diagnosis of thalassemias and fetal and neonatal hematology.

15 Pipop Jirapinyo, Thailand Professor of Pediatrics, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Siriraj BangkokNoi, Bangkok 10700 Education: Mahidol University Medical Degree 1970-1977 Mahidol University Pediatric Residency 1978-1980 Children’s Hospital of Fellowship in Pediatric 1983-1985 Buffalo, NY Gastroenterology and Nutrition

Pornchai Kingwatanakul, Thailand

Pornchai Kingwatanakul Chief, Section of Pediatric Nephrology King Chulalongkorn Memorial Hospital Faculty of Medicine, Chulalongkorn University President, The Thai Pediatric Nephrology Association Graduation: Chulalongkorn University Training: The Children’s Mercy Hospital, Kansas City, Missouri, USA

Rome Buathong, Thailand

Dr. Rome BUATHONG, a medical epidemiologist and travel medicine specialist, is currently working for Bureau of Epidemiology, Department of Disease Control, Thailand Ministry of Public Health. He is a head of Outbreak Investigation and Public Health Emergency Response under the Bureau. His main function is outbreak investigation and emergency response both national and international. He was also working with WHO country office for Thailand in 2015. His area of interests include emerging vector-borne, emerging diseases and international health.

16 Seetha Shankaran, USA

Dr. Seetha Shankaran is Professor of Pediatrics at Wayne State University School of Medicine. From 1990 to 2016 she served as Director of the Division of Neonatal-Perinatal Medicine in the Department of Pediatrics based at Chil- dren’s Hospital of Michigan and Hutzel Women’s Hospital. She is involved in patient care, research, education and advocacy for children. Her research includes performing clinical trials of new therapies, neuroprotection and long term follow up of high risk infants. She was the WSU site Principal Investigator of the NICHD multi-center Neonatal Research Network from its founding in 1985 to 2016 and performed the first US trial of neuroprotection with hypothermia for hypoxic ischemic encephalopathy (HIE) in term infants with continued follow up of trial participants to childhood. This therapy has become the standard of care for HIE. She also demonstrated the safety and efficacy of the cooling strategy, comparing standard cooling with longer and/or deeper cooling. Dr. Shankaran was also the site PI of the study evaluating impact of maternal lifestyle during pregnancy (MLS) on childhood and adolescent outcome funded by NIDA and NIMH.

Seksit Osatakul, Thailand

Associate Professor Seksit Osatakul is currently Head of the Division of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand. He obtained both M.D and the Thai Board of Pediatrics from the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, then he trained in pediatric gastroenterology and hepatology at the Royal’s Children Hospital, Brisbane, Australia. His area of interest is functional GI disorders, particularly defecation disorders in children.He was the President of Thai Pediatric Society of Gastroenterology and Hepatology between 2014-2016.

17 Sirinuch Chomtho, Thailand

Associate Professor Sirinuch Chomtho is a faculty staff in the Nutrition Division, Pediatric Department, Faculty of Medicine, Chulalongkorn University in Bangkok, Thailand. She received her medical and pediatric training from Chulalongkorn University. From 2003-2008, she was a research fellow at the MRC Childhood Nutrition Research Center, Institute of Child Health, University College London, UK. She received her PhD in pediatric nutrition in 2006 and diploma in pediatric nutrition from the UK Royal College of Pediatric and Child Health in 2007. Her research has focused on the effects of early nutrition on long-term health and she has special interest in infant nutrition and breastfeeding. She is currently a scientific committee in the Society of Pediatric Nutrition of Thailand and a member of the Academy of Breastfeeding Medicine.

Siriwan Wananukul, Thailand

Professor Siriwan Wananukul is Head, Department of Pediatrics, Faculty of Medicine at the Chulalongkorn University, Bangkok, Thailand and President of Pediatric Dermatological Society of Thailand. She has qualified for the Board of Pediatrics and Board of Dermatology, Thailand. She is a member of several professional societies including the Pediatric Dermatological Society of Thailand, The Dermatological Society of Thailand, The Royal College of Phy- sicians of Thailand and is an International Fellow of the American Academy of Dermatology. Professor Siriwan has published more than 50 articles in both Thai and international medical journals. She has participated as a speaker for the 13th World Congress of Pediatric Dermatology, the Regional Meeting in Pediatric Dermatology in Thailand, Indonesia, Malaysia, Philippines and Singapore. Research interests include atopic dermatitis, vascular anomalies and cutaneous infections.

18 Soamarat Vilaiyuk, Thailand

Dr. Vilaiyuk received her medical degree and completed her pediatric residency training from Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand. Then, she furthered her study in pediatric rheumatology at University of Pittsburgh School of Medicine, USA and completed her fellowship training in 2008. Currently, she is Assistant Professor of Pediatrics and Chief of Rheumatology Division, Pediatric Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University. She is Program Director of Pediatric Residency training and Pediatric Rheumatology fellowship training program at Faculty of Medicine Ramathibodi Hospital. She is also an Assistant Dean of Corporate Communi- cation at the same institution.

Somsak Lolekha, Thailand

Professor Somsak Lolekha received his Doctor of Medicine from Mahidol University, Bangkok and then pursued a Doctor of Philosophy at the University of Illinois Medical Center, Chicago, USA. He is a diplomat at the American Board of Pediatrics, Thai Board of Pediatrics, Thai Board of Family Medicine, and the Thai Subspecialty Board on Pediatric Infectious Diseases. Prof. Lolekha was president of World Society of Pediatric Infectious Diseases (1999-2002). He was the first president of Asian Society of Pediatric Infectious Diseases (1994-2002). He was also president of Pediatric Infectious Disease Society of Thailand (2003-2009). He was the president of Royal College of Pediatricians of Thailand (2001-2005 and 2007-2016).

Stephen M. Rosenthal, USA

Stephen M. Rosenthal, MD, Professor of Pediatrics, UCSF, is Medical Director of the UCSF Child and Adolescent Gender Center (CAGC). He has authored multiple manuscripts on transgender youth, and is co-author on the 2017 En- docrine Society (ES) Clinical Practice Guideline for Gender-Dysphoric/ Gen- der-Incongruent Persons. He has had significant experience conducting multi-center trials, and is currently Principal Investigator (PI) (multiple PI format) for NIH/NICHD “The Impact of Early Medical Treatment in Transgender Youth”. Dr. Rosenthal has served on multiple committees of the ES and the Pediatric Endocrine Society (PES), and has just completed his term as PES President. He continues to serve on the PES Board of Directors as Immediate Past President. Dr. Rosenthal was also recently elected as Endocrine Society Vice President, Clinical Scientist Position. 19 Suporn Treepongkaruna, Thailand

Professor of Pediatrics Head, Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand President, the Thai Society of Pediatric Gastroenterology and Hepatology President-Elect, the Asian Society of Pediatric Gastroenterology, Hepatology and Nutrition (APPSPGHAN)

Suradej Hongeng, Thailand

Division of Hematology/Oncology, Department of Pediatrics Ramathibodi Hospital, Mahidol University Rama VI Rd., Bangkok, 10400 Thailand Education: 1987 - M.D. (Hons) Ramathibodi Hospital, Mahidol University Bangkok, Thailand 1991 - Diploma of The Thai Board of Pediatrics 1993 - Diplomate of The American Board of Pediatrics 1996 - Diplomate of The American Board of Pediatric Hematology and Oncology Specialty: Pediatrics (Children), General Pediatrics, Pediatric Hematology (Blood)

Thaschawee Arkachaisri, Singapore

Dr. Tash earned his MD with 1st class honors from Mahidol University, Thailand (1991). He completed his Pediatric specialty training at the University of Illinois at Chicago in 1996. With the interest in Immunology especially in autoimmunity, he continued his fellowship trainings in Allergy and Immunology at the State University of New York at Buffalo (1996) and Pediatric Rheumatology at the Hospital for Special Surgery, Weill Medical College at Cornell University in New York, USA (1998). After his fellowship graduation, he returned to Bang- kok, Thailand and established the first Pediatric Rheumatology discipline in Thailand at the Division of Rheumatology, Department of Pediatrics, Faculty of Medicine at Siriraj Hospital and Mahidol University (2000-2002). He joined The Division of Rheumatology at the Children’s Hospital of Pittsburgh (2003- 2008) at an Assistant Professor of Pediatrics and set up the Scleroderma Clinic, which was the first Pediatric Scleroderma Program in the US, and worked closely with Dr. Thomas A. Medsger, jr at the University of Pittsburgh. He moved 20 to Singapore in 2009 and joined KKH and Duke-NUS Graduate Medical School as an associate professor and senior consultant and headed the newly established Rheumatology and Immunology Service at KKH. His current research interests are focusing on the characterization and development of prognostic biomarkers of local common rheumatic diseases (enthesitis related arthritis (ERA), childhood onset systemic lupus erythematosus cSLE, systemic vasculiti- des). He also serves as a reviewer for many peer review rheumatology journals.

Tawee Chotpitayasunondh, Thailand

Queen Sirikit National Institute of Child Health Education: - 1972 MD from Siriraj Hospital, Mahidol University - 1976 Thai Board of Pediatrics, Children’s Hospital Bangkok - 1975 DTM&H from Faculty of Tropical Medicine, Mahidol University Professional: Pediatric infectious diseases specialist for 35 years, topics of interest Speciality: eg. TB, HIV/AIDS, Antibiotics, Vaccines, Influenza, Avian/Pandemic flu. : WHO Temporary Consultant on Pediatric HIV/AIDS, Antivirals, Avian/Pandemic Influenza:- Clinical Management and Antivirals, during the past 10 years.

Teeradej Kuptanon, Thailand

Position: Assistant Professor Pediatric pulmonologist and sleep specialist at Ramathibodi hospital and sleep disorders center, Mahidol University, Bangkok, Thailand. Education: 1989-1995 Mahidol Doctor, Sinakarinwiroj University 1996-1998 Diploma of Pediatric, Queen Sirikit Children Hospital 1998-2000 Pediatric Pulmonary Fediatric Pulmonary Fellow, Queen Sirikit Children Hospital 2003-2004 Certificate of Sleep Disorder Medicine Tulane University, LA, USA He helps Thailand sleep society to teach the national sleep technician program and develops national pediatric obstructive sleep apnea guideline. He interests in Pediatric sleep disorders, Noninvasive positive pressure ventilation and Pediatric sleep hygiene. He is actively involved in Pediatric clinical service, Residency training and Fellowship training programs as well as research in pediatric respiratory diseases and Pediatric sleep medicine.

21 Tri Wangrangsimakul, Thailand

Dr. Tri Wangrangsimakul BSc(hons) MB ChB MRCP FRCPath DTM&H Research physician at Mahidol-Oxford Tropical Medicine Research Unit (Chiangrai and Bangkok) Infectious diseases and microbiology specialist registrar (Oxford)

Vilawan Chirdkiatgumchai, Thailand

Vilawan Chirdkiatgumchai, MD Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University Position : Assistant Professor Specialty: Developmental & Behavioral Pediatrics Education: • Thai Board of Pediatrics 2006 • Thai Board of Developmental & Behavioral Pediatrics 2008 • Leadership Education in Neurodevelopmental and Related Disabilities, Cincinnati Children’s Hospital Medical Center, USA 2011 • Clinical Fellowship in Developmental & Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, USA 2013 Area of Interest: ADHD, Sleep Problems

Vorasuk Shotelersuk, Thailand

Director of the Excellence Center for Medical Genetics, Faculty of Medicine, Chulalongkorn University (CU) Education: - 1992 MD, Faculty of Medicine, CU - 1999 American Board of Medical Genetics (Clinical Genetics and Clinical Biochemical Genetics) - Outstanding Researcher of Thailand Award Outstanding Scientist of Thailand Award

22 Weerasak Chonchaiya, Thailand

Appointment: Associate Professor Specialty: Developmental and Behavioral Pediatrics Position: Head of the Division of Growth & Development, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Qualification & Education: M.D. (First Class Honor), Faculty of Medicine, Chulalongkorn University 1993-1999 Thai Board of Pediatrics and Master of Science (Pediatrics), Faculty of Medicine, Chulalongkorn University 2002-2005 Thai Sub-Board of Developmental and Behavioral Pediatrics, Faculty of Medicine, Chulalongkorn University 2005-2007 Certificate in Neurotherapeutics and Developmental & Behavioral Pediatrics, M.I.N.D. Institute, University of California-Davis, Sacramento, CA, USA 2008-2010 Visiting Scholar, Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA 2010-2011 Area of Interest: Impact of electronic media exposure on EF, development, behaviors, and sleep in early childhood, autism spectrum disorder, and neurodevelopmental disorders

Won Soon Park, Korea

Won Soon Park, MD, PhD. Professor Department of Pediatrics Samsung Medical Center Sungkyunkwan University, Seoul, Korea

23 KEYNOTE ADDRESS

24 Keynote address 2 December 1, 2017 / 9.15 - 10.15 hr. Room: Kamolthip 1-2

Roles of pediatricians for achieving national and global nutrition security

Ladda Mo-suwan Faculty of Medicine, Prince of Songkla University, Thailand

Nutrition is important not only for an optimal growth of children, nutrition in the early life has been well documented to have long term effects on cognitive function and health outcomes. Malnutrition in utero and early postnatal years have been found to associate with increased risks to non-communicable diseases later in life. To address the problem of maternal and child nutrition, in 2012 the World Health Assembly has endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified a set of six global nutrition targets that by 2025 aim to reduce anemia in women of reproductive age, low birth weight, stunting and wasting in the under-five; increase the rate of exclusive breastfeeding and halt the increase of childhood overweight. How- ever, five years later the Global Nutrition Report 2017 demonstrated that, at the global level, the world is off course to meet most of these targets. For countries in Asia, though stunting and wasting prevalence decrease but still do not meet the targets, while overweight is on the rise. To achieve the targets by 2025, speeded action is needed. Inter- ventions should be taken at the policy, health-system and community levels, and through an intersectoral approach. Besides providing counseling on infant and young child feeding through child health supervision in the well child care setting, pediatricians can play the leading role in linking concerned stakeholders to assure food and nutrition security for all children in their care through interventions in child care setting and schools.

25 PLENARY LECTURE

26 Plenary lecture 1 November 29, 2017 / 11.00-12.00 hr. Room: Kamolthip 1-2

Zika virus: The threat of maternal and fetal infection

Tawee Chotpitayasunond Queen Sirikit Nationnal Institute of Child Health, Ministry of Public Health, Thailand

Zika virus (ZIKV) is one member of the Family Flaviviridae, Genus Flavivirus, transmitted by Aedes mosquitoes. This virus was first isolated from a rhesus monkey in Zika forest, Uganda on 1947 but first human infection were diagnosed on 1952 in Uganda and Tanzania. Since then, ZIKV infection have been reported from Southeast Asia, Africa and wide spread outbreak in 2015 in South, Central and North America. On 2017, the incidence of ZIKV infection is dramatically decreasing among most countries with unexplained reason. Zika virus in nature is in a sylvatic transmission cycle between non-human primate and mosquitoes while human infection is an accidental event. Zika virus may be transmitted to human via the following routes such as mosquito bites (most common), sexual, blood transfusion, organ transplantation and maternal-fetal transmission. Pregnant women who become infected with ZIKV will present mild or asymptomatic illness but they can transmit the virus to their fetus with potentially causes serious consequences. Reports from several Zika endemic countries especially Brazil had shown that there had been increase in microcephaly or other brain defects in fetus or newborn babies if pregnant women acquire prenatal ZIKV infection. The incubation period between mosquito bites and onset of symptom is around 2-14 days. Symptomatic ZIKV infection including pregnant women and children occur in 20-25% of individual whom infected. Clinical features of ZIKV infection usually mild symptomatic which include low grade fever (65%) , maculopapular rash (90%), arthralgia (65%) and non-purulent conjunctivitis (55%) while the majority (80%) of infected-individual are asymptomatic. Intrauterine ZIKV infection via maternal-fetal transmission is the most concern of the serious outcome withf microcephaly or other neurological complications among newborn infants. Clinical manifestations in infant and children with postnatal infection are similar to the symptoms seen in adult with ZIKV infection.

27 Diagnosis of ZIKV infection is solely base on laboratory findings. The gold standard for diagnosis is positive PCR for ZIKV from body fluid specimens while immunological test (IgG or Ig M) have some limitation because of cross reaction with other flaviviruses such as dengue, JE, Yellow fever or West Nile virus. Diagnosis of ZIKV infection among pregnant women is very challenging due to then only 20% are symptomatic while the diagnosis of congenital Zika disease in newborn babies is positive PCR for ZIKV from urine or serum. Fortunately, positive ZIKV IgM in newborn baby is highly suggestive intrauterine ZIKV infection which need long term follow up. There are no specific treatment or vaccine for ZIKV infection. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) should be avoided.Preventing mosquito bites are more important by cloths covering, using insect repellent , sleep in the mosquito nets and destroying the breeding place in the household and environment. Conclusion: ZIKV infection is one of most important international public health threat especially Dengue endemic area including Asia. Surveillance of ZIKV infection among pregnant women, newborn with microcephaly or other brain anomalies and GBS will help to forecast this problem. The biomedical and clinical research are essential for better understanding of new knowledge in providing the appropriate strategies for prevention, especially vaccine, and treatment of this disease in the future.

28 Plenary lecture 2 November 30, 2017 / 08.30 - 09.15 hr. Room: Kamolthip 1-2

Child muaythai-boxing: Conﬂict of health and culture

Jiraporn Laothamatas Chakri Naruebodindra Medical Institute, Thailand

Advanced MR Imaging Detecting Brain Damage due to Pediatric Thai Boxing Hypothesis: Young boxers who have received chronic repeated injury from fight will be people at risk of cognitive abnormality, memory dysfunction or brain disorder in the future. Objectives: To investigate scientific evidence of brain injury such as brain connectivity, brain growth and repetitive minor injuries such as Diffusion Tensor maps, brain volume, functional MRI and iron accumulation. Material and methods: 108 (0-<2 years), 165 (2-5 years) and 60 (>5 years) kid boxers and 200 nonboxing kids were recruited for neuropsychological and structural and advanced MRI study such as DTI, R2* and fMRI studies at 0 and 2 years. Results: Decreased FA, increased MD and increased R2*, decreased memory and increased motor function were found in boxer group compare to non-boxer group with statistically significant. These abnormality increase with longer years of boxing. The IQ of the boxer group is also decreased compare to normal control and progressively decreased with longer years of boxing. Conclusion: Boxing in pediatrics has definitely caused structural brain damage in both gross and microstructural brain damage and functional brain damage such as memory tasks with only better motor skill. These damages increase in severity with numbers of years of boxing. Neuropsychological test has shown significantly decreased overall IQ with longer years of boxing

29 Plenary lecture 3 November 30, 2017 / 09.15 – 10.00 hr. Room: Kamolthip 1-2

Food allergy

Pipop Jirapinyo Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University

Food allergy in children is the continuing process of food allergy in early infancy period. Cow milk is the first food that is the cause of allergy in very young infants, followed by other foods after the infants expose. This is the unique disease of infants. So we define it as “food allergy of infancy”. The extensive hydrolysated formulas and amino acid-based formulas are widely recommended to use for diagnosis and treatment of cow milk allergy in very young infants. However, if the infants are still allergic to these formulas, we do not have best tool to use for diagnosis and also for treatment. We hence innovate 2 formulas to solve this problem. They are chicken-based formula and a new amino acid-based formula. These formulas have been scientically proven to be better than the current therapeutic formulas mentioned above.

30 Plenary lecture 4 November 30, 2017 / 10.45 - 11.30 hr. Room: Kamolthip 1-2

Complement-mediated kidney diseases

Christoph Licht Department of Pediatric Nephrology, Research Institute, the Hospital for Sick Children, Canada

Complement-mediated kidney diseases comprise a spectrum of conditions, which are caused by genetic or autoimmune defects disrupting the physiological regulation of the innate complement system. While host tissue is heavily guarded against complement at- tack, complement activation is designed to allow for rapid escalation e.g. to defeat in- vading microbes and is triggered by repetitive molecular patterns present in bacterial membranes (lectin pathway), and the presence of antigen-antibody (immune) complexes (classical pathway). By difference, complement activation can also occur via the consti- tutively active alternative pathway, which therefore requires tight control via fluid phase and membrane-anchored regulators. Since 1998, an increasing body of literature has identified defects of complement control and linked them to specific diagnoses such as atypical haemolytic uremic syndrome (aHUS) and C3 glomerulopathy (C3G). In aHUS, gain and loss of function mutations have been identified affecting components of the complement cascade either propelling its activation or contributing its regulation, respectively. While complement mutations can be identified in about 50% of aHUS patients, about 10% carry anti-Factor H (FH) autoantibodies, all together causing complement dysregulation on (endothelial) surfaces. By contrast, in C3G – overarching classification of C3 glomerulonephritis (C3GN) and dense deposit disease (DDD) – complement mutations are found in <50% and autoantibodies to the convertases in up to 80% of cases, all together enhancing complement activation in the fluid phase. The firm link of aHUS and C3G pathogenesis to complement dysregulation allows for new, specific treatment strategies aiming at re-establishing complement control and rais- es hopes for better patient outcomes.

31 Plenary lecture 5 November 30, 2017 / 11.30 - 12.15 hr. Room: Kamolthip 1-2

Precision medicine: How genetic technologies transform pediatric practice

Vorasuk Shotelersuk Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Thailand

Description: Molecular techniques have rapidly advanced in recent years and have played an important role in both fundamental and applied researches, and medical practice. I will present clinical applications of two technologies. First, next generation sequencing (NGS) revolutionizes a molecular diagnostic method. Etiologic mutations of rare genetic disorders including those with many possible causative genes such as intel- lectual disabilities and epileptic encephalopathy can be efficiently identified by whole exome sequencing (WES) or whole genome sequencing (WGS). With definite diagnoses and classification of diseases by its mutated genes, a more specific management guideline for that particular patient and a more precise genetic counselling can be given. This also leads to new and hopeful preventive and treatment strategies. Secondly, techniques of genome editing give new hopes for definite treatment of genetic diseases. The most recent one, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated (Cas) protein 9 system is readily adopted to several laboratories around the world and develops very fast over the past few years. I will discuss about our experience in using genome editing techniques in gene therapy of rare genetic diseases and our attempt to generate universal cell or tissue donors.

Contribution: This presentation is intended to prepare the audience for a possible change in the standard of care for children with genetic diseases in the era of clinical molecular genomics.

32 Plenary lecture 6 December 1, 2017 / 08.30 - 09.15 hr. Room: Kamolthip 1-2

Executive functions: Essential skills for children in the digital world

Weerasak Chonchaiya Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand

Executive functions (EFs) are top-down mental processes from prefrontal cortex needed for organization and direction of cognitive, behavioral, and emotional activity of each individual. Basic EFs including working memory, inhibitory control, and cognitive flexi- bility generally begin to develop in early childhood and have tremendous developmental progression during the preschool years. EF is one of the various tasks essential for 21st century skills required for children to succeed in their lives, especially in the digital era. Those with EF impairment, particularly poor self-control at age 3, have increased risk of early smoking, school dropout, and teen parenthood during adolescence. Moreover, early childhood self-control also predicts physical health, substance dependence, personal finances, and criminal offending outcomes almost 30 years later. There are several risk and protective factors that could potentially affect development of the EFs. EF problems are likely to occur in those with preterm birth, difficult temperament, neurodevelopmental disorders, adverse childhood experiences, and fast-paced electronic media exposure. On the other hand, responsive parenting, martial arts with mindful awareness, social pretend play, developmentally appropriate hands-on activities, positive early childhood experiences, especially reading books with the child, and optimal sleep could help enhance the EFs. Pediatricians should be aware of the importance of EF development since early childhood and various factors affecting them. As such, children’s EFs could be maximized to reach their potential.

33 SYMPOSIUM

34 Symposium 1 November 29, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 2

Introduction of new vaccines at need in Asia

Kulkanya Chokephaibulkit Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand

Thailand started National Immunization Program (NIP) since 1977. The new vaccines gradually added into the program with the current schedule in Table 1. There are many recently developed vaccines which are not included in the current NIP but available by self-pay. The inclusion of new vaccines into the NIP requires complex process with the evidence of acceptable health economic analysis and budget impact. The most recent new vaccine included in NIP was human papilloma virus (HPV) vaccine for the 5th grade school girls without catch-up in older girls. This will be delivered at school. The new vaccines to be included soon are Haemophilus influenzae type b (Hib) vaccines in pentavalent co-formulate with diphtheria-tetanus-whole cell pertussis-hepatitis B (DTP-HB- Hib), and rotavirus vaccine (Rota). Pneumococcal conjugate vaccines (PCV) were found not to be cost-effective in Thai context but require updated analysis as the cost factors of each variable change over the time. Dengue vaccine is one of the most needed vaccine from societal perspectives; however, the current price is not cost-effective. As Asia is becoming a melting community, the region should work together to secure vaccine availability and accessibility.

Age in month (M) or year (Y) NIP Self – pay Birth BCG, HB

1 M HB (for HBsAg+ mother only) 2 M DTwP-HB, OPV/IPV DTaP-IPV-Hib-HB, PCV, Rota 4 M DTwP-HB, OPV/IPV DTaP-IPV-Hib-HB, PCV, Rota 6 M DTwP-HB, OPV DTaP-IPV-Hib-HB, PCV, Rota Influenza x2 (1M apart) 9-12 M MMR 12-18 M Live JE VZV, HAV, PCV 18 M DTwP, OPV DTaP-IPV-Hib, HAV 2 ½-4 Y MMR, Live JE VZV (or MMRV) 4-6 Y DTwP, OPV Tdap-IPV 10-12 Y dT Tdap-IPV, Denguex3 (6 M apart) HPVx2 (6 M apart in 5th grade girls) HPVx2 (2 M apart) 6M – 18Y Influenza yearly to 2 Y Influenza yearly

35 Symposium 1 November 29, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 2

Introduction of new vaccines at need in Asia

Fiona Russell The University of Melbourne and Murdoch Children Research Institute, Australia

Global Health 2035: The Grand Convergence in Public Health is an effort to eliminate global disparities in infectious, child and maternal mortality rates. With scale up of existing interventions and the development of new ones, by 2035 the mortality rates of lower- income countries and rural areas of middle-income countries will converge with those of higher income countries. Vaccines remain on of the most effective tools to improve public health. Prioritisation of which vaccines to implement is becoming increasingly complex. The choice of vaccine is often made on the mortality and severity of the disease, the safety of the vaccine and the full economic benefit of the vaccination program. Newer World Health Organization recommended vaccines to prevent pneumonia (pneumococcal conjugate vaccine) or diarrhoea (rotavirus vaccine) have not yet been introduced in many countries due to competing priorities, limited implementation capacity and health system readiness concerns, or financial considerations. However, to achieve the Convergence, scale up of pneumococcal and rotavirus vaccines, in addition to higher coverage from existing vaccines, including Hib vaccine are required. This talk will focus on the priority new vaccines to achieve the Convergence and discuss the burden of disease and vaccine effectiveness in the region.

36 Symposium 2 November 29, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 1

Comprehensive care for excellent outcomes of thalassemia diseases

Duangtida Songdej Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand Pimlak Charoenkwan Department of Pediatrics, Chiang Mai University Faculty of Medicine Maharaj Nakorn Chiang Mai Hospital, Chiang Mai 50002, Thailand Ampaiwan Chuansumrit Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

Thalassemia, a disorder of hemoglobin synthesis, is a major public health problem in Thailand as 40% of the population are carrier and 1% of the population are affected. It was among the first extensively studied human single gene disorders. Over the past three decades, increasing numbers of genetic modifier of the disease phenotype, such as co-inheritance of a- and β-thalassemia, Xmn-I polymorphism at position -158 of HBG2 and expression of BCL11 A on chromosome 2p16, have been identified. Additionally, genetic factors influencing iron absorption, bilirubin metabolism and bone metabolism have been explored. Various advance technologies have been developed to achieve an accurate pre- and post-natal diagnosis. Management of newly diagnosed patients with thalassemia disease is based on regular follow-up to monitor growth, size of liver and spleen and pre-transfusion levels of hemoglobin. Minimal weight and height are aimed at 50th centile according to affected patients’ age and pre-transfusion hemoglobin levels are aimed at 9 to 10 g/dL to maintain optimal growth and development. Leucocyte depleted packed red cells with complete red cell antigen typing from the newly donated blood are preferred for regular transfusion of patients with thalassemia. After 10-15 transfusions or patients’ serum ferritin level approaching 1,000 ng/mL, early oral iron chelation in forms of tablet or liquid solution should be initiated. Subsequently, various parameters suggesting iron overload should be closely monitored. Weekend hospital service for regular transfusion is extremely helpful for thalassemia children as the patients’ absence from school and their parents’ absence from work can be minimized.

37 Keyword: Thalassemia Symposium 3 November 29, 2017 / 16.00 - 17.30 hr. Room: Kamolthip 2

Update in birth asphyxia management 2017

Won Soon Park Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Despite continuing improvements in perinatal and neonatal intensive care medicine, perinatal asphyxia and the resultant hypoxic ischemic encephalopathy (HIE) continue to represent a major cause of mortality and morbidity in the newborn infants. Currently, hypothermia has been known as the only effective therapeutic intervention for perinatal asphyxial brain injury. However, even therapeutic hypothermia was not effective against severe perinatal asphyxial brain injury. Recently, the neuroprotective effects of exogenously administered mesenchymal stem cells (MSCs), reported both in the adult stroke and newborn HIE animal models, raised great hopes of MSCs transplantation as a novel therapeutic strategy to protect the perinatal asphyxial brain injury. Umbilical cord blood (UCB) is considered a promising source for human MSCs on account of its easy availability, less immunogenicity and more proliferation capacity compared to the other sources such as bone marrow and adipose tissue. These findings suggest that human UCB derived MSCs could be the optimal cell source for transplantation. In this lecture, the experimental results whether human UCB derived MSCs might be a promising therapeutic candidate for the treatment of severe perinatal asphyxial brain injury, and a combination of currently clinically available hypothermia treatment and MSCs transplantation synergistically mitigate severe type of neonatal brain injury will also be presented. Other issues essential for the translation of experimental results into the clinical trials such as the safety measures, determining the optimal timing and route for MSCs transplantation will also be discussed.

38 Symposium 4 November 29, 2017 / 16.00 - 17.30 hr. Room: Kamolthip 1

Transgender youth care: Has its time come?

Stephen Rosenthal University of California San Francisco, USA

In many countries throughout the world, increasing numbers of gender nonconforming/ transgender youth are seeking medical services to enable development of physical characteristics consistent with their experienced gender identity. Such medical services are based on longitudinal studies demonstrating that those individuals who were first identified as gender dysphoric in early or middle childhood and continue to meet the mental health criteria for being transgender at early puberty are likely to be transgender as adults. This lecture addresses studies that shed light on biologic determinants of gender identity, current clinical practice guidelines for transgender youth, challenges to optimal care, and priorities for research.

39 Symposium 4 November 29, 2017 / 16.00 - 17.30 hr. Room: Kamolthip 1

Transgender youth care: Has its time come?

Pat Mahachoklertwat-tana Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand

Transgender person is the one whose assigned sex at birth differs from his/her current gender identity or expression. Nowadays, the prevalence of transgender people in Thai- land is increasing. Increased society acceptance is one of the possible explanations as it allows them to disclose their gender identity. However, other factors may be involved but to date, no evidence-based studies exist. With regards to health care for this population, there is a dearth of specific educational program in transgender health for health care professionals. Only few medical schools in Thailand incorporate this specific health care curricula for medical students, resident physicians and nurse practitioners. Therefore, health care centers, especially in public health care sector, specifically focusing on transgender care are limited. Significant number of Thai transgender people have poor education, unemployment and poverty. More than 90% of transgenders bought hormones to use from over-the-counter pharmacy. Thus, there are high prevalences of adverse health outcomes from self-prescribing hormones in this population. In addition, lack of access to basic health care and social supports pro- hibits them from standard health care system. They treated themselves without monitoring of adverse effects and long-term complications. In the past, sex reassignment surgery (SRS) had been performed in young adolescents (<12-15 years of age). In 2009, Med- ical Council of Thailand issued the criteria for SRS, including performing before 20 years of age is not allowed and agreement of at least 2 psychiatrists is needed. In childhood and adolescent transgenders, the prevalence is about 5% in the studies in schools. However, national data is still lacking. Majority of these adolescents had no psychological assessment and intervention. Few studies showed increased frequencies of depression, suicidal ideation and suicidal attempt. Many children received self-administered cross-sex hormones at a young age (<10-12 years). They were usually only concerned about the sex hormone effects without awareness of its adverse effects. Thus, the doses of sex hormones used were relatively high. Moreover, many adolescents were involved in unsafe sexual practices and substance abuse. Collectively, these unsafe habits and practices put them at risk of further ill health.

40 Owing to the fact that health care problems in transgender population are increasing and the unmet health care needs are also increasing, it is the time to initiate and expand our health care system to cover the needs of these people. Transgender health education should be introduced in medical practice and specialty training. The expectations are setting special care centers, evolving and providing standards of care. Hopefully, many illnesses related to misuse of hormones can be prevented and quality of life of these people is improving in the near future.

41 Symposium 4 November 29, 2017 / 16.00 - 17.30 hr. Room: Kamolthip 1

Transgender youth care: Has its time come?

Jiraporn Arunakul Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

Background: Gender variant in Thailand at present seems to be more understood and accepted. However a lot of gender variant youths are still facing the rejection from the social, especially their families. We have done the research on family acceptance in LGBTQ youths and found that only half of them believed their parents would accept who they are and who they want to become. Our study also found that a lot of transgender youths used hormones for transition by themselves. Gender variation clinic (Gen-V) clinic was founded on 2014 for comprehensive care of LGBTQ youths. Description: Gender variation clinic (Gen-V clinic) founded by one of adolescent medicine specialist, dedicated to providing comprehensive care and support to youths with gender variant and their families. Our clinic includes specialists who have interest in this expertise including of adolescent medicine doctor, pediatrics endocrinologists, adult endocrinologists, obstetrics gynecologist, child-adolescent psychiatrist, plastic surgeon, psychologist and nurse practitioner. We aim to be the role model of comprehensive care in gender variation youths either transgender or homosexual. Initially, Gen-V clinic planned to see patients age between 10-24 year, but now we expanded to age 40 as the increasing number of needed. Apart from mental and emotional aspects of each unique condition, we also provide the hormonal treatment following the guideline of The World Profession- al Association for Transgender Health (WPATH) and an Endocrine Society Clinical Guide- line. This collaborative works allows us to develop the best possible treatment plan for each adolescent and the support to family especially dealing with transition. However, we faced the challenges of accessing to service as the limitation of teen’s confidentiality, hormonal expense and unaware of available of the clinic. Conclusion: Transgender youths in Thailand has been facing the risks of family rejection and self medicated hormonal use. Gender variation clinic and multidisciplinary care allow the providers to develop the best possible care to each adolescents and being the resource of teaching center.

42 Symposium 5 November 30, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 2

Breast milk composition and health effects in healthy and preterm infants

Magnus Domelloff Department of Clinical Science, Unit of Pediatrics, Sweden

Breast milk is a highly complex biological tissue which contains numerous bioactive components, including oligosaccharides, non-protein nitrogen, nucleotides, complex lipids, growth factors, hormones, bioactive peptides, enzymes, immunoglobulins, leucocytes, bacteria and exosomes. Breast milk content also varies by postnatal age, maternal diet and even from meal to meal. There is good evidence that breastfeeding, compared to formula feeding, reduces mortality in low income settings and reduces the risk of infections and promotes cognitive development in term infants. Breastfeeding also affects infant growth, stool consistency and the fecal microbiome, and may reduce the risk of childhood obesity. There is a continuous development of infant formulas in order to approximate the nutrient content of breast milk and to reduce the gap in health outcomes between breastfed and formula-fed infants. Recent changes in infant formulas include a reduced protein content and addition of long-chain polyunsaturated fatty acids. Recent studies by our group suggest that addition of milk fat globule membrane to infant formula reduces the risk of infections and promotes cognitive development in infants. In preterm infants, the best proven benefit of breast milk is reduction of the risk ofnecrotizing enterocolitis (NEC). In addition, multinutrient fortification of breast milk is needed to achieve recommended nutrient intakes and normal growth in very low birth weight infants. The mother’s own breast milk is the best diet for preterm infants. When mother’s own milk is not available, there is recent evidence that fortified donor milk reduces the risk of NEC compared to infant formula.

43 Symposium 5 November 30, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 2

Breast milk composition and health effects in healthy and preterm infants

Sirinuch Chomtho Nutrition Division, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Thailand

Breast milk is a complex biological fluid which contains numerous nutritional as well as bioactive components. There are a number of breast milk compositions that varied according to maternal diet such as micronutrients and fatty acid compositions. This session will address the variation in breast milk composition according to maternal diet and nutritional status and highlight some problems in clinical practice. The increasing incidence of cow milk protein allergy in exclusively breast-fed infants causes more lactating mothers to restrict dietary cow milk protein and other food protein allegen, possibly effecting protein content in human milk. Moreover, fatty acids in breast milk are well-known to be varied greatly by maternal dietary intakes. Nevertheless, data on fatty acids composition in lactating mothers undertaking exclusion diets was scarce. We have evaluated the quantity and quality of protein as well as fatty acid composition in breast milk of Thai lactating mothers undergoing dietary restriction due to their infants’ allergic conditions. In a group of 50 mothers (aged 33.7±3.6 years), sixteen (32%) were restricted more than 8 food items for a median of 1.3 (Q1-Q3 0.6-3.0 months) before the second breast milk collection. Most common dietary restriction was cow milk followed by egg, wheat, soy, seafood, peanut, marine fish and freshwater fish (88, 74, 64, 58, 54, 50, 44, 32%, respectively). After dietary restriction, the amount of total protein, casein, whey and their fractions were significantly lower especially for lactoferrin and alpha-lactalbumin. The total polyunsaturated fatty acids (PUFA) showed no significant change, while total SFA was lower and total MUFA was higher after exclusion diet. Neither the mothers nor infants in this study showed any sign of protein-energy malnutrition. We have concluded that the restriction of protein in lactating mother should be made with utmost caution since it can significantly affect breast milk protein and fatty acid composition. The clinical significance of these findings was yet to be determined.

44 Symposium 6 November 30, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 1

Highlight topics in childhood functional GI disorders

M.A. Benninga Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands

In 2006, a consensus concerning functional gastrointestinal intestinal disorders (FGIDs) in infants, toddlers and children was described. At that time, little evidence regarding epidemiology, pathophysiology, diagnostic workup, treatment strategies, and follow-up was available. Consequently, the criteria for the clinical entities were more experience based than evidence based. The era of diagnosing an FGID only when organic disease has been excluded is waning, as we now have evidence to support symptom-based diagnosis. In RomeIV, we extend this concept by removing the dictum that there was “no evidence for organic disease” in all definitions and replacing it with “after appropriate medical evaluation the symptoms cannot be attributed to another medical condition.” This change allows the clinician to perform selective or no testing to support a positive diagnosis of an FGID. In the past decade, new insights have been gained about the different FGIDs) in all age groups. Based on those, further revisions have been made to the criteria. The description of infant colic has been expanded to include criteria for the general pediatrician and specific criteria for researchers. Furthermore, two new clinical entities were added to the existing FGIDs, namely functional nausea and functional vomiting. Rome III’s “abdominal pain related FGIDs” has been changed to “functional abdominal pain disorders” and a new term was derived, functional abdominal pain-not otherwise specified, to describe children who do not fit a specific disorder, such as irritable bowel, functional dyspepsia, or abdominal migraine. Rome IV FGID definitions should enhance clarity for both clinicians and researchers. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S. Gastroenterology. 2016 Functional Disorders: Children and Adolescents. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Gastroenterology. 2016

45 Symposium 6 November 30, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 1

Highlight topics in childhood functional GI disorders

Suporn Treepongkaruna Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Probiotics for functional gastrointestinal disorders: An evidence-based

Functional gastrointestinal disorders (FGIDs) are common in infants and children. Man- agement of FGIDs includes reassurance, dietary intervention and medications. However, current treatment options do not provide a satisfactory relief of symptoms in many children leading to patient and parental distress. Probiotics are live organisms that, when administered in adequate amounts, confer a health benefit on the host. Studies have shown that many FGIDs are associated with dysbiosis or imbalance of gut microbiota. Using probiotics to modulate gut microbiota may offer some benefit in management of FGIDs. The beneficial effects of probiotics are strain-specific, therefore, evidences of efficacy of individual probiotic strains for specific FGIDs are essential for clinical uses.

According to a meta-analysis of RCT studies, Lactobacillus reuteri DSM 17938 reduces crying time in breast-fed infants with infantile colic, but its role in formula-fed infants is less clear. The efficacy ofL. reuteri DSM 17938 for preventing infantile colic was shown in one large RCT study. There are some moderate- to low-quality evidences suggesting that probiotics may be effective in improvement of abdominal pain in children with functional abdominal pain disorders, particularly in irritable bowel syndrome (IBS). Probiotics which have been shown some efficacy include L. rhamnosus GG and VSL#3 in IBS, and L. reuteri DSM 17938 in functional abdominal pain-NOS. In functional constipation, limited evidence available does not support the routine use of probiotics. Further high-quality studies are required to make a clear conclusion for probiotic uses in FGIDs in children.

References 1. Szajewska H. What are the indications for using probiotics in children. Arch Dis Child 2016;101:398-403. 2. Newlove-Delgado TV, Martin AE, Abbott AR, et al. Dietary intervention in recurrent abdominal pain in children. Cochrane Database of Systematic Reviews 2017: CD010972. 3. Wojtyniak K, Szajewska H. Systematic review: probiotics for functional constipation in children. Eur J Pediatr. 2017;176:1155-62. 4. Xu M, Wang J, Wang N, et al. The efficacy and safety of the probiotic bacteriumLactobacillus reuteri DSM 17938 for infantile colic: A meta-analysis of randomized controlled trials. PLoS One. 2015;10:e0141445.

46 Symposium 6 November 30, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 1

Highlight topics in childhood functional GI disorders

Seksit Osatakul Division of Gastroenterology and Hepatology, Department of Pediatrics, Prince of Songkla University, Hat Yai, Songkhla, Thailand

The rationale of pharmacotherapy in the management of functional abdominal pain disorders (FAPDs) in children relates to the pathogenesis of these disorders, which involves the interaction of psycho-emotional stress and the brain-gut axis. Treatment of children with FAPDs with pharmacologic agents is commonly practiced which accounts for 85% of outpatient visits of children presenting with functional abdominal pain in Songkla- nagarind Hospital. To date, there have been 14 randomized control trials (antispasmod- ics 4 studies, antidepressants 3 studies, famotidine 1 study, other medications 6 studies) that evaluated the efficacy of pharmacotherapy in children with functional abdominal pain disorders. Because of the limited number of studies and weaknesses in the study deigns, there was no conclusive evidence to support the efficacy of pharmacotherapy in children with FAPDs. The cornerstone of treatment is the biopsychosocial approach and medications should be reserved for children with severe symptoms.

47 Symposium 7 November 30, 2017 / 16.30 – 18.00 hr. Room: Kamolthip 2

Allergic prevention in childhood: The evidence – based

Hugo Van Bever National University Singapore, Singapore

Recently, a number of primary preventive measures for allergy have been investigated. From various studies, mainly on the prevention of food allergy and eczema, it is now clear that partial prevention has become a reality. At this moment it can be stated that research on the subject is making good progress: the right track has been identified and combining interventions might be the way to go in the near future. Successful interventions that have been studied include the role of early moisturizing, administration of bacterial products and early exposure to specific food antigens, mainly to peanuts. Interventions during pregnancy that have been studied include maternal exposure to an environment rich in microbial compounds (i.e. living on a farm), and the administration of bacterial products. Both were able to decrease allergy in the offspring. In contrast, allergen avoidance (food and inhalants) during pregnancy had little effect. Administration of vitamin D and fish oil supplementation seem to be effective during pregnancy. Prolonged breast feeding (up to 6 months) is still the best, but in many cases unable to completely prevent the development of allergy. Trying to improve the anti-allergic features of breast milk might be an interesting field of future research. In contrast, prevention of respiratory allergic diseases, such as allergic rhinitis and asthma, is still impossible, which seems to be due to the pivotal role of respiratory viruses (RSV, HRV) in the onset of asthma and rhinitis. The role of early exposure to inhalant allergens, such as house dust mite, has not been completely elucidated, although it seems that early exposure is more effective than attempts to avoid contact with inhalant allergens. There- fore, a step forward to a future solution might be controlled exposure to allergens, as can be achieved by specific immunotherapy. The role of preventive immunotherapy deserves intensive research. In conclusion, preventing allergies is still under intense research, but partial prevention of food allergy and eczema has become a reality. More and better studies are needed on primary prevention and on the early events of allergic diseases. Interventions should be safe, and without any risk of altering other immune functions.

48 Symposium 7 November 30, 2017 / 16.30 – 18.00 hr. Room: Kamolthip 2

Allergic prevention in childhood: The evidence – based

Chalerat Direkwatanachai Pantipa Chatchatee Allergy&Immunology Division, Department of Pediatrics Chulalongkorn University King Chulalongkorn Memorial Hospital, Bangkok, Thailand

The incidence of allergic diseases in children has been on the rise. Genetics, environmen- tal exposures, and lifestyle all contribute to the risk to develop the diseases. The causes for the increase in childhood allergic diseases are multifactorial, therefore potential preventive strategy may involve a number of interventions. In this session, the following data and update on allergy prevention will be presented: Burden and impact of allergic diseases in children, Role of early weaning and bacterial products in allergy prevention and role of immunotherapy in prevention of house dust mite allergy.

49 Symposium 8 November 30, 2017 / 16.30 – 18.00 hr. Room: Kamolthip 1

Pediatric sepsis: Update in management

Rujipat Samransamruajkit Chalermthai Aksilp Jarin Vaewpanich Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Thailand

Pediatric sepsis is a leading cause of mortality and morbidity in infant and children. Im- plementation of sepsis guideline for neonatal and children sepsis and septic shock demonstrated improving survival. The management of pediatric sepsis in the guidelines focus on first-hour of fluid resuscitation, administration of broad-spectrum empirics antibiotic and early inotrope therapy if needed. In 2017, new update on management of neonatal and pediatric sepsis and septic shock recommended use peripheral intravenous/intraos- seous epinephrine infusion as a first line inotropic support in fluid-refractory septic shock.

Goals of therapy include normal perfusion pressure (MAP-CVP), ScvO2 > 70% and cardiac index 3.3-6.0 L/min/m2. Non-invasive hemodynamic monitoring such as Doppler ultrasound, PICCO and echocardiogram were recommended to guide fluid and inotrope/ vasopressor titration to achieve the goals in complicated cases. Extracorporeal membrane oxygenation (ECMO) is an option for patient without response to any treatment but survival rate is not more than 50 precent. Other updated therapy for sepsis and septic shock will be reviewed and discussed during this session.

50 Symposium 9 December 1, 2017 / 10.45 – 12.00 hr. Room: Kamolthip 2

Emerging important rheumatic diseases in ASEAN

Soamarat Vilaiyuk Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine at Ramathibodi Hos- pital and Mahidol University, Bangkok Thailand Thaschawee Arkachaisri Rheumatology and Immunology, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital and Duke-NUS Medical School, Singapore

Childhood onset rheumatic diseases encompass a wide range of autoimmune and autoinflammatory diseases. The epidemiologic data of the condition was just available after our international collaboration on Childhood onset Rheumatic Disease Registry, RECORD establishment and this inception cohort data was recently published. Detail of descriptive epidemiologic analysis will be presented in comparison to that of the West. The following topics will be emphasize on three main clinical practical issues which frequently encountered by primary paediatricians – fever, joint pain and skin manifestations. Fever of unknown origin (FUO) frequently creates diagnostic dilemma. The emerging group of new rheumatic diseases namely autoinflammatory diseases as part of the FUO differential diagnosis will be introduced. Practical immunopathogenesis and group clinical presentations along with representative diseases that may be encountered in routine general pediatric care will be touched in detail. Next, approach to the most common complaint in rheumatology clinic – joint pain, will be presented. Differentiation between inflammatory and mechanical joint pain, practical differential diagnosis and preliminary investigations will be guided. Lastly, specific cutaneous manifestations overlapping dermatologic and rheumatologic area including vasculitis and scleroderma will be presented. Clinical characteristics, practical immunopathogenesis leading to targeted investigations are introduced in detail. Overview of the treatment and outcomes will be shared.

51 Symposium 10 December 1, 2017 / 10.45 – 12.00 hr. Room: Kamolthip 1

How to make good night sleep and dream?

Vilawan Chirdkiatgumchai Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

Sleep is essential for children’s learning, memory, and general well-being. Sleep deprivation has adverse consequences, including daytime sleepiness, increased behavioral problems, decreased attention span, and poor school performance. Children and adolescents with bedtime resistance / prolonged sleep onset are at risk for reduction of sleep duration, and sleep deprivation. Successful management for bedtime resistance does not only result in improvement in children’s sleep quality but also alleviation of parental stress and improvement of parental sleep. Therefore, pediatricians should play an important role in evaluation and management of bedtime problems to prevent adverse consequences. Bedtime problems vary with age. Insomnia of childhood – sleep onset association type is common during infancy through preschool-aged children with the prevalence of 15 to 20% in children aged 1 to 3 years. Insomnia of childhood – limit setting type is common among school-aged children with prevalence of 10 to 30% in this group. Delayed sleep – wake phase disorder is common in adolescents with prevalence of 7 to 16% in adolescents. Even though good sleep hygiene practice is helpful to prevent bedtime resistance / prolonged sleep onset in all age groups, once these problems occur, specific sleep behavioral interventions are needed for successful management of each condition. Updated and practical points of these interventions in pediatric practice will be reviewed and discussed during this session.

52 Symposium 10 December 1, 2017 / 10.45 – 12.00 hr. Room: Kamolthip 1

How to make good night sleep and dream?

Montida Veeravigrom Department of Pediatric, Chulalongkorn University, Thailand

Sleep is an important activity for child ‘s life. During sleep, there are synaptic homeostatic processes which is fundamental to child ‘s memory. Sleep disturbances cause excessive daytime sleepiness, cognitive dysfunction and impair memory. Pediatrician should screen for sleep disorder in well child visits. Currently American Academy of Pediatrics (AAP) recommend screening snoring in each well child visit. Neurological aspects of sleep disorders which pediatrician should know included restless leg syndrome and central hypersomnia. Restless syndrome (RLS) is the most common pediatric movement disorder with worldwide prevalence of 1-2%. RLS has been underrecognized among Thai pediatrician and parents. Characteristic symptoms include uncomfortable feelings in legs with urge to move, relieving or getting better with movement and usually occurs during evening or bedtime. Iron and dopamine system play a role as main mechanism in RLS. Central hypersomnia in children includes diagnosis such as narcolepsy type I, narcolepsy type II and Kline-Levin syndrome. Narcolepsy symptoms consist of excessive daytime sleepiness, sleep hallucination, sleep paralysis and cataplexy. Mechanism of narcolepsy is lack of orexin (hypocretin) in hypothalamus. Narcolepsy causes psychological and social complications in children and adolescent. It is essential to manage narcolepsy in a holistic care.

53 Symposium 11 December 1, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 2

The challenging tropical infectious diseases

Tri Wangrangsimakul Mahidol-Oxford Tropical Medicine Research Unit (Chiangrai), Mahidol University, Bangkok, Thailand

Scrub typhus, a tropical infection caused by the obligate intracellular bacteria Orientia tsutsugamushi, is the leading treatable cause of acute febrile illness in Southeast Asia. In the Greater Mekong region, it ranks as the second most commonly reported cause of non-malarial fever after dengue. Traditionally, the endemic area extends to large parts of the Asia-Pacific but recent reports from Africa and South America suggests the disease may be ubiquitous throughout the tropics. There are an estimated 1 million cases annu- ally with reported mortality rates of 12 and 13% from southern India and northern Thai- land, respectively. In Thailand, the disease incidence has increased 2-3 fold over the last decade (mirroring reports from South Korea and China) with the burden of disease being highest in the northern region, followed by the southern, northeastern and central regions. Despite this, scrub typhus remains a neglected and understudied tropical disease. Over 20 years ago, reports emerged from Chiang Rai of scrub typhus infections and isolates that were resistant to doxycycline and chloramphenicol, antibiotics normally used to treat the disease. Subsequently, azithromycin was shown to be an effective alternative treatment. However, uncertainties remain regarding the optimal treatment in areas where drug-resistant strains are known to be present. Other aspects including the epidemiology, ecology, diagnosis, pathogenesis and immunology of the disease remain unresolved and incomplete. Here, I will briefly review these topics and present findings from a prospective observational study of pediatric scrub typhus cases from Chiang Rai.

54 Symposium 11 December 1, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 2

The challenging tropical infectious diseases

Elizabeth Ashley Director of Clinical Research, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.

Malaria is still responsible for more than 400 000 child deaths every year. Most of these deaths are from severe falciparum malaria and occur in sub-Saharan African countries where intense malaria transmission occurs. Intravenous artesunate is the treatment of choice but is still not accessible everywhere. There is good evidence that fluid boluses in children with shock and malaria increase mortality and should not be given. The optimal blood transfusion strategy for children with severe malarial anaemia is still debated but trials are ongoing. A malaria vaccine (RTS,S/AS01) has been licensed but it confers only limited protective efficacy and a decision on its use has been delayed pending evidence from new Phase Four trials. Insecticide–impregnated bednets and seasonal malaria chemoprophylaxis remain vitally important prevention tools in high transmission areas. In Asia falciparum malaria incidence has been going down steadily but at the same time has become more drug-resistant and more difficult to treat. The disappearance of the disease from urban areas increases the risk of physicians missing the diagnosis unless a careful travel history is taken. Recurrent episodes of vivax malaria result in considerable morbidity in children. Giving primaquine to eradicate the dormant liver stages in children is complicated by the long course and the lack of paediatric formulations. Plasmodium knowlesi has been revealed as causing a significant burden of disease in Malaysia and is probably under-recognised elsewhere in Asia.

55 Symposium 11 December 1, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 2

The challenging tropical infectious diseases

Nicholas White MORU, Faculty of Tropical Medicine, Mahidol University, Thailand

Melioidosis is an infection by the saprophytic soil bacterium Burkholderia pseudomallei. The disease is endemic to parts of South and East Asia and Northern Australia. In north-eastern Thailand melioidosis accounts for approximately 20% of all community acquired septicaemias. It is estimated there are approximately 165,000 human melioidosis cases per year worldwide and 89,000 deaths. Although systemic infections occur predominantly in adults, septicaemic melioidosis also occurs in children, particularly in immunocompromised or diabetic patients. Melioidosis also presents a unique syndrome in childhood; unilateral (or rarely bilateral) suppurative parotitis which carries a relatively good prognosis provided there is early incision, drainage, and appropriate antibiotic therapy. Septicaemic melioidosis is characterised by metastatic abscess formation commonly affecting lungs, liver, and spleen. Pyomyositis may occur either primarily or secondarily and skin, soft tissue, bone and joint infections may also occur. Approximately half of all cases have either primary or secondary lung involvement. The systemic disease is indolent even with appropriate antimicrobial therapy and the mean time to fever clearance is approximately nine days. Many patients require over one month’s hospitalization. B. pseudomallei is intrinsically resistant to most beta-lactams and the aminoglycosides, but is sensitive to the third generation cephalosporins, ureido-penicillins, carbapenems, chloramphenicol, the tetracyclines, and trimethoprim - sulphamethoxazole. B. pseudomallei is also sensitive to co-amoxiclav. Serious infections should be treated with either ceftazidime (120mg/kg per day) or meropenem (50mg/kg/day) followed after at least 10 days of parenteral treatment by higher dose oral trimethoprim sulphamethoxazole.

56 Symposium 12 December 1, 2017 / 14.00 - 15.30 hr. Room: Kamolthip 1

Up-to-date: Stem cell transplantation for pediatricians

Won Soon Park Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Despite recent advances in neonatal intensive care medicine, neonatal lung or brain injury resulting from bronchopulmonary dysplasia (BPD) or intraventricular hemorrhage (IVH) still remains a major cause of neonatal mortality and long-term morbidities in survivors. Although there have been few effective treatments or preventive strategies available for these intractable neonatal disorders, recent progresses in the stem cell research support the assumption that stem cell therapy might be a promising novel therapeutic modality for treating neonatal lung or brain injury resulting from these intractable disorders. In this lecture, recent advances in the stem cell research for treating neonatal intractable disorders such as BPD or IVH will be summarized. In particular, the preclinical translational research data, covering important issues for clinical translation such as therapeutic efficacy, optimal cell type, route, dose and timing of stem cell therapy essential for successful clinical translation will be focused. In addition, the successful phase I clinical trial results of human umbilical cord blood derived mesenchymal stem cell therapies for BPD and IVH will also be discussed.

57 MEETING THE EXPERT

58 Meeting the expert December 1, 2017 / 07.30 - 08.15 hr. Room: Duangkamol

Dermatology: Spot diagnosis

Siriwan Wananukul Department of Pediatrics, Faculty of Medicin, Chulalongkorn University, Thailand

This session will present common skin conditions for dermatologist and primary pediatric practitioner. There are changes in treatment of many skin diseases nowadays. Correct diagnosis and proper management lead to best result of skin disease. The clue to diagnosis, differentiation and updates on management of common skin condition such as infection, infantile hemangioma, acne, atopic dermatitis and other common skin diseases will be discussed.

59 Meeting the expert December 1, 2017 / 07.30 - 08.15 hr. Room: Kamolruedi

The two faces of hypernatremia

Pornchai Kingwatanakul Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Hospital, The Thai Red Cross Society

Sodium plays the most important role in regulating osmolality of the extracellular fluid, as well as the total body osmolality. Changes in serum sodium level will result in the shift of water between intra- and extra-cellular fluid compartments. This condition may cause the deleterious effect on many organs, especially the central nervous system. Clinicians preferred to keep serum sodium in normal range to help prevent osmotic disequilibrium. In the recent years, treatment-induced hypernatremia are wildly used in the treatment of medical and surgical conditions, such as traumatic brain injuries, fluid resuscitation in burn victims and hypovolemic shock. The hypertonicity from hypernatremia may help maintain intravascular volume more efficiently. It may also help decrease brain edema and subsequent brain damage.

60 ORAL PRESENTATION

61 O-01

Reliability and validity of different pediatric triage systems in the emergency department

Kanokwan Aeimchanbanjong, Uthen Pandee Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Background: Triage system is an important tool to prioritize ill children. There are four international pediatric triage systems: Manchester Triage System (MTS), Emergency Severity Index version 4 (ESI), Pediatric Canadian Triage and Acuity Scale (CTAS), and Australasian Triage Scale (ATS). We use Ramathibodi Triage System (RTS) in our hospital. The objective of this study were to assess and compare the reliability of 5 triage systems as well as its validity for predicting hospital admission in pediatric patients at emergency department. Objective: Determine the best triage system in pediatric emergency department Methods: The study was divided into two phases. The first phase determined inter-rater reliability of five triage systems among pediatric residents and pediatric triage nurses. The second phases, a total of 1,041 patients were divided into five levels in each triage system then categorized patients into two groups: high acuity (triage level 1, 2) and low acuity (triage level 3, 4, and 5). Then we compared the triage acuity with admission. Finally, we expressed the validity of five triage systems in predicting admission by area under the receiver operating characteristics curves (AUC), sensitivity and specificity. Results: In phase I, RTS showed perfect inter-rater reliability with kappa of 1 follow by ESI and CTAS (kappa of 0.8-0.9). In phase II, ESI illustrated the best validity by predicting ability for admission (sensitivity 52%, specificity 81%, AUC 0.78, 95% CI 0.74-0.81). Conclusion: RTS showed perfect inter-rater reliability. ESI and CTAS demonstrated good inter-rater reliability. ESI illustrated the best validity for triage system.

62 O-02

Factors associated with induction remission in childhood high risk acute lymphoblastic leukemia

Roro Rukmi Windi Perdani, M.Kes., SpA Departement of Pediatrics Faculty of Medicine Lampung University/Dr. Abdul Moeloek Hospital, Sumantri Brojonegoro Street No 1 Bandar Lampung 35145 Lampung Province Indonesia

Background: Induction is critical phase of chemotherapy in high risk Acute Lympho- blastic Leukemia (ALL) in order to gain remission. Induction remission associated with some factors such as age, initial leucocyte count and nutritional status. Objective: To determine factors associated with induction remission Method: A retrospective cohort study, in 0-18 years old children who were diagnosed with high risk ALL in Dr. Kariadi Hospital Semarang from May 2014 - May 2016. Con- secutive sampling was performed in subject selection. Data was taken from medical record and analyzed using SPSS. Bivariate analysis by using Chi-Square, Fisher’s Exact test, and relative risk, multivariate analysis by using logistic regression test, with significancy of p< 0.05 and 95% CI Result: There were 55 subjects, 34 (61.8%) males and 21 (38.2%) females; 44 (80%) got remission and 11 (20%) didn’t. Mean age was 6.96 ± 3.62 years, mean Hb was 8.91 ± 2.51 g/dL. There were more malnutrition subjects (65.5%) than normal nutritional status subjects; (34.5%); abnormal leucocyte count (74.5%) than normal (25.5%); trombositopenia (76.4%) than normal (23.6%); with febrile netropenia (52.7%) than without febrile netropenia (47.3%); without infection complication (83.6%) than with infection (15.4%); more mild bleeding complication (78.2%) than severe bleeding complication (21.8%); with prolonged coagulation study (50.9%) than normal (49.1%).Mild bleeding complication gained remission higher than severe bleeding complication (RR 5.3; 95% CI, 2.064 – 13.369) Conclusion: Bleeding complication was the factor associated with induction remission. Mild bleeding complication gained higher remission than severe bleeding complication Keyword. Bleeding complication, remission induction, high risk ALL

63 O-03

High prevalence of hepatitis B antibody loss and de novo hepatitis B virus (HBV) infection in a child with living-do- nor liver transplantation

Palittiya Sintusek, Nawarat Posuwan, Nataruks Chaijitraruch, Voranuch Chongsrisawat and Yong Poovorawan

Background: Hepatitis B antibody loss is common in immunocompromised children but clinical implication of revaccination is warranted. Objectives: To assess the seroprevalence of hepatitis B virus(HBV) among previously vaccinated pediatric liver transplant recipients and present a case study. Materials and methods: This cross-sectional study assessed the HBV immunity in 52 vaccinated children underwent liver transplantation. Results: The time after liver transplantation was 2.43 years(0.15-7.92). The anti-HBs antibody titers pre- and post-transplantation were 404.5(44 to >1000) and 52.4 (0 to 644.3) mIU/mL, respectively. The rates of non-response to previous vaccination were 43% at 2 years(n=30), 60% at 2-4 years(n=15) and 100% at >4 years(n=7) post-transplantation. Of particular interest was a cirrhotic child whose anti-HBs antibody was more than 1,000 mIU/mL before receiving a liver transplant from his anti-HBc-negative father. He had vascular stricture post liver transplantation then underwent venoplasty*3 and totally received blood component transfusion*20. Three years post-transplantation, de novo HBV infection was diagnosed with no vaccine escape mutants. Conclusions: Loss of HBV immunity post-transplantation was unexpectedly common and resulted in de novo HBV infection. For the case study, the route of HBV transmission was inapparent. In Thailand, donated blood is routinely screened for HBV using the nucleic acid amplification test, which was repeatedly performed on the 15 donors who provided donated blood to this child. None had evident HBV occult infection. Therefore, de novo HBV infection may have resulted post-transplantation when this child lost protective immunity to HBV despite prior high anti-HBs antibody level pre-transplantation. Thus, this study underscores the importance of sufficient anti-HBs antibody levels post-transplantation.

64 O-04

Correlation of Quantiferon-TB Gold, T-Spot.TB and Tuber- culin skin test in children younger than 5 years with tuberculosis exposure or tuberculosis disease

Keswadee Lapphra, MD1, Paninun Srinuchasart, MD1, Maneeprang Thovarabha2, Parnwas Pinnobphun3, Alan Maleesatharn1, Kulkanya Chokephaibulkit, MD1 1Department of Pediatrics Faculty of Medicine Siriraj Hospital, Mahidol University 2Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 3Biomed Diagnostics (Thailand) Co LTD. Bangkok, Thailand

Background: Interferon gamma release assays (IGRAs) for diagnosis tuberculosis (TB) infection may be useful in children younger than 5 years. Objective: To evaluate correlation between IGRAs and tuberculin skin test (TST) in BCG vaccinated children younger than 5 years. Material and Methods: A cross-sectional study was conducted in immunocompetent children age 3 months- 5 years with recent history of exposure to TB or diagnosed with any type of TB disease. Blood for QuantiFERON-TB Gold In-Tube test (QFT-GIT), T-SPOT. TB and TST were performed in each patient. Agreement of each test were evaluated by kappa (0.81-1.00 = almost perfect agreement, 0.61-0.80 = substantial, 0.41-0.60 = moderate, 0.21-0.40 = fair, 0.01-0.20= none to slight, 0 = no agreement) Results: 60 (48.3% male) children were enrolled. 43 (71.7%) had recent TB exposed and 17 (28.3%) had TB diseases. The median age was 3.3 (IQR: 1.6-4.3) years. Of all the tests performed, 8 (13.3%) QFT-GIT, 12 (20%) T-SPOT.TB and 15 (25%) TST (>10mm) were positive. There was moderate agreement between IGRAs and TST; k =0.531 at TST ≥10 mm. and k =0.576 at TST > 15 mm. Agreement between QFT-GIT and T-SPOT.TB were moderate with k = 0.517 (p <0.001) in all patients, and 0.815 (p <0.001) in patients with TB disease. Conclusion: Both QFT-GIT and T-SPOT.TB had lower positivity rates than TST (> 10 mm) in young children with TB infection. Our finding did not support the use of IGRAs for diagnosis of TB infection or disease in children younger than 5 years. Keywords: TST, QFT-GIT, T-SPOT.TB, young children Research fund: Faculty of Medicine, Siriraj hospital, Mahidol university

65 O-05

Clinical manifestation, treatment outcome and prognostic factor of pediatric anti-NMDA encephalitis

Napa Pruetarat1, Wiracha Netbaramee2, Siriporn Pattarathitikul3, Montida Veeravigrom1, 4 1 Department of Pediatrics, King Chulalongkorn Memorial Hospital / The Thai Red Cross Society 2 Department of Pediatrics, Chonburi Hospital, Chonburi, Thailand 3 Department of Pediatrics, Prapokklao Hospital, Chanthaburi, Thailand 4 Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Background: Anti-NMDA encephalitis is an acute autoimmune neurological disorder first described in adults and increasingly recognized in pediatric population. There are research studies about this disease worldwide. However, there are few publications about pediatric Anti-NMDA encephalitis in Thailand. Objective: The objective of this study is to describe the clinical manifestation, treatment outcome and prognostic factor of children with Anti-NMDA encephalitis. Materials Methods : Our study is a retrospective study of children with Anti-NMDA encephalitis from three tertiary care hospitals: King Chulalongkorn Memorial Hospital Chonburi hospital and Prapokklao hospital from January 2007 - August 2017. The mod- ified Rankin score (mRs) was used as a parameter to measure severity of the disease and treatment outcome. Result: During the study period, 14 cases were collected.(4 patients were male, 10 patients were female). The median age was 7.8 years old. The median follow up time was 20.5 months. Clinical manifestation findings were behavioral dysfunction (100%), movement disorder (93%), speech disorder (79%) and sleep disorder (79%). All patients received first-line immunotherapy (corticosteroid 100%, Intravenous immunoglobulin 77%, and plasma exchange 15%). The second-line immunotherapy (cyclophosphamide) was administered to these patients about 62%. During first 12 months, 6 patients (46%) achieved good outcome (mRs <= 2). And until 24 months, 7 patients (53%) achieved good outcome. In multivariate analysis, the prognostic factors were status epilepticus, pre mRs Score, ICU admission and time to medication. Conclusion : Clinical manifestation findings of Anti-NMDA encephalitis in Thai children were not difference from studies in other countries. Percentage of the patient with good outcome was lower in our study compared with previous research studies. The prognostic factors were status epilepticus, pre mRs score, ICU admission and time to medication.

66 POSTER PRESENTATION

67 P001

Antimicrobial susceptibility of S. pneumoniae causing invasive disease in central Thailand, 2012-2016

Wanatpreeya Phongsamart1, Somporn Srifeungfung2, Perapon Nitayanon2, Tanittha Chatsuwan3, Vipa Treerauthaweeraphong4, Pimpha Rungnobhakhun5, Kulkanya Chokephaibulkit1 1Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University 2Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University 3Department of Microbiology, Chulalongkorn University 4Microbiological Laboratory, Queen Sirikit National Institute of Child Health 5Microbiological Laboratory, Bhumipol Adulyadej Hospital, Bangkok, Thailand

Background: Antimicrobial resistance among Streptococcus pneumoniae has been a global concern. We studied antimicrobial susceptibility of pneumococcus causing invasive pneumococcal diseases (IPD) in our setting that had pneumococcal conjugate vaccine coverage of <30%. Materials and methods: Pneumococci from normally sterile sites from patients with- in the “Pneumococcal Laboratory Network” in central Thailand during 2012-2016 were tested. Microbroth dilution method were performed to determinine minimal inhibitory concentration (MIC) of penicillin, cefotaxime and meropenem. Susceptibilities to erythromycin, linezolid, ofloxacin, tetracycline, trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin were tested by disk diffusion method. We used meningitis criteria for penicillin and cefotaxime susceptibilities if the specimens were cerebrospinal fluid (CSF) or blood isolated from the patients diagnosed with meningitis. Results: There were 276 pneumococcal isolates studied. Specimens were blood (263, 95.3%) and CSF (13, 4.7%). The age ranged from 2 months to 93 years and majority (46.7%) were children aged <5 years. High susceptibilities to cefotaxime (94.6%), ofloxacin (98.2%), linezolid (99.6%) and vancomycin (100.0%), but low to erythromycin (50.0%), TMP-SMZ (41.3%), and tetracycline (27.2%) were observed. Susceptibilities to penicillin, meropenem, and clindamycin were 85.9%, 85.9%, and 84.8%, respectively. Serotype 19A was identified in 36 (13.0%) of all isolates and was associated with less susceptibility to penicillin (75.0% vs 87.5%%, p = 0.045), meropenem (52.8% vs 90.8%, p <0.001), erythromycin (33.3% vs 53.8, p =0.022) and TMP-SMZ (16.7% vs 45.0%, p =0.001) than non-19A isolates. Conclusions: Decreased susceptibilities of pneumococcus causing IPD to penicillin, meropenem, erythromycin, TMP-SMZ, and tetracycline is alarming in our setting with low vaccine utilization. Keywords: Invasive pneumococcal disease, antimicrobial susceptibility

68 P002

The results of adenoid tissue culture of children receiving adenoidectomy

Chan Il Song Department of Pediatric Otorhinolaryngology, Jeju National University Hospital, Jeju, Korea

Background: Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae are generally known as the common pathogens that colonized in the nasopharynx of children. Objectives: In this study we investigated the characteristics of the main pathogens colonizing in the adenoids in children. Methods: We retrospectively analyzed the adenoid tissue culture from 62 children (aged 2–15 years) who received adenoidectomy. Results: All of 62 patients had more than one bacterial species and 25 patients have 2 bacterial species. Staphylococcus aureus, Streptococcus mitis/oralis, Streptococcus pneumonia, and Neisseria species constituted the major microorganisms which were cultured from these adenoidectomies, at 21.8%, 17.2%, 13.8%, and 13.8%, respectively. Streptococcus pneumonia, Streptococcus mitis/oralis, and Neisseria species were the most prevalent in the preschool-aged children (age<6), whereas S. aureus and Streptococcus mitis/oralis were more prevalent in the school-aged children (age≥6). In addition, all of methicillin-resistant Staphylococcus aureus (MRSA) were cultured from the school-aged children.

Conclusions: Compared to the previous studies, the main pathogens colonizing in the adenoids were different in this study. Haemophilus influenzae was cultured only one patient, while Neisseria species were one of the common pathogens.

69 P003

Food sensitization in young Thai children with atopic dermatitis

Mongkol Lao-araya, M.D.1, Phuwat Feilung, M.D.1, Dararat Dankai, B.Sc.2 1Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 2Section of Immunology, Central Laboratory, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Background: Atopic dermatitis (AD) is the most common allergic skin disease in young children. Food allergen plays role as triggering factors of AD. There are few data about IgE-mediated food sensitization in Thai young children with AD. Objective: To study the prevalence and factors associated with food sensitization among AD-children aged less than 5 years. Methods: A prospective, observational study in children aged less than 5 years with AD at allergy clinic, Chiang Mai University hospital was performed. The participants were assessed for IgE-sensitization by parent-interview, skin prick test (SPT), serum specific IgE (SIgE; ImmunoCAP, Thermo Fisher). Results: A total of 101 children were enrolled, median age 9.3 months (IQR: 6.1-17.1 months). The severity of AD were mild (37.6%), moderate (59.4%), and severe (3.0%). There were high over all rates of food sensitization (64.4%). The correlation of food sensitization results between SPT and SIgE was moderate (keppa=0.398). The common food allergens were egg white (55.4%), cow’s milk (34.7%), wheat (30.7%), peanut (17.8%), and soy (10.9%). House dust mite sensitized (20.7%) were found only in participants aged more than 1 year. The significant factors associated with food sensitization were personal history of other atopic disease, exclusive breast feeding > 6 months, and moderate to severe AD. Conclusions: The prevalence of food sensitization in Thai children with AD aged less than 5 years is high. Further studies to evaluate clinical relevance of food IgE-sensitization, food allergies, and elimination diet treatment are required. This study supported by Faculty of Medicine, Chiang Mai University Research Fund

70 P004

Prevalence of iron deficiency in infants of diabetic mother at the age of 6-12 months

Pontipa Engkakul, Sudathip Kositamongkol Departments of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, THAILAND

Background: Iron deficiency and iron deficiency anemia are global problems in infant. The Infant of diabetic mother (IDM) usually have low iron storage at birth, therefore they has are at risk for developing iron deficiency and iron deficiency anemia. Objective: To determine the prevalence of iron deficiency and iron deficiency anemia in children who were born to IDM between 6 and 12 month-old and to identify associated risk factors. Study design: This is a prospective descriptive study of 50 healthy, full-term, IDM at the age of 6-12 months. Growth, history of food intake and maternal history of diabetes were assessed. Iron status and anemia were determined by hemoglobin, serum ferritin and transferrin saturation. Results: Thirty IDM (60%) had iron deficiency. Eleven infants (32%) had iron deficiency anemia; 18 infants (36%) had iron deficiency without anemia; 7 infants (14%) had anemia with iron sufficient; and 13 infants (26%) were found to be normal. Exclusive breastfeeding was significantly associated with iron deficiency; all exclusively breast-fed infants had iron deficiency (12/12). Conclusion: There was high prevalence of iron deficiency and iron deficiency anemia in IDM. Therefore, screening for iron deficiency is recommended. Moreover, iron supplementation the age of 6 months should be considered in these infants especially in the exclusively breastfed infants.

71 P005

Clinical feature and outcomes of bcgosis following neonatal BCG immunization

Supattra Rungmaitree, MD1, Rattanachai Rermruay, MD1, Sunsanee Chatpornvorarux, MD1, Chantapat Brukesawan, MD1, Orasri Wittawatmongkol, MD1, Keswadee Lapphra, MD1, Wanatpreeya Phongsamart, MD1, Nantaka Kongstan, RN1, Benjawan Khumcha, BA1, Kulkanya Chokephaibulkit, MD1 1Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Background: Bacille Calmette-Guérin (BCG) vaccination at birth may cause benign local adverse effects (AE). More serious AE (BCGosis) have been rarely reported. Objective: To describe clinical feature and outcomes of BCGosis that required medical attention at a tertiary care center in Bangkok, Thailand, from January 2007 to December 2016. Method: We retrospectively reviewed the medical records selected by ICD-10. The inclusion criteria were the patients under 3 years of age who developed lymphadenitis, osteitis, or disseminated infections which BCG was the possible pathogen. The cases were classified into suspected (compatible clinical picture), probable (possible cases with M.tuberculosis complex identified), and confirmed (probable cases with molecular confirmation ofM.bovis BCG strain) BCGosis. Results: There were 95 children identified, 57 (60.0%) were male, the median age at presenting symptom was 3.5 (0.6 – 28.7) months. Of these, 25 (26.3%) were suspected, 49 (51.6%) were probable, and 21 (22.1%) were confirmed BCGosis. Overall, 87 (92%) children had lymphadenitis corresponding to BCG site, 5 (5%) had osteitis, and 3 (3%) had disseminated BCGosis. Five children had immunodeficiency, three of them had disseminated BCG and two had lymphadenitis. All 5 children with BCG osteitis underwent surgical interventions in combination with anti-tuberculosis treatment, while 57 (65.5%) of lymphadenitis had surgical excision. Long-term complication was found in one patient with osteitis who eventually had leg length discrepancy. Conclusion: BCG regional lymphadenitis was the common feature of BCGosis. None of the BCG osteitis were immunocompromised hosts suggested the potential virulence of BCG in neonates.

72 P006

Diagnostic value of abdominal X-ray for children with clinical suspected intussusception at King Chulalongkorn Memorial Hospital

Rukwong P., MD and Sintusek P., MD Department of pediatrics, Faculty of medicine, Chulalongkorn university

Objective: Ultrasound is considered the gold standard for diagnosing intussusception but depends on operator and not available in the resource-limited area. The present study aims to evaluate the diagnostic value of abdominal x-ray in children with clinical suspected intussusception. Material& Method: Medical records of 119 children who had clinical suspected intussusception mostly based on the first year pediatric residents at King Chulalongkorn Memorial Hospital, were retrospectively reviewed from 2006 to 2016. Intussusception was confirmed by ultrasound findings or operative reduction. Abnormal abdominal x-ray for intussusception was defined as an opacity or filling defect at right lower quadrant, or findings consistent with small bowel obstruction. Results: Eighty nine children suspected intussusception with mean aged of 2.05 years (2.05±2.49, 65%male) were included. The mean age of children with intussusception was 1.81 (1.81±2.43, 67%male). Of all, 48% children diagnosed intussusception had abnormal abdominal x-ray as a clue. The sensitivity, specificity, PPV, NPV and accuracy of abdominal x-ray were 68.3%, 53.4%, 78.2%, 41.2% and 64.0% respectively.

Conclusion and discussion: Intussusception is more common in preschool boys in the present study. Although abdominal x-ray is cheap and available worldwide, it has low diagnostic value. Developing of scoring model to diagnose intussusception that included abdominal x-ray, age, sex and other clinical clues might increase the diagnostic value, early recognition and timely management. Prospective study evaluates the diagnostic value of the scoring model should be merit.

73 P007

Predictors of adverse outcomes following central line- associated bloodstream infection in children

Chaisiri Srijareonvijit1, Wanatpreeya Phongsamart1, Sumalee Pakaworawuth2, Kulkanya Chokephaibulkit1 1Division of Infectious Diseases, Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 2Center for Nosocomial Infection Control, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Background: Central line-associated bloodstream infection (CLABSI) has been a major cause of nosocomial infection that leads to significant morbidity and mortality. Objectives: We aimed to determine the predictors of adverse outcomes following CLABSI among pediatric patients. Methods: Medical records of children diagnosed with CLABSI from January 2012 to June 2017 at a tertiary care center in Bangkok were retrospectively reviewed. Clinical data, risk factors, pathogen isolated, and outcomes were collected. Factors associated with adverse outcomes, defined as persistent bacteremia or fungemia for more than 7 days after treatment, complications from CLABSI, or death were analyzed using logistic regression model. Results: There were 199 culture-proven CLABSI identified in 170 children. The incidence of CLABSI was 3.8 episodes per 1,000 central line-days. The most common pathogens were coagulase-negative Staphylococci (16.9%), Acinetobacter spp. (12.8%), and Can- dida spp. (11.5%; 57.7% were non-albicans). Sixty-six patients (33.2%) had adverse outcomes, including 44 (22.1%) persistent bacteremia/fungemia, one infective endocar- ditis, and 21 (10.6%) deaths. Independent predictors of adverse outcomes were presence of more than one central venous catheter (CVC) (odds ratio [OR], 2.0 [95% CI, 1.1-3.9]; p = .030), CVC was kept in situ for >3 days after diagnosis (OR, 3.0 [95% CI, 1.2-7.0]; p = .014), delayed (>3 days of diagnosis) appropriate antimicrobial treatment (OR, 1.3 [95% CI, 1.0-1.7]; p = .026), and Candidemia (OR, 6.3 [95% CI, 2.3-17.1]; p < .001). Conclusions: Adverse outcomes following CVC was found very common. Prompt treatment with appropriate antibiotic and removal of infected CVC may prevent adverse outcomes following CLABSI. Keyword: Central line-associated bloodstream infections.

74 P008

Gastrointestinal manifestations and clinical outcome of henoch-schönlein purpura in pediatric patients in King Chulalongkorn Memorial Hospital

Varisa Piriyakitphaiboon, Palittiya Sintusek, Nataruks Chaijitraruch, Voranush Chongsrisawat Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand

Background: Henoch-Schönlein purpura (HSP) is the most common cause of vasculitis in children. The gastrointestinal manifestations may vary from mild abdominal pain to life- threatening condition, such as massive intestinal bleeding or perforation. Methods: A retrospective study of children diagnosed with HSP based on the presence of palpable purpura, was performed in King Chulalongkorn Memorial Hospital from 1 January 2007 to 31 September 2017. Result: A total of 61 patients enrolled in this study with the mean age of 8± 3.7 years, and the male to female ratio was 1.1:1. Development of joint and renal involvement were observed in 22 (36.1%) and 19 (31.1%) patients, respectively. Gastrointestinal manifestations were presented in 56 patients (91.8 %). The onset of GI symptom occurred before, after and at the same time with purpura, were found in 11(20%), 25 (46%) and 18 (33%) patients, respectively. The most common cause of hospitalization was intestinal bleeding (28 patients; 46%) followed by severe abdominal pain (23 patients; 38%). Relapse was found in 11 patients (18 %). Prognosis of HSP patients remained good, but there was a case of death from massive gastrointestinal bleeding. The neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) were significantly higher in patient with severe abdominal pain when compare to those who had mild symptom (7.8 vs 4.2 and 12.5 vs 4.6 mg/L, respectively; P<0.05). Conclusion: Most HSP patients have a good clinical outcome. The NLR and CRP are associated with the severity of abdominal pain in HSP patients.

75 P011

A single center study on prevalence of neonatal anemia in well-appearing term infants

Danunart Annoppornchai, Sudatip Kositamongkol Department of Pediatric, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

Background: Anemia has been accepted as a public health problems worldwide. Anemia in early childhood has potential effect on long-term health and cognitive outcomes. Neonatal anemia was studies extensively especially in preterm infants. However, there were limited studies focused on anemia in term infants. Objective: To assess prevalence and causes of anemia in well-appearing term newborn in Thammasat Hospital. Method &Study Design: This study was a retrospective cross-sectional study. Inclusion criteria was term neonates born in Thammasat hospital during March-June 2017. Exclusion criteria were neonates admitted in intensive care unit, major congenital anomalies or syndromic disorders. Demographic data of mother-infant dyads, predischarge hematocrit screening and laboratories result from anemic work up were extracted from medical records. Neonatal anemia were defied as hematocrit <45%. Result: Four-hundred and fifty-five term neonates were enrolled. Thirty-three neonates had anemia (7.3%). Feto-maternal transfusion (28.2%), Feto-placental transfusion (20.5%) and ABO incompatibility (7.7%) were the top three causes of anemia documented in this study.

Conclusion: Neonatal anemia is not an uncommon problems in neonates. Feto-maternal transfusion was the major cause of anemia in well-appearing neonates. Keyword: Term newborn, healthy, Anemia, Feto-maternal transfusion

76 P012

“Smoke-free home” campaign and prevalence of hoursehold exposure to secondhand smoke in children

Naiyana Neesanan, Rachada Kaseamsup, Kim Sakulnum Social Pediatrics Unit, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.

Background: Children’s exposure to secondhand smoke (SHS) is mainly attributed to adult smoking in the home. The harms of SHS exposure on children and pregnant women are evident including low birth weight and risk of asthma and respiratory tract infection. Moreover, children who exposed to family SHS in were more likely to smoke when they grew up. Objective: To examine children’s SHS exposure at home before and after the campaign. Methods: A single arm, open-label trial was conducted among caregivers of children receiving care at Queen Sirikit National Institute of Child Health during May-September 2016. Parents completed the questionnaires on SHS exposure and children’s illness. All caregivers received the 5A’s framework for smoking cessation counselling (Ask, Advise, Assess, Assist, and Arrange) to promote smoke-free home environment. Smoking status and behavior were re-evaluated at 3-month follow-up. Results: 466 out of a total of 1,020 households surveyed (45.7%) reported family smoking with 20% (n=101) prevalence of indoor smoking. Among the 40% of smoking households (n=187 with 210 smokers) who were available for complete follow-up survey, 6.6% (n=14) quitted smoking. Additionally, 95% (54/57) of households with initial indoor smoking behavior reported no longer smoking inside their house at 3 month follow-up. Family SHS exposure was associated with increased risk of respiratory tract infection and wheezing in children under 5 years of age with odds ratios and 95% confidence intervals of 1.9 (1.43 -2.51), and 2 (1.38-3.03), respectively. Conclusion: The “Smoke-free Home” Campaign appears to reduce smoking behavior and household indoor exposure. Keywords: smoke-free home, secondhand smoke, children Disclosure: The study was funded by Thai Health Promotion Foundation.

77 P013

Performance of the “next generation sequencing” in the detection of potential pathogens isolated in critically ill children with persistent fever unresponsive to broad- spectrum antibiotic

Warunee Punpanich Vandepitte,1,5 Rungrat Sukharom,2 Nuanjun Wichukchinda,3 Daisuke Motooka,4 Shota Nakamura4 1Division of Infectious Diseases, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand 2Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand 3Medical Genetics Center, Medical Life Science Institute, Department of Medical Sciences, Ministry of Public Health, Thailand. 4Department of Genome Informatics, Research Institute for Microbial Diseases (RIMD), Osaka University, Suita, Osaka, Japan 5College of Medicine, Rangsit University, Bangkok, Thailand

Background: Critically ill children with refractory fever despite broad -spectrum antimicrobial therapy are common infectious disease consultation. The causes of persistent fever in these cases are rarely identified by conventional diagnostic methods. Next-generation sequencing (NGS) is a promising technology to identify known and novel pathogens where currently available diagnostic methods fail to yield diagnosis. Objectives: To identify potential pathogens in blood and/or tracheal aspirates from critically ill children with severe pneumonia and refractory fever using NGS technology.

Methods: Blood and tracheal aspirates from 34 critically ill children aged less than 15 years with refractory fever despite broad-spectrum antibiotics were sent for microbial identification by NGS technology using HiSeq2500 (Illumina, Inc) platform. Results: Multiple organisms were identified in 82% of blood samples identified with Stenotrophomonas maltophilia andMycobacterium chelonae being the 2 most common bacteria (n=21 or 61.8% each) followed by Pseudomonas aeruginosa(n=3 or 8.8%). The 3 most common viruses identified in blood were human herpes virus/HSV (n=9 or 26.4%), rhinovirus (n=7 or 20.5%) and human bocavirus (hBoV) (n=3 or 8.8%), respectively. Aspergillus oryzae was the most commonly identified fungus in blood (n=17 or 50%). The distribution of organisms in tracheal aspirates was rather similar to those from blood samples. 78 Conclusion: The identification of S. maltophilia, M. chelonae, HSV, rhinovirus and hBoV in blood and trachea suggests their potential role in refractory fever in critically ill children receiving broad spectrum antibiotics. However, the results of this study should be inter- preted with caution as no control group was available. Keywords: next generation sequencing, critically ill, fever, pneumonia, respiratory failure, children, Stenotrophomas maltophilia, Mycobacterium chelonae

79 P015

Efficacy of breast milk application on skin integrity in preterm infant: A randomized controlled trial

Jaruta Oonjittichai, Pajaree Thitthiwong, Sangkae Chamnanvanakij Department of Pediatrics, Phramongkutklao Hospital

Background: Preterm has compromised skin integrity leading to increased transepider- mal water loss. However, there was no study on the benefit of breast milk promoting skin moisture in preterm. Objective: To compare skin condition between infants using breast milk and topical oil applied on skin. Methods: We conducted a prospective, randomized controlled trial. Infants with gestational age less than 37 weeks; birth weight less than 1,800 grams; age less than 7 days; requiring incubator and receiving breast milk were recruited. The intervention group received their own mother breast milk applied 4 times daily for 28 days or until incubator weaning. The control group received olive oil applied once daily. Skin hydration was measured by using moisture meter on day 7, 14, 21 and 28 after enrollment. Skin condition was assessed by skin condition grading scale (Lane & Drost). Fluid intake, weight and infection rate during hospitalization were monitored. Results: 13 and 12 infants were enrolled to the intervention and control groups, respectively. Birth weight, gestational age, gender and skin condition at enrollment were comparable between groups. There were no differences in skin condition and hydration between two groups. Fluid intake, weight and infection rate were comparable between groups. Conclusion: We demonstrated no differences in skin condition between using breast milk and olive oil. However, there was no complication of breast milk application. We concluded that breast milk can be used as an alternative skincare in preterm.