Abstracts from the 4th Excellence in Paediatrics Conference Committees EiP Advisory Board Chair: Dimitri A. Christakis, MD MPH, George Adkins Professor of Pediatrics, University of Washington & Director, Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, USA Members (listed in alphabetical order): Frederick A. Connell, MD, MPH, Professor & Associate Dean, School of Public Health, University of Washington, Seattle, USA Hanna Nohynek, MD, PhD, Senior Scientist, Professor of International Health National Institute for Health and Welfare, University of Tampere, Finland Massimo Pettoello-Mantovani, MD, PhD, Professor of Pediatrics & Director, Institute of Pediatrics & Residency Program, University of Foggia, Italy Secretary General, European Paediatric Association (EPA-UNEPSA) - Union of National European Paediatric Societies and Associations Terence Stephenson, Nuffield Professor of Child Health, Institute of Child Health, UCL & Chairman, Academy of Royal Medical Colleges, UK Steering Committee Chair: Dimitri A. Christakis, MD MPH,George Adkins Professor of Pediatrics, University of Washington & Director, Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, USA Members (listed in alphabetical order): Terence Stephenson, Nuffield Professor of Child Health, Institute of Child Health, UCL & Chairman, Academy of Royal Medical Colleges, UK Richard C. Wasserman, Professor of Pediatrics at the University of Vermont (UVM) College of Medicine and Director of Pediatric Research in Office Settings (PROS), the practice-based research network (PBRN) of the American Academy of Pediatrics (AAP), USA Antonio Nieto, Vice-President of the Spanish Pediatric Association-AEP & Paediatric Allergy Unit, Hospital Infantil La Fe, Valencia, Spain Angel Carrasco, General Secretary of the Spanish Pediatric Association AEP, Spain Page 1 of 154 Contents Pages SPEAKERS’ ABSTRACTS 3–22 SPEAKERS INDEX 23 MEETINGS ON THE OCCASION OF EiP 24-30 ORAL PRESENTATIONS (OP01–OP12) 31-40 Theme: Adolescence Medicine Theme: Allergy-Immunology Theme: Cardiology Theme: Dermatology Theme: Gastroenterology, Nutrition & Metabolism Theme: General Paediatrics Theme: Genetics Theme: Infectious Diseases Theme: Neonatology Theme: Nephrology POSTER PRESENTATIONS (PP001–PP118) 41-142 Theme: Adolescence Medicine Theme: Allergy-Immunology Theme: Cardiology Theme: Children’s Environmental Health Theme: Dermatology Theme: Endocrinology Theme: Gastroenterology, Nutrition & Metabolism Theme: General Paediatrics Theme: Genetics Theme: Haematology & Oncology Theme: Infectious Diseases Theme: Neonatology Theme: Nephrology Theme: Neurology / Neurodevelopmental Paediatrics Theme: Other Theme: Pulmonology AUTHOR INDEX 143-154 Page 2 of 154 SPEAKERS’ ABSTRACTS SP01 Amy Berrington de González, DPhil, Senior Investigator, Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Maryland, USA RADIATION RISK TO PAEDIATRIC PATIENTS FROM MEDICAL IMAGING Around the world radiation exposure from medical imaging has doubled in the past 10 to 15 years. Much of this increase is due to the dramatic rise in computed tomography (CT). These procedures provide great medical benefits, but the associated radiation exposure is typically about ten times higher than from conventional X-rays. There are concerns, therefore, about the potential future cancer risks from the increases in CT scans and other higher dose medical imaging tests including nuclear medicine and interventional radiography. These concerns are greatest for children because they are more radiosensitive and because the radiation dose per procedure is often higher, and more organs may be exposed. We conducted the first cohort study examining cancer risks after CT scans in childhood. In this study of 200,000 children in the UK who were followed up for 10-20 years after their first CT scan we found an increased risk of leukemia and brain tumors with a clear dose-response relationship. The results suggested that in children the dose to the red bone marrow from 5-10 head CTs could approximately triple the risk of leukemia, and the dose to the brain from 2-3 head CTs could approximately triple the risk of brain tumors. Despite these large relative risks, because these cancers are relatively rare the absolute risks are small: about one excess cancer per 10,000 scans. Clinical benefits should outweigh these small absolute risks providing the scan is clinically justified. However, this first direct evidence of potential cancer risks after CT scans emphasizes the need to keep radiation doses as low as possible and to consider alternative procedures, which do not involve ionising radiation, if appropriate. As well as presenting the results from this new study I will describe the trends in medical imaging around the world and discuss the potential cancer risks according to the type of procedure and the age of the patient. Page 3 of 154 SP02 Marie-Noël Bruné Drisse, Department of Public Health and Environment, World Health Organization, Geneva, Switzerland CHILDREN'S ENVIRONMENTAL HEALTH: TAKING ACTION About 3 million children of less than five years of age still die every year due from diseases and affections that could be prevented by healthier environments. These include respiratory infections, pneumonia, diarrhea and malaria. Children are uniquely vulnerable to toxic chemicals, heavy metals, unsafe water, air pollution. Global environmental conditions are also changing and we are exposed to the risks posed by climate change, potential endocrine-disrupting chemicals, or new kinds of wastes, such as electronic waste, distributed to and recycled in different parts of the world. Some environmental pollutants can have effects that may be linked to hormonal and developmental problems, as well as to certain types of cancer. There is a higher awareness that early-life exposures can have an impact on our risk of developing future non-communicable diseases, such as cardiovascular disease, obesity and diabetes. The World Health Organization has been working with partners in a number of activities on children's health and the environment. These include publications for health professionals, awareness-raising and advocacy, training activities for pediatric doctors and nurses, promoting collaborative research and coordinated long-term studies. Health professionals can have a special role by being able to better identify, diagnose and treat diseases and conditions related to the environment, but also by reaching communities with preventive messages, reaching policy-makers, creating a difference. Healthier children lead to healthier families and communities. By creating healthier environments health can be improved. Page 4 of 154 SP03 Felip Burgos, MSc, RPFT, RN, Respiratory Diagnostic Center (Lung Function Laboratory), Respiratory Department, Hospital Clínic, University of Barcelona, IDIBAPS,Spain HOW TO USE SPIROMETRY IN PRIMARY CARE Forced Spirometry (FS) is currently being promoted as an indispensable tool for primary care doctors and nurses to diagnose and monitor chronic airways disease. Several previous studies indicate that primary care spirometry increases rates of diagnosis for chronic respiratory disease and may also lead to improvements in its treatment. The use of FS could help detect cases at an early stage when intervention may prevent further progression of the disease. However, good quality FS requires comprehensive training of staff, reliable equipment, and well-standardised measurement procedures. This may be difficult to achieve in primary care practice, especially when tests are rather infrequently administered. Although children’s and their parents’ reporting of asthma symptoms is important in staging and managing paediatric asthma, many children and parents do not perceive asthma symptoms adequately. In addition, physical findings seem to be inadequate for assessing obstruction that may be present despite a normal physical examination. Despite a large body of evidence showing that airway obstruction in children with asthma is associated with ongoing respiratory morbidity and a reduced FEV1 in adulthood, FS is not routinely performed by physicians who treat children with asthma as an objective measure of airway obstruction. According to the Asthma Insights and Reality Europe Study (a survey that assesses the current level of asthma control in Western Europe), a large proportion of children with asthma are treated without lung function measurements, and physicians base their treatment decisions on symptom reports and auscultation. Ideally, FS should be available on-site in primary care practices. Portable, lightweight and cheap spirometers that can be connected into a computer are now available, making FS technically feasible at the primary care level. References: . Rabe KF, et al. Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J. 2000;16:802–807 . Fuhlbrigge AL,et al.FEV1 is associated with risk of asthma attacks in a pediatric population. J Allergy Clin Immunol. 2001;107:61–67 . Kitch BT, et al. A single measure of FEV1 is associated with risk of asthma attacks in long-term follow-up. Chest. 2004;126:1875–1882 . Zanconato S, et al.Office spirometry in primary care pediatrics: a pilot study. Pediatrics. 2005 Dec;116(6):792- 797 . Miller MR, et al. ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J. 2005 Aug;26(2):319-38 Page 5 of 154 SP04 Andrew Bush, Professor