Advances in Neonatal and Pediatric Nutrition July 19-21, 2018 London, UK

Roula AbdelMassih received her Ph.D. in Biological Sciences from the University of Glasgow, U.K. in 2001. She served as the Chair of the Department of Biology, from 2008-2011. She obtained a Certificate of Completion for the Art and Practice of Leadership Development Program (May 2016) at Harvard. She was elected as a TWAS Young Affiliate from 2011 to 2015, selected by The New York Academy of Sciences and the STS to participate in the 2015 Future Leaders program in Japan and was elected as an education fellow in the National Academies in the Life Sciences (2015-2016). Her primary research focus is on the identification of biologically active plant components (anti-proliferative, anti-bacteria).

Yerba Mate, Ilex paraguariensis, is used in the preparation of infusions in South America and in some areas within the Middle East. In the present work, the antibacterial activity of the dialyzed aqueous extract of commercial leaves of Mate was tested against Gram negative and Gram-negative bacteria. Antibacterial activity was observed against all tested strains with a greater activity against Gram-positive bacteria. Further studies were performed on reference strains and clinical isolates of Staphylococcus aureus. The MIC of the aqueous extract ranged between 1.25 and 2.5 mg/ml. Checkerboard synergy tests were done to study the synergism/antagonism between Yerba Mate and different antibiotics. Mate extract showed no synergy with Cefotaxime and Ciprofloxacin for most of the tested strains with a few showing an additive effect. Gentamicin showed antagonism with a number of strains; As for Clarithromycin, almost all the strains showed an additive effect between the Mate extract and the antibiotic. A more in-depth analysis to identify the active molecule responsible for this activity is important for a better understanding of the potential role of Yerba Mate in developing new antibacterial agents and in elucidating its interactions with antimicrobial agents used in the clinical setting.

Aim: Vitamin D deficiency is a public health problem. We aimed to assess the effectiveness of vitamin D fortification of staple food for improving vitamin D level in children.

Methods: We performed a systematic review and meta-analysis of Randomized Controlled Trials (RCTs) evaluating the use of vitamin D fortified food products compared to no fortification in healthy children aged 0-18 years. The primary outcomes are vitamin D level and vitamin D deficiency prevalence. The secondary outcomes are school performance and infection rate.

It was screened for titles and abstracts, assessed full text for eligibility and performed data extraction. We performed metaanalysis using random effects model and reported effect estimates with 95% confidence interval.

Results: We identified 2224 articles and screened 1776 after removing duplicates. 86 articles were assessed eligible for full text assessment and 17 RCTs were included for data extraction with 3157 patients. The RCT’s were performed in ten different countries. The interventions included fortification of milk, juice, bread and yogurt compared to no fortification. Vitamin D

fortification improved the vitamin D level by MD 17 nmolL (95%CI 5.32, 28.67) and reduced vitamin D deficiency prevalence by relative risk (RR) of 0.61 (95%CI 0.49-0.76). Vitamin D level improved more in lower middle income countries MD 25.66 nmol/l ((95%CI 24.71, 26.61) and when used in school based programs MD 31.20 (95%CI 30.20, 32.21) compared to clinic

based programs MD 16.07 (95%CI 11.63, 20.50).

Conclusion: Our systematic review is the first to assess the impact of fortification of staple food on vitamin D status for children. Vitamin D fortification is an effective way to reduce vitamin D deficiency prevalence specially in low middle income countries and school-based programs.

Avneet Kaur, Senior Consultant and Neonatologist at Apollo Cradle, New Delhi, India. She completed her graduation & post graduation from Manipal universisty and did her superspecialisation in Neonataology from Sir Gangaram Hospital, New Delhi. She is a gold medalist in Neonatology. She was awarded “Indian Giani Award for Neonatology” 2015 by AAP. She has published more than 20 papers in reputed journals.

Despite the fact that feeding a preterm neonate is a fundamental and inevitable part of its management, this is a field which is beset with controversies.In order to match the high rates of nutrient deposition achieved by infants in utero, the nutrient needs are inherently high at this stage of development. In addition, they often have medical conditions that increase their metabolic energy requirements, including hypotension, hypoxia, acidosis, infection, and surgery. Though vigrous nutrition improves growth and neurological outcomes, and reduces the incidence of sepsis and possibly even chronic lung disease

& retinopathy of prematurity. However, it is also important to avoid rapid advances in feeding, which may result in feeding intolerance or necrotizing enterocolitis (NEC), and to recognize that excess of some nutrients may have toxic effects. There is a great deal of heterogeneity of practice among neonatologists pediatricians regarding feeding VLBW infants. A number

of important questions that needs to be answered with respect to feeding VLBW infants were systematically reviewed in the literature, and critically appraised with the level of evidence. The presentation touches upon trophic feeding, nutritional feeding, fortification, role of DHA, feeding in special circumstances, assessment of feed tolerance using abdominal girth or

gastric residuals, role glycerin enemas etc.

Showkat Hussain Tali is a Consultant Pediatrics and Neonatologist Health Services Kashmir, India. After obtaining his Bachelor's degree in 2005, he obtained his MD in Pediatric Medicine from University of Kashmir in 2010 and became Board Certified in Neonatology from the National Board of India in 2016. In the same year he joined Adesh University as Assistant Professor in Pediatrics and in charge of Neonatology. In November 2017 he joined Health services Kashmir as Consultant Pediatrics. He has 20 publications mostly in international journals. He has received many awards including Science Talent Search Award (1997), Creative Writing Award (2006) and Official Spot light Certificate by EET CRS at New Delhi (2017). On May 26/2017, he presented speech in International Congress of Gynecology and Obstetrics, Prague, Czech Republic. In September 2017 he presented his research paper and a poster at Los Angeles, California, USA at 14th World Pediatric and Neonatal Care conference. He also moderated at 14th World Pediatric and Neonatal care conference USA and Co-Chaired a session. In September 2017, he presented his scientific paper at 7th International Arab Neonatal Care Conference, Dubai, UAE and got first place prize for his presentation. He is scientific committee member to Izmir Katip Celebi University Turkey for International Healthy Growing Kids Congress to be held in December 2018. He is also Editorial Board Member of Archives of Pediatrics and Neonatology, an international journal.

Although exclusive breast feeding is universally accepted as the best feeding for the babies during first six months of life, only 40% of women do breast feed their babies for some wrong perceptions and misconceptions. To the best of our knowledge, this is the first study in the Kashmir valley at secondary level of health care system that examines knowledge, attitude and perception of mothers regarding breast feeding in the first six months of age of their babies. We enrolled 100 mothers in our study. Majority of our subjects was mothers aged between 20 to 30 years (65%), from rural back ground (78%) and multipara (60%). Most of the mothers (84%) were literate, from joint families (76%), from middle socioeconomic back ground (64%). There was slight preponderance of male sex in babies (56%) and majority were of birth order 2 (42%) followed by birth order 1 (36%). Most of the pregnancies were planned (71%) and sex preference at the time of birth was male (60%). Mode of delivery was vaginal in 69% cases and 31% babies were born by lower segment cesarian section (LSCS). Breast feeding was practiced by 72% of mother followed by formula milk (20%). Eight percent (8%) of the mothers were giving animal milk to their babies. The main reason for not giving exclusive breast milk was the perception that the mother is not producing

enough milk [(75%)]. Majority of the mothers were giving formula or animal feeds through bottle (78.5%). Though weaning was not started until six months of age in majority of the babies but as many as 33% of mothers had started it before six months. Insufficient milk production was reported as the main reason for early weaning. Almost all the mothers (97%) were aware of

advantages of breast feeding and no one (0%) was thinking that it is harmful. As many as 90% of the mothers were thinking that formula feeding is harmful and 70% would believe that animal milk feeding is also harmful. When asked about the age of starting weaning, 90% of the mothers could give correct reply. Eighty percent (80%) of the mothers gave an answer that breast feeding needs to be continued for two years of age. Majority of the mothers is aware of the advantage of breast milk and time of weaning. But a significant proportion of women either does not breast feed their babies or start early weaning with

the perception that they are unable to produce enough milk. This seems a major area that needs to be addressed for successful exclusive breast feeding in the first six months of life in developing countries.

Lili Ji is currently a doctoral candidate at the College of Environmental and Science Technology of Donghua University. She has published more than 10 papers in reputed journals. Lili Ji has completed her PhD at the College of Environmental and Science Technology of Donghua University. Her research field is high value utilization technology of marine resources. She has published more than 30 papers in reputed journals.

Selenium is an essential micronutrient, whose main function is as an antioxidant through its incorporation into proteins to alleviate oxidative stress in cells. This study examined the effects of selenium combined with protein through the selenitealgae- oyster pathway in the pearl oyster Pinctada martensii. The study was designed to explore the possible role of selenoprotein

against oxidative damage induced by hydrogen peroxide (H2O2) of cardiomyocytes and its potential mechanisms. The results showed that the combination rate between selenium and protein improved significantly via the enrichment effect. Furthermore, selenoprotein can protect cardiomyocytes that are oxidatively injured by H2O2. The beneficial effects of selenoprotein were likely mediated by an inhibition of Malondialdehyde (MDA) and an increase in the activity of Superoxide Dismutase (SOD) and Glutathione peroxidase (GSH-Px), A maintenance of the mitochondrial membrane potential and a reduction of intracellular Ca2+ overload.

Sheenam Garg is a Microbiologist and has earned her MSc in Microbiology from Kurukshetra Institute, India. She has completed her PhD in Dairy Microbiology from National Dairy Research Institute, India and worked on research project entitled: Impact of probiotic L. reuteri LR6 on the gut and systemic immunity using protein energy malnutrition murine model. Besides, she holds Post graduate diploma in Intellectual Property Rights. Her research interests include expertise in Microbiology, Molecular Biology and Cell Biology techniques as well as in-vivo studies. She is a Recipient of Haryana Merit Scholarship and Institutional Fellowship during MSc and PhD

programme respectively. Also, she has qualified National Eligibility Test recognized by UGC/CSIR. She has published many national/international research/review papers, book chapters and popular articles in reputed journals.

Protein Energy Malnutrition (PEM), one of the global devastating problems, contributes to nearly half of the deaths in children below five years of age. Inadequate intake or inappropriate nutrient absorption drives the people towards PEM, which exhibit a series of metabolic changes that leads to reduction in body weight, profound impairment on mucosal integrity,

villi morphology and loss of beneficial gut flora as well as depression in mucosal immune response. Thereby, PEM is significant, nevertheless underestimated for infection susceptibility due to perturbances in gut flora and decreased protein, calorie source. In absence of any specific therapies, the therapeutic potential of diet, known to play a significant role in shaping gut microbiota, can be used to cure dysbiosis. However, encouraging data suggests that probiotics supplementation as an adjuvant to renutrition diet may help in reverting gut dysbiosis condition, occurred due to PEM. Therefore, the aim of the study is to develop PEM murine model and to evaluate body weight (primary indicator), organ index, histopathological changes between the

malnourished and control group. Also, the malnourished gut had disturbed gut microbiota which resulted in malabsorption of nutrients and leaky gut conditions. However, oral administration of Lactobacillus reuteri LR6, as probiotic fermented milk (PFM-109 cfu/animal/day) and bacterial suspension (BS–109 cfu/animal/day) in PEM showed a significant improvement in

morphological parameters and had a modulating effect on the gut microenvironment and mucosal immunity. Therefore, the study suggests that probiotics as a dietary supplement might assist in reversing malnutrition, acting as an adjuvant to boost gut barrier function.

 

She is Consultant in Neonatal Pediatrics at Chelsea & Westminster Hospital, London UK (Dec 2000 – date) , Honorary Senior Lecturer in Child Health; Division of Medicine, Imperial College London, UK and also Lead of Specialist Training and the current Neonatal College Tutor. Their unit is a specialist perinatal tertiary center and designated unit in the sector for neonatal surgery. Her area of interest is research and clinical care aimed at enhancing the brain development of high risk babies is focused on factors such as nutrition especially essential lipids of the mother and newborn infants in relation to their developmental and health outcomes - Nutritional intervention in the pre-conception period, pregnancy, newborn period in baby and assess the effect on brain development and disorders in infants.

The health and wealth of a nation is dependent on an optimal diet and nutritional status of pregnant women as it lays the cornerstone of both physical and mental development in their children who become the future generation. It has been recognized that poor nutrient intake during pregnancy and lactation adversely affects the health of both the pregnant mother and her baby (1). Less affluent societies, especially in the developing world are particularly at risk of maternal ‘mis-nutrition’ and infant malnutrition. The negative effect of infant malnutrition on a rapidly developing brain has now become a major concern of the United Nations World Food Programme (UN-WFP). It has been said that “if children under two do not receive sufficient nutrition they will be sentenced to a lifetime of mental and physical limitations. We now have what

I call the burden of knowledge and WFP is looking for ways to ensure we prioritize those under twos, the most vulnerable of all in the world” (Josette Shaaron Executive Director’s report to the Board of UN-WFP; June 2010). Unbalanced, mismatched maternal dietary and nutritional choices (‘mis-nutrition’) during pregnancy and lactation can have very significant impact on

fetal and neonatal brain development. Human and animal studies have shown that malnutrition has irreversible effects on brain size and function. Approximately 70% of brain development occurs before birth and nearly all the rest while the baby is breast-feeding so during this phase of the child’s life adequate maternal nutrition is mandatory for normal brain development

More recently, there has been recognition of the importance of Long Chain Polyunsaturated Fatty Acids (LCPUFAs) such as Arachidonic acid (ArA), an omega-6 fatty acid and Docosahexaenoic acid (DHA), an omega-3 fatty acid obtained mainly from fish oil and other animal sources. These LCPUFAs have been shown to be essential for infant brain growth and development

and to also significantly impact on pregnant women’s health. Therefore, our focus in this session will be to explore the impact of these LCPUFAs on the developing brain.

Asthma has been referred to as an umbrella of multifactorial diseases with similar clinical features including mast cell and eosinophil infiltration causing airway hyperresponsiveness, inflammation and airway obstruction that subsequently lead to symptoms of wheeze, cough, dyspnoea, tightness in the chest especially at night and early morning. It has been hypothesized

that diets low in omega 3 fatty acids have contributed to the escalation in childhood asthma prevalence. We conducted a clinical trial of six months duration to investigate the effect of fatty fish (Ω3) intake in paediatric asthma. Seventy-two (72) children (54.2% boys; 45.8% girls), 5-12 years old with doctor-diagnosed ‘mild asthma’ were selected from a paediatric clinic

in Athens, Greece and randomized to two groups. The intervention group consumed two fatty fish meals per week (≥ 150g fillet fatty fish/meal) as part of the Greek Mediterranean diet and the control group, their usual diet. Pulmonary function was assessed using spirometry, bronchial inflammation with exhaled Nitric Oxide analysis (eNO), asthma control and quality of life

qualitatively using scores. Multiple linear regression model showed a statistically significant change in eNO for the intervention group (95%CI: -27.39, -0.91; beta = -14.15; p=0.037) after adjusting for confounders of age, sex, regular physical activity and BMI. A unit increase in fatty fish intake reduced bronchial inflammation by 14 ppb. No significant differences were observed for spirometry, asthma control or quality of life. This clinical study highlighted that dietary Ω3 fatty acids intake as fatty fish might be a useful adjunct therapy for paediatric asthma.