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Prenatal Pediatrics PowerPoint Presentation

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Description : This presentation Prenatal Pediatrics is intended to provide the pediatrician with an enhanced understanding of developmental plasticity and its role in the long-term outcome of the high-risk fetus, the expanding role of the pediatrician in the prenatal and postnatal care of the high-risk fetus and the unmet challenges for detection, surveillance and long-term monitoring of the offspring of high-risk pregnancies.

Tags : Pediatrics, Child Health, pediatric practice, pediatrician, health providers, Prenatal Pediatrics, high-risk fetus, postnatal care

Published on : Jul 18, 2020 | Views : 1530 | Downloads : 3

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Slide 1-

FUTURE OF PEDIATRICS FUTURE OF PEDIATRICS 1
Slide 2-

FUTURE OF PEDIATRICS 2 Meet Our Speaker Adre du Plessis, MBChB Today’s presenters have no conflicts to disclose: No financial or business interest, arrangement or affiliation that could be perceived as a real or apparent conflict of interest in the subject (content) of their presentation. No unapproved or investigational use of any drugs, commercial products or devices
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Prenatal Pediatrics Building a Bridge for Children from High-Risk Pregnancies FUTURE OF PEDIATRICS FUTURE OF PEDIATRICS Adre J. du Plessis, MBChB Director, The Prenatal Pediatrics Institute Chief, Division of Prenatal and Transitional Pediatrics Children’s National Hospital Washington DC
Slide 4-

Objectives FUTURE OF PEDIATRICS This presentation will provide the pediatrician with an enhanced understanding of: developmental plasticity and its role in the long-term outcome of the high-risk fetus; the expanding role of the pediatrician in the prenatal and postnatal care of the high-risk fetus; and the unmet challenges for detection, surveillance and long-term monitoring of the offspring of high-risk pregnancies.
Slide 5-

FUTURE OF PEDIATRICS 5
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What is the role of the pediatrician in fetal care? FUTURE OF PEDIATRICS 6 Pediatricians are increasingly involved in fetal care for several major reasons During pregnancy Pediatric subspecialists increasingly involved Counseling families Planning to manage hazardous transition 50 years experience with ‘the ex-utero fetus’ – prematurity and NICU care Advancing fetal diagnostics After birth Care of fetal anomalies and their complications Prenatal origins of later chronic disorders
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FUTURE OF PEDIATRICS 7
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Consequences of Fetal Adversity: Timing of Manifestations Fetal Adversity Childhood Adulthood Neonatal Fetal FUTURE OF PEDIATRICS 8
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Fetal Neonatal Childhood Adulthood Adversity Fetal Consequences of Fetal Adversity: Timing of Manifestations FUTURE OF PEDIATRICS 9
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Fetal Neonatal Childhood Adulthood Adversity Fetal Consequences of Fetal Adversity: Timing of Manifestations FUTURE OF PEDIATRICS 10
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Fetal Neonatal Childhood Adulthood Adversity Fetal Consequences of Fetal Adversity: Timing of Manifestations FUTURE OF PEDIATRICS 11
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Environmental Influences on the Genome Single Genotype Range of Phenotypes Environmental influences Epigenetic modification FUTURE OF PEDIATRICS 12
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Identifying Fetal-Onset Conditions in Utero Currently we identify only the tip of the iceberg! FUTURE OF PEDIATRICS 13
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Congenital anomalies may have important developmental effects The fetus is not a lesion! DIATRICS FUTURE OF PE 14 Fetus Brain Growth with Congenital Heart Disease
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Developmental Plasticity FUTURE OF PEDIATRICS 15 Characteristics of developmental plasticity (DP) Nature of the response depends on the nature of the environmental cue There are critical windows of plasticity in different organ systems Duration of developmental plasticity is time-limited: operates longer for processes associated with growth and metabolism (e.g., the brain) Some environmental influences are clearly pathological and result in developmental disruption and teratogenesis – with no adaptive advantage – rather than channeling development
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Fetal Origins of Lifespan Health Risk (Barker Hypothesis) Dutch Famine (“Winterhonger) 1944- 1945 The fetus adopts anticipator physiology Plasticity – two-edged sword FUTURE OF PEDIATRICS 16
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The growth-restricted fetus FUTURE OF PEDIATRICS 17
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Fetal Growth Restriction FUTURE OF PEDIATRICS 18 Fetus not meeting its genetically destined growth potential Placental insufficiency is the leading cause BW <10th percentile for gestational age (Kingdom & Smith, 2000) PLUS Evidence of placental insufficiency (decreased umbilical artery Doppler flow) (Figueras & Gratacos, 2014) Between 3 – 15% pregnancies in the developed world Up to 6-old greater in low-income countries Global incidence of ~30 million/year (de Onis et al. 1998; Bernstein et al. 2000; Lackman et al. 2001; Fang, 2005; Chauhan & Magann, 2006; Figueras & Gratacos, 2014)
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Brain Development in Fetal Grown Restriction Structural Deficits Reduced head circumference Reduced total and grey matter volume Reduced hippocampal and cerebellar volume Reduced total cell number Reduced myelin content/ delayed myelination Thin cortex with altered gyrification Reduced connectivity FUTURE OF PEDIATRICS 19
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Brain Development in Fetal Grown Restriction Functional Deficits Motor Impaired gross, fine, and visuomotor skills Cerebral palsy Cognition and learning Decreased IQ/impaired executive function Memory (esp. verbal) impairment Behavior Social interaction deficits/Autistic spectrum disorders Attentional deficits/Hyperactivity Anxiety, irritability, and depression FUTURE OF PEDIATRICS 20
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Fetal Growth Restriction: Consequences and Timing of Manifestation Fetal demise Fetal brain injury Prematurity related brain injury Perinatal asphyxia Fetal Growth Restriction Infancy, Childhood, Adulthood Neonatal Fetal Obesity Diabetes Hypertension Dyslipidemias • Heart disease • Stroke • Attentional disorders Developmental delay Behavioral dysfunction Autism Mood disorders Schizophrenia FUTURE OF PEDIATRICS 21
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Mental health disorders are now recognized as the most common complication of pregnancy Maternal stress and depression may have profound effects on fetal development FUTURE OF PEDIATRICS 22
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Prenatal Stress Questionnaires Healthy Pregnant Volunteers (n=90) Prenatal Stress/Anxiety 27% tested positive for stress/anxiety Edinburgh Postnatal Depression Scale 8% tested positive for depression FUTURE OF PEDIATRICS Limperopoulos et al. 2019 23
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Fetal Brain Growth and Maternal Psychological Distress Limperopoulos et al. 2019 FUTURE OF PEDIATRICS 24
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Brain Plasticity Fetal Environment Aberrant Development Postnatal Window of Opportunity for Developmental Intervention ~ 3 years Birth FUTURE OF PEDIATRICS 25
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Brain Plasticity Fetal Environment Aberrant Development FUTURE OF PEDIATRICS 26 Postnatal Window of Opportunity for Developmental Intervention ~ 3 years Birth
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The Prenatal Pediatrics Institute at Children’s National FUTURE OF PEDIATRICS FUTURE OF PEDIATRICS 27
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FUTURE OF PEDIATRICS Prenatal Pediatrics – Subspecialty Program Directors 28 Prenatal Cardiology Mary Donofrio Prenatal Neurology Adre du Plessis Prenatal Neurosurgery Carlos Sanchez Prenatal Orthopedics Matthew Oetgen Prenatal Urology Hans Pohl Prenatal Imaging Dorothy Bulas Prenatal Reconstructive Surgery Albert Oh Prenatal Surgery Tim Kane Prenatal Genetics Jamie Fraser Prenatal ENT Brian Reilly Prenatal Genetic Counseling Anne Lawrence Prenatal Pediatrics Prenatal Endocrinology Andrew Dauber Prenatal Nephrology Marva Moxey-Mims Prenatal Blood Disorders Alexis Leonard
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FUTURE OF PEDIATRICS Multidisciplinary Programs supporting Prenatal Pediatrics 29 Prenatal-Neonatal Transition Program Cardiac Neurodevelopmental Outcome (CANDO) Program Skeletal Dysplasia Program Heterotaxy Program Perinatal Mental Health Program Spina Bifida Program Colorectal-Pelvic Anomaly Program Critical Care Delivery Program Perinatal Palliative Care Program Positive Re-evaluation of Urogenital Differences (PROUD) Program Prenatal Pediatrics Perinatal Mental Health Support Program
Slide 30-

FUTURE OF PEDIATRICS FUTURE OF PEDIATRICS 30 Summary The current and future state of Prenatal Pediatrics The focus should expand beyond anatomic malformations Major obstetric complications (placental failure; pre-eclampsia; infection; diabetes, maternal stress/depression, substance abuse; many others ) pose significant risk to the infant, child, and adult, potentially across the lifespan The focus on the whole fetus not only ‘abnormalities in pictures’ There is an urgent need for improved communication, referral, and monitoring of the high-risk fetus before and after birth
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Prenatal Pediatrics Institute Contact: Phone 202-476-7409 Fax 202-476-5897 June 18, 2020

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MarieAltmann

About : I am a passionate Pediatrician with experience of working in world-renowned hospital systems as well as community-based clinics. I have skills like Advocacy, Team Building, Event Planning, and Public Speaking. A dedicated and worthy healthcare services professional with a MPH focused in International studies from Tulane School of Public Health and Tropical Medicine.
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