The IX t h Makassed Medical Congress - American University of Beirut

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T h e I X t h M a k a s e d M e d i c a l C o n g r e s s INFECTIONS NEONATALES PRECOCES: DIAGNOSTIC ET TRAITEMENT Joseph Haddad MD Je reprends ici les recommandations de la Haute Autorité de Sante en France. Le diagnostic repose sur : 1- Des critères anamnestiques classes en 2 catégories majeurs (fièvre maternelle,chorioamniotite, bactériurie asymptomatique etc.) ou mineurs (liquide amniotique teinte ou meconial, rupture de 18h etc..). Il faut admettre que tout enfant qui va mal est suspect d’infection quelque soit la situation. 2- Les données du bilan biologique entre autres NFS et marqueurs de l’inflammation CRP, IL6, et Procalcitonine. 3- La bactériologie Entre autres l’hémoculture les frottis périphériques et la Ponction Lombaire L’ECBU n’est pas recommande. 50
Hepatitis B VIRAL HEPATITIS Florence Lacaille MD Chronic hepatitis B remains a public health problem in many countries, due to the very efficient neonatal and sexual transmission of the virus, the low rate (increased by alcohol drinking) of severe complications before late adulthood, and despite the extension of vaccination programs. Acute hepatitis B is rare in childhood, and may occur very rarely after neonatal transmission, or after sexual exposure in adolescents. In children, chronic hepatitis B is mostly asymptomatic, and the children are often « tolerant » to the virus. However, hepatocarcinoma may develop even at a young age. Cirrhosis may be seen from adolescence. The treatment in childhood is difficult. It is most often not the treatment of a disease, but the prevention of possible complications in adulthood. Therefore it is neither mandatory nor urgent. Screening for complications of hepatitis B should be done once or twice a year. Vaccination of people in close contact with the patient (family) is mandatory, in order to prevent horizontal transmission. Interferon (preferentially long-acting = pegylated) is efficient only in children with elevated transaminases and a low viral load. It is not very well tolerated, should not be used before 3-4 years of age and avoided at adolescence, and should be strictly monitored. Nucleot(s)ide analogues are increasingly used in adults, but the duration of treatment is not well defined, and may be very long (life long ?). Lamivudine leads to the frequent emergence of resistant mutants and should not be used alone. Adefovir is not very efficient. Tenofovir, entecavir and telbivudine have not yet been studied in children. They should not be used outside of a protocol. Hepatitis C The virus is only parenterally transmitted, explaining the high rate of contamination in Egypt due to massive antischistomiasis treatment. Unsafe blood transfusion can also be a cause. The rate of mother-to-child transmission during pregnancy is low (5%), but it is nowadays nearly the only way of contamination for children in countries with a safe blood bank system. The risk of complications in childhood is even lower than for hepatitis B. Cancer has not been seen, and cirrhosis is extremely rare. Alcohol use should be prevented, and vaccination against hepatitis A and B implemented. The treatment, pegylated interferon and ribavirin, depends on the viral genotype. It is very efficient in genotypes 2 and 3 (over 80% success rate), and totally eliminates the virus. In genotype 1 (the more frequent), it is only 50% efficient. Like in hepatitis B, it does not cure a disease, but prevents complications later in life. It is therefore neither mandatory nor urgent. It should be discussed individually, according to the symptoms (usually none), the child’s age, the genotype, the viral load (to determine the duration, 6 or 12 months), the additional risk factors for the liver (hepatotoxic treatment, iron overload of a chronic anemia, co-infection with another virus…). 51
Page 1 and 2: The IX th Makassed Medical Congress
Page 3 and 4: CONGRESS PRESIDENT Said Sayegh, MD,
Page 5 and 6: GENERAL INFORMATION
Page 7 and 8: • Target Audience: Physicians, Pr
Page 9 and 10: Durriya Sinno, MD Pediatrics Americ
Page 11 and 12: Moderators
Page 13 and 14: PEDIATRICS Bassem Abou Merhi, MD Pe
Page 15 and 16: Maroun Sokhn, MD Pediatrics Saint G
Page 17 and 18: Scientific Program
Page 19 and 20: Session 3: Intensive Care Neonatolo
Page 21 and 22: Session 1: Pediatric Intensive Care
Page 23 and 24: 8:00 - 8:05 08:05 - 08:10 Welcome r
Page 25 and 26: Cardiology Session III: Interventio
Page 27 and 28: Cardiology Session VI: Intervention
Page 29: Cardiology Symposia (NON-CME) Frida
Page 32 and 33: T h e I X t h M a k a s e d M e d i
Page 100 and 101:
T h e I X t h M a k a s e d M e d i
Page 102 and 103:
T h e I X t h M a k a s e d M e d i
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The IX t h Makassed Medical Congress - American University of Beirut

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