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

EARLY CHILDHOOD DEVELOPMENT WORKSHOP
Durriyah Sinno, MD AND Lama Charaffeddine, MD
More than 200 million children worldwide fail to reach their potential in cognitive development
due to poverty, poor health and nutrition, and deficient care. Early experiences during
development form the basis for enhancing the physical, mental, and psychological well being
of children through an entire life time. This workshop is an introduction to the Care for Child
Development. The goal is to provide pediatricians with additional skills to allow them to better
screen for developmental delays and intervene to enhance early childhood development. It is
intended to help physicians recognize the importance of Early Childhood Development (ECD),
describe the scientific basis and implications of ECD, identify available developmental screening
tools and discuss their culture specificity. The workshop will be interactive where the audience will
practice using the WHO/UNICEF Care for Child Development tool kit, in addition to recognizing
the four domains of child development and analyzing mother-child interaction
PERINATAL MANAGEMENT OF DISORDERS OF SEXUAL DEVELOPMENT (DSD)
Alaa EL GHONEIMI, MD, PhD, FEBPS, FEAPU
Fetal sex détermination is now a current and accurate ultrasound finding during the routine
prenatal ultrasound. Any discrepancy of the typical aspect of the fetal external genitalia should
alert the gynecologist and a multidisciplinary prénatal counseling be arranged. Th Prenatal
thérapeutique measures are now available for the congénital adrenal hyperplasia, otherwise for
the oser anomalies; the main advantage of the prénatal diagnosis is to expand the work up and
to prépare an optimal néonatal management in a specialized center witloof an extensive delay
in sex détermination or in worse cases a mistake in the sex determination.
The aim of neonatal management is mainly to identify the anomaly and to determine the
optimal choice for sex determination. The urgent medical management of congenital adrenal
hyperplasia (CAH) cases should start immediately.
The initial workup (hormonal, karyotype, imaging, molecular biology) and the clinical assessment
by experienced pediatric endocrinologist and surgeon, can clarify in most of the cases the
exact diagnosis and the determination of sex breading. This decision should be made in a
multidisciplinary way including all the participants in the future management of the child, and the
parent’s opinion should be taken seriously in consideration. The role of a specialized psychologist
is mandatory in the process of evaluation of the family environment and in establishing a strong
trusting relationship with the parents for the future management of the child. The decision is a
major step and will depend on many factors: external genitalia, internal genitalia, hormonal
synthesis, fertility, social environment (especially in delayed diagnosis).
The reconstruction surgery will be planned according to the final diagnosis and the choice of sex breading.
The feminizing genitoplasty is usually done when the child is 3 to 6 months of age. Currently there is still a
controversy regarding the age and the type of surgery to be done. The virilizing genitoplasty is planned
around the age of one, hormonal stimulation of external genitalia is sometimes needed, but again there is
still controversy on its benefits and indications.
In conclusion, the DSD should be considered as a major anomaly and that even with the most sophisticated
techniques of investigations or reconstruction, it is still a challenging anomaly to manage. For one more this
entity needs an optimal multidisciplinary management to be able to give children and their families the
optimal therapy.
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