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

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EARLY CHILDHOOD DEVELOPMENT WORKSHOP<br />

Durriyah Sinno, MD AND Lama Charaffeddine, MD<br />

More than 200 million children worldwide fail to reach their potential in cognitive development<br />

due to poverty, poor health and nutrition, and deficient care. Early experiences during<br />

development form the basis for enhancing the physical, mental, and psychological well being<br />

<strong>of</strong> children through an entire life time. This workshop is an introduction to the Care for Child<br />

Development. <strong>The</strong> goal is to provide pediatricians with additional skills to allow them to better<br />

screen for developmental delays and intervene to enhance early childhood development. It is<br />

intended to help physicians recognize the importance <strong>of</strong> Early Childhood Development (ECD),<br />

describe the scientific basis and implications <strong>of</strong> ECD, identify available developmental screening<br />

tools and discuss their culture specificity. <strong>The</strong> workshop will be interactive where the audience will<br />

practice using the WHO/UNICEF Care for Child Development tool kit, in addition to recognizing<br />

the four domains <strong>of</strong> child development and analyzing mother-child interaction<br />

PERINATAL MANAGEMENT OF DISORDERS OF SEXUAL DEVELOPMENT (DSD)<br />

Alaa EL GHONEIMI, MD, PhD, FEBPS, FEAPU<br />

Fetal sex détermination is now a current and accurate ultrasound finding during the routine<br />

prenatal ultrasound. Any discrepancy <strong>of</strong> the typical aspect <strong>of</strong> the fetal external genitalia should<br />

alert the gynecologist and a multidisciplinary prénatal counseling be arranged. Th Prenatal<br />

thérapeutique measures are now available for the congénital adrenal hyperplasia, otherwise for<br />

the oser anomalies; the main advantage <strong>of</strong> the prénatal diagnosis is to expand the work up and<br />

to prépare an optimal néonatal management in a specialized center witlo<strong>of</strong> an extensive delay<br />

in sex détermination or in worse cases a mistake in the sex determination.<br />

<strong>The</strong> aim <strong>of</strong> neonatal management is mainly to identify the anomaly and to determine the<br />

optimal choice for sex determination. <strong>The</strong> urgent medical management <strong>of</strong> congenital adrenal<br />

hyperplasia (CAH) cases should start immediately.<br />

<strong>The</strong> initial workup (hormonal, karyotype, imaging, molecular biology) and the clinical assessment<br />

by experienced pediatric endocrinologist and surgeon, can clarify in most <strong>of</strong> the cases the<br />

exact diagnosis and the determination <strong>of</strong> sex breading. This decision should be made in a<br />

multidisciplinary way including all the participants in the future management <strong>of</strong> the child, and the<br />

parent’s opinion should be taken seriously in consideration. <strong>The</strong> role <strong>of</strong> a specialized psychologist<br />

is mandatory in the process <strong>of</strong> evaluation <strong>of</strong> the family environment and in establishing a strong<br />

trusting relationship with the parents for the future management <strong>of</strong> the child. <strong>The</strong> decision is a<br />

major step and will depend on many factors: external genitalia, internal genitalia, hormonal<br />

synthesis, fertility, social environment (especially in delayed diagnosis).<br />

<strong>The</strong> reconstruction surgery will be planned according to the final diagnosis and the choice <strong>of</strong> sex breading.<br />

<strong>The</strong> feminizing genitoplasty is usually done when the child is 3 to 6 months <strong>of</strong> age. Currently there is still a<br />

controversy regarding the age and the type <strong>of</strong> surgery to be done. <strong>The</strong> virilizing genitoplasty is planned<br />

around the age <strong>of</strong> one, hormonal stimulation <strong>of</strong> external genitalia is sometimes needed, but again there is<br />

still controversy on its benefits and indications.<br />

In conclusion, the DSD should be considered as a major anomaly and that even with the most sophisticated<br />

techniques <strong>of</strong> investigations or reconstruction, it is still a challenging anomaly to manage. For one more this<br />

entity needs an optimal multidisciplinary management to be able to give children and their families the<br />

optimal therapy.<br />

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