Scientific Program

Day 1 :

Keynote Forum

Michael Stark

New European Surgical Academy

Keynote: The Evidence-Based C-section And The Risks Involved In The Exaggeration Of Its Use

Time : 10:45-11:20

Biography:

Prof. Dr. Michael Stark specializes in Obstetrics and Gynecology.  His main interest is gynecological oncology.  He initiated the VIEZION project which combines targeted chemotherapy, PIF and stem-cell therapy for improving post-surgical oncological treatment.
Prof. Stark is currently the scientific and medical advisor of ELSAN, a 120 hospital group in France and is a guest scientist at the Charite’s University Hospital in Berlin. 
Since 2004 he has been the President of the New European Surgical Academy (NESA), an international inter-disciplinary surgical organization with members in 54 countries and a formal cooperation agreement with FIGO concerning transmission of knowledge to countries with limited resources. 
In 2011, Prof. Stark was nominated as the Medico Del Anno (Doctor of the Year) in Italy, and is an Honorary Member of the French, Polish, Russian and Italian Gynecological Associations.
In the years 1983-2000 he was the medical director and head of Ob/Gyn department of the Misgav Ladach General Hospital in Jerusalem, and between 2001 and 2009 the chairman of all Ob/Gyn departments of the HELIOS Hospital Group in Europe. He was the scientific director of the European novel Tele-surgical system.  He was visiting Professor at the Universities of Toronto, Moscow, Beijing, Milan, Adana, Uppsala and the Weill-Cornell University hospital in New York. 
He modified operations like the vaginal and abdominal hysterectomy and Cesarean Section and developed the concept of single-entry natural orifice surgery.  He was involved in the development of the trans-oral thyroidectomy and TransDouglas abdominal surgery.  
 

Abstract:

The evidence-based C-section and the risks involved in the exaggeration of its use

As most abdominal operations have endoscopic alternatives, caesarean section will remain the only abdominal operation in the future. Therefore it is of utmost importance to constantly evaluate the different steps for their necessity and for their optimal way of performance. The modified Joel-Cohen method results in a shorter incision to delivery time, lower rate of febrile morbidity compared to the traditional Pfannenstiel incision. Opening peritoneum using bi-digital stretching rather than sharp instruments proved to be safer, and exteriorization of the uterus makes stitching easier and avoids unnecessary bleeding. Suturing the uterus with one layer only results in stronger scars and reduced pain. Leaving both peritoneum layers open reduces adhesions. The fascia being sutured continuously with first knot underneath the fascia prevents irritation in the sub-cutis and by a right-handed surgeon, from the right to the left, proved to be ergonomic. Since the introduction of this modified and simplified method, it has been evaluated in dozens of peer-reviewed publications from different countries. Without exception, all showed various advantages of this method: shorter operation time, shorter hospitalization, quicker mobiliza­tion, less blood loss, lower rate of febrile morbidity, lower costs, and less need for painkillers. Only 10 instruments and three sutures are needed, which simplifies the workload of nurses. In order to standardize this operation, it is important to use constantly the same needles and instruments. Big needle is necessary for the uterus, as fewer steps are done and therefore less foreign body reaction. This operation is recommended as universal routine method for caesarean section and its principles should apply to all surgical disciplines. Unfortunately, the rate of cesarean section is rising constantly around the world. As evolution continues, it might be influenced by this high rate. In this presentation, the logic of the need to limit the numbers of cesarean section based on anthropological studies will be presented.

Keynote Forum

Ryszard Lauterbach

Jagellonian University, Poland

Keynote: Non-activated protein C in treatment of neonatal sepsis

Time :

Biography:

Ryszard Lauterbach has completed his PhD and Postdoctoral studies from Jagiellonian University Medical College in Kraków. He is the Head of Department of Neonatology, Jagiellonian University Medical College and Vice-President of Polish Neonatal Society. He has published more than 75 papers in reputed journals and has been serving as an Editorial Board Member of repute

Abstract:

Background: Previously, we found that plasma protein C activity ≤10% significantly increased the probability of the occurrence of death during neonatal sepsis. Thus, if the activity of plasma protein C declined during the course of sepsis to ≤10%, we administered a non-activated protein C zymogen to increase a protein C activity. The aim of that retrospective analysis was to explore treatment effects of protein C zymogen (PC) supplementation in septic infants, with plasma protein C activity ≤10%.

Methods: A database was used to locate 85 newborns treated with PC from among 458 analyzed infants with confirmed sepsis.

Results: The median birth weight and gestational age of treated infants were, respectively 1010.0 g and 29 weeks. In 47 infants, early-onset sepsis (EOS) developed whereas in 38 neonates late-onset sepsis (LOS) was recognized. PC was given as a single dose of 200 IU/kg. Among 458 septic patients, death occurred in 19 newborns (4.2%), exclusively in infants with plasma protein C activity ≤10%. In 15 infants, death occurred in the course of EOS and 4 newborns died of LOS (EOS versus LOS; p=0.036; Chi-square with the Yates correction).

Conclusions: An increased risk of death in septic neonates with plasma protein C activity ≤10% suggests the necessity for its evaluation and possibility of supplementation of protein C zymogen.

 

Day 2 :

Keynote Forum

Taketoshi Yoshida

Toyama university hospital, Japan

Keynote: Dr.

Time :

Biography:

Taketoshi Yoshida graduated from Toyama Medical and Pharmaceutical University and got medical license in 1994. He has completed his PhD in 2002 from Toyama University. He has performed genetic research work at Institute for Virus Research, Kyoto University and German Rheumatism Research Centre, Berlin. He is the Director of Maternal and Perinatal Center, Toyama University Hospital. He focuses on the neonatal basic and translational research at present.

Abstract:

Caffeine is a methylxanthine and a first-line pharmacotherapy agent in apnea of prematurity. Caffeine is preferable to theophylline because of its fewer adverse effects and a wider therapeutic window. In general, measurement of serum caffeine concentration is not required in preterm neonates because a majority of them can maintain therapeutic levels. We present the first reported case of a preterm neonate, whose serum caffeine concentration exceeded therapeutic levels, resulting in rhabdomyolysis. Caffeine is metabolized by the hepatic cytochrome P-450 monooxygenase pathway, but its activity is lower in premature infants than in adults. Therefore, more than 85% of the administered dose of caffeine is recovered unchanged in the urine of an infant during the 1st month of life. Since we are interested in caffeine metabolism in preterm infants, we measured serum caffeine concentration in 24 preterm infants, sequentially. We addressed the relationship between caffeine metabolism and postnatal age or postmenstrual age. Our aim is to elucidate the development and systems of caffeine metabolism according to their growth. Although caffeine has been used in many NICUs, I would like to discuss caffeine metabolism in preterm infants.

 

  • Neonatology | Perinatology | Pediatric surgery
Location: Taunus
Speaker

Chair

Ryszard Lauterbach

Jagiellonian University, Poland

Speaker

Co-Chair

Michael Stark

New European Surgical Academy, Germany

Session Introduction

Hippolite O Amadi

Imperial College London, UK

Title: Dr
Speaker
Biography:

Hippolite O Amadi medical career has lasted three decades, since 1987, cutting across engineering-in-healthcare, orthopaedics and neonatology research. His current global prowess in neonatal innovations has been greatly influenced by his academic exploits, both as a student and later Professor at Imperial College London, UK. His current practice and research-groups span the entire regions of Nigeria, covering 25 tertiary hospitals over two decades; enabling him an unprecedented access to evidence based data on a national representative scale. He has since been a regular in the WHO and World Bank list of global thinkers on African perspective of climate-change impact on neonatal health.

Abstract:

Successive demographic reports of UNICEF and WHO, since 2007, shows that Nigeria’s early neonatal deaths has remained high, at 79%. There was no significant improvement all through the years of MDG as almost 50% of deaths before age of five are currently neonatal. Neonatal mortality rate (NNMR) increases sharply with decreasing birthweight and postnatal age; hence, there is little chance of survival for over 90% of extremely low birthweight (ELBW) neonates at most Nigerian newborn centres. We preliminarily carried out a nationwide investigation and confirmed consistency in excessive long periods of time before most deceased neonates attained thermal stability within acceptable physiological range of 36.5°C–37.4°C. We investigated high climatic ambient temperatures and found adverse corelation with neonatal thermal morbidity. We concluded that such overpowering physiological thermal deficiencies might be responsible for mortalities within first week of life; hence the need for innovation of devices and protocols that could reverse this. We devised the recycled incubator technology to create affordable alternative for incubator intervention. We define the etiology of climate-induced neonatal evening-fever syndrome (EFS) and synthesised a nursery-building parttern that lowers climatic harsh impact on neonates. We innovated the Handy-approach and initial-setpoint-algorithm temperature protocols that enabled patient-specific interactive technique for quick attainment of neonatal normotherm. Comparative studies of the outcome of these innovations against facility-based national averages showed, among others: improved availability and sustainability of functional incubators (average: 18 systems vs. 3); early mortality of ELBW reduced (average: <1% vs. 80%); overall facility-based NNMR reduced (average: 31/1000 vs. 245/1000).

Inge Schmitz Feuerhake

Society for Radiation Protection, Germany

Title: Professor

Time : 12:00-12:25

Speaker
Biography:

Inge Schmitz Feuerhake has completed her Doctorate in Physics in 1966 at the University of Hannover, Germany. She did research in Nuclear Medicine for seven years at the Medical University of Hannover where she also was the Manager of a Nuclear Reactor for research. Since 1973, she is Professor of Medical Physics at the University of Bremen, Germany, now in the status of retirement. She works in the field of Radiation Dosimetry and Radiation Effects. She has published more than 50 papers in reputed journals.

Abstract:

In former times of radiation research the genetically significant dose was regarded as the main measure for protection in diagnostic radiology, because the hereditary effects were considered to be the most dangerous sequelae and also the effects in embryos and foetuses. There was also establishment of the 10 days rule in order to exclude exposure in the period of possible pregnancy. The International Commission on Radiological Protection (ICRP), however, who is the leading expert board for radiation protection in the developed countries, claims that the genetic radiation risk is nearly negligible and radiation-induced effects after exposure in utero will not occur below doses of 100 mSv. They refer to reportedly absent effects in the acute exposed Japanese A-bomb survivors and leave out the conditions in cases of low dose chronical exposure as for example by radioactive contaminations. We review findings about increases of stillbirths, congenital malformations and Down´s syndrome in a variety of European regions affected by Chernobyl fallout. They confirm former and later observations after occupational exposure and diagnostic x-rays, which show high radiation risks for the descendants of exposed parents. Our conclusion is that medical diagnostic radiation exposure in Germany has contributed to the rising rates of congenital malformations in this country. Minimization of gonadal doses must become again a central aim in radiation diagnostics for children and patients in reproductive ages. Current dose limits for occupational exposure and in pregnancy must be lowered considerably.

Udo B Hoyme

Ilm-Kreis-Kliniken, Germany

Title: Dr
Speaker
Biography:

Udo B Hoyme has graduated from University of Hamburg, Germany in 1973. In 1993 he became the Chairman of the Department of Obstetrics and Gynaecology, Medical School Erfurt and later HELIOS Kliniken. In 2013, he retired as Head of the Department of Obstetrics and Gynaecology, St. Georg-Klinikum Eisenach. He is working as Senior Consultant in Ilm-Kreis-Kliniken, Arnstadt, Germany. He has published more than 300 papers and he is an editor and reviewer of several international journals.

Abstract:

In the initial so-called Erfurt prematurity trial almost 20 years ago, based on a simple screening strategy with intravaginal pH self-measurements (cut off pH>4.5), adequate physician based medical diagnosis and immediate antimicrobial therapy of genital infection, 0.3% of the neonates <32+0 weeks were seen in an intervention group vs. 3.3% (p<0.01, n=2722) in the control group. In the larger state wide Thuringia campaign limited to the year 2000 the figures were 0.94% vs. 1.36% (p<0.01, n=16,276). The rate of newborns <1000 g was reduced to 0.38%, the lowest incidence ever seen in any of the German states, however, after discontinuation of the campaign for several reasons the preterm birth rates mounted in the state to the same level as prior to the program. As long as we do not have alternative safe, simple and cheap methods, intravaginal pH-measurement is the best option to detect women at risk and in need for specific diagnostic assessment followed by efficient medical treatment, e.g. lactobacilli, e.g. in case of bacterial vaginosis preferably by clindamycin before week 23. The practical cheap regime should be generally implicated as an indicated step of optimizing and rationalizing the national health care system. Good news for at least 18,000 pregnant women annually: The government of our state of Thuringia has decided in 2016 to re-establish a pH self-care screening program similar to that of the year 2000. Beginning at zero almost one year after initiation >80% of pregnant women in the state have their vaginal pH measured in December 2017. First pregnancy outcome parameters will be available by mid of 2018.

Luka Van Leugenhaege

Artesis Plantijn University College, Belgium

Title: Ms
Speaker
Biography:

Luka Van Leugenhaege has completed her Bachelor’s degree in Midwifery in 2012 from the University College Artesis Antwerp, Belgium. She worked as a Midwife at the Fertility Clinic of GZA St. Augustinus Wilrijk. She graduated as a Master of Science in Nursing and Midwifery in 2014. In September 2016, she got the opportunity to teach and conduct research at the Artesis Plantijn University College, Antwerp. Alongside she started working as an Assistant at the University of Antwerp. On behalf of the University she started participating in a local network to help poor pregnant women get the medical and psychosocial help they need, called PANZA.

Abstract:

Vulnerability among patients has always been difficult to define. Especially during pregnancy, vulnerability needs extra attention and care because of the impact and adverse effects on mother and child. As a healthcare professional, it’s imperative to gain insight into obvious and less obvious characteristics of vulnerability during pregnancy. An interdisciplinary team of midwives, social workers and nurses mapped the characteristics of vulnerability focussing on pregnancy. They developed a screening tool as for healthcare workers to determine whether a patient is in need of extra individualised care. The next step in this research project is to develop a perinatal trajectory to provide adequate care for their specific medical, psychological and social needs. This abstract offers results of a pilotstudy conducted in Antwerp to test and adjust the screening tool and an overview of different trajectories that exist to provide care for women in this situation.

Pages Anne Sophie

Centre Hospitalier Public du Cotentin, France

Title: Mrs
Speaker
Biography:

Pages Anne Sophie has completed her MD in 2015 from University of Bordeaux. She is a Neonatologist at the Hospital of Cherbourg in Normandy, France. She has published two articles in French journals.

Abstract:

Introduction: Extra uterine growth restriction (EUGR) is associated with long term effects on growth and neurodevelopmental outcomes in preterm infants. The objective of our study was to evaluate the effects of a change in nutritional policy on the postnatal growth of premature infants.

Method: Prospective observational study carried out between 01/01/14 and 31/12/14 in all newborns less than 33 weeks gestational age (GA) admitted at the CHU of Bordeaux after modification of the nutrition policy at the beginning of January 2014. This cohort was compared to a retrospective historical cohort of children born between 01/01/12 and 31/12/12. In the second period, the nutrient intakes received were evaluated and compared with the recent recommendations (ESPGHAN 2005, 2010, nutritional care of preterm infant). The impact of EUGR was compared between the two populations.

Results: 144 children were included, among which 66 in the 2012 cohort and 78 in the 2014 cohort. Their initial characteristics are similar. The moderate EUGR rate is 86.4% in 2012 vs. 39.7% in 2014 and the severe EUGR rate is 21.2% in 2012 vs. 5.1% in 2014. In 2014, half of the newborns had an energy deficit and 2/3 had a protein deficit at the end of the 6 weeks of hospitalization.

Conclusion: Our study shows that the optimization of the nutrition policy can reduce the incidence of EUGR.

Marie Fabre Grenet

Assistance Publique Hôpitaux de Marseille, France

Title: Mrs
Biography:

Abstract:

Aims: The link between deformational plagiocephaly and psychomotor development is a recurrent question in medical publications. Main publications are about term infants but there is a lack of data about impact of deformational plagiocephaly on long term neurodevelopment of premature infants. We try to establish a possible relation between deformational plagiocephaly during the first year of life and the psychomotor score at 4 years in the prematurely born infants. Other risk factors potentially impacting the psychomotor score have been studied.

Material & Methods: A retrospective study of the files of the children followed by the health network “Naître et Devenir Région PACA Ouest Corse Sud” and included in the data base has permitted to select a cohort of 594 prematurely born infants under 33 weeks of gestational age. Those children have been developmentally evaluated during the first year of life and at 4 years by the EVAL Mater test. The “Naitre et Devenir” network is following up the prematurely born under 33 weeks of gestation infants of the West Provence Alpes Côte d’Azur and South Corsica from discharge to 7 years. 170 specially trained pediatricians are developmentally following the infants at term, 3, 6, 9, 12, 18 and 24 months of corrected age and 3, 4 5,6 and 7 years. Data are collected in a specially designed data base.

Results: There is no significative link between deformational plagiocephaly during the first year of age and a pathological psychomotor score at age 4, but some risk factors have been put in evidence: being a boy, born under 28 weeks of gestational age, weighted at birth under 1000 g, having a neuromotor score of Latal et Ferriero equal or more than 2 at 3 months of corrected age and in a lesser manner having a prescription of physiotherapy during the first year.

Conclusion: The researches on deformational plagiocephaly in the full term infant are suggesting a link between deformational plagiocephaly and developmental delay predominantly on the motor side, with an increase rate of special needs services at school age. Now the asking question is whether the deformational plagiocephaly is the origin of the delay or an early sign of special brain condition with an early motor delay in the full term born. Our results suggest that deformational plagiocephaly in the prematurely born infant may not be linked to neurodevelopmental delay but just due to a long time spent in supine position because of the early birth associated to physiological hypotonia and axial extension. Other risk factors like being a boy, born under 28 weeks of gestation, weighing less than 1000 g, a neuromotor score of Latal and Ferriero more than 2 at 3 months of corrected age and having a prescription of physiotherapy during the first year of life are strongly connected to a delayed psychomotor development at age 4.

Christy Varghese

University of Manchester, UK

Title: Mr
Speaker
Biography:

Christy Varghese is currently a 4th year Medical Student at the University of Manchester undertaking clinical placement at the Royal Preston Hospital, Preston. He was part of the Pediatric Society at the university. He undertook a 10 week research dissertation project under the guidance of Dr. Dhia Mahmood, Neonatologist at Royal Preston Hospital.

Abstract:

Introduction: Early-onset neonatal sepsis is defined as infection within 72 hours of delivery within a healthy baby. There are a number of risk factors for neonatal sepsis identified. Babies with at least 2 risk factors are placed on the sepsis pathway and started on antibiotics awaiting results of investigations such as blood culture, C-reactive protein (CRP) and possible lumbar puncture. The study looked at those neonates on the sepsis pathway to identify factors that may likely predict sepsis defined in this study as a CRP of >10 mg/L.

Material & Methods: This was a retrospective study conducted in the northwest of England focusing on Royal Preston Hospital. The study used data from neonates who were treated for suspected sepsis within the first 72 hours post-birth. A total of 102 babies were selected using random selection and information regarding various variables was obtained. Data was collected from the Lancashire Teaching Hospital Trust (LTHTr) electronic documentation softwares. The initial analysis involved univariate and bivariate analysis. Multivariate logistic regression was also performed to understand which factors were the best predictors to assess severity of sepsis.

Results: There were a total of 55 (53.9%) male neonates and 47 (46.1%) female neonates. There were only 4 neonates with culture proven sepsis. Bivariate analysis showed more mature neonates are more likely to have higher CRP. Multiple regression analysis of neonatal factors found gestation age (p<0.0001) and respiratory distress (p=0.0121) to be the two significant variables in predicting increased CRP levels.

Conclusion: In conclusion, a third of neonates had high CRP. There was only one neonate with a positive blood culture that grew GBS. 22 lumbar punctures were conducted which were all negative. The study showed that neonates on the sepsis pathway are more likely to have high CRP if they showed respiratory distress. In addition to this, within the population of neonates on the pathway, neonates who are more mature are more likely to have a high CRP as a proxy for sepsis. Paradoxically, babies with prolonged ROM were less likely to have high CRP which was found to be statistically significant but clinically less significant. No other factors could accurately predict sepsis in neonates.

 

Murod M Jafarov

Tashkent Pediatric Medical Institute, Uzbekistan

Title: Mr
Biography:

Abstract:

Purpose: Frequency of a congenital anomaly of an ear in the European countries meets 1:6000 newborns, in the USA microtia and anotia meets at 3 of 10000 newborns, in Japan this indicate 1:4000, In the Asian countries of Pacific ocean high frequency of these figures, to 1:900 is marked. According to ENT Department of TPMI in Uzbekistan the microtia and anotia meets 1:2000 children. In the Aral Sea region the data is considerably above and has made 1:650 newborn. The purpose of this research was studying a condition of otoplasty in Uzbekistan in the past, its condition now and to find optimum methods for improvement of operative treatment of patients with congenital anomaly of ear and to present our result for reconstructive surgery of the congenital and acquired general defect of ear.

Materials & Methods: We surveyed more than 150 children, which were operated in the Tashkent Pediatric Medical Institute Clinics. The given operations were made during 2003-2016. If to compare the previous operations, which have been carried out till 2003, and operation now it is possible to see on significant improvements of quality of operation. But the main thing - the result did not justify expectation of patients. Tactics of operation demanded a basic change in all technique of operation.

Results: Postoperative care of patients also demanded a basic change. The main thing which was absent in such operations was correct care of patients. Using modern technologies, we have considerably made progress in rehabilitation of children with microtia in Uzbekistan.

Conclusions: Second-stage method reduces time of surgical intervention and it turns out single-stage formation framework of auricle. The framework, formation in three dimensions’ gives more the best aesthetic result. We hope, that the future technologies will be more noninvasive and will give that result the patient of whom they dream, i.e. they will receive natural ear.

Shailesh Adhikary

BP Koirala Institute of Health Sciences, Nepal

Title: Mr
Biography:

Shailesh Adhikary qualified as a Surgeon from Post Graduate Institute in Chandigarh, India in 1994 and currently working as a Clinical Teacher and a Surgeon at the Community Based Medical College in Eastern Nepal for 12 years and has published 34 papers at national and international journals and is serving as an Editorial Board Member for Asian Journal of Surgery. He is also the Governor of Endoscopic Laparoscopic Surgeons of Asia working to promote the Minimal Access Surgery Development across Nepal and in Asia.

Abstract:

Introduction: Penetrating or perforating abdominal or chest injuries are very uncommon in the paediatric age group and are associated with a high mortality. Impalement injuries are consequence of penetration by elongated, usually fixed objects through the body.

Case Summary: A 10-year young child suffered from a penetrating injury to the left iliac fossa when he had fallen down from a coconut tree on to the sharp bamboo fence. The bamboo stick penetrated the abdominal wall, perforated the jejunal loops at two sites along with the fundus of stomach, the left diaphragm, upper lobe of the left lung and the bevelled end of the bamboo had exited at the neck after tearing apart the neck muscles and skin sweeping along with it few scattered pieces of jejunal tissues which were seen lying alongside. He was brought to the hospital five hours after the accident. On arrival he was in agony, dehydrated and scored 15/15 on Glasgow scale, remained haemodynamically stable, saturation of 93% with oxygen supplement. On examination a 75x5 cm bamboo stick was in situ, which entered 4 cm medial to the left anterior superior iliac spine and exited 3 cm above the skin at the posterior triangle of neck.

Operation: Imaging modalities were followed by exploration via the left thoracoabdominal incision. The thorax, mediastinum and neck were assessed in the beginning and after confirming that no great vessels were at risk, the foreign body was then carefully removed. The perforated stomach, jejunum and diaphragm were repaired. The upper lobe of lung had to be resected. An abdominal drain and two intercostal drains were placed. The total operative time was 3.30 hours and the child was managed in intensive care for four days and was finally discharged after two weeks.

Conclusion: A rare penetrating injury with damage to the multiple organs could be managed successfully possibly because of teamwork and also due to some sensible move by the villagers as they did not try to fiddle around with the foreign body.

Ubaidullah khan

Alhada Armed Forces Hospital, Saudi Arabia

Title: Mr
Biography:

Al Hada Armed Forces Hospital is a tertiary care hospital with specialist training programmes for pediatric department. It has approximately 400 in-patient beds. The pediatric surgery unit provides tertiary care service for the region. The unit serves inpatient, outpatient, NICU and emergency. Each month 200 operations done as a day case, admit and emergency basis. He is responsible for all pediatric surgery inpatients care, NICU, PICU, OR and emergency especially trauma patients at Al Hada hospital. This region have high trauma patient due to location and high turnout of visitors to Makkah, the only link road from western region. Saudi Arabia has second in world with high morbidity and mortality related trauma. He is a dedicated and committed employee of Al Hada Hospital and he strives to achieve its vision of providing excellence in healthcare.

Abstract:

Background: To determined the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard.

Methods: A prospective evaluations of all ultrasound for appendicitis from January 1, 2014, to December, 2017, was conducted at our hospital. A diagnostic protocol was adopted for each patient, US as the initial imaging modality followed by CT in patients with an equivocal clinical presentation. The imaging, operative findings, and pathology of 223 patients (females 80, males 143, age less than 14years) with diagnosed appendicitis were collected. The sensitivity, specificity, predictive value, and negative appendectomy rate were also analyzed. All those patients which had subjected to surgery were included to evaluate the true result of ultrasound in diagnosis of appendicitis.

Results: Of the 223 pediatric appendectomies performed in this time period, a total of 192 (86%) were diagnosed by ultrasound. The histopathology of 8 was normal (3.1%), CT done in 11 and three was normal. The negative appendectomy rate was 3.1%. US were the sole imaging modality in all patients.

Conclusions: In the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure.