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and it's a pleasure to be here are some
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of you participated in this initiative
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actual many of you and I want to thank
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you for collecting data for us we're
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collecting data on closing strategies in
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the different clinics and a goal is to
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harmonize some of these dozing
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strategies the name is spit those i'm
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involved
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heading up the focus group on dozing in
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neonates and we have a couple of folks
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already participating thanks to eric and
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offers to universities are but it
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represented here and it would like to
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have someone from Bern and Zurich so if
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you're interested in participating in
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this I think interesting and important
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national project come to me or Eric
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today or send an email so this project
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is supported by the government by all
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states by universities in fact it's
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co-sponsored by the Department of of
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health park and the goal is to analyze
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what is done now and to come off a
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process to harmonize dozing in neonates
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and we learned that it is so complex to
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understand just in terms of branding
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buildings when to start how long to give
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antibiotics how to combine these drugs
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this project is focusing just on those
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in so it's not about indication or how
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long is just about those in and several
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steps involved so far we collected those
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information from all major clinics for
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the most frequently used most important
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tracks 35 trucks and V started with the
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harmonization process for a trucks and a
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goal is within the next 2-3 years
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basically agree on a harmonized dozing
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strategy on all these 35 trucks i give
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an example
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amoxicillin
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we see that clicks are using this in a
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different way some are using it all
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frequently and others not
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it's fascinating that in the tents miss
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clinics we found almost every
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combination of those in strategy
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everything was different in terms of
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dozing the given time in terms of those
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intervals and at different toes total
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doses daily doses and even how you
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calculate those is different clinics use
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just body weight and others have very
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complex calculations with PMA of PNA
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orchestration HR combination and we did
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some investigation and just to give you
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first finding it doesn't help to cover
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complex calculation so there's no
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evidence to us that the complex way of
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calculating closing forever Sicilian
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helps and i will show it's more
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important to get those into all correct
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and todos this is the result if you have
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these different approaches and you the
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x-axis is basically the time after birth
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and told those is on the y-axis we took
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the two extremely extremely preterm and
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the term and you can see that those
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things not only different at the given
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time after above their way it's switched
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its stepwise function is different and
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in fact it's so different that at
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certain time points they said threefold
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difference in till today those so
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1-click would give 70 milligrams and
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another what give 200 program and this
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is a simulation study in 1,000 children
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actual neonates and you can see that
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each clinic has a different color a
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color represent 1000 approach is not
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there to clinics actual similar two and
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three but other than that there's no
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consistency in fact in one clinic for
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the two approaches within one clinic
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now we did some investigation simulation
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study ins wanted to know what's the
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impact of these differences and if you
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have a certain target let's say and I'm
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a sea of 84 e coli and we can discuss
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whatever this is an important target but
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what you can see is that if you want to
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stay above that concentration level some
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dozing approaches will do well and
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others not
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and here's simulation and what we
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learned is that for our mock Celine it's
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more important to have the doesn't world
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correct so you can give green means you
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have well above these concentrations
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target potential target considerations
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and you can give it every 6 hours 25
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become or hi jose AV eight to 12 hours
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some Kleenex give 25 million per
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kilogram every eight to 12 hours and we
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have some evidence that this may result
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in too low concentrations
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so what we learned is that it's a
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combination of different factors that
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may help to achieve top conservation
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this is just an example that we have to
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think in a more quantitative way if you
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want to look at building stretches for
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some antibiotics so conclusion is yes if
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it's just a goal to stay fifty percent
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above a certain target consideration for
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books it is just an example all
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guidelines all those instructions you're
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using may be fine but if you have a
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different target if you want to treat
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equal I in combination with another to a
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drug then you may have to think about a
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harmonized optimized dozing strategy now
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we are going through all these trucks
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and give you another example
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caffeine is the most frequently used
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drug we did a snapshot in Switzerland
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and it was the most frequently you
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struggle to give a day in n seals and
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typical doesn't strategy is to give a
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loading dose of 20 milligrams and then
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five minutes per day
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now what we can see
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in a simulation study given the fact
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that clearance of the truck is
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increasing on time due to moderation is
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that the concentration of this truck is
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going on
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victory is decreasing 34% different 2
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months so don't think it gives the same
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maintenance those that the concentration
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levels stay consistent they actually
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decrease now if you want to maintain
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concentrations you may need to increase
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the dozing everyone at two weeks so we
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did an optimization study in a
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simulation study and we showed that if
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you increase their maintenance those by
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one gram per Coulomb per day every 12
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weeks you're able to maintain the levels
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some clinics give actually 10 grand
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because there's some evidence that it
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may be safe up to 20 30 milligram per
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liter concentration if you give 10
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become you may be above certain target
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so we have published is and hopefully we
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can do even study together to see ever
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more complex those adjustment will you
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know bring some benefit or whatever as
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simple increase or Target or at
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maintenance intimidate me actually
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maintain that concentration levels so
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different approaches another example how
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we can maybe do some simulation studies
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to better understand how those things
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strategy we are using have an impact on
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exposure and efficacy
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so in summary we would like to work for
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field first we have this expertise and
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you like to have a person from Bern and
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Zurich helping us to think about
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harmonization for these different drugs
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and we also want to work closely with
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the society here with Matthias and
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others to have a smooth process in terms
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of harmonizing these treatments and I'm
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very much open for your feet
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back and after my presentation as want
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to thank Christophe Berra who is heading
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up the entire project in Switzerland for
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spearheading such an important national
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effort thank you

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Conference program

Welcome Words
M. Roth-Kleiner, R. Arlettaz Mieth
10 Jan. 2017 · 9:33 a.m.
526 views
Short Reports Introduction
E. Giannoni, T. Karen, Resp. Lausanne, Zürich
10 Jan. 2017 · 9:38 a.m.
Association of Axonal Injury and Preeclampsia
Katrina Evers, Neonatology UKBB
10 Jan. 2017 · 9:39 a.m.
182 views
Q&A - Association of Axonal Injury and Preeclampsia
Katrina Evers, Neonatology UKBB
10 Jan. 2017 · 9:44 a.m.
102 views
Retinopathy of Prematurity
Roland Gerull, Bern
10 Jan. 2017 · 9:47 a.m.
154 views
Q&A - Retinopathy of Prematurity
Roland Gerull, Bern
10 Jan. 2017 · 9:54 a.m.
Parechovirus Infection: A Rare Cause of Neonatal Encephalitis (in French)
Dr Truant AS, Cheffe de clinique, Néonatologie, CHUV, Lausanne
10 Jan. 2017 · 9:59 a.m.
350 views
Q&A - Parechovirus Infection: A Rare Cause of Neonatal Encephalitis
Dr Truant AS, Cheffe de clinique, Néonatologie, CHUV, Lausanne
10 Jan. 2017 · 10:04 a.m.
234 views
112 views
Genetic Susceptibility to Neonatal Group B Streptococcal Disease
Alessandro Borghesi, Fellay lab, EPFL
10 Jan. 2017 · 10:17 a.m.
131 views
Q&A - Genetic Susceptibility to Neonatal Group B Streptococcal Disease
Alessandro Borghesi, Fellay lab, EPFL
10 Jan. 2017 · 10:25 a.m.
Psychomotor Development in Children Prenatally Exposed to Methadone
G. Grand-Guillaume-Perrenoud, Pediatrics, Children's University Hospital Geneva
10 Jan. 2017 · 10:27 a.m.
Q&A - Psychomotor Development in Children Prenatally Exposed to Methadone
G. Grand-Guillaume-Perrenoud, Pediatrics, Children's University Hospital Geneva
10 Jan. 2017 · 10:34 a.m.
Introduction to Christoph Berger's Presentation
C. Kind, R. Gerull, Resp. St.Gallen, Bern
10 Jan. 2017 · 10:37 a.m.
Vertical Infections: An Update
Christoph Berger, Zürich
10 Jan. 2017 · 10:40 a.m.
253 views
Q&A - Vertical Infections: An Update
Christoph Berger, Zürich
10 Jan. 2017 · 11:15 a.m.
Introduction to Eric Giannoni's Presentation
R. Pfister, S. Kämpfen, Resp. Geneva, Basel
10 Jan. 2017 · 11:44 a.m.
Sepsis, Antibiotics and Resistances: Where Are We?
Christoph Bührer, Berlin
10 Jan. 2017 · 2:21 p.m.
145 views
Use and Abuse of Antibiotics in Neonatology
Martin Stocker, Lucerne
10 Jan. 2017 · 2:50 p.m.
291 views
Panel Discussion : Controversies on Use of Antibiotics in Neonatology
Martin Stocker, Christoph Berger, Eric Giannoni, Christoph Bührer
10 Jan. 2017 · 3:10 p.m.
105 views
Introduction to Christoph Bührer's Presentation
Romaine Arlettaz Mieth , Neonatologist, Zürich, President of the Organizing Committee
10 Jan. 2017 · 3:47 p.m.
Evidence-Based Haemodynamic Management in Neonatal Sepsis
Christoph Bührer, Berlin
10 Jan. 2017 · 3:48 p.m.
416 views
Q&A - Evidence-Based Haemodynamic Management in Neonatal Sepsis
Christoph Bührer, Berlin
10 Jan. 2017 · 4:16 p.m.
SwissNeoDose Project
Marc Pfister, Ped Pharmacology, UKBB
10 Jan. 2017 · 4:20 p.m.
112 views
Awards (Case of the Year; Milupa; Best Poster Case Report; Best Oral Short Presentation) & Closing Comments
Matthias Roth-Kleiner, CHUV, President of the SSN
10 Jan. 2017 · 4:30 p.m.