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

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Conference program

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

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