WORLD ASSOCIATION OF PERINATAL MEDICINE

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Madrid 2015

Report on the 12th World Congress of Perinatal Medicine
3-6 November 2015, Madrid-SPAIN

Being at the City of Madrid in the month of November is great experience since autumn allows a steady comfortable weather in this important world capital. The Municipal Conference Center provided a comfortable, high technology and agreeable venue with the standard features the 12th World Congress of Perinatal Medicine required.

Academic activities promptly began on the 3rd of November with high quality courses, many of them already well known, such as the International Inter- university Ian Donald School of Medical Ultrasound, the International Society of the Fetus as a Patient, Fetal Neurology and Fetal Echocardiography, Hemodynamic monitoring of the sick neonate, Noninvasive ventilation and Developmental Care. Other pre-congress activities included an industry sponsored ISPAT Session and a Spanish session on Fertility and Infertility in the Ovarian Cycle: Clinical Applications and Research (organized by the Natural Family Planning Teacher's Association of Spain). Each of these sessions provided a highly professional and skilled vision of topics with great importance to current maternal-fetal medicine, obstetric and neonatal practice. The insight of experts from India, Italy, Indonesia, Mexico, Croatia, Germany, Russia, Poland, Montenegro, Hungary and the United States broadened the experiences and understanding of various concepts and clinical situations.

At that very day the Opening Ceremony was full of warm greetings, including enthusiastic welcome addresses from Professor Aris Antsaklis, WAPM President, Mr. Jesus Sanchez Martos, the Minister of Health of the Community of Madrid, and Mrs. Soraya Saenz de Santamaria, Deputy Prime Minister of the Government of Spain.

The ceremony was highlighted with the various prices and recognitions awarded to professors and experts in the field of Perinatal Medicine. The father and founder of Perinatal Medicine, Professor Erich Saling announced the names of the winners of Erich Saling Perinatal Prize in 2015 – Prof. dr. Luis Cabero Roura (Spain) as a prominent obstetrician and Prof. dr. Xavier Carbonell-Estrany (Spain) as a distinguished neonatologist.

International Academy of Perinatal Medicine awarded Prof. dr. Asim Kurjak, on behalf of the International Academy of Perinatal Medicine. WAPM Presidential Awards were given to prof. dr. Manuel Sánchez Luna, prof. dr. Joachim Dudenhausen, and prof. dr. Kypros Nicolaides. World Congress of Perinatal Medicine in Madrid 2015 awarded obstetricians prof. Frank Chervenak, prof. Ritsuko Pooh, prof. Bo-Hyun Yoon, prof. Gian Carlo Di Renzo, dr. Mario Merialdi, and prof. José Villar. World Congress of Perinatal Medicine in Madrid 2015 awarded neonatologists prof. Eduardo Bancalari, prof. Avroy Fanaroff, and prof. Ola Saugstad. Special award to the Order of Saint John of God in recognition of its exemplary care work, developed over five centuries in more than 50 countries were given to prof. Christian Speer and prof. Anne Greenough.

The Keynote Lectures were dedicated to the future development of Neonatology and Obstetrics in the 21st Century. They were presented by Prof. Eduardo Bancalari (USA) and Prof. Aris Antsaklis (Greece).

The 4th of November was the most intensive and active. The working day was opened at 8 a.m. with the oral presentations in 7 rooms simultaneously. In the other 4 rooms participants could meet the experts and discuss the crucial issues of maternal, fetal and neonatal medicine with them. The morning Plenary Session on Mechanisms responsible for preterm labor and fetal injury presented the brilliant lectures of leading experts Professor Roberto Romero as an Obstetrician, Professors Luc Zimmermann and Manuel Carrapato as Neonatologists who discussed the possible causes and consequences of prematurity. Then the special lectures were held by Kypros Nicolaides (UK) and Michael Gravett (USA) who presented unique information focusing on topics "Noninvasive prenatal diagnosis in 2015” and “The first postnatal growth standards for infants born preterm: The Preterm Postnatal Follow-up Study of the INTERGROWTH 21st Project”. Professors Gian Carlo Di Renzo, Bernat Serra, Jose Luis Bartha and Agustin Conde-Agudelo presented the overview of the new issues in the obstetrical management of acute preterm labor, giving new insights on outcomes, prediction, tocolytic agents, corticosteroid administration and neuroprotection.

Crucial topics such as prediction and prevention of fetal death were addressed by professors Chiara Benedetto (Italy) and Gerard H. A. Visser (The Netherlands). Hypertension in Pregnancy with the important topic of Screening of Preeclampsia in the first trimester was presented by Professor Aris Antsaklis, anticoagulation therapy, endothelial dysfunction, epidemiology of preeclampsia as well as gestosis and histocompatibility. Specific details on preeclampsia prediction and prevention were further presented by Francesc Figueras (Spain), Ignacio Herraiz (Spain), Alberto Galindo (Spain), Michael Gravett (USA) and Kypros Nicolaides (UK) and Liliana S. Voto (Argentina).

The popular session on Fetal Surgery with professors Eduard Gratacós (Spain), Ruben Quintero (Qatar), Jan Deprest (Belgium), Kurt Hecher (Germany), Alberto Galindo (Spain), Elena Carreras (Spain) addressed many important issues such as the surgical treatment of twin-to-twin transfusion syndrome, urinary obstruction, diaphragmatic hernia, cardiac malformations and myelomeningocele. Another concurred session was Postpartum hemorrhage with well-known and important speakers like Prof. Dan Farine (Canada), Zoltan Papp (Hungary) and Mark Kurtser (Russia).

The parallel session on bronchopulmonary dysplasia (BPD) attracted a lot of neonatologists and basic scientists. The following issues were covered by the leading experts: Prof. Jaques Belik (Canada) concentrated on pulmonary hypertension and BPD, Prof. Eugenio Baraldi (Italy) investigated the possible links between BPD and adult chronic lung disease, Prof. Won Soon Park (South Korea) presented innovations in human stem cell therapies of BPD, Prof. Egbert Herting (Germany) made an overview of less invasive surfactant administration.

Interesting conferences that dealt with topics both in basic science and clinical field were Genomics in Obstetrics and Neonatology that included Noninvasive

prenatal testing, microarray analysis and genome wide sequencing as well as rapid sequencing in various congenital anomalies and aneuploidies; the session Empowering of parents was also included with emphasis given to the family interaction and involvement. The Nestle nutrition Institute supported an important industry symposium which was aimed at the Importance of nutrition for mother and infant in the first 1000 days and elicited nutritional issues of diabetes in pregnancy (Prof. Frank Louwen, Germany), nutrition of the small for gestational age neonate (Prof. Ekhard Ziegler, USA), human milk fortification (Prof. Jean-Charles Picaud, France).

Stabilization of the very low birth weight infant was characterized by the international team of speakers including Prof. Nestor Vain (Argentina), Prof. Uwe Ewald (Sweden), Prof. Eduardo Bancalari (USA) and Prof. Corrado Moretti (Italy).

Global Challenges in Neonatology in developed and developing countries were thoroughly discussed by Prof. Milan Stanojevic (Croatia), Prof. Hilary Whyte (Canada), Prof. Maria Dolores Elorza (Spain), Prof. Dharmapuri Vidyasagar (USA), Prof. Jose Maria Carrera (Spain).

A special section for nurses was conducted in Spanish and dealt with skin care in high risk neonates.

The 5th of November was also an important congress day with a significant share of activities starting with 14 sessions for oral presentations early in the morning.

Special lectures were made by two brilliant experts: the excellent obstetrician, Professor Asim Kurjak (Croatia) focused on imaging of fetal neurobehaviour, and the prominent neonatologist, Professor Linda S. De Vries (The Netherlands) devoted her talk to brain imaging and prognosis of neurodevelopmental outcome in preterm infants. The problem of twin gestations and advanced parental age was addressed by Professors Isaac Blickstein (Israel), Anton Mikhailov (Russia), Joseph Schenker (Israel) and Corinne Hubinont (Belgium). A separate session on Fetal biometry for the diagnosis of growth disorders was organized by Jason Gardosi (UK) and Francesc Figueras (Spain), Aris Papageourghiou (UK), and Wesley Lee (USA). Many participants took part in parallel sessions dealt with perinatal infections in pregnancy and diabetes and obesity during pregnancy.

One of the main neonatal parallel sessions was dedicated to hypoxic ischemic encephalopathy (HIE). The distinguished speakers shared their experience and opinion on long term outcome in HIE (Prof. Linda S. De Vries, the Netherlands), therapeutic cooling (Prof. Marianne Thoresen, Norway), cord blood cells for HIE (Prof. Michael Cotton, USA) and erythropoietin for neuroprotection in very preterm infants (Prof. Jean Claude Fauchere, Switzerland).

The concurrent parallel session on neonatal screening of critical congenital heart defects (CCHD) in infants using Pulse Oximetry joint evidence based scientific approaches and practical application and global implementation of this effective technique. That topic was discussed by Prof. Andrew Ewer (UK), Prof. Gerard R. Martin (USA), Prof. Ilona Narayen (The Netherlands). The further hot panel discussion was supported by Prof. Luc Zimmerman (The Netherlands), Prof. Manuel Sanchez-Luna (Spain), Prof. Daniele De Luca (France), Prof. Gerard Loeber (The Netherlands), Prof. Gerard R. Martin (USA), Prof. Nestor Vain (Argentina).

Respiratory syncytial virus infection is a real challenge for preterm infants concerning its outcomes, diagnosis, clinical management, prediction and prevention. Multiple issues of RSV infection in infants were thoroughly analyzed by Prof. Xavier Carbonell-Estrany (Spain), Prof. Octavio Ramilo (USA), Prof. Anne Greenough (UK), Prof. Paolo Manzoni (Italy) during the industry symposium supported by Abbvie.

The hot discussion was continued during the plenary session on the role of microbiome in health and disease, in Perinatal medicine. The newly discovered peculiarities of microbiome in pregnancy and neonatal period were characterized by Prof. Francisco Guarner (Spain), Prof. Phillip Bennett (UK), Prof. Josef Neu (USA).

The parallel session “On the edge of viability” chaired by Prof. Josef Figueras (Spain) and Prof. Avroy Fanaroff (USA) triggered great interest of clinicians, educators and scientists. Prof. Ola D. Saugstad (Norway) tried to determine the limits of viability. Prof. Maximo Vento (Spain) analyzed the optimal target saturation in the periviable neonate. Prof. Avroy Fanaroff (USA) compared the guidelines for the management of extremely premature deliveries and neonates. Prof. Marta Thio (Australia) discussed the most common shortcuts during neonatal resuscitation and stabilization in the delivery room.

Neonatal nutrition remains the essential part of neonatal care. Highly qualified and respected speakers such as Prof. Paolo Manzoni (Italy), Prof. Virgilio P. Carnielli (Italy), Prof. Teresa Del Moral (USA), Prof. Nobuhiko Nagano (Japan) focused on the relationships between nutrition and neonatal infection, strategies to promote adequate growth in the preterm infant, probiotics in immaturity and developmental aspects of lipoprotein metabolism in newborn infants.

Important topics like Gestational Diabetes were highlighted with current diagnosis, treatments, risk factors and new concepts on physiopathology.

The parallel session focused on Prevention of Preterm delivery chaired by Prof. Luis Cabero (Spain) and Prof. Eduardo Da Fonseca (Brazil) had high class experts like Professor Roberto Romero (USA), presenting the role of progesterone in preventing preterm birth. The other experts dealt with cervical cerclage (Prof. Eduardo Da Fonseca, Brazil), pessary (Prof. Maria Goya, Spain) and prevention of preterm birth in twin gestations (Prof. Agustin Conde- Agudelo, Colombia). Problems during the second stage of labor were addressed with the use of ultrasound monitoring and the use of forceps, vacuum and other devices.

The last plenary session of the day was very interesting for obstetricians and pediatricians. It was chaired by Prof. Asim Kurjak (Croatia) and Prof. Ives Ville (France) and was devoted to the developmental origins of health and disease, the long-term effects of nutrition in pregnancy, the links between bacterial and viral infections in pregnancy and the risk of autism and schizophrenia in offspring and the long-term cardiovascular consequences in infants small for gestational age (SGA). Original reports were made by Prof. Chittaranjan Yajnik (India), Prof. Celso Arango (Spain) and Prof. Eduard Gratacós (Spain). Activities were adjourned during the General Assembly, with a report on the results of the WAPM Board meetings.

The final day of activities (the 6th of November) included 13 sessions for oral presentations of participants in the morning. Then important plenary and parallel sessions were conducted with crucial current topics such as “Chorioamnionitis, fetal inflammatory response and neonatal sepsis” (speakers – Prof. Roberto Romero (USA), Prof. Octavio Ramilo (USA) and Prof. Christian P. Speer (Germany), “Emerging procedures to return to natural birth” (organized by FLAMP), “Preterm delivery and limits of viability” (organized by SENeo- SEGO). “Preterm Premature Rupture of Membranes” symposium addressed aspects dealt with biochemical markers of PROM (Prof. Gian Carlo Di Renzo, Italy), new rapid tests for intraamniotic infection diagnosis (Prof. Maria Teresa Gervasi, Italy), management of PROM (Prof. Montse Palacio, Spain) and new developments on antibiotic use in patients with preterm PROM (Prof. Bo-Hyun Yoon, South Korea). The special lecture in obstetrics on the prediction and prevention of preterm birth was delivered by Prof. Gian Carlo Di Renzo (Italy). Another special lecture “The Survival Miracle of Very Low Birth Weight Infants” was conducted by the famous neonatologist, the author of popular text books in neonatology Prof. Avroy Fanaroff (USA).

At the President's session Prof. Erich Saling (Germany) talked about the evolution of perinatal medicine, Prof. Frank Chervenak (USA) explained forcefully the danger and challenge to perinatal medicine imposed with the planned home birth in the developed world. Professor Xavier Carbonell-Estrany shared the unique experience of his hospital in organizing in-home care of the early discharged preterm newborns.

Activities were finalized with a memorial meeting “Tribute to Prof. Dr. Roberto Caldeyro Barcia” and a Closing Ceremony where an obstetrician, Prof. Aris Antsaklis forwarded his position of President of WAPM to a neonatologist, Prof. Milan Stanojevic as the next WAPM President, the WAPM flag was given to Professor Cihat Sen, inviting all of us to the 13th World Congress of Perinatal Medicine in Istanbul (Turkey) in 2017 and before it – to the 9th World Congress of Perinatal Medicine in Developing Countries in Asunción (Paraguay) in May, 2016.

At the 12th World Congress of Perinatal Medicine in Madrid there were altogether 3260 attendants from 92 countries with 240 invited speakers. Besides 2260 full registered attendants, there were additional 740 delegates with less than full registrations from low income countries, residents, students, nurses, midwifes, and members of non-profit organizations.

Prepared by: Rodrigo Ayala and Marina Degtyreva