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Updates on the5th EuropaediatricsCongressThe 5th Europaediatrics 2009 is 6 months awayand the excitement is rising! The Europaediatricscongress is the highlight of the activities ofEPA/UNEPSA and aspires to be the meeting pointof paediatricians not only from Europe but fromall over the world. The 5th Europaediatrics followsthe past congresses of EPA/UNEPSA held in Rome(2000), Prague (2003), Istanbul (2008) and Moscow(2009).The activities of the flagship event of EPA/UNEPSAare coherent with and consequent to the followingmission points of the Constitution of EPA/UNEPSA:• To improve the quality of paediatric patient carein all European countries• To stimulate collaborative research in paediatricsin Europe• To encourage cooperation between NationalPaediatric Societies in Europe and betweenpaediatricians working in primary, secondaryand tertiary paediatric care in Europe• To promote the exchange of national experiencesin the various fields of patient care and makenational practices known to others.Scientific ProgrammeThe scientific programme of the 5th Europaediatrics,addresses to paediatricians involved in primaryand/or secondary care and other specialists andprofessionals involved in child and adolescent care inEurope. In the context of 5th Europaediatrics, variousauthoritative international societies and associationswill share the scientific organization of Symposia andinteractive Courses with EPA/UNEPSA:• Advanced Paediatric Life Support Working Group• Cochrane Collaboration• European Medicines Agency• European Society for Paediatric Endocrinology• European Society for Paediatric Gastroenterology,• Hepatology and Nutrition• Paediatric Nursing Associations of Europe• Thalassaemia International FederationThe Preliminary Scientific Programme is nowavailable on the official website of the congress.Discover the topics that will be covered in thecongress and start planning which sessions you wishto attend.Abstract SubmissionThe deadline for the submission of your abstracts isshortly due. You may submit your abstracts until 10March 2011. Don’t miss the opportunity to presentyour work in the largest European paediatricscongress. All accepted abstracts will circulate asa supplement in Evidence-Based Child Health: ACochrane Review Journal, the official journal of EPA/UNEPSA. Check out in the official website the simpleprocedure you need to follow in order to registerand submit an abstract.The Host City and the Congress VenueThe city of Vienna will host the 5th Europaediatricsas the Austrian capital is an excellent location foran international medical congress. It is a city rich inculture, with all the modern amenities, and boastsan impressive history in the medical sciences.Vienna is located in the heart of Europe, and is easyto reach by plane, train or car. The city offers anexcellent conference infrastructure and the highlyprofessional services required to organize the 5thEuropaediatrics.The congress will be held in the Austria CenterVienna (ACV), the largest conference center inAustria and one of the largest and most modern ofEurope. ACV is located between the tower blocks ofthe Donau City district and the Vienna InternationalCentre (U.N.), in the most modern part of Vienna.Important DatesDeadline for abstract submission: 10 March 2011Deadline for early registration: 10 March 2011For regular updates about the congress please visit:www.europaediatrics2011.orgThe 5th Europaediatrics features an impressivelist of organising and scientific committees whosepresence guarantees the success of the upcomingcongress.4

Updates on the 5th Europaediatrics CongressScientific CommitteeChairmanArmido Rubino, ITALYEUROPEAN PAEDIATRIC ASSOCIATION(EPA / UNEPSA) COUNCILPresidentProf. Andreas KonstantopoulosSecretary GeneralProf. Massimo Pettoello-MantovaniVice PresidentProf. Alexander BaranovVice PresidentProf. Manuel MoyaCouncilorsProf. Fugen Çullu ÇokuğraşProf. László SzabóTreasurerProf. Jochen EhrichPast PresidentProf. Armido RubinoPresident of 5th EuropaediatricsProf. Dr. Wilhelm KaulferschLocal Organising CommitteePresidentProf. Dr. Klaus SchmittVice PresidentProf. Dr. Wilhelm KaulferschSecretaryProf. Reinhold KerblMembersErrol Alden, USAGeneroso Andria, ITALYShimon Barak, ISRAELResch Bernhard, AUSTRIASergio Augusto Cabral, BRAZILFranco Chiarelli, ITALYGiovanni Cioni, ITALYFugen Çullu Çokuğraş, TURKEYSten Dreborg, NORWAYJochen Ehrich, GERMANYMargaret Fisher, USAAndreas Gamillscheg, AUSTRIAZachi Grossman, ISRAELKalle Hoppu, FINLANDIsidor Huttegger, AUSTRIADr. Wilhelm Kaulfersch, AUSTRIAReinhold Kerbl, AUSTRIAAndreas Konstantopoulos, GREECEGiuseppe Masera, ITALYJulije Mestrovic, CROATIAJoseph Milerad, SWEDENManuel Moya, SPAINLeyla Namazova, RUSSIALyudmila Ogorodova, RUSSIAAnne Ormisson, ESTONIAJosef Riedler, AUSTRIAKlaus Schmitt, AUSTRIAMike Smith, UKLászló Szabó, HUNGARYGiorgio Tamburlini, ITALYArunas Valiulis, LITHUANIANikolay Nikolaevich Volodin, RUSSIAMehmet Vural, TURKEYMaximillian Zach, AUSTRIA5

Respiratory MedicineSessions presentedin the context ofExcellence in PaediatricsA report from LondonOne thousand paediatricians from all over theworld had the opportunity to attend the secondExcellence in Paediatrics conference in Londonfrom 2 till 4 December 2010.Along with selected centres of excellence inpaediatric care, EPA/UNEPSA and the CochraneChild Health Field presented a number of respiratorymedicine sessions within the context of Excellencein Paediatrics. These special sessions took place onSaturday, 4 December 2010 in London and focusedon significant respiratory issues and updateddelegates upon prevention, medication andtreatment.LondonEPA/UNEPSA was an official supporter of thisprestigious international paediatric conference andwas present at the exhibition area of the conferencewith a booth promoting the future events andinitiatives of the Association.LondonSpecial interviews with top notch speakers,webcasts of selected sessions as well as speakers’presentations and snapshots from the entireconference will be available soon throughwww.epa-unepsa.org and the conference’swebsite www.excellence-in-paediatrics.org.Save the dates for the 3rd edition of Excellence inPaediatrics which will take place in Istanbul, Turkeyon 1-3 December 2011.EPA/UNEPSA Council Meeting& General AssemblyOn the sidelines of the scientific meeting inLondon, EPA/UNEPSA held a Council Meeting andthe General Assembly. The representatives of themember societies that attended the Assemblycontributed with their votes to define the directionand the immediate steps for the European PaediatricAssociation.The tenures of two Council members wererenewed after holding elections on Saturday, 4December 2010. The Council that currently leadsthe Association has the following composition:• A. Konstantopoulos, President (term ends in 2011)• M. Pettoello-Mantovani, Secretary General (termends in 2011)• A. Baranov, Vice-President (term ends in 2011)• M. Moya, Vice-President (term ends in 2012)• J. Ehrich, Treasurer (term ends in 2011)• F. Çullu Çokuğraş, Councilor (term ends in 2012)• L. Szabó, Councilor (term ends in 2011)• A. Rubino, Past President• W. Kaulfersch, Ex-officio member, President of the5th Europaediatrics 20116The Council and General Assembly adopted anumber of principles on the association’s ethicalconduct and an initiative to organise additionaleducational activities as of 2011. In addition,EPA/UNEPSA has embraced 2 new members, theRomanian Society of Pediatrics and the RomanianSociety of Social Paediatrics, reaching now thenumber of 40 member societies.

EuropeanPaediatricAssociation(EPA/UNEPSA)Join the most extensivepaediatric networkin Europe!Since the launch of the individual membershipscheme, the European Paediatric Association(EPA/UNEPSA) embraces a constantly increasingnumber of individual members from all overEurope.EPA/UNEPSA welcomes all doctors who arecertified as paediatricians in Europe and aremembers of their respective National PaediatricSociety/Association participating in EPA/UNEPSA.By joining EPA/UNEPSA, you gain access to anetwork of 38 national European associations andopen yourself to a new world of opportunities.BenefitsThe individual membership is offered at aprivileged 50 Euro annual fee and encompassesa set of benefits that aim to provide value to thewide community of European paediatricians.• On line access to the Evidence Based Child HealthJournal is a core benefit of individual membershipto our association and we are excited by theprospect of making such a valuable resourcewidely available to paediatricians across Europe.• Our members will enjoy reduced registrationfees to Europaediatrics as well as to other eventsorganised by our Association.• The quarterly newsletter aims to be a source ofcurrent information relevant to the interests ofEuropean paediatricians.• Finally, our members will find in our websitea valuable tool and resource (access to themembers-only section, on-line directory ofmembers, complimentary or privileged prices foradditional on-line services).Individual membership is offered on an annualbasis starting on the 1st January of each year andending on the 31st of December.You may apply on line for an individual membership.Please visit our website www.epa-unepsa.orgfor more details and to fill out a registration form.We look forward to welcoming all of you inEPA/UNEPSA!7

Announcement8Vomitingmanagementin childrenWhat the general practitionershould do and when to consultwith a specialistM. Pettoello-Mantovani andA. CampanozziVomiting is a common symptom of acute and chronicillness in childhood. It is a coordinated event usuallypreceded by nausea in association with increasedsalivation, gastric atony, and reflux of duodenalcontents into the stomach, resulting from nonperistalticcontractions of the small bowel. In thediagnosis and management of nausea and vomitingin childhood, age of presentation and chronicity ofsymptoms are both important clinical features toassess.In many countries it is not unusual that generalpractitioners (GP) are the first professionals consultedby the families or caregivers to check a vomitingchild. Therefore, is important for them to resolve fewkey questions useful both for a correct managementof the symptom, and for taking the correct decisionon whether to refer the vomiting child to a pediatricspecialist.Key clinical questionsShould the presentation of vomiting be acute,the general practitioner needs first to ask himselfwhether the child have a cause other than infectivegastroenteritis. A second important question regardsthe child hydration and it is whether there is anyreason why oral rehydration is not appropriate andalso whether the child needs admission to hospital fornasogastric or intravenous rehydration. If symptomshave been present for weeks or months, the GP needsto consider whether the child is failing to thrive andconclusively whether the child requires referral forspecialist investigation.Children presenting with acute onsetvomiting: diagnoses to be consideredViral gastroenteritis commonly presents with acutevomiting and diarrhoea. However, other conditionsshould always be taken in consideration in exploringthe cause of these clinical features. In fact, an acutepresentation of vomiting may be the onset mark ofa different kind of infection (including undiagnosedurinary tract infection, septicaemia, appendicitis ormeningitis), an acutely evolving surgical abdomen(including intussusception, malrotation with volvulusof the midgut) or a metabolic illness such as diabeticketoacidosis.CAUSES OF NAUSEA AND VOMITING IN CHILDRENAcute vomiting associated to diarroheaFood poisoning• Infectious agents (viruses, bacteria, parasites)• Toxic agents (poisonous mushrooms, improperly preparedexotic foods, or pesticides on fruits and vegetables)Food allergy or intolerance (due to early introduction ofnew food usually before the age of 24 months)• Cow’s milk protein allergy• Coeliac diseaseNon-gastrointestinal infections• Urinary tract infections• Septicemia• MeningitisSurgical• Appendicitis• Malrotation /volvolus• Intestinal intussusceptionAcute vomiting with no associated symptomsSurgical obstructionMeningitisAppendicitisMetabolic diseasesPyloric stenosisIncreased intracranial pressureDrug poisoningChildren presenting with acute vomiting:the warning signsImmediate investigation in a hospital emergency roomsetting is the rule for any child who is vomiting bloodor bile or has severe abdominal pain or abdominalsigns. Emergency room investigations should includeabdominal X-ray, abdominal ultrasound and a septicevaluation, including full blood count, blood cultures,urine cultures and lumbar puncture.

Vomiting management in childrenWhat the general practitioner should do and when to consult with a specialist9Additional red flag symptoms requesting immediatehospital evaluation and management are: high fever,abdominal distension and/or tenderness, persistenttachycardia or hypotension, neck stiffness and/orphotophobia.A special attention must be devoted to vomitingchildren with chronic illness, poor growth and infantsless than 6 months of age. In such population acautious evaluation of both differential diagnosis andhydration status must be performed.Infants and children presentingwith chronic vomiting: diagnosisto be consideredVomiting is a quite common feature of early infancy.In particular, vomiting together with regurgitationand rumination are symptoms suggestive ofgastroesophageal reflux, which may evolve ingastroesophageal reflux disease due to possible tissuedamage (oesophagitis, obstructive apnoea, reactiveairway disease, pulmonary aspiration, or failure tothrive).During the first year of life congenital gastrointestinalanomalies such as malrotation can be present andfood allergies are a frequent evidence at the time offirst introduction of the offending antigen into theinfant’s diet. In the older child vomiting is frequentlypreceded by nausea.Differential diagnosis of chronic presentations ofvomiting in the older child include gastroesophagealreflux, gastritis and cyclical vomiting, and specialistreferral is usually necessary for further investigationwhich may include endoscopy or consideration ofnongastrointestinal causes of vomiting such as raisedintracranial pressure or inborn errors of metabolism.Infant regurgitation: first, establishthe difference with vomitingInfant regurgitation is defined as the passage ofrefluxed gastric content into the oral pharynx, whilstvomiting is defined as expulsion of the refluxed gastriccontent from the mouth.Regurgitating infants usually present such event twoor more times per day for 3 or more weeks in the first1–12 months of life in an otherwise healthy infant.In these children, associated features of retching,haematemesis, aspiration, apnoea, failure to thrive, orabnormal posturing suggestive of a metabolic disorder(for instance galactosaemia), other gastrointestinaldisease, or central nervous system disease are absentto explain the symptom. However, it is important toconsider congenital obstruction of the gastrointestinaltract in infants presenting with vomiting in the firstweek of life, particularly if bile stained.As infant regurgitation is a physiologic and transientevent possibly due in part to the immaturityof gastrointestinal motility, parental educationand reassurance are of primary importance in itsmanagement, along with lifestyle changes, includingappropriate prone positioning after meals, the useof thickened formula and smaller volume feedings.However, although dietary treatment could beconsidered a first-line approach, it must be takenin consideration that the misuse of hypoallergenicand thickened formulas could lead to nutritionalimpairment. Regurgitating infants should undergoappropriate follow-up.Gastroesophageal refluxand gastroesophageal reflux diseasein vomiting children: when to thinkabout itGastroesophageal reflux (GER) is the passage of gastriccontents into the esophagus with or without ejectionof contents from the mouth due to regurgitation orvomiting. GER is a normal, physiologic process whichcan occur several times per day in healthy infants,and to a lesser frequency in children, and adults.GER in healthy infants does not need treatment. GERis a normal physiologic process that occurs severaltimes per day in healthy infants, children, and adults.Approximately 50% of normal 3- to 4-month-oldinfants regurgitate at least once per day and it isreported that an elevated number of caregivers ineconomically advanced countries seek medical helpfor this normal behavior (1).Gastroesophageal reflux disease (GERD) is identifiedby the presence of troublesome symptoms and/orcomplications of persistent GER.

Vomiting management in childrenWhat the general practitioner should do and when to consult with a specialist11of infantile colic, regurgitation, or prolonged crying (5).However, in infants over six months a trial of formulachange may include infant soy formula for two weeks.If improvement is not noted following a 2 week trialof soy formula, then specialist referral is warranted toassess whether progression to extensively hydrolysedformula is required.NOTE: the use of partially hydrolysed formulae orthe unmodified mammalian milk protein, includingunmodified cow’s, sheep, buffalo, horse or goats’milk, or unmodified rice milk, is not recommended forinfants. These milks are not adequately nutritious toprovide the sole food source for infants. Furthermore,the risk of possible allergenic cross-reactivitymeans that these milks or formulas based on othermammalian milk protein are not recommended forinfants with suspected or proven CMPA (5).Children with CMPA: vomiting and othersigns and symptomsCow’s milk protein allergy can induce immediatereactions (vomiting, perioral or periorbital oedema,urticaria, or anaphylaxis) occurring several minutesto two hours after the initial ingestion of cow’s milkprotein. Skin prick testing (SPT) and/or measuringfood specific serum IgE antibody levels (RAST testing)reveal the IgE mediated nature of immediate reactionsto the introduction of cow’s milk protein. By contrast,late CMPA reactions, including vomiting, diarrhoeaand severe irritability, take place within several hoursto days of newly introduced cow’s milk protein and areoften difficult to diagnose. In these cases, to consultwith a specialist is advisable since reactions are usuallySPT negative and elimination or challenge protocolsare required to make a definitive diagnosis. Foodallergy forms due to non-IgE mediated reaction arenot associated with anaphylaxis. Referral to a specialistis recommended in a vomiting infant with suspectedCMPA who has failure to thrive or bloody diarrhoea.Infants with evidence of immediate reactions toCMPA suggestive of IgE mediated food allergy shouldbe urgently referred to a paediatric allergist for SPT.MANAGEMENT OF THE ACUTELYVOMITING CHILDDehydration is a frequent finding in vomiting children.To establish an effective management it is vital toassess the degree of dehydration, since inaccurateassessment of dehydration can have importantconsequences, such as a delay in administeringurgent treatment, or overtreatment with unnecessaryinterventions.Conventionally, patients are classified into subgroupsfor minimal or no dehydration (9% loss ofbody weight) (6, 7).However, degrees of dehydration relate to clinicalsigns and change in body weight if a recent reliableweight is available. There are no specific clinicalsigns associated with mild dehydration(9% of body weight. Because of thisthreshold effect, it may be difficult to distinguishbetween mild and moderate dehydration based onclinical signs alone.Severe dehydration >9% of body weight loss aremore pronounced and include sweaty, cyanoticlimbs, rapid weak pulse and low blood pressure.The child with vomiting should continue to be fed(including breastfeeding as appropriate) unlessseverely dehydrated. Most children can be rehydratedwith oral or nasogastric feeds unless they have severedehydration, in which case intravenous resuscitationis essential (8).

Vomiting management in childrenWhat the general practitioner should do and when to consult with a specialistSome common sense for clinical management ofdehydration in vomiting children:• Laboratory studies should be limited to thosenecessary to guide management.• No unnecessary medications should be used.• Antiemetic medications are not recommended in achild acutely presenting with vomiting as they areunlikely to be effective and may be harmful.• Breast-fed infants should continue nursing ondemand and those on formula should continue theirusual formula as soon as rehydration is achieved inamount sufficient to satisfy energy and nutrientrequirements.• Lactose-free or lactose-reduced formulas areusually not justified. In fact, although medicalpractice has often favoured beginning feeds withdiluted formula, such as half or quarter strength, nosufficient evidence exist supporting such practice.Management of childrenwith mild dehydrationFor those mildly dehydrated infants and children,treatment is aimed at replacing ongoing losses. Andthey should be encouraged to increase the frequencyof their usual drinks. However, undiluted commercial‘soft drinks’ should be avoided as they present asignificant osmotic load to the intestine which canresult in increased vomiting and/or diarrhoea. Toensure optimal management at home, parents shouldbe given advice.age with gastroenteritis may need more frequentreview in the early stages of the illness.Parents should be advised to be in touch promptlyif the child has significant diarrhoea (showing morethan 8–10 watery motions per day), refuses to drink,has vomiting or diarrhoea continuing after 1 week,or there is evidence of significant dehydration suchas few wet nappies, pallor, peripheral shut down ordrowsiness. Finally, it is important to inform parentsthat significant abdominal pain requires urgentevaluation.Management of childrenwith moderate dehydrationIf the child is moderately dehydrated and able totolerate fluids then a trial of ORS is appropriate. Inparticular, ORS 50-100 mL/kg over 3 to 4 hours isindicated to replace estimated fluid deficit, withadditional ORS given to replace existing losses.Although WHO guidelines recommend a maximumrate of 20 mL/kg, the rate may be individualized.Small volumes of fluid should be offered initiallyby using a teaspoon, syringe, or medicine dropper,gradually increasing the administered amount astolerated. It is safe to give ORS very rapidly andfrequent, small bolus feedings will be generally bettertolerated than larger boluses which may increasevomiting.12Written handouts are useful to reinforce key messagesto carers, which should include encouraging regularfluid intake even if the child continues to havevomiting or diarrhoea. Oral rehydration solution (ORS)can be given in addition to breastfeeding. If the infantis bottle fed, clear fluids or ORS should be offered forthe first 2 hours and then normal formula in smallbut more frequent amounts. 1 mL ORS for each gramlost to vomiting or diarrhoea or 10 mL/kg for eachdiarroeal stool, 2 mL/Kg for each episode of emesis.There is no need to restrict food. Daily review by theGP is appropriate until initial evidence of symptomaticimprovement, although babies under 6 months ofIn case a child requests a volume of ORS greater thanestimated, more can be offered.If the child is unable to tolerate fluids then admissionto hospital and placement of a nasogastric tube is asafe and effective way to rehydrate most children withmoderate dehydration, even if the child is vomiting.Management of childrenwith severe dehydrationSevere dehydration represent a medical emergency.In fact, admission to hospital is requested for any childwith severe dehydration, and immediate rehydration

Vomiting management in childrenWhat the general practitioner should do and when to consult with a specialistuntil circulation is restored either through intravenousor intra-osseous access. Urgent electrolytes, glucose,FBC, blood gas and urinalysis should be considered aswell as consideration of the need for septic work up orurgent surgical consult.Summary: key points in evaluatinga vomiting childKey points for a general evaluation of vomitingchildren are listed in the table below.EVALUATION OF VOMITING CHILD KEY POINTS1. In a child presenting with an acute episode of vomiting,always consider other diagnoses before orienting to a viralgastroenteritis. Especially if the subject show haematemesis,bilious or projectile vomiting, abdominal tenderness, high feveror meningism.2. The child with chronic presentations of vomiting should bereferred to a specialist for careful assessment if there is evidenceof failure to thrive, symptoms suggestive of cow’s milk allergyor gastroesophageal reflux disease or in the older child withunremitting symptoms3. Mild dehydration can be managed at home4. Moderate dehydration may require referral to a specialistand admission to hospital pediatric unit for nasogastric tuberehydration if oral fluids are not tolerated5. Severe dehydration requires urgent admission to hospitalpediatric unit for intravenous hydration and treatment of shockREFERENCES1) Vandenplas Y. Thickened infant formula does what it has to do:decrease regurgitation. Pediatrics 2009; 123:e549-502) Campanozzi A, et al. Prevalence and natural history ofgastrooesophageal reflux: pediatric prospective survey.Pediatrics. 2009; 123:779-7833) Vandenplas Y, et al. Guidelines for the diagnosis andmanagement of cow's milk protein allergy in infants. Arch DisChild 2007; 92: 902-9084) Koletzko B, et al. Standards for infant formula milk. BMJ 2006;18;332(7542):621-25) ESPGHAN Committee on Nutrition. Soy Protein Infant Formulaeand Follow-On Formulae: A commentary by the ESPGHANCommittee on Nutrition. Journal of Pediatrics Gastroenterologyand Nutrition 2006: 42:352-3616) The treatment of diarrhoea—a manual for physicians and othersenior health workers. Geneva, Switzerland: World HealthOrganization; 2005. Fourth revision.7) Guarino A, et al. European Society for PaediatricGastroenterology, Hepatology, and Nutrition/European Societyfor Paediatric Infectious Diseases Evidence-based Guidelinesfor the Management of Acute Gastroenteritis in Children inEurope. Journal of Pediatric Gastroenterology and Nutrition2008; 46:S81–S1228) Duggan C, et al. Nutrition in Pediatrics. BC Decker inc. Ontario.Fourth Edition (2008)It is not unusual that children with mild and moderatedehydration will fail to improve with ORT, therefore itis meaningful to observe dehydrated children untilsigns of dehydration recede. Hydration status shouldbe reassessed on a regular basis, with more frequentmonitoring given to the children whose status is morefragile. Such assessment may need the consult witha specialist and can be carried out in an emergencyroom, office, or other outpatient setting.13

14Historyof the CroatianPediatric SocietyThe Republic of Croatia is a country with 4.4 millionof residents, 840.000 of which are children up to18 years old. The indicators of children's healthcare are good: perinatal mortality is 4.6/1000 ofborn altogether of birth weight ≥1000 g, whilethe mortality of infants is 4.5 in respect to 1000liveborn infants. All children in Croatia up to 18years of age have national health care insurance.Primary pediatric care includes around 75% ofchildren, and the others are included in healthcare provided by family doctors. In secondary andtertiary care there exist 23 children departmentswithin general hospitals, 3 children hospitals and 4pediatric departments within university hospitals.The first educated pediatrician in Croatia wasRadovan Marković. In 1904 he founded thefirst Children's Department in hospital "Sestremilosrdnice" in Zagreb. Already in 1903 he wrote,for that time a very modern manual "Children'scare: instructions for a young mother". In 1923the Department of Pediatrics at Medical Schoolin Zagreb was established. The first Head ofthe Department of Pediatrics was ProfessorErnest Mayerhofer. He wrote the first manualon pediatrics in 1925, and in 1939 he wrote thetextbook "Pediatrics". Professors Marković andMayerhofer are well known for their social workand their support to educating people on healthcare. Thus they were writing about children'shealth care and trying to actively implementregulations on children's health care. The pediatricambulatory services have been established in1908 when Dr. Žiga Švarc founded the Children'sClinic in Zagreb. From that day on, the ambulatoryservices in Croatia have been implementingchildren's and mother's primary health care andhave considerably contributed to improvement ofchildren's health care.Linking pediatricians in Croatia was formallyorganized in 1930 when Professor Mayerhoferestablished the Section of Croatian Pediatricianswithin the Croatian Medical Association. Sincethen the Section has been continuously workinguntil year 1993 when the Croatian Pediatric Society(CPD) has been founded. The first president of CPDwas Professor Duško Mardešić. The duties of CPDare as follows: development of children's healthcare, professional and scientific improvement,organizing professional congresses, collaborationwith other professional societies, cherishingmedical ethics, controlling health care measuresand providing professional opinions. Besides CPD,8 subspecialist pediatric societies (neurology,endocrinology, gastroenterology, nephrology,cardiology, pulmology, preventive/social pediatricsand immunology) and three sections (metabolism,intensive medicine and neonatology) are active inCroatia. All the subspecialist pediatric societies andsections organize their annual national symposia.CPD organizes congresses regularly, every twoyears, always together with the Society of PediatricNurses. So far, nine Congresses of CPD have beenheld. In this newsletter issue we have prepareda special report on the Congress of CPD, held inOctober 2010. Besides, every year CPD holdsthe symposium "Croatian pediatric school". Thesymposium includes eminent Croatian and foreignexperts, who give instructions to professionalson actual problems regarding various fields ofpediatrics.CPD also has a well organized web page(www.hpd.com.hr). The page contains variousnews, notifications on congresses in Croatia andabroad, and recommendations from CPD. Besides,it provides the possibility of organizing discussion

History of the Croatian Pediatric Societygroups and sending announcements to allCroatian pediatricians.Today there are 606 active pediatricians in Croatia,236 of which are in primary care. In larger citiesthe children's healthcare relies on pediatrician,but in smaller places there is a lack of pediatriciansin primary care. The majority of pediatricians arewomen (78%). Distribution by age is adverse, only23% of pediatricians is younger than 44. However,the number of pediatric residents in the last 5years increased from 78 to 165, thus we expecta significant improvement in age structure ofpediatricians over the next few years.Croatian pediatricians publish more than 100scientific papers per year, 40 of which find theirplace in journals quoted in Current Contents.The journal Paediatria Croatica, that was firstpublished in 1958 by the name of "Arhiv za zaštitumajke i djeteta" (Archives for Mother and ChildProtection), helps scientific work to a great extent.The journal Paediatria Croatica publishes papersin Croatian and English language, thus we inviteall the European pediatricians to collaboratewith us and submit their manuscripts. PaediatriaCroatica is indexed/abstracted in: ThomsonScientific, Embase/Excerpta Medica, Amsterdam,Index Copernicus, Journal Citation Reports/Science Edition, Science Citation Index Expanded(SCIE), Abstracts Journal, All-Russian Institutefor Scientific and Technical Information (VINITI),Scopus, Google Scholar, and Scientific Commons.The journal's web page is www.paedcro.com.member of European Academy of Pediatrics (EAP).Professor Josip Grgurić was a member of the EPACouncil. CPD's members actively participate ininternational association's activities, especiallythe EPA's. Therefore, at the 5th Europaediatricscongress that will be held in Vienna in June2011, we expect the usual numerous attendanceof Croatian pediatricians, while three Croatianpediatricians are going to participate at theCongress as lecturers. Moreover, the EPA plansto organize a workshop in 2011 in Split onemergencies in pediatrics.Professor Julije MeštrovićPresident of Croatian Pediatric SocietyProfessor Josip GrgurićMember of Executive Board of Croatian PediatricSociety15CPS is a member of European Pediatric Association(EPA/UNEPSA), International Pediatric Association(IPA), Union of Middle-Eastern and MediterraneanPediatric Societies (UMEMPS) and an associate

Research Projectby the Cochrane Child Health FieldDear Paediatrician,At the Cochrane Child Health Field, we are testing a format of summarizing andpresenting evidence as a way of answering specific clinical questions, called a“Clinical Answer”. You are invited to participate (approximately 10 minutes) bylooking over a 1-page Clinical Answer, and completing a short survey afterwards.Your participation in this study will help us develop Clinical Answers that are bothuseful and usable for paediatricians.Step 1: Look over an example of a Clinical Answer (5 minutes). It may be helpfulto keep the Clinical Answer document open while you are completing the survey.http://www.cochranechildhealth.ualberta.ca/CA_Bronchiolitis.pdfStep 2: Complete the online survey (5 minutes).https://surveys.aict.ualberta.ca/tsqs/rws5.pl?FORM=Feedback_cYour participation, and the data from the survey, are anonymous.Thank you, we deeply appreciate your participation. Also, please help usby forwarding this invitation to your paediatrician colleagues who may beinterested.Iva Seto, BSc BA MLISResearch Coordinator, The Cochrane Child Health Field(www.cochranechildhealth.org)16

News from aroundthe worldUNITED STATES OF AMERICAThe American Academy of Paediatrics (AAP) 2010National Conference & Exhibition, one of the world’slargest educational events in paediatrics was held inSan Francisco, USA on 2-5 October 2010.This year’s conference attracted approximately13.000 delegates. The scientific programme covereda wide range of thematic streams and includedmultiple interactive, practical and networkingsessions.In addition to the top-notch CME programmingoffered by AAP, the flagship pre-conference event,Paediatrics for the 21st Century (Peds 21), turnedits focus this year to Health Information Technologyand Quality. The importance of HIT for improvingpatient outcomes, and the latest technologywas on display in the AAP Paediatric Office of theFuture to help delegates in their ascent for qualityimprovement.The programme also included several specialevents including the Opening Plenary Sessions, theWelcome Reception, the Ribbon Cutting Ceremonyin the Exhibit Hall, the President’s Reception, theAnnual Business Luncheon and many more.Next year the AAP National Conference will takeplace in Boston, 15-18 October 2011.CROATIATthe 9th Congress of Croatian Pediatric Society(CPD) was held in Požega on 6-9 October 2010.The city of Požega is located in northwest Croatiaand is well-known for its outstanding Departmentof Pediatrics. 330 pediatricians participated in theCongress of CPD, making it the most successfulcongress of CPD so far. The presidents of nationalpediatric societies from Slovenia, Austria, Hungaryand Bosnia and Herzegovina were also present: Dr.Ivan Vidmar, Professor Wilhelm Kaulfersch, ProfessorLaszlo Szabo and Dr. Željko Rončević. Dr. Ivan Vidmarwas proclaimed the first honorary member of theCroatian Pediatric Society.CroatiaGuests and invited lecturers: Prof. Laszlo Szabo, Prof. Fabrizio Simonelli,Prof. Wilhelm Kaulfersch and Prof. Shimon BarakUnited States of AmericaFrom left: Prof. Renée R. Jenkins, AAP- Past President (2008-2009)Prof. Andreas Konstantopoulos, President of the European PaediatricAssociation & President elect of the International Paediatric AssociationProf. Judith S. Palfrey, AAP-Immediate Past President (2010-2011)Prof. Errol R. Alden, AAP-Executive DirectorIntroductory lectures were held by eminent guestlecturers. Professor Shimon Barak from Tel Avivpresented the current situation in primary pediatriccare in Europe. Professor Fabrizio Simonelli fromFlorence expounded on the difficulties of childrenduring their hospital stay. Professor WilhelmKaulfersch presented the work of European PediatricAssociation and CPD's active participation in itswork. Then he introduced the 5th Europaediatricscongress that will be held in Vienna in June 2011.Professor Julije Mestrovic presented the currentsituation in Croatian pediatrics, especially in relationto the appearance of new diseases in children.Representatives of Croatian Pediatric Subspecialtysocieties and sections lectured on guidelines andrecommendations of the societies and respectivesections. Their articles have been published in the17

News from around the worldsupplement of Croatian pediatric journal PaediatriaCroatica. The same articles will also be published onCPS's web page.A large number of original articles have beensubmitted for the Congress. The steeringcommittee chose 20 of them to be delivered asoral presentations, and 130 papers were presentedin poster form. The best original papers wereannounced at the gala dinner, and the rewards weregiven to their first authors: docent Alenka Gagro, Dr.Marija Radonic, and Dr. Branka Polic.The three winners whose papers were publishedin scientific journals in between two Congresseswere announced during the ceremonial part ofthe Congress. The awarded papers are the onesfrom Professor Ivo Baric, Professor Ljerka CvitanovicSojat and Gordana Jakovljevic MD, PhD. Theauthors presented their papers and those of theirassociates at plenary lectures. The works of youngpediatricians have been presented in the same way.The 'Ernest Mayerhofer' award was given to Dr. IvaHojsak, and the 'Radovan Markovic' award to Dr.Tamara Zigman.table on “Primary pediatric care” was about theresponsibility of a pediatrician in preservation ofchildren's health, especially by means of preventionmethods. The difficulties in work of pediatricians inprimary health care were presented as well as theperspectives of organizing primary pediatric care inCroatia. The round table on “Prevention of injuriesof children” and introduction of national program ofthe Ministry of Health and Social Welfare' includedparticipation of representatives of the Ministryof Health and Social Welfare, the police and civilassociations, along with pediatricians and familypractitioners.During the Congress different aspects of children'shealth care were considered, and the generalattitude of the Congress' participants is consistentwith the conclusions of European Pediatric Societyon special responsibility of pediatricians in children'shealthcare in the modern world (The EPA ⁄ UNEPSACommittee on Challenges and Goals of Paediatricsin the 21st Century. Acta Paediatrica 2010; 99,:13–18).CroatiaCroatiaAssembly of Board of Directors at the 9th Congress of the Croatian PediatricSociety18Award winners for the best scientific papers at the Congress of CroatianPediatric Society, from left: President Julije Meštrović, award winnersIva Hosjak, Gordana Jakovljević, Ivo Barić, Ljerka Cvitanović Šojat, secretaryAlenka Gagro, President of awards committee Neda AberleAcknowledgements for distinctive and lastingcontribution to improving health care for childrenand the pediatric profession in the Republic ofCroatia were given to former presidents of CPS,Professors Vlado Oberiter, Duško Mardešić, MladenKriž and Josip Grgurić, and the longtime director ofCroatian Pediatric School, Professor Livio Balarin.At the end of the Congress two round tables wereheld with topics of general interest. The roundPORTUGALThe 11th Congress of the Portuguese PaediatricSociety (SPP) was held in Funchal at the island ofMadeira on 6-8 October 2010. The congress focusedon the following areas of paediatric care:• Training and Research• Community Paediatrics in the Community• Emergency PaediatricsThese subjects were covered in 11 conferences, 14round tables, 7 sessions of "Meet the Professor",seven workshops and a course. 86 Portuguese and8 international distinguished speakers run thesesessions and shared their scientific knowledge with

News from around the worldthe audience. This year’s congress attracted 700delegates.435 abstracts were submitted and 97% of themwere accepted and presented in the context ofthe congress: 49 oral presentations, 102 posterswith classroom presentation and discussion and272 display posters. The evaluation was conductedby the national jury of the joint committee of theDirectorate of SPP and the respective sections.Special prizes were awarded to the best abstracts.EPA/UNEPSA was present at the exhibition area ofthis important meeting and promoted the futureevents and initiatives of the Association.Next year the 12th Congress of the PortuguesePaediatrics Society will take place on 6-8 October2011 in Albufeira, Algarve.SLOVENIASlovenian Paediatric Society organises its nationalcongress every four years. The 5th Congress of theSlovenian Paediatric Society took place at Radencion 16-18 September 2010. Radenci is located inthe northeast part of the country. The congressis primarily aimed at paediatricians in primary,secondary and tertiary care and attracted 250delegates.Paediatric Emergencies, Chronically Ill Child onPrimary Level of the Health Care, Management ofResistant Epilepsy in Children and Adolescents werethe main topics. Various hot topics were covered bydistinguished national and European experts.SloveniaPortugalProf. Andreas Konstantopoulos during his speech at the 5th Congress of theSlovenian Paediatric SocietyPicture from the EPA/UNPESA booth at the 11th Congress of SPP in Funchal,Portugal19

Calendar of Events202011The 15th Congress of pediatricians of Russia“Actual problems of pediatrics”RUSSIA, Moscow, 14-17 February, 20111st Global Congress for Consensus inPediatrics and Child HealthFRANCE, Paris, 17 - 20 February 201111. Jahrestagung der Gesellschaft furPaediatrische SportmedizinGERMANY, Munich, 18 - 20 February 20112011 Neonatal Ultrasound CourseWhy, how and when an ultrasound image?ITALY, Florence, 14-17 March 201111th Congress of the European Society ofMagnetic Resonance in Neuropaediatrics –ESMRNNETHERLANDS, Amsterdam,24 - 26 March 2011Royal College of Paediatrics and ChildHealthAnnual Conference 2011UK, Warwick, 5-7 April 201137. Jahrestagung der Gesellschaft fürNeuropädiatrieGERMANY, Munich, 7 - 10 April 201133rd UMEMPS Congress &13th Congress of Jordanian Pediatric SocietyJORDAN, Amman, 4-7 May 201112th International Congress of PediatricLaboratory Medicine –ICPLMGERMANY, Berlin, 13 - 15 May 201122nd International Congress of the EuropeanSociety of Pediatric Intensive Care –ESPNICGERMANY, Hannover, 25 - 28 May 201129th Annual Meeting of the European SocietyforPaediatric Infectious Diseases –ESPIDNETHERLANDS, Hague, 7 - 11 June 201116th Congress of the European Union forSchool and University Health and Medicine(EUSUHM-2011)RUSSIA, Moscow, 9 - 11 June 201149th Panhellenic Congress of PaediatricsGREECE, Costa Navarino, Messinia,10 - 12 June 2011European Society for DevelopmentalPerinatal & Paediatric Pharmacology - ESDP2011NORWAY, Oslo, 15 - 17 June 201112th European Congress of PaediatricSurgery –EUPSASPAIN, Barcelona, 15 - 18 June 201123rd Congress of the InternationalAssociation of Paediatric Dentistry –IAPDGREECE, Athens, 15 - 18 June 201158th Annual International Congress of theBritish Association of Paediatric Surgeons–BAPSUK, Belfast, 19 - 22 June 20115th Europaediatrics 2011AUSTRIA, Vienna 23 - 26 June 20117th European Meeting of the InternationalSociety for Neonatal Screening –ISNSSWITZERLAND, Geneva, 28 - 30 August 20112nd International Signa Vitae Conference inPediatric / Neonatal Intensive Care andAnesthesiologyCROATIA, Split, 2 September 2011Excellence in Child Mental HealthTURKEY, Istanbul, 1 - 3 December 2011Excellence in PaediatricsTURKEY, Istanbul, 1 - 3 December 2011

21List of MemberCountriesAlbaniaAlbanian Pediatric SocietyArmeniaArmenian Association of PediatricsAustriaOesterrechische Gesellschaft fur Kinder-und Jugendheilkunde(OEGKJ)BelgiumSociete Belge de Pédiatrie/Belgische Vereiniging voorKindergeneeskundeBosnia and HerzegovinaPediatric Society of Bosnia and HerzegovinaBulgariaBulgarian Pediatric AssociationCroatiaCroatian Pediatric SocietyCyprusCypriot Pediatric SocietyCzech RepublicCzech National Pediatric SocietyDenmarkDansk Paediatrisc SelskabEstoniaEstonian Pediatric AssociationFinlandFinnish Pediatric SocietyFranceSociété Française de PédiatrieGeorgiaGeorgian Pediatric AssociationGermanyDeutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ)GreeceHellenic Paediatric SocietyHungaryHungarian Pediatric AssociationIrelandRoyal College of Physicians of Ireland/Faculty of PaediatricsIsraelIsraeli Pediatric AssociationItalySocietà Italiana di PediatriaLatviaLatvijas Pediatru AsociacijaLithuaniaLithuanian Paediatric SocietyLuxembourgSociété Luxembourgeoise de PédiatrieMacedoniaPediatric Society of MacedoniaMoldovaMoldovan Paediatric SocietyThe NetherlandsNederlandse Vereninging voor KindergeneeskundePolandPolskie Towarzystwo PediatrycznePortugalSociedade Portuguesa de PediatriaRomaniaSocietatea Română de PediatrieSocietatea Romana de Pediatrie SocialaRussiaThe Union of Paediatricians of RussiaSerbia and MontenegroPaediatric Association of Serbia and MontenegroSlovakiaSlovenska Pediatricka SpolocnostSloveniaSlovenian Paediatric SocietySpainAsociación Española de PediatríaSwedenSvenska BarnlakarforeningenSwitzerlandSociété Suisse de Pédiatrie/Schweizerische Gesellschaft für PadiatrieTurkeyTürk Pediatri KurumuUkraineUkraine Pediatric AssociationUnited KingdomRoyal College of Paediatrics and Child HealthRoll over your mouse to visit the websites of the NationalAssociations.Visit www.epa-unepsa.org for contact information for each memberorganisation.

EPA Newsletter issue 8Newsletter of the European Paediatric Association (EPA/UNEPSA)Editor: Prof. Manuel MoyaPublicationEPA/UNEPSA CouncilPresidentProf. Andreas KonstantopoulosSecretary GeneralProf. Massimo Pettoello-MantovaniVice PresidentProf. Alexander BaranovVice PresidentProf. Manuel MoyaCouncilorsProf. Fügen Çullu ÇokuğraşProf. László SzabóTreasurerProf. Jochen EhrichPast PresidentProf. Armido RubinoPresident of 5th EuropaediatricsProf. Dr. Wilhelm KaulferschEPA/UNEPSA website: www.epa-unepsa.orgEPA/UNEPSA Account Manager: Lefteris AivaliotisContact information: epa-unepsa@candc-group.com© 2010 All rights reserved by the European Paediatric Association (EPA/UNEPSA)www.epa-unepsa.org22 20“We would appreciate your feedback, keeping our newsletter updated!Please send us your news, proposals or comments atepa-unepsa@candc-group.com”