This session will be the initial venue for release of the proceedings from the current NHLBI Working Group. The Working Group, appointed by the National High Blood Pressure Education Program, is presently conducting an update of the national guidelines for the evaluation and management of hypertension in children and adolescents. Presentations will include reports on the results of a re-examination of the national childhood blood pressure data and the rationale for definition of hypertension in childhood. Speakers will also address the impact of obesity on pediatric hypertension, methods to detect and evaluate target organ damage due to hypertension, blood pressure instrumentation issues and new data on treatment of hypertension in the young, including both pharmacologic and non-pharmacologic treatments.

Definition of Hypertension with a Re-examination of the National Data on Blood Pressure in Children and Adolescents
Bonita E. Falkner, Thomas Jefferson University, Philadelphia, PA

Relationship Between Cardiovascular Risk Factors and Sequelae in Hypertensive Children
Elaine Urbina, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Pharmacologic and Non-pharmacologic Management of Childhood Hypertension
Joseph T. Flynn, Children's Hospital of Montefiore, Bronx, NY

Measuring Blood Pressure: The Truth Revealed
Bruce Z. Morgenstern, Mayo Clinic, Rochester, MN

Clinical investigation is an exciting area of pediatric research. This workshop will explore various aspects of clinical investigation including the concept of bias, the impact of recent HIPAA regulations and two current multi-center trials in nephrology.

Bias in Clinical Decision Making
Debbie Gipson, University of North Carolina, Chapel Hill, NC

HIPAA Regulatory Challenges to Clinical Research
Joanne Pollak, Johns Hopkins Medicine, Baltimore, MD

Focal and Segmental Glomerulosclerosis Multicenter Trial
Sandra L. Watkins, University of Washington/Children's Hospital, Seattle, WA

Chonic Kidney Disease Trial
Susan L. Furth, Johns Hopkins Hospital, Baltimore, MD

This mini course will set the stage for several discussions of particular issues of major importance and interest. What is "preparedness" and what are the real risks of continuing terrorism in the United States? What is the current status of preparedness in the U.S. hospital and public health systems? How do children differ from adults in terms of response to weapons of mass destruction (chemical, biological and radiological)? How do these differences matter in disaster planning? Are the needs of children being incorporated in local, state and federal disaster plans? Smallpox, anthrax and other biological threats: Where do we stand? What do we do? Nuclear power plants, nuclear weapons, dirty bombs and potassium iodide: What do we know? The mental health consequences of terrorism: What have we learned since 9/11, how do we prepare children for an increasingly vulnerable world, building resiliency and sustaining a positive vision. The new pediatric agenda: What do we have to teach students, residents and pediatricians about the pediatric aspects of terrorism planning. Children and exposure to weapons of mass destruction: science and the essential research agenda.

Introduction
Paul H. Saenger, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Welcome and Context
Irwin Redlener, National Center for Disaster Preparedness, Columbia University Mailman School of Public Health, New York, NY

Pediatric Preparedness for Terrorism and Disasters
David S. Markenson, Columbia University Mailman School of Public Health, New York, NY

Biological Weapons of Terror: What Pediatricians Need to Know
Theodore J. Cieslak, U.S. Army Research Institute of Infectious Diseases, Ft. Detrick, MD

Helping Children and Families Cope with Terrorism
David J. Schonfeld, Yale University School of Medicine, New Haven, CT

Radiologic Terrorism, Children and the Question of Potassium Iodide
Thomas P. Foley, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA

Chronic kidney failure usually progresses inexorably to end-stage disease. This symposium will consider new insights into the progression of CKD that can be gleaned from population-based studies of patients, analysis of clinical findings in those patients, and studies of the cell biology of progressive renal fibrosis. Advances in our understanding of disease mechanisms will offer opportunities for novel approaches to treatment.

Epidemiology of Chronic Kidney Disease in Children and Risk Factors for Progression
Susan L. Furth, Johns Hopkins Hospital, Baltimore, MD

New Markers of Progression in Chronic Kidney Disease
Kevin V. Lemley, Stanford University Medical Center, Stanford, CA

Molecular Pathophysiology of Renal Fibrosis
H. William Schnaper, Northwestern University, Chicago, IL

New Targets for Therapeutic Intervention
Allison A. Eddy, Children's Hospital and Regional Medical Center, Seattle, WA
 

Visit in February 2004 for the poster program schedules.
 

TLRs (Toll-like receptors) are a family of transmembrane germ line coded pattern recognition receptors that bind structural motifs common to pathogenic organisms. These structural motifs include endotoxin, products of gram+ organisms, fungi and mycobacteria, as well as DNA and RNA structures common to bacteria and virus but not mammalian cells. The TLRs are expressed by diverse cell types. TLR signaling initiates the innate immune/inflammatory host response to pathogens and also initiates antigen processing for acquired immunity.

Moshe Arditi will review the recent progress in understanding how children respond to pathogens. Maria Abreau will explore how immune signaling is central to both the maintenance of normal gut function and how chronic GI disease may develop. Christopher Karp will then explore how immune signaling relates to the hygiene hypothesis regarding the striking increase in the prevalence of both allergic and autoimmune diseases in children in Westernized countries over recent decades. The goal is to provide an update about newly described mechanisms signaling inflammation/immunity that are central to multiple homeostatic and disease processes in children.

Toll Like Receptors—Bridging Innate and Adaptive Immunity
Moshe Arditi, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA

TLR Signaling in the Gut in Health and Disease
Maria Abreu, Cedars-Sinai Medical Center / UCLA School of Medicine, Los Angeles, CA

Signaling the Hygiene Hypothesis
Christopher Karp, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Children who are victims of violent behavior or merely observers of violence may learn destructive or self-destructive patterns of behavior. Violence is a major public health problem. This symposium will focus on breaking the cycle of violence and will showcase speakers who are working on violence prevention in the pediatric emergency department, school and community. The speakers will demonstrate what can be done by physicians who see the importance of this issue and the ways in which we can make a difference.

Violence Prevention in Primary Care: Moving from Public Health to Private Practice
Robert D. Sege, Tufts-New England Medical Center, Boston, MA

Beyond Treat and Street: Violence Prevention in the Emergency Department
Joel Fein, The Children’s Hospital of Philadelphia, PA

Efforts in the Community
Sheryl A. Ryan, University of Rochester School of Medicine, Rochester, NY

The symposium will provide the state of the art approach to these two common and intimately related conditions. The session will start with discussion of the genetics and embryology of vesicoureteral reflux and their implications in its management. New observations on the modes of treatment and the imaging studies indicated in the infant and child with UTI will be addressed next. As those requiring long-term intervention are mostly children with vesicoureteral reflux, a pediatric urologist point of view of it will follow. Both, long-term medical and surgical management will be reviewed, and the new information on the use of non-surgical endoscopic intervention as a new tool to treat vesicoureteral reflux will be discussed. Finally, our increasing understanding of the role of bladder function and dysfunction in the development, progression and resolution of vesicoureteral reflux and urinary tract infections will be reviewed.

Vesicoureteral Reflux as a Developmental Disorder
Anthony Atala, Children's Hospital, Boston, MA

Acute Urinary Tract Infection—Evaluation and Treatment
Alejandro Hoberman, University of Pittsburgh School of Medicine, Pittsburgh, PA

Surgical and Non-surgical Management of Vesicoureteral Reflux
Linda Shortliffe, Stanford University, Stanford, CA

Dysfunctional Voiding
Seth L. Schulman, Children's Hospital of Philadelphia, Philadelphia, PA
 

Visit in February 2004 for the poster program schedules.
 

The National Children’s Study is a national prospective, longitudinal study of environmental effects, including physical, chemical, biological and psychosocial effects, on child health and development. The goal of the study is to improve the health and well-being of children. The study will examine these environmental effects on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. The study is led by a consortium of federal agency partners: the U.S. Department of Health and Human Services, including the National Institute of Child Health and Human Development (NICHD); the National Institute of Environmental Health Sciences (NIEHS); the Centers for Disease Control and Prevention (CDC); and the U.S. Environmental Protection Agency (EPA). For additional information, visit the website at http://www.nationalchildrensstudy.gov/.

The National Children’s Study—An Overview
Duane Alexander, NICHD, National Institutes of Health, Bethesda, MD

The National Children’s Study—Methods
Peter C. Scheidt, National Institutes of Health, Bethesda, MD

Children’s Health and Environmental Exposures: The Most Important Unanswered but Answerable Questions
Michael Weitzman, The AAP Center for Child Health Research at the University of Rochester, Rochester, NY

Despite the dramatic increase in patient and graft survival following solid organ transplantation over the past decade, complex and potent immunosuppressive regimens have led to significant complications. In this multidisciplinary symposium, the pathophysiology and therapy of infections, lymphoproliferative disease and growth abnormalities following solid organ transplantation will be reviewed. In addition, the problem of non-compliance with complex immunosuppressive regimens—a major cause of organ loss/dysfunction post transplantation—will be reviewed.

Infections Following Solid Organ Transplantation
Michael Green, University of Pittsburgh School of Medicine, Pittsburgh, PA

Post-transplant Lymphoproliferative Disease: Pathophysiology and Treatment
Vikas R. Dharnidharka, University of Florida Health Science Center, Gainesville, FL

Growth Disorders Following Solid Organ Transplantation
Leona Cuttler, Case Western Reserve University, Cleveland, OH

Compliance with Complex Medical Regimens Post-transplantation: Anticipatory Therapies
Robert Wells, Children's Hospital Central California, Fresno, CA

The application of imaging technologies to solving questions in biology and medicine is revolutionizing medicine by accelerating analyses in situ and in vivo and providing new perspectives on biological processes as diverse as development, neoplasia and injury repair. In this plenary session, three internationally recognized speakers will focus on developmental processes and discuss how these new imaging technologies are providing dynamic insights into the genetic and epigenetic mechanisms that underpin hematopoiesis and vascular development.

Introduction
Lisa M. Guay-Woodford, University of Alabama at Birmingham, Birmingham, AL

Dynamic Imaging of Fluid Forces in Developing Mouse Vasculature
Mary Dickinson, Beckman Institute–Caltech, Pasadena, CA

Microscopic Imaging of Angiogenesis
Donald M. McDonald, University of California, San Francisco, CA

Watching Hematopoietic Stem Cell Engraftment and Hematopoiesis in Living Animals
Christopher H. Contag, Stanford University School of Medicine, Stanford, CA

Questions from the audience
 

Visit in February 2004 for the abstract program schedules.
 

Diabetes mellitus (DM) affects about 17 million people in the United States and is the sixth leading cause of death. Type 1 DM, formerly known as juvenile onset or insulin-dependent diabetes, typically presents in the pediatric age group. The incidence/prevalence of type 2 DM, a disease once seen only in adults, has been rising steadily in children. Type 2 DM is strongly associated with obesity, inactivity, family history of diabetes, history of gestational diabetes and racial or ethnic background. Nephropathy is a serious complication of DM and is associated with significant morbidity and mortality. This symposium will focus on the epidemiology, pathophysiology and emerging therapies for this serious disease.

The Epidemic of Obesity in North American Children
Thomas N. Robinson, Stanford University School of Medicine, Palo Alto, CA

Insulin vs. Glucose in Diabetic Nephropathy
Roland Blantz, University of California at San Diego and VASDHCS, San Diego, CA

Anticipating and Preventing Cardiovascular Complications of Diabetes Mellitus
Rulan Parekh, Johns Hopkins University, Baltimore, MD

Potential Therapies for Diabetic Nephropathy
Tom Hostetter, National Institutes of Health, Bethesda, MD
 

Management of children on dialysis accounts for a significant portion of pediatric nephrology practice. This workshop is designed to provide an update for the practicing pediatric nephrologist in a number of areas pertinent to this therapy. Bruce Morgenstern will speak about measures to determine dialysis adequacy. Deepa Chand will give a talk on the difficult issue of vascular access in children. Bradley Warady will speak on new advances in the management of anemia and growth failure in children with renal disease. Finally, Timothy Bunchman will provide practical information on continuous venovenous replacement therapies.

Adequacy in Dialysis
Bruce Z. Morgenstern, Mayo Clinic, Rochester, MN

Vascular Access
Deepa H. Chand, The Children's Hospital, Cleveland, OH

Treatment of Anemia/Growth
Bradley A. Warady, The Children's Mercy Hospital, Kansas City, MO

Practical Considerations in CRRT
Timothy E. Bunchman, DeVos Children's Hospital, Grand Rapids, MI
 

Worldwide, more than 1,500 children per day become infected with HIV through mother-to-child transmission. Currently there are 2.7 million children living with HIV infection across the globe, >90% of whom reside in developing countries. While there have been enormous successes in the prevention and treatment of pediatric AIDS in the United States and Europe, it remains an open question as to how effectively these public health gains can be replicated in the poor countries of the world, which bear the greatest burden of disease. Efforts to develop an HIV vaccine appropriate for preventing infection among the world's children and adolescents are finally under way on a global scale. We will discuss these issues and accompanying controversies as they apply to the children of the developing world.

AIDS in Children—A Global Public Health Crisis
David L. Pugatch, Hasbro Children's Hospital and Brown Medical School, Providence, RI

Preventing Mother-to-Child Transmission of HIV in Developing Countries—Successes, Failures and Challenges
Catherine M. Wilfert, Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, CA and Washington, DC

HIV Treatment for Children—Can the Successes of Rich Countries Be Duplicated in Resource-Poor Settings?
Mark W. Kline, Baylor College of Medicine, Houston, TX

Finding an AIDS Vaccine That Works for the World's Children
Richard A. Koup, Vaccine Research Center, National Institutes of Health, Bethesda, MD

Although antihypertensive medications have been used in children for decades, until recently no antihypertensive medications had labeling for children less than 12 years of age. In response to the general absence of labeling information for children, the 1997 Food and Drug Administration Modernization Act was passed, which offered 6-month extension of market exclusivity in return for approved clinical trials of medications with pediatric indication. As the prevalence of hypertension in children has increased, the need for labeling information for antihypertensive medications in children has become more pressing. For these reasons, the FDA specifically targeted antihypertensive medications, and in response numerous clinical trials for these medications have been performed in children over the past 5 years. As a result of these trials, new information has come to light about the current epidemiology of pediatric hypertension, the impact of new guidelines for adult hypertension management for children and the ethics of pediatric hypertension clinical trials. This symposium will address these issues, as well as summarize the FDA perspective of the results of the FDAMA legislation to date.

Scope of the Problem of Juvenile Hypertension: Changing Epidemiology and Measurement Technology
Jonathan M. Sorof, UT-Houston Medical School, Houston, TX

FDA Perspective on FDAMA: Successes, Failures and Future Directions
Rosemary Roberts, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD

Recently Published Guidelines for Adult Hypertension and Their Implications for Children
Ronald J. Portman, UT-Houston, Medical School, Houston, TX

Ethical Controversies Generated by Pediatric Antihypertensive Trials: Risks, Benefits and Protection of Children
Joseph T. Flynn, Children's Hospital of Montefiore, Bronx, NY

As the medical profession moves forward to realize the vision of a family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent health care system it will be important to assure developmentally appropriate care for young adults with special health care needs. This workshop will explore the epidemiology, medical psychosocial implications and barriers to implementation of the transition from pediatric care to the adult system. Tools for the transition process will be presented.

The Scope of the Problem
Cheri W. Goldman, University of New Mexico Health Science Center, Albuquerque, NM

Pediatrician's Perspective on Transitioning
Stuart Goldstein, Baylor College of Medicine/Texas Children's Hospital, Houston, TX

Internist's Perspective on Transitioning
Richard S. Goldman, University of New Mexico Health Science Center, Albuquerque, NM

Bridging the Gap—Lessons Learned
Patience H. White, George Washington University School of Medicine, Washington, DC