Approaches to the diagnosis, prevention, and treatment of chronic conditions in childhood and adolescence have changed greatly with greater survival of most children, even with severe conditions. Thus, for most children, new issues include preparation for adulthood rather than expectation of early death. Community pediatricians have increasing numbers of children with chronic conditions in their practices and thereby face new challenges in the care of these children and their families. Advances in molecular biology and genetics will lead to more effective ways to identify and treat many conditions. At the same time, children and adolescents face a great rise in new epidemics of chronic conditions, with marked increases in obesity, asthma, Type 2 diabetes, mental health conditions (especially ADHD and depression). This session will examine new advances in the biology of chronic conditions, important changes in epidemiology, consideration of important outcomes for children and adolescents with chronic conditions, and new efforts to improve their pediatric care.

Overview

New Morbidities: Clinical and Social Changes in Childhood Chronic Conditions
James M. Perrin, Mass General Hospital for Children, Harvard Medical School, Boston, MA

Prospects for New Treatments
Alan B. Ezekowitz, Massachusetts General Hospital, Boston, MA

Improving the Care of Children with Chronic Illness
Carole M. Lannon, AAP liaison, National Initiative for Children's Helathcare Quality, University of North Carolina, Chapel Hill, NC

Outcomes of Chronic Conditions: What Should We Measure?
Ruth E. K. Stein, Albert Einstein College of Medicine/Children's Hospital of Montefiore, Bronx, NY

This 3-hour minicourse will help the primary and subspecialty care providers understand better the changing field of diabetes mellitus: its pathophysiology, epidemiology, and advances in management. The availability of new treatments and devices for the care of patients with Type I diabetes has changed dramatically over the past decade. The rising prevalence of Type 2 diabetes, closely linked to the obesity epidemic, is bringing a formerly "adult" disease into the pediatricians' offices. This minicourse will provide an overview of four pertinent areas, by speakers who are leaders in the field.

Cell Biology of Human Pancreatic Islets
Alberto Hayek, University of California San Diego Medical School, La Jolla, CA

Islet Transplantation in Humans: 2001 and Beyond
R. Paul Robertson, Pacific Northwest Research Institute, Seattle, WA

BREAK

Type 2 Diabetes in Childhood and Adolescence
Francine R. Kaufman, Children's Hospital of Los Angeles, USC School of Medicine, Los Angeles, CA

Advances in molecular genetics, in our understanding of the origin of metabolic diseases and in imaging techniques are all having a major impact on perinatal medicine. The role of these new insights and interventions is no greater anywhere than their impact on the care of the fetus. This symposium will review these advances from the point of "The Fetus as the Patient." We will present new data demonstrating maternal-fetal chimerism and the role of this phenomenon in various pathobiologies. Advanced fetoscopic imaging techniques and the ways they can support new fetal therapies will be presented. Molecular diagnosis of genetic metabolic disorders can now be made prenatally to allow earlier fetal treatment and improvement in outcomes.

Overview
James F. Padbury, Women & Infants Hospital of Rhode Island, Brown University, Providence, RI

Bidirectional Feto-Maternal Cell Trafficking: Relevance for Pediatric and Adult Disorders
Diana W. Bianchi, Tufts University, New England Medical Center, Boston, MA

Fetal Surgery: In Praise of Tunnel Vision
Francois Luks, Brown University School of Medicine, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI

Genetic Metabolic Disorders: Current Status of Prenatal Diagnosis and Treatment
Mark Korson, Tufts University, New England Medical Center, Boston, MA

Discussion

This session will provide important new mechanistic information about the maternal, placental and fetal influences on certain adult onset diseases. Investigators undertaking studies that are on the cutting edge will provide an overview and share some of their recent experimental results during this session. The first lecture will concentrate on maternal health and its role on adult onset diseases; the second lecture will delineate the role of placental factors; while the third session will detail fetal origins of adult hypertensive disease.

Overview
Sherin U. Devaskar, Mattel Children's Hospital, University of California, Los Angeles, CA

Maternal Health and Its Influence on Adult Onset Diseases
Judith G. Hall, University of British Columbia, Vancouver, Canada

The Placenta Dilemma
Susan Fisher, University of California, San Francisco, CA

Fetal Origins of Adult Hypertension
Susan Bagby, Oregon Health Sciences University, Portland, OR

Discussion

It has long been hypothesized that tumor expansion is dependent on the growth of new blood vessels. Recently, a new understanding of the molecular mechanisms of vascular development and growth has been achieved and has suggested new targets for cancer treatment. This program will clarify the role of novel growth factors in vascular development and tumor growth and review the novel strategies currently being developed to interfere with tumor growth.

Cellular Interactions During Vascular Development
Patricia A. D'Amore, Schepens Eye Research Institute, Harvard Medical School, Boston, MA

Angiopoietins and the Regulation of Vascular Growth
Jocelyn Holash, Regeneron Pharmaceuticals, Tarrytown, NY

Tumor Angiogenesis at the Cellular Level
Lance Munn, Massachusetts General Hospital, Boston, MA

Hormones regulate critical biological functions including neurologic growth, sexual differentiation, and organ maturation, through intricate signaling mechanisms. Pregnant women, infants, and children are increasingly exposed to chemicals in the environment that mimic or block hormones, often at very small doses. Exposure to these endocrine disruptors occurs at home, in the workplace and the community, and even as a consequence of medical care. This session will review the growing evidence of adverse health effects due to exposure to endocrine disruptors and discuss new research efforts that will help fill in the gaps in our knowledge in this area.

Overview
Philip John Landrigan, Center for Children's Health & the Environment, Mt. Sinai School of Medicine, New York, NY

Evidence of Endocrine Disruption: Lessons from Wildlife
Louis Guillette, University of Florida, Gainesville, FL, University of Florida, Gainesville, FL

NHANES: A Rich Source of National Pediatric and Adolescent Exposure Data
Elaine Gunter, NHANES Laboratory, Centers for Disease Control & Prevention, Atlanta, GA

Biomarkers in Endocrine Disruptor Research
Cynthia F. Bearer, Case Western Reserve University, Cleveland, OH

Type 2 diabetes (DM2) is increasingly a pediatric disease, especially among minority youth. While there is extensive patient educational material available for adults, there is very limited information oriented toward youth. As a consequence, patient and family education for youth with DM2 is often haphazard - with the physician and diabetes educator being forced to select from materials that are behaviorally or intellectually inappropriate. For example, adult education literature focuses on avoiding long-term sequelae, like end stage renal disease; however, adolescents have a limited ability to undertake long-term planning and many have not yet been exposed to the important role of the kidneys.

In the workshop, an overview of contemporary educational material available for DM2 adults and a survey of DM2 materials used by pediatric diabetes specialist will be provided. Then, the participants will evaluate the style and content of 2 contemporary videotapes and 2 chapters from DM2 educational manuals. Finally, a roundtable discussion will be held to identify 8-10 key concepts to be communicated to youth with DM2, the format that would most effectively communicate these (e.g., manuals vs. videotapes) and potential barriers to translating concept into action.

Daniel E. Hale, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX

The Human Genome Project is impacting every aspect of medicine. Dr. Craig Venter, President of Celera Genomics, one of the chief architects of this venture, will discuss the accomplishments of the human genome project and implications for future impact on health and disease in this special one-hour state of the art lecture.

Sequencing the Human Genome
J. Craig Venter, President, Celera Genomics, Rockville, MD

Supported in part by an educational grant from the Columbus Children's Hospital, Columbus, OH

Advances in molecular genetics and high through-put analytical chemistry like tandem mass spectrometry (MS/MS) are enabling technologies that permit expanded newborn screening for presymptomic diagnosis of disorders not previously feasible. The prototype genetic disease for which newborn screening is now available is cystic fibrosis. The group of metabolic diseases that can now be diagnosed by MS/MS includes medium chain acyl-CoA dehydrogenase (MCAD) deficiency and related disorders of fatty acid oxidation. This symposium will address the issue of whether these diseases should be added to expanded newborn screening profiles. If so, what is the sensitivity and specificity of the currently available tests? If included in expanded screening programs, who should do the testing and how? What are the implications for genetic counseling? Should any of the new approaches be adapted to preconceptual testing? What important policy issues are created by this new capacity? There is substantial variation among states currently on screening programs. Should there be national guidelines? Who should decide about expanded screening? How will these new tests be paid and by whom?

Overview
James F. Padbury, Women & Infants Hospital of Rhode Island, Brown University, Providence, RI

Newborn Screening for Cystic Fibrosis: An Opportunity To Give Every CF Patient a Healthy Start
Philip M. Farrell, Dean and Alfred Dorrance Daniels Professor on Diseases of Children, University of Wisconsin Medical School, Madison, WI

Tandem Mass Spectrometry and Expanded Newborn Screening
Charles R. Roe, Medical Director, Institute of Metabolic Diseases, Baylor University Medical Center, Dallas, TX

Public Policy Issues in Expanded Newborn Screening
Bradford L. Therrell, Director and Professor, National Newborn Screening and Genetics Resource Center, University of Texas Health Science Center, San Antonio, TX

Part One of this session will address emerging data concerning nitric oxide use in the NICU. Controversies, uses, abuses and treatment of the LBW infant and the child with acutely decompensated CLD will be discussed.

Part Two of this session will cover the expanding understanding of hyperinsulinemic neonatal hypoglycemia. Presentation, diagnosis, identification of focal versus diffuse hypersecretion and the results of tailored interventions will be discussed.

Expanded Uses of Nitric Oxide in the Neonate
John P. Kinsella, University of Colorado, Children's Hospital, Denver, CO

Roberta A. Ballard, University of Pennsylvania and Children's Hospital, Philadelphia, PA

Krisa P. Van Meurs, Stanford University School of Medicine, Stanford, CA