Discipline - Pediatrics I - National Institute for Mother and Child Health "Alessandrescu-Rusescu"

Associate Professor Ciomartan Tatiana, PhD tenured
Associate Professor Popp Alina-Mihaela, PhD tenured
Head of works Stan Iustina Violeta, PhD tenured
Head of works Brezan Florin-Nicolaie, PhD tenured
Head of works Ritivoiu Mirela-Elena, PhD tenured
Assistant Professor Codreanu Ioana Florentina, PhD tenured
Assistant Professor Balanescu Anca, PhD tenured
Assistant Professor Tudor Lucia Maria, PhD fixed term

The discipline of Pediatrics I and II operates within the "Alessandrescu-Rusescu" National Institute for Maternal and Child Health, an institute of reference in the field of mother and child health. The institute could be proud of its notable results over the course of more than half a century, in the areas of pediatrics, neonatology, obstetrics-gynecology and medical research.

The Pediatrics I and II Clinics have worked in the Institute since 1958, when the actual department of Pediatrics was called ’Emilia Irza’ Children Hospital. ’Emilia Irza’ was considered the cradle of the university education in the pediatrics discipline in the modern era of ’Carol Davila’ University of Medicine and Pharmacy, because the vast majority of pediatrics professors of that time were trained in this hospital, under the guidance of the Romanian Pediatrics esteem – Prof. Dr. Alfred Rusescu, Prof. Dr. Răzvan Prişcu, Prof. Dr. Valeriu Popescu şi Prof. Dr. Mircea Maiorescu.

Among the trainees of the four main figures, there are outstanding teachers, such as Prof Dr. Eugeniu Pascal Ciofu, former dean and vice-rector of "Carol Davila" University of Medicine and Pharmacy – head of Pediatrics Discipline in the ’Grigore Alexandrescu’ Central Clinical Hospital for Children, Prof. Dr. Adrian Georgescu - manager of IOMC and head of Discipline of Pediatrics I, Prof. Dr. Florea Iordăchescu - manager of the ’M. S. Curie’ Emergency Clinical Hospital and head of pediatrics discipline from this hospital., Prof. Dr. Ioan Gherghina, head of discipline II Pediatrics IOMC, Prof Dr. Constantin Arion, vice-rector UMF and head of pediatrics discipline from the Fundeni Institute, as well as Prof. Dr. Dimitrie Dragomir – head of pediatrics discipline in the "Victor Gomoiu" Clinical Hospital.

The discipline of Pediatrics I prides itself with the professional activity of Professor Dr, Adrian Georgescu, manager of IOMC for more than 16 years, and head of the discipline of Pediatrics I until 2003, mentor to many generations of students, residents, PhD, the coordinator of the Pediatrics Compendium (that has reached the third edition) but also with the activity of Professor Dr. Ioana Alina Anca.

Professor Dr. Ioana Alina Anca managed the Discipline I in the period of October 2003- June2015. In addition to the activity of Professor in Pediatrics, she was also a founding member of the Group of Pediatric Cardiology, a pioneer in the Romanian pediatric ecography (unique author of  the book titled ‘ultrasound in neonates and infants – practical approach’), coordinator of numerous postgraduate courses, senior member of the Institute’s scientific research team. She claimed universitary courses, mentored the practical training and managed the undergraduate studies of many generations of students, proving to be an exceptional teacher, with outstanding qualities to share knowledge and with a proper and protective attitude towards the young disciples.

Associate Professor Dr. Tatiana Ciomârtan, the current head of the Discipline I Pediatrics, began her professional career under the guidance of Prof. Dr. Răzvan Prişcu, Prof. Dr. Adrian Georgescu, Dr. Octavian Rusu and the team of academic staff and eminent physicians of the Institute. From them, she had the privilege to agnowledge the theoretical notions and practical skills, as well as the love for newborns and children for whom she cared for over 25 years. Multiple internships abroad (Japan, Mexico, Great Britain, USA etc) in the field of Pediatrics, Neonatology and Pediatric Intensive Therapy, have opened new horizons and challenged her to strive for the initiation of Pediatric subspecialisation in Romania. The activity of medical, didactic and research assistance of the Pediatrics I Discipline team is intended to be a a normal continuation of its rich tradition.

In the Institute there were developed areas of high expertise in pioneering such as initiating national program of screening for hereditary diseases. Since 1975, in the Institute came the first structures that allowed the development of the current national program of screening for phenylketonuria and congenital hypothyroidism – even now tens of thousands of newborns in all counties in southern Romania continue to benefit from the work of the screening laboratory and of the Center of Excellence in maternal-fetal medicine. The cabinet of Genetics of the Institute has long been coordinated by Dr. Emil Tomescu, one of the most important Romanian experts in cystic fibrosis and pioneer in the pediatric genetics in our country.

Besides the academic valences of the hospital, we should also mention the elements of pioneering in drafting protocols and guides of practice, with the Institute Methodological Letters being the most significant before 1989 and forming the basis of the guidance and control work in the field of Pediatrics in Romania. Currently, the Institute is the methodological and technical body of the Ministry of Health in the field of women and children health, it is involved in the education for health and it is the coordinator of national programmes for mother and children health.

The Institute participated and still participates substantially in research activity and development of Guidelines for Growth and Development of Children, as well in developing the Practice Guidelines of the National Society of Pediatrics. The Institute is known as one of the highest medical education units that offer medical asisstance in hospital units and ambulatory; It is known as a unit of high medical educaton (obstetrics-gynecology, neonatology and pediatrics), center of specialisation and postgraduate education but also an education center for nursing staff. The scientific research ( in the field of mother and children health) is a major objective of the Institute’s activity. Dozens of clinical studies have been conducted in the Institute in various pediaric areas – studies of antibiotic therapy, vaccinology, studies at asthma patients, cystic fibrosis patients and at patients with other pediatric respiratory diseases, studies in the imunology area, pediatric rheumatology, studies regarding techniques of pediatric imaging. Thus, it has accumulated valuable expertise.

In the discipline of Pediatrics 1, the practical works are conducted in the intensive care unit, the clinical unit of Pediatrics I, the clinical unit of Pediatrics II, the emergency room and in the pediatric ultrasound room.

Pediatrics curriculum for medical students, Discipline Pediatrics I INSMC, Check list of the practical work activities

  1. Medical history and communication
    • Reasons of presentation
    • History of actual disease
    • Personal pathological history
    • Personal physiological history
    • History of the development
    • History of nutrition
    • History centered on organs and systems
    • Family history
    • Social aspect
  1. Clinical examination
    Differences in performing the clinical examination at children and adults
    • General approach
    • Vital functions
  1. Pediatric clinical examinaton
    • General
    • Teguments and ganglia system
    • Head
    • Eyes
    • Years
    • Nose
    • Oral cavity, pharynx
    • Throat
    • Thorax / Lung
    • Cardio-vasculary
    • Abdomen
    • Osteo-muscular systemm
    • Nervous system – usually performed by observing the children
    • Genito-urinary

Recognizing and treating the sick child

  • Prioritizing care for a sick child;
  • Use of a systematic approach (ABCDE)in assisting a sick child;
  • Demonstrate the ability to perform basic management of the airway;
  • Perform cardiopulmonary resuscitation – appropiate maneuvers for the age of the patient;
  • Realizing the moment when in need and knowing how to obtain help;
  • Calculaton of scores for early diagnosis of deterioration of a child’s health;
  • Use of early diagnosis scores for identifying deterioration of a child’s health;

Common/serious ways of debut for some illnesses
Identification, in different contexts (primary care, ambulatory), of:

  • Key elements of anamnesis,
  • Key elements of the clinical examination,
  • signs of seriousness,
  • differential diagnoses,
  • initial investigations,
  • initial treatment,
  • existence of national clinic guidelines (where applicable)

For the ways of debut, the student must demonstrate the ability to:

  • identify the clinical sign of debut
  • perform an initial evaluation of the child,
  • initiate a basic treatment,
  • seek help when necessary.

Writing of medical prescriptions

  • Writing recipes based on age, body weight and body surface area of the child,
  • Identifying the most common prescribing errors at children,
  • Emphasizing differences in drug metabolism at infants, children and adults,
  • Identifying the main tools for ensuring safe prescription at children (hospital’s pharmacist, books such as "Takamoto"),
  • Identifying appropiate resources for cases of poisoning (ToxApel etc),
  • Writing a secure, accurate and legal prescription for a child using Takemoto or local or national guidelines for various medications.

Practical procedures / investigation

  • Identifying the main challenges to perform practical procedures at children,
  • Describing the techniques of performing the practical procedures at children (e.g. distractions, play therapy, local anesthetics),
  • Describing the utility of performing the practical procedures at children,
  • Interpreting the laboratory tests used commonly at children,
  • Interpreting the gasometer at children,
  • Interpreting the thorax X-rays at children;

Describing the principles (not to do practically):

  • Of the aseptic techniques to perform practical procedures at children,
  • Of the procedures used frequently in infants (e.g. blood sampling from the heel in infants)

Physiological events, growth and development

  • Describing psysiological influences on normal growth in childhood,
  • Identifying the main physiological changes from birth to adulthood,
  • Describing the healthy child’s alimentation and healthy eating behaviour from birth to adulthood,
  • Describing normal behaviour from birth to adulthood,
  • Describing the main procurement of child development between 0 and 5 years,
  • Describing the principles of the immunization scheme of children from Romania,
  • Describing the main schemes of prevention from rickets;

Abuse prevention in children

  • Listing the risk factors for child abuse,
  • Defining the main types of child abuse,
  • Describing the symptoms, signs and signs of seriousness of abuse at children,
  • Identifying the procedure of lifting suspicion of abuse at children,
  • Identifiying the duty of every medical personnel to report any suspicion of abuse at children;

legal and ethical bases of child health

  • Explaining the principles of obtaining medical consent at child and youth,
  • Describing the principles of confidentiality regarding children and youth– see the bioethics courses for students - http://www.eticamedicala.ro/,
  • Explaining the parental responsibility over a child ( and who are the people that can have it),
  • Identifying the ethical and legal dilemmas in Pediatrics;

Public health/ global health

  • Explaining the concepts of reportable diseases,
  • Identifying the national sources of information regarding the reportable diseases,
  • Describing the social and environmental determinants for health child in Romania and in the world,
  • Listing some of the special needs of health at vulnerable groups in Pediatrics (e.g. children from broken families, with low socio-economical level, refugees);

Good governance, patient safety and good practice

  • Explaining the importance of patient safety in relation to child health,
  • Describing the opportunities of improving the patient safety in Pediatrics (e.g. learning from critical incidents and accidents prevented at the last moment, projects of improvement of the quality of medical assistance in Pediatrics),
  • Describing the importance of lifting suspicion when the safety of the patient may be compromised,
  • Demonstrating the willingness to improve continuously the knowledge, reflection and learning (including families),
  • Demonstrating the capacity to perform a basic bibliographic research to answer a clinical question in Pediatrics;

Attitude/behaviour

General principles of child health for medical students:

  • Children are not a reason to be scared,
  • Children are different from adults,
  • The health and welfare of children are important to all doctors,
  • The multidisciplinary approach is a vital component of pediatric practice.

* child – meand newborn,infant, child or young.

Bibliography for students

  • Compedium of Pediatrics 3’rd edition, Georgescu A, Anca IA, 2009
  • Nelson’s Textbook of Pediatrics, ed 17, 2015
  • Cloherty Manual of Neonatal Care, ed 2012

Optional courses for students

  1. Shaking baby syndrome – diagnosis, prophylaxis and treatment, academic staff: Associate Professor. Tatiana CiomAcrtan, Assitant Lecturer Dr. Anca Lădaru
  2. Inhalation therapy at children, academic staff: Assistant Lecturer Iustina Stan
  3. Pediatric ecography, general notions, academic staff: Assistant Lecturer Dr. Beata Acs, Asistant Lecturer Dr. Mirela Ritivoiu

Subdomains of interest for research activity

  • Bronchial asthma,
  • cystic fibrosis,
  • neonatal sepsis,
  • prematurity,
  • retinopathy of prematurity,
  • celiac disease,
  • neonatal screening
  • bronchial asthma
  • cystic fibrosis
  • neonatal sepsis
  • prematurity
  • retinopathy of prematurity
  • celiac disease
  • neonatal screening
  1. Joint Action on Nutrition and Physical Activity – project financed from European funds, initiated in 2015.
  2. Safety and tolerability of products from oatmeal enriched in calcium and iron, in gluten free diet. Partnership programmes ANCS/UEFISCDI. Finance contract 111/2012. Coordinator : Dr. ing. Denisa Duta. Institute of Food Bioresources. On course.
  3. Prospective Celiac Disease Diagnosis Evaluation. ProCeDe DRKS00003555/2012. Coordinator: Prof. Sibylle Koletzko, Ludwig-Maximilians-University of Munich, Germany. Finished.
  4. Improvement in coeliac disease diagnostic. Prognostic value and disease specificity of early diagnosis markers. A Finish-Romanian multicentric collaborative study. Finnish- Romanian Project on Celiac Disease 20534/2011. Coordinator: Prof. Markku Maki. University of Tampere, Finland. On course.
  5. "Clinical and anatomo-pathological study of nephritic syndrome at children: evaluation of etiology and early therapeutic conduct", finance contract nr 4182/2006, National Programme for Excelence Research, CEEX project. Finished
  1. Tatiana Ciomartan - „Arginine vasopressin plasma levels could indicate children undergoing cardiopulmonary bypass that might benefit from exogenous arginine vasopressin" – published in Critical Care Medicine 2010; Oct;38(10):2079-81. ISSN: 0090-3493. Impact factor 6,147
  2. Tatiana Ciomartan - "The n-3 polyunsaturated fatty acids – another option in the management of persistent pulmonary hypertension of the newborn?" – published in Critical Care Medicine 2011; Iun;39(6):1587-9. ISSN: 0090-3493. Impact factor 6,147
  3. Tatiana Ciomartan - "Telemedicine — A useful adjunct in the care of critically ill children" – published in Critical Care Medicine 2012; Sept; 40(9):2731-2. ISSN: 0090-3493. Impact factor 6,147
  4. Tatiana Ciomartan - "Are We Any Closer to Predicting Outcomes of Pediatric Cardiac Arrest?" – published in Critical Care Medicine 2014; 42:753-4. ISSN: 0090-3493. Impact factor 6,147
  5. Tatiana Ciomartan - "What is the best fluid for volume resuscitation in critically ill adults with sepsis? The jury is still out, but a verdict is urgently needed…" – published in Critical Care Medicine 2014; 42 (7):1722-3. ISSN: 0090-3493. Impact factor 6,147
  6. Suciu N, Pop L, Panaitescu E, Suciu ID, Popp A, Anca I. Fetal and neonatal outcome in celiac disease. The Journal of Maternal-Fetal and Neonatal Medicine 2014;27:851-5.
  7. Taavela J, Popp A, Korponay-Szabo IR, Ene A, Vornanen M, Saavalainen P, Lähdeaho ML, Ruuska T, Laurila K, Parvan A, Anca I, Kurppa K, Mäki M.A prospective Study on the Usefulness of Duodenal bulb biopsies in celiac disease diagnosis in children: urging caution. Am J Gastroenterol 2016;111:124-33.
  8. Stan IV, Comanici V, Matei D, Craiu M –The family practitioner’s role in the management of patients with cystic fibrosis. Pneumologia 2013; 62(3):161-5. Indexed PubMed PMID 24274000
  9. Craiu M, Stan IV – The characteristics of severe asthma at little aged children in Romania. Pneumology 1/2014; 36-43.
  10. Protocols of diagnosis and treatment in Pediatrics – coordinator Prof. Dr. Nanulescu Mircea – Cystic fibrosis -Mosescu S, Stan IV; Ed. Almateea 2014: 327-332.
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