REGISTRATION FORM                                                                7th Annual Regional Neonatology Symposium:
________________________________________________________________________   ENHANCING THE MANAGEMENT OF THE
First Name                   MI            Last Name
                                                                                   HIGH RISK INFANT
Last 4 digits of Soc Sec # (for transcript purposes) Credentials
________________________________________________________________________   Friday, October 28, 2011
Employer                                   Employer County
                                                                           11:30 am – 6:30 pm
Job Title                                  Department                      Renaissance Charlotte Suites Hotel
                                                                           2800 Coliseum Centre Drive
________________________________________________________________________   Charlotte, North Carolina 28217
Address (❏ Home ❏ Work)
City                         State         Zip Code
Work Phone Number            Home Phone Number
Fax Number                   Email Address

Registration Fee: $35.00

Event #: 33678
Payment Options:
❏ Check enclosed (make checks payable to Charlotte AHEC)
❏ Visa       ❏ MasterCard      ❏ Discover        ❏ American Express)
Credit Card # or CHS Bus. Unit/Dept. #     Exp. Date
Cardholder’s Signature or Dept. Head Signature

Mail Form and Payment to:
Charlotte AHEC - ATTN: Registrar
PO Box 32861 • Charlotte, NC 28232-2861
or Fax form to 704.512.6561
You may register online at www.charlotteahec.org

                                                                                                             Sponsored by
                                                                             Carolinas HealthCare System, Charlotte AHEC Continuing Medical Education (CME)
                                                                                          Levine Children’s Hospital, Department of Neonatology
PROGRAM DESCRIPTION                                                                     AGENDA
This program focuses on evaluating the evidence and discussing potential practice       11:30 a.m.       Registration
changes related to the high risk infant.                                                12:00 p.m.       Buffet Lunch
                                                                                        1:00 p.m.        Transfusion Related Gut Injury After PRBC Transfusion
OBJECTIVES                                                                                               Edmund LaGamma, MD
At the end of this symposium, participants should be able to:                           2:00 p.m.        Nutritional Issues Associated with Short Bowel Syndrome
• Evaluate the bene ts and risks associated with nutritional management of the infant                    Samuel A. Kocoshis, MD
  with Short Gut Syndrome                                                               3:00 p.m.        Break
• Discuss the evidence surrounding transfusion related acute gut injury                 3:30 p.m.        Infection and the Preterm Brain
• Review the long-term e ects of intraventricular hemorrhage (IVH) in the premature                      Michael O'Shea, MD
                                                                                        4:30 p.m.        Long Terms E ects of IVH
• Discuss potential outcomes related to infection and the preterm brain
                                                                                                         Michael O'Shea, MD
                                                                                        5:30 p.m.        Reception
Neonatologists, Neonatal Nurse Practitioners, Neonatal Nurses, Neonatal Respiratory
                                                                                                                    SYMPOSIUM LOCATION
FACULTY                                                                                    The Renaissance Charlotte Suites is conveniently located in the heart of Charlotte
                                                                                                and easily accessible from the Charlotte/Douglas International Airport.
Samuel Kocoshis, MD
Medical Director, Pediatric Nutrition and Intestinal Care Center
                                                                                           A complimentary shuttle from the airport is available simply by calling the hotel’s
Medical Director, Small Bowel Transplantation Program                                                                         front desk.
Professor of Pediatrics, Cincinnati Children's Hospital
Cincinnati, Ohio
Edmund LaGamma, MD
Chief, Division of Newborn Medicine                                                     Carolinas HealthCare System, Charlotte Area Health Education Center is the continuing
Director, Neonatal-Perinatal Fellowship Program                                         education provider for this activity.
Professor of Pediatrics, Biochemistry & Molecular Biology                               ACCREDITATION STATEMENT
The Regional Neonatal Center-Maria Fareri Children's Hospital-                          This activity has been planned and implemented in accordance with the Essential
Westchester Medical Center, New York Medical College                                    Areas and policies of the Accreditation Council for Continuing Medical Education
Valhalla, New York                                                                      (ACCME) through the direct sponsorship of Carolinas HealthCare System/Charlotte
Michael O'Shea, MD                                                                      AHEC. The Carolinas HealthCare System/Charlotte AHEC is accredited by the ACCME to
Vice Chair, Pediatrics                                                                  provide continuing medical education for physicians.
Professor, Pediatrics, Hypertension and Vascular Research Center
Epidemiology & Prevention, Social Sciences & Health Policy                              CREDIT DESIGNATION STATEMENT
Wake Forest Baptist Medical Center                                                      The Carolinas HealthCare System/Charlotte AHEC designates this Live Activity for a
Winston-Salem, North Carolina                                                           maximum of 4.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the
                                                                                        credit commensurate with the extent of their participation in this activity. Other
PROGRAM COORDINATORS                                                                    healthcare professionals 0.4 CEUs.
                                                                                        POLICY ON FACULTY AND SPONSOR DISCLOSURE
Thomas Kueser, MD                                Jay M. Kothadia, MD                    The Carolinas HealthCare System/Charlotte AHEC adheres to the ACCME Standards
Division of Neonatology                          Neonatal-Perinatal Medicine
                                                                                        regarding industry support of continuing medical education. Disclosure of faculty and
CMC-Levine Children's Hospital                   Pediatrix Medical Group
Charlotte, North Carolina                                                               commercial support relationships, if any, will be made known at the activity.
Pam Spivey, MSN, RN, CCNS                                                               ADA STATEMENT
Neonatal Clinical Nurse Specialist                                                      If you need any auxiliary aids or services identi ed in the American with
CMC-Levine Children's Hospital                                                          Disabilities Act in order to attend this conference, please call Gabriela Staley at
Charlotte, North Carolina                                                               704.512.6596 or by email at gabriela.staley@carolinashealthcare.org.

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