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CALL FOR PAPER

ABSTRACT SUBMISSION DEADLINE 15 FEBRUARY 2016

FINAL
ANNOUNCEMENT
INDONESIAN PEDIATRIC
CRITICAL CARE FOUNDATION
In Collaboration With

UKK ERIA

PEDIATRIC EMERGENCY AND


INTENSIVE CARE WORKING GROUP
INDONESIAN PEDIATRIC SOCIETY
(UKK ERIA IDAI)
Endorsed By

CABANG JAWA BARAT

INDONESIAN PEDIATRIC SOCIETY


WEST JAVA BRANCH

8 INDONESIAN
proudly present and organized,

th

pr2

PRE SYMPOSIUM WORKSHOPS


Tuesday, 19 April 2016
Basic Mechanical Ventilation in Newborn Infants
Wednesday-Thursday, 20-21 April 2016
Sepsis Management in Pediatric: Update & Integrated
Approach
Fluid & Hemodynamic Management in Severe Dengue
Infection
Wednesday, 20 April 2016
Trilogy of Challenges in Improving Long Term Outcome
of Preterm Infants
Advanced Modes of Mechanical Ventilator in Children
Thursday, 21 April 2016
Integrated Course of Non-Invasive Ventilation in
Critically ill Neonates and Children

8th INDONESIAN PICU NICU UPDATE &


EXHIBITION
Friday - Saturday, 22 23 April 2016

POST-SYMPOSIUM WORKSHOP
Sunday, 24 April 2016
An Introduction Course on General Movements Method:
Early Detection of Newborn Infants at High Risk for
Developmental Disorder

PICU NICU
Update
with the theme

Fighting Infection
in Early Life &
Optimizing Long
Term Developmental
Outcome

The Trans Luxury


Hotel Bandung
19, 20-21, 22-23, 24
April 2016

WELCOME MESSAGE
Dear Colleagues,
Over the last few decades, the challenges faced by survivors at the early childhood are
discussed and their treatments have a direct impact on the developing brain and on the
quality of life of these children and their families. In the 8th Indonesian PICU NICU Update
22 23 April 2016 with the theme this year; Fighting Infection in Early Life & Optimizing
Long Term Developmental Outcomes, we present an outline for understanding systemic
interactions among the multiple factors that influence the childs development over time and
take into account contextual variables through the conceptual of trilogy: fighting infection,
adequate nutrition and brain monitoring, linking the developmental challenges associated
with each and strategies for optimizing cognitive available to meet these challenges. The 8th
Indonesian PICU NICU Update will be packed with innovative workshops in pre-settings on
19, 20-21 April 2016 and post-setting on 24 April 2016 at The Trans Luxury Hotel Bandung.
Organized by Indonesian Pediatric Critical Care Foundation - in collaboration with Pediatric
Emergency and Intensive Care (ERIA) Working Group/Indonesian Pediatric Society, and with
the endorsement of Indonesian Pediatric Society West Java Branch, the annually Indonesian
PICU NICU Update has been continuously kept Its work force to share Its leading clinical and
management practice innovations in the field of pediatric and neonates critical care to its
growing members. In Bandung as the venue place, a melting pot of art-deco cultures and
wide variety culinary, the combination of beauty of Paris van Java is something you should
not missed. We have prepared an exciting two days schedule for you to fully load up on
the latest information on neonatal and pediatric critical care with the expertise of leading
national and international figures.
The 8th Indonesian PICU NICU Update is the perfect opportunity to promote the art and
science of pediatric and neonatal intensive care, raising awareness amongst doctors and
other allied healthcare professionals in the field. We aim to provide plenty of opportunities to
interact and networking with each other.
We hope to see you again in Paris van Java this 2016!

Abdul Latief, dr, SpA K


President of the Indonesian Pediatric Critical Care Foundation
INDONESIAN PEDIATRIC CRITICAL CARE FOUNDATION

MANAGEMENT COMMITTEE
To achieve learning excellence, The Indonesian Pediatric Critical Care Foundation (Yayasan Pediatri
Gawat Darurat Indonesia) resources and expertises are set to make comprehensive range of
educational needs

FOUNDER
Abdul Latief
Antonius H. Pudjiadi
Dadang Hudaya Somasetia
Darlan Darwis
Dzulfikar Djalil Lukmanul Hakim
H. Munar Lubis
Novik Budi Wardhana
Silvia Triratna
Susetyo Harry Purwanto
CO-CHAIR
Yani Akhyar Kasim
Darlan Darwis
TRUSTEE
Susetyo Harry Purwanto
Dadang Hudaya Somasetia
Silvia Triratna
PRESIDENT
Abdul Latief
VICE-PRESIDENT
Antonius H. Pudjiadi
TREASURER

Eva Miranda Marwali

MEMBERS
Chairul Yoel
Dzulfikar Djalil Lukmanul Hakim
Novik Budi Wardhana
Ririe Fachrina Malisie
Irene Yuniar
Rismala Dewi
Nurnaningsih
Rinawati Rohsiswatmo
Risma Kerina Kaban
Lily Rundjan
Rosalina Dewi Roeslani
STRATEGIC TEAM
Abdul Latief
Antonius H. Pudjiadi
Ririe Fachrina Malisie
Rinawati Rohsiswatmo
Lily Rundjan

GENERAL INFORMATION
Event

PRE SYMPOSIUM WORKSHOPS

The 8th INDONESIAN PICU-NICU UPDATE

Tuesday, 19 April 2016

Theme

Basic Mechanical Ventilation in Newborn Infants

Wednesday-Thursday, 20-21 April 2016

Place

- Sepsis Management in Pediatric: Update & Integrated


Approach
- Fluid & Hemodynamic Management in Severe Dengue
Infection

The Trans Luxury Hotel - Bandung

Wednesday, 20 April 2016

Fighting Infection in Early Life & Optimizing Long Term


Developmental Outcomes

Organized By
Indonesian Pediatric Critical Care Foundation

Audience
Specialists in Neonates Intensivist Pediatric Intensivist;
Pediatric Respiralogy; Pediatric Hematology; Pediatric
Infectious Diseases; Pediatric Neurology; Pediatric
Nutrition & Metabolism; Pediatric Gastroenterology;
Pediatric Immunology; Pediatric Cardiology Pediatric
Surgery Pediatric Anesthesiologists
Trainee

- Trilogy of Challenges in Improving Long Term


Outcome of Preterm Infants
- Advanced Modes of Mechanical Ventilator in Children

Thursday, 21 April 2016

- Integrated Course of Non-Invasive Ventilation in Critically ill Neonates and Children


8th INDONESIAN PICU NICU UPDATE & EXHIBITION
Friday - Saturday, 22 23 April 2016

POST-SYMPOSIUM WORKSHOP
Sunday, 24 April 2016

An Introduction Course on General Movements Method:


Early Detection of Newborn Infants at High Risk for Developmental Disorder

ICU and Emergency Doctors


General Practitioners
Critical Care Nurses

Registration Secretariat & Mailing Address

Indonesian Pediatric Critical Care Foundation has chosen a cooperate organizer, who will ensure a smooth and
efficient management of the scientific exhibition, hotel
accommodation, registration management and other programs linked to the 8th Indonesian PICU NICU Update.
For any further information about these services, do not
hesitate to contact the Secretariat & Mailing Address:

c/o. Global Echo Organizer convex

Email
: secretariat@picunicu.org
Homepage : www.geoconvex.com
Registration & Accommodation:
Office Hours : 021.3149318 3149319
Mobile
: 0811.882080
Fax
: 021.3153392

Exhibition

The 8th Indonesian PICU NICU Update will host a scientific


exhibition on 22 23 April 2016 including the latest technology, equipment for clinical management & research
and literature.

Pre and Post Symposium Workshops

To emphasize the importance of this essential part of its


8th Indonesian PICU-NICU Update will organize intractable
two full days, which consist of scientific lectures, case studies and/or hands-on special design courses, as its pre-symposium workshop programs. The program will be held on
Tuesday - Thursday, 19 21 April 2016 (for Physicians only).
Also Post setting on 24 April 2016. See detail schedule.

Call For Papers

Participants are invited to submit Free Paper not later than


15 February 2016. The eligible presenters must be registered as Participant. Free Paper Committee will select the
eligible Abstract to be presented as Poster Presentation on
22 & 23 April 2016.

Official Language

The official languages of the 8th Indonesian PICU NICU


Update is in English & Indonesian. English will be used for
all printed materials, presentation along with overseas
speakers and discussions. Simultaneous translation will not
be provided.

Disclaimer

Every attempt will be made to present the program as


printed. However, Organizers and its agent reserve the
right to alter or cancel, without prior notice, any of the
arrangements, time tables, plans or other items relating directly or indirectly to the Scientific Meeting, for any cause
beyond its reasonable control. In the event of cancellation
of the Scientific Meeting, all pre-paid fees will be refunded
in full. The Organizers and its agent are not liable for any
loss or inconvenience caused as a result of such alteration
and cancellation.

PRE SYMPOSIUM WORKSHOPS


Pre Symposium Workshops, conducted by experts of Pediatric and Neonates will
update participants on the current state-of-art on developing participants skill and
technique in management of Pediatric & Neonates critically ill patients.
Certificate with IDI & CPD IDAI Accreditations (for General Practitioners and
Pediatricians) will be issued for all registrants.
Each workshop participants is limited to 60 upon payment made.
In the case that payment made after full seats, the registration made will be returned
to its payer bank account.

AGENDA
SYMPOSIUM &
EXHIBITION

PRE SYMPOSIUM WORKSHOPS


Tuesday
19 April16

Wednesday
20 April16

Trilogy of Challenges in
Improving Long Term
Outcome of Preterm
Infants*

Basic Mechanical
Ventilation in
Newborn Infants

Advanced Modes of
Mechanical Ventilator in
Children**

Thursday
21 April16

Friday
22 April16

Saturday
23 April16

Integrated Course
of Non-Invasive
Ventilation in
Critically ill Neonates
& Children***

Sepsis Management
in Pediatric: Update &
Integrated Approach
Day 1

Sepsis Management
in Pediatric: Update &
Integrated Approach
Day 2

Fluid & Hemodynamic


Management in Severe
Dengue Infection Day 1

Fluid & Hemodynamic


Management in Severe
Dengue Infection Day 2

The 8th Indonesian PICU


NICU Update & Exhibition

POST
SYMPOSIUM WORKSHOPS
Sunday, 24 April 2016

An Introduction Course on General


Movements Method: Early Detection
of Newborn Infants at High Risk for
Developmental Disorder

* Priority Registrants of Regular Course March 2016 Edition


** Compulsory Registrants after Basic Mechanical Ventilation in Critically ill Children Period 2011-2016
*** Compulsory Registrants after Trilogy of Challenges in Improving Long Term Outcome of Preterm Infants & Advanced Modes of Mechanical Ventilator in Children

ALL WORKSHOP PARTICIPANTS ARE COMPULSORY REGISTRANTS FOR


8th INDONESIAN PICU NICU UPATE 22-23 APRIL 2016

BASIC MECHANICAL VENTILATION


IN NEWBORN INFANTS
TUESDAY, 19 APRIL 2016

Grand Ballroom 3, The Trans Luxury Hotel Bandung

Course Director
Lily Rundjan

PROGRAM
ONE DAY

TUESDAY, 19 APRIL 2016

08.00 - 08.15

Opening

08.15 - 08.45

Basic Principles of Mechanical Ventilation

08.45 - 09.15

Ventilator Modes and Wave Forms

09.15 - 09.45

Initial Setting and Adjusting

09.45 - 10.15

Coffee Break

10.15 - 10.45

Monitoring of Babies on Ventilatory Support

10.45 - 11.15

Weaning Strategies

11.15 - 11.45

Volume Guarantee

11.45 - 13.00

Lunch

13.00 - 13.30

Blood Gas Analysis

13.30 - 14.00

Nursing Care of Ventilated Babies and Troubleshooting

14.00 - 14.30

Coffee Break

14.30 - 16.45

Divided in to 3 groups @ 45 Minutes


Volume Guarantee
Interpretation of Wave Forms
Initial Setting and Adjusting

16.45 - 17.15

Summary

Instructor Team

Team Perinatology - Cipto Mangunkusumo National General


Central Hospital

TRILOGY OF CHALLENGES IN IMPROVING LONG TERM


OUTCOME OF PRETERM INFANTS
WEDNESDAY, 20 APRIL 2016

Grand Ballroom 3, The Trans Luxury Hotel Bandung


Compulsory Requirement
The participant of the Trilogy of Challenges in Improving Long Term Outcome of Sick Neonates Workshop is strongly
recommended to pre-join the Regular Course March 2016 Edition (NICU Field Workshops). The participant names upon
date base will be verified and prioritized accordingly.
Participants, whose are interested in joining the Regular Course March 2016 Edition may visit http://picunicu.org/updatedregular-courses-schedule/ for the running schedule in PICNIC ACADEMIA Regular Course program.

Course Director

Lily Rundjan

PROGRAM
ONE DAY

WEDNESDAY, 20 APRIL 2016

INSTRUCTOR

08.00 - 08.15

Introduction

08.15 - 08.45

Nutritional Needs of Preterm Infants to Achieve


Optimal Growth and Development

Virgilio P. Carnielli (Italy)

08.45 - 09.15

Prevention of Brain Injury

Frank Bel (Netherlands)

09.15 - 09.45

Strategies to Achieve Zero CRBSI

Gomez Joseph Manuel (Singapore)

09.45 - 10.15

Coffee Break

10.15 - 10.45

Feeding SGA Infants

Virgilio P. Carnielli (Italy)

10.45 - 11.15

Brain Monitoring with NIRS and Amplitude EEG

Frank Bel (Netherlands)

11.15 - 11.45

A Systematic Approach to Antibiotics Selection in Neonatal Unit

Gomez Joseph Manuel (Singapore)

11.45 - 12.15

Therapeutic Hypothermia in HIE Infants: Is It Too Complicated

Frank Bel (Netherlands)

12.15 - 12.45

Closed Vascular Access System Implementation in Reducing


Bloodstream Infection Rate in Low Birth Weight Preterm Infants

Lily Rundjan (Jakarta)

12.45 - 13.30

Lunch
Hands-on Workshop
[Participants are divided into 4 Groups @ 60 minutes Rotation]

13.30 - 14.30

Workshop: Application of NIRS, Cooling in HIE

Frank Bel (Netherlands) &


Lily Rundjan (Jakarta)

14.30 - 15.30

Workshop: Nutritional Care

Virgilio P. Carnielli (Italy) &


Rina Rohsiswatmo (Jakarta)

16.00 - 17.00

Workshop: Infection Control (Management of


Outbreak in Neonatal Unit)

Gomez Joseph Manuel (Singapore) &


Adhi Teguh (Jakarta)

(15.30 - 16.00)

Coffee Break

17.00 - 17.15

Course Wrap and Evaluation

ADVANCES MODES OF MECHANICAL


VENTILATION IN CHILDREN
WEDNESDAY, 20 APRIL 2016

Grand Ballroom 2, The Trans Luxury Hotel Bandung


Compulsory Requirement
The participant of the Advances Modes of Mechanical Ventilation in Children must have been passed the Basic Mechanical Ventilation in Pediatric Workshop during 2011-2016. The
participant names upon date base 2011-2016 will be verified
accordingly.
Participants, whose are interested in joining this Advances
Modes of Mechanical Ventilation in Children Workshop may
participate the Basic Mechanical Ventilation in Pediatric
Workshop previously in PICNIC ACADEMIA Regular Course

ONE DAY

program running. Please visit http://picunicu.org/basic-mechanical-ventilation-in-pediatric-workshop/ for the running


schedule.
Learning Objective
This workshop is specially prepared for the practitioners of
pediatric intensive care unit, who has the sufficient knowledge about the basic mechanical ventilation. This workshop
will extend in advances understanding and learning about
ventilator settings and modes to optimize the difficult cases
in critically ill children.

Course Director
Ririe F. Malisie

PROGRAM

WEDNESDAY, 20 APRIL 2016

08.00 - 08.15

Introduction

08.15 - 08.45

Pre-Test
Overview

Instructor Team
Abdul Latief (Jakarta)
Antonius H. Pudjiadi (Jakarta)
G. Dharma Mulyo (Jakarta)
Irene Yuniar (Jakarta)
Ririe Fachrina Malisie (Pekanbaru)
Sri Martuti (Solo)
Yusrina Istianti (Semarang)
Saptadi Yuliarto (Malang)

08.45 - 09.15

Close-loop Ventilation

09.15 - 10.00

AsynchronyW

10.00 - 10.15

Discussion

10.15 - 11.00

Coffee Break
New Modes in Mechanical Ventilation

11.00 - 11.45

Dual Modes BIPAP & Pressure Regulated Volume Control

11.45 - 12.15

Pressure Support Ventilation & Proportional Assist Ventilation

12.15 - 12.30

Discussion

12.30 - 13.30

Lunch

13.30 - 16.30

Hands-on Workshop
[Participants are divided into 6 Groups @ 35 minutes Rotation]
Proportional Pressure Support (PPS) & Volume Guaranteed (VG)
Volume Target Pressure Control & Support (VTPC/VTPS)
Adaptive Support Ventilation (ASV)
Pressure Controlled Volume Regulated (PCV-VG)
Pressure Regulated Volume Control (PRVC)
Volume Ventilation Plus for Weaning (PAV+)

16.30 - 17.15

Coffee Break

17.15 - 17.45

Post-Test

17.45 - 18.00

Course Wrap and Evaluation

SEPSIS MANAGEMENT IN PEDIATRIC: UPDATE


& INTEGRATED APPROACH WORKSHOP
WEDNESDAY - THURSDAY, 20 - 21 APRIL 2016
Grand Ballroom 3, The Trans Luxury Hotel Bandung

Learning Objective
To enhance the updated knowledge and practical guidelines in the integrated management of sepsis in children included the understanding sepsis pathophysiology in children, the International standard for pediatrics sepsis & Surviving
Sepsis Campaign as well as the Early Goals Directed Therapy for pediatric sepsis implementations.
After completing the workshop, registrants are expected to understand the difference between hemodynamic in children and adult, and the capability to manage hemodynamic in pediatric sepsis, to choose appropriate early antibiotics
in pediatric sepsis, diagnosis and manage the coagulation in children with sepsis and giving the protective ventilation
strategy in children with sepsis. Registrants are also expected to be able to give the nutritional and metabolic support in
children with sepsis, sedation and analgesia in children with sepsis, assess the severity and mortality prediction in septic
children and use the computerize system to do the register upon pediatric sepsis management guidelines

Course Director
Abdul Latief

DAY 1

WEDNESDAY, 20 APRIL 2016

08.00 - 08.15

Introduction

08.15 - 08.45

Pre-Test

08.45 - 09.30

The Surviving Sepsis Campaign

09.30 - 10.15

Pediatric Sepsis Definition

10.15 - 10.30

Discussion

10.30 - 11.10

Coffee Break
GROUP DISCUSSION
[Participants are divided into 4 Groups @ 50 minutes
Rotation]

11.10 - 12.00

Early Goal Directed Therapy

12.00 - 13.00

Lunch

13.00 - 13.50

Fighting Infections

13.50 - 14.40

Protective Ventilation Strategy

14.40 - 15.30

Glucose Control

15.30 - 16.10

Coffee Break

DAY 2

THURSDAY, 21 APRIL 2016


GROUP DISCUSSION
[Participants are divided into 4 Groups @ 45 minutes
Rotation]

08.00 - 08.45

Sedative and Analgesic

08.45 - 09.30

Coagulation Problems

09.30 - 10.10

Coffee Break

10.10 - 10.55

Pediatric Logistic Organ Dysfunction Score

10.55 - 11.40

Nutritional Support

11.40 - 13.30

Lunch & Friday Pray

13.30 - 14.30

Program Based Sepsis Management

14.30 - 15.00

Post Test

15.00 - 15.40

Coffee Break

15.40 - 15.55

Course Wrap & Evaluation

Instructor Team
Abdul Latief (Jakarta) ; Dadang Hudaya (Bandung) ; M. Supriatna (Semarang) ; Nurnaningsih (Jogjakarta)

FLUID & HEMODYNAMIC MANAGEMENT


IN SEVERE DENGUE INFECTION
WEDNESDAY - THURSDAY, 20 - 21 APRIL 2016

Board Room, The Trans Luxury Hotel Bandung

Earlier Schedule
Participants, whose are interested in Fluid & Hemodynamic
Monitoring in Shock Dengue in earlier schedule may join
the Regular Course March 2016 Edition and visit http://
picunicu.org/updated-regular-courses-schedule/ for the
running schedule in PICNIC ACADEMIA Regular Course
program.
Learning Objective
- To understand the shock dengue in Indonesia
- Diagnose and general management of shock dengue

DAY 1

WEDNESDAY, 20 APRIL 2016

-
-
-
-

Basic intravenous fluid therapy in children


Pato physiology and clinical shock dengue in children
Hemodynamic assessment with ultrasonography
Assessment and management of shock dengue in children in the case of bleeding and transfusion
- Diagnose and management electrolyte, acid base balanced in shock dengue
- Encephalopathy dengue
Course Director
Antonius H. Pudjiadi

DAY 2

THURSDAY, 21 APRIL 2016 INTERACTIVE DISCUSSION

08.00 - 08.15

Introduction

08.00-08.35

Management of Bleeding

08.15 - 08.35

Pre-Test -INTERACTIVE DISCUSSION

08.35-09.10

08.35 - 09.10

Current Situation of Dengue Infection in Indonesia

Diagnosis and Management of Electrolyte/Acid-base


Imbalance

09.10 - 09.45

Diagnosis and Management of Dengue Hemorrhagic


Fever

09.10-09.45

Dengue Encephalopathy

09.45-10.15

Coffee/Tea Break

09.45 - 10.20

Intravenous Fluid Management in Children

10.15 - 12.15

COMPREHENSIVE SKILL STATION

10.20 - 10.50

Coffee/Tea Break - INTERACTIVE DISCUSSION

10.50 - 11.25

Pathophysiology of Shock in Children

11.25 - 12.00

Noninvasive in Hemodynamic Assessment

12.15 - 13.00

Lunch

12.00 - 12.35

Management of Dengue Shock in Children

13.00 - 15.00

COMPREHENSIVE SKILL STATION - CONTINUED

12.35 - 13.15

Lunch

13.15 - 16.00

SKILL STATION
[Participants are divided into 3 Groups @ 60 minutes
Rotation]
1. Diagnosis of dengue infection
2. Non-invasive hemodynamic assessment
3. Dengue Shock Management

15.30-15.45

CASE DISCUSSION (with Keypads)

15.45-16.00

Course Wrap & Evaluation

10

[Participants are divided into 3 Groups @ 80 minutes


Rotation]

[Participants are divided into 3 Groups @ 80 minutes


Rotation]
15.00 - 15.30

Coffee/Tea Break

15.30-15.45

CASE DISCUSSION (with Keypads)

15.45-16.00

Course Wrap & Evaluation

Instructor Team
Abdul Latief (Jakarta)
Antonius H. Pudjiadi (Jakarta)
Irene Yuniar (Jakarta)
Mulya Rahma Karyanti (Jakarta)

INTEGRATED COURSE OF NON-INVASIVE VENTILATION


IN CRITICALLY ILL NEONATES AND CHILDREN
THURSDAY, 21 APRIL 2016

Grand Ballroom 2, The Trans Luxury Hotel Bandung


Compulsory Requirement
The participant of the Integrated Non-Invasive Ventilation in Critically ill Neonates and Children is compulsory to register
for Trilogy of Challenges in Improving Long Term Outcome of Preterm Infants & Advanced Modes of Mechanical Ventilator in Children.
Course Director
Lily Rundjan and Ririe F. Malisie

ONE DAY

THURSDAY, 21 APRIL 2016

INSTRUCTOR

08.00 - 08.15

Introduction

Ririe Fachrina Malisie (Pekanbaru)

08.15 - 08.45

Optimizing Non-Invasive Respiratory Support in


Neonate

Risma K. Kaban (Jakarta)

08.45 - 09.30

The Role of Non-Invasive Ventilation in Acute and


Chronic Pediatric Disease

Marti Pons-Odena (Spain)

09.30 - 09.45

Discussion

09.45 - 10.25

Coffee Break

10.25 - 10.55

The Role of Bi-Level CPAP in the Management of


Preterm Infants

Giovanni Vento (Italy)

10.55 - 11.25

Nasal High Flow versus NCPAP

Peter Davis (Australia)

11.25 - 11.55

How To Begin and Synchronization During NIV in


Children?

Marti Pons-Odena (Spain)

11.55 - 12.10

Discussion

12.10 - 13.40

Lunch

13.40 - 16.10

Dry Workshop:
Nasal HFO as A New Modality

Giovanni Vento (Italy)

Non-Invasive Positive Pressure Ventilation (NIPPV)

Peter Davis (Australia)

Non-Invasive Ventilation - Neurally Adjusted


Ventilatory Assist (NIV-NAVA)

Marti Pons-Odena (Spain)

16.10 - 16.50

Coffee Break

16.50 - 17.20

Course Wrap and Evaluation

Ririe Fachrina Malisie (Pekanbaru) & Lily Rundjan


(Jakarta)

11

DAY 1

FRIDAY, 22 APRIL 2016

SCIENTIFIC

TRANS CONVENTION CENTER 1


08.00 - 08.30

Grand Opening - KEYNOTE LECTURE - Chairperson: Abdul Latief (Jakarta)

08.30 - 09.00

Revisiting the Algoritm of Haemodynamic Management in Pediatric Septic Shock - Antonius H. Pudjiadi (Jakarta)

09.00 - 09.30

Advances and Controversies in Parenteral Nutrition of Preterm Infants - Virgilio P. Carnielli (Italy)

09.30 - 10.00

Asynchrony Management with Non-Invasive Ventilation - Marti Pons-Odena (Spain)

10.00 - 10.40

Coffee/Tea Break
Trans Grand Ballroom 2-3

PEDIATRIC ICU -FLUID THERAPY UPDATE - Chairperson: Hari Kushartono (Surabaya)


10.40 - 11.00

Rehydration Therapy with Balanced Solution for Children with Diarrhea - Arina Setyaningtyas B.Pudjo (Surabaya)

11.00 - 11.20

Small Volume Resuscitation in Shock Dengue - Dadang Hudaya Somasetia (Bandung)

11.20 - 11.30

Discussion

11.30 - 13.00

Lunch & Friday Pray

PEDIATRIC INFECTION UPDATE - Chairperson: Munar Lubis (Medan)


13.00 - 13.20

Invasive Fungal Infection in Critically ill Children - Ririe F. Malisie (Pekanbaru)

13.20 - 13.40

Blood Level IL-6 Indicate the Post-operative Infection in Mayor Surgery in Children - Albert Daniel Solang (Manado)

13.40 - 14.00

How to Minimize the Central-Line-Association Blood Stream Infection in PICU? - Rismala Dewi (Jakarta)

14.00 - 14.20

Combating the Antibiotic Resistance in PICU - Irene Yuniar (Jakarta)

14.20 - 14.40

Discussion

14.40 - 15.10

Coffee/Tea Break

COMPREHENSIVE MANAGEMENT APPROACH IN PICU - Chairperson: Ari Lukas Runtunuwu (Manado)


15.10 - 15.30

Inadequate Enteral Protein Intake is Associated with Mortality in Critically ill Children - Yusrina Istanti (Semarang)

15.30 - 15.50

Early Detection in Acute Kidney Injury in Critically Ill Children - Partini Pudjiastuti Trihono (Jakarta)

15.50 - 16.10

Patient-Centered Care in Pediatric Intensive Care Unit Setting - Johnny Nurman (Jakarta)

16.10 - 16.25

Discussion

YOUNG INVESTIGATOR - Chairperson: M. Supriatna TS (Semarang)


16.25 - 16.40

Early Goals Directed Therapy is Associated with Increase Respiratory Morbidity and Mortality
Desy Rusmawatiningtyas (Jogjakarta)

16.40 - 16.55

Increasing of the Red blood cell Distribution Width (RDW) is Correlated With the Severity of Pediatric Sepsis
Gemma Nazri Yanni (Medan)

16.55 - 17.10

Validity of Stroke Volume Variation by Using Non-Invasive Cardiac Out put Monitoring in Hypovolemic Chidren
I Nyoman Budi Hartawan (Denpasar)

17.10 - 17.20

Discussion

SCIENTIFIC PROGRAM

DAY 2 SATURDAY, 23 APRIL 2016


TRANS CONVENTION CENTER 1
KEYNOTE LECTURE - Chairperson: Abdul Rachman Sukadi (Bandung)
08.00 - 08.30

What Matters in the Long Term of NICU Graduates? - Bernie Endyarni (Jakarta)

08.30 - 09.00

Minimally Invasive Surfactant Therapy (MIST) - Peter Davis (Australia)

09.00 - 09.30

The Role of Driving Pressure in Non-Injured Lung: How Low Should We Go?
Ririe F. Malisie (Pekanbaru)

09.30 - 10.00

Longterm Cognitive Development After Sepsis in Early Age


Ahmad Suryawan (Surabaya)

10.00 - 10.40

Coffee/Tea Break
Trans Grand Ballroom 2-3

Trans Convention Center 1

11.40 - 11.55

NEONATAL ICU -NEONATAL ENTERAL & PARENTERAL


NUTRITION UPDATE Chairperson: Risma K. Kaban (Jakarta)
Serial Blood Lactate Level as a Prognostic Factor of Sepsis Mortality
Human Milk Fortified for ELBW
Nurnaningsih (Yogyakarta)
Rinawati Rohsiswatmo (Jakarta)
Inotropes and Other Vasoactive Agents in Pediatric Septic Shock: What is New? Probiotics of Very Preterm Infants
Saptadi Yuliarto (Malang)
Virgilio P. Carnielli (Italy)
National Guideline and Clinical Practice: Sepsis Diagnostic & Management in
Facilitating Breastfeeding and Kangaroo Mother Care in the
Pediatric - Abdul Latief (Jakarta)
NICU : Identifying Barriers - Rosalina Roeslani (Jakarta)
Discussion
Discussion

11.55 - 13.00

Lunch

PEDIATRIC ICU - NEW ISSUES IN PEDIATRIC SEPSIS


Chairperson: Antonius H. Pudjiadi (Jakarta)
10.40 - 11.00
11.00 - 11.20
11.20 - 11.40

PEDIATRIC VENTILATION UPDATE -

NEONATAL RESPIRATORY UPDATE

13.00 - 13.20

Non-Invasive Home Ventilation in Children, Are They Useful?


Marti Pons-Odena (Spain)

Optimizing Non-Invasive Respiratory Support in NICU


Risma Kerina Kaban (Jakarta)

13.20 - 13.40

Ethical Aspect of Withdarawal Ventilatory Supported


Chairul Yoel (Medan)

Nasal HFOV as a New Modality


Giovanni Vento (Italy)

13.40 - 14.00

Probiotics Prevents Ventilator-Associated Pneumonia


Dzulfikar Djalil (Bandung)

High Flow Nasal Cannulae vs Nasal CPAP vs NIPPV : Which One


Is Superior? - Peter Davis (Australia)

14.00 - 14.15

Discussion

Discussion

Chairperson: Ririe F Malisie (Pekanbaru)

PRO-CON - Chairpersons: G.Dharma Mulyo & Rina Rohsiswatmo (Jakarta)


Invasive versus Non-Invasive Mechanical Ventilator
14.15 - 14.30

Invasive: Antonius H. Pudjiadi (Jakarta)

14.30 - 15.00

Non-Invasive: Marti Pons-Odena (Spain)

15.00 - 15.20

Pro and Con - HFOV As A Primary Or Secondary Mode

15.20 - 15.35

Primary Mode: Giovanni Vento (Italy)

15.35 - 15.50

Secondary Mode: Peter Davis (Australia)

15.50 - 16.20

Pro and Con

16.20 - 16.40

Closing Remark

16.40 - 17.00

Coffee/Tea Break

14

Chairperson: Lily Rundjan (Jakarta)

POST SYMPOSIUM WORKSHOP


AN INTRODUCTION COURSE ON GENERAL MOVEMENTS METHOD :

EARLY DETECTION OF NEWBORN INFANTS AT HIGH RISK FOR DEVELOPMENTAL DISORDER


SUNDAY, 24 APRIL 2016

Grand Ballroom 2, The Trans Luxury Hotel Bandung


Learning Objective
Detection of children with a developmental disorder at an early age is notoriously difficult. Recently, a form of assessment in newborn infants was developed based on the quality of general movements (GMs). The quality of GMs at 2 to 4
months post-term has been found to have the highest predictive value for developmental disorders implies an indication
for early intervention. During the course participants will learn how to assess general movements ofpreterm and term
infants. The Training Course will consist of lectures and self-practice sessions during which video recordings of general
movements of preterm and term infants will be analyzed.

Course Director

Ahmad Suryawan (Surabaya)

PROGRAM

ONE DAY

SUNDAY, 24 APRIL 2016

INSTRUCTOR

08.00 - 08.10

Introduction
LECTURE SESSION

Abdul Latief (Jakarta)

08.10 - 08.40

Overview of General Movements (Pre-Test)

Ahmad Suryawan (Surabaya)

08.40 - 09.00

Newborn Infants - Who Are at Risk for Developmental Disorders?

Setya Wandita (Yogyakarta)

09.00 - 09.20

Developmental Assessment Tools for Preterm Infants

Eddy Fadlyana (Bandung)

09.20 - 10.00

GMs Method - An Introduction and Practical Issues

Ahmad Suryawan (Surabaya)

10.00 - 10.15

Discussion

10.15 - 10.35

Coffee Break
PRACTICAL SESSION

10.35 - 11.05

Practical 1: GMs - Preterm

11.05 - 11.35

Practical 2: GMs - Writhing

11.35 - 12.05

Practical 3: GMs - Fidgety

12.05 - 13.00

Lunch

Ahmad Suryawan (Surabaya)

LECTURE SESSION
13.00 - 13.30

GMs Method - Clinical Significances and Validity

Ahmad Suryawan (Surabaya)

PRACTICAL SESSION
13.30 - 14.00

Practical 4: Compilation Exercise (Post-Test)

Ahmad Suryawan (Surabaya)

14.00 - 15.00

Practical 5: Analyzing the Test (Panel Discussion)

Ahmad Suryawan (Surabaya)


Setya Wandita (Yogyakarta)
Eddy Fadlyana (Bandung)

15.00 - 15.15

Course Wrap and Evaluation

15.15 - 15.30

Afternoon Coffee Break

15

FREE PAPER
CALL FOR PAPER

To emphasize the scientific value of 8th Indonesian PICU


NICU Update which will be held on 22-23 April 2016 at
Trans Luxury Hotel Bandung, the Organizing herewith
cordially invites the pediatricians and physicians the Call
for Paper.
Participants are invited to submit Abstracts for Poster Presentations not later than 15 February 2016. The presentations of research studies related to Neonatal and Pediatric
Emergency & Intensive Care.
SUBMISSION CLOSING DEADLINE: 15 FEBRUARY 2016
FORMALITY
Free Paper Presenters need to complete the Registration
formalities before submitting Free Paper Abstract.
Abstracts will not be processed until the registration fee
have been received and acknowledged. Abstract submission via email to secretariat@picunicu.org

GENERAL REGULATION

No abstracts will be considered after the closing deadline.


Abstracts must be typed in English
Abstracts are submitted by online with file attachment.
Fax or mail will not be accepted or acknowledged.
Presenting author of abstract must be registered
as participant. Registration payment must be firstly
completed through web on-line registration before you
proceeded for abstract submission on-line. Registration
must be received by the Secretariat before the announced deadline to ensure inclusion of the abstract in
the meeting publications and in order to be scheduled
for presentation.
Abstract must be original and must not be or have
been published or presented at any other meeting
prior to this meeting.
As condition of submission, Organizing Committee
requires you to agree to such publication and to surrender any copyright over the abstract s submitted to
Secretariat
Other special request other than above procedures
shall be submitted in written through email: secretariat@geoconvex.com

16

ABSTRACT PREPARATION

Please prepare the following information:


Abstract Title limited 20 words in UPPER CASE
Author and co-author names with the first mentioned
and underline for presenting author
Full name shall be written by first name and followed
by family name
Authors names must be in upper and lower case (J.J.C.
Londa)
Affiliation details: department, institution/hospital, city,
state (if relevant), country
Abstract text limited to 250 words, including acknowledgements
It should consist of five paragraphs, clearly stated/labeled in UPPER CASE:
o Background
o Objective
o Methods
o Results
o Conclusions.
They should briefly describe, respectively, the problem
and aim being addressed in the study, how the study
was performed, the salient result, and what the authors
conclude from the results.
Avoid using non standard abbreviations, unfamiliar
terms, symbols, or acronyms not easily understood by
the general readers
Use generic names of drugs. Express numbers as numerals.
Tables A Maximum of 3 Tables of up to 10 rows x 10
columns can be included per abstract
Graph and images It is important to note that each
image included in the abstract is worth 30 words. A
maximum of 3 images can be included per abstract.
The maximum pixel size of the graph/image is 600(w) x
800(h) pixel.
You may upload the file using word-processing software (e.g. Word) for editing your abstract and counting
the number of words. The words count is affected as
graphs/tables/images are included.

FREE PAPER
WITHDRAWAL / CHANGES

Revised abstract is allowed for one time only and


should be clearly stated as the subject of email and
received by 15 February 2016 to be final review by the
Free Paper Committee.
Withdrawal/changes will not be possible after the
above mentioned date.

ABSTRACT ACKNOWLEDGEMENT

Submission of abstract will be acknowledged by email


reply to each nominated email address at the latest
before closing deadline.
Submitted abstracts will be reviewed by the Free Paper
Committee after 15 February 2016. The coordinator will
review the abstracts to be allocated in poster upon category, quality, clarity, and relevance for the audience,
as well as the significances of the paper.
Notification will be emailed to nominated email address at the latest 2 weeks working days after closing
deadline along with the detail, including Poster Viewing Session schedule, and instructions.
The Poster Panel provided for later Poster Presentation
is in the vertical size 90 X 150 cm (Portrait)

PUBLICATION

Abstracts accepted Poster Presentations will appear


in the official Program Book with ISSN. In order for
abstract to be published, the presenter must fulfill
appropriate Registration Fee in term of administrative
purpose.
The Organizing Committee has a right reserve to edit
the format of abstract due to the printing task for publication in terms of uniformity purpose.
WONDER OF BANDUNG CITY AND THE TRANS LUXURY
HOTEL

WELCOME TO
PARIS VAN JAVA
Bandung, capital of West Java, is a great place to visit any
time of the year as its not only renowned for its picturesque open vista, but the town also offers many attractions well worth a visit.
Surrounded by green fertile mountains, Bandung today
is Indonesias center for learning and creativity. Here is
the wellknown, Institut Tekonologi Bandung (ITB) established since 1920, the university that has produced many
of Indonesias top scientists from engineers, geologists to
leaders in business management. Today Bandung is one of
Indonesias most prestigeous university towns. Bandung
is also the center of Indonesias burgeoning ICT technology, at the same time it is a center of arts and artists. Every
weekend and long holidays the city is filled with young
people from Jakarta who flock to Bandung to enjoy its
youthful creative atmosphere in music, painting, fashion,
and the culinary arts.
While along the present Jalan Juanda, then known as Dago
Boulevard, were the houses of the elite with their green
lawns and flower gardens fronting opulent homes. In
those colonial heydays in the early 20th century, Bandung
became known as Parijs van Java, or the Paris of Java,
where Dutch planters and ladies paraded and flaunted
their wealth and beauty along the boulevards and Bragaweg, then the Champs Elysees of the East.
Standing some 768 m above sea level, Bandung is today
the countrys third largest city after Jakarta and Surabaya.
Since the opening of the Cipularang Toll road, which cuts
down travel from Jakarta to two hours from the previous
four hours over the tortuous Puncak Pass, Bandung has
become the favorite weekend getaway to relax and escape
from the hectic pace of metropolitan Jakarta.
For Bandung offers trendy fashion wear at reasonable prices at its myriad factory outlets, a wide range of delicious
local and international cuisines, and a distinct colonial
European-style atmosphere combined with captivating
traditional arts.

17

REGISTRATION & ACCOMMODATION


HOW TO GET THE REGISTRATION FORM

1. From our website:


Download the PDF file of the updated Announcement
by logged into http://www.geoconvex.com/upcoming-event/ and click further to mentioned related
event.
Find the last pages of Announcement to print the
Registration Form for fax purpose. You may also save
the soft copy in your personal PC for your perusal and
further use.
2. From our secretariat address:
You may get the soft/hard copy of Announcement to be
delivered to your nominated email/ home address by
sending the request to secretariat@picunicu.org or SMS to
+62811882080

HOW TO REGISTER
REGISTRATION ON-LINE
Its easy as 1-2-3-4:
1. Log into http://geoconvex.biz
2. You have to create your User ID and password
when you Log-In
3. Complete the required fields to next proceed.
4. Keep your Registration ID for your further reference
(e.g. Free Paper Submission).
GROUP REGISTRATION
For company or institution who would like to make Group
Registration and Accommodation Bookings may communicate directly to our registration department at secretariat@picunicu.org for further collective group handling.
REGISTRATION OFF-LINE
(Recommended for Domestic Participants Only)
1. Fax the Registration Form to +62213153392 or Email to
secretariat@picunicu.org along with proof of payment
(e.g. copy of bank transfer slip).
2. Payment Proof is strongly recommended to be done
along with your Registration Form submission. Photocopied forms are acceptable.
3. You may bring your payment proof as foreseen at the
Re-Registration counter. Essentially, the name tag
issued is an initial confirmation of registrants.

18

REGISTRATION CONFIRMATION
- On-Line Registered Participant will receive Registration
Notification, followed by Registration Receipt after the
payment has been effectively cashed in to our Event
Bank Account.
- Off-Line Registered Participants are strongly suggested
to make Re-Confirmation due to incoming facsimiles/
Email and/or payment made to our Registration Department, hotline numbers at office hours.

CANCELLATION AND REFUND POLICY

REGISTRATION
Notification of Registration cancellation for scientific symposium must be made in writing or emailed to the Secretariat. Registration Fee is refundable with the following
cancellation policy:
One month before event 50% refund of Fee paid
On and After the date No refund
No Show registration cannot be refunded.
ACCOMMODATION
Hotel room rate is net for room only.
Please note that official check-in time is 14.00 local
time and check-out time is 12.00 local time. Approval of
early check-in and late check-out is at discretion of the
hotel.
No reservation will be made without full deposit of
nights booking due to room availability.
v Any changes and cancellations regarding to room
reservation in pre-registration period must be done
in writing to the Secretariat at least 168 hours prior to
arrival. After the date, guaranteed payment for 1 night
will be charged.
No Show will be applied on the first night for delayed
or postpone staying that causes the loss of 1 night
room deposit made.
In the event of materialization, the hotel will charge
the full amount duration of stay upon check-out that
causes the loss of mentioned deposit made.
Refund may only be made after the event by bank
transfer. Official letter should be submitted to Secretariat address mentioning its payers Bank Account.

REGISTRATION & ACCOMMODATION


PAYMENT METHOD
A. BANK TRANFER
Bank transfer is strongly recommended rather than any
other payment method. Bank Transfer should be paid to
this Event Bank Account:
Bank Name
Branch
Address
No. Account
Acc.Holder

: CIMB Niaga
: Kemang Branch
: Jalan Kemang Raya No. 4, Jakarta Selatan
: 253-0100.219005
: GEO convex

Bank remittance must be paid by registrant, otherwise the


registration receipt or badge will not be issued due to the
less payment.
B. CASH TO SECRETARIAT ADDRESS
Cash can be paid directly to the Secretariat Address. Cash
payment is ONLY valid for domestic participant.
C. ON SITE PAYMENT
Please indicate your On Site Payment remark on the
Registration Form. On site payment is only valid for
conference registration, not eligible for workshops or
room bookings.
On site payment with Bank Notes IDR, shall be brought
upon arrival.
The Bank Draft is to be made payable to GEO convex
and to be drawn on Indonesia Bank.
Payment by Credit Card with EDC Machine will only be
provided at the venue hotel by signing your personal
authorization and the Credit Card transaction charges
will be applied based on venue hotels regulation.
The Organizing Committee holds no responsibility for
any exchange rates applied by the Credit Card vendor
when the statement converted into local currency.

Payment by Credit Card with EDC Machine will only be provided at the venue hotel by signing your authorization and
the Credit Card transaction charges will be applied based
on venue hotels regulation. The Organizing Committee
holds no responsibility for any exchange rates applied by
the Credit Card vendor when the statement converted into
local currency.
REGISTRATION FEE INCLUDE
Name Badge & Symposium Kit.
Name Badge MUST BE worn entering to all scientific
sessions and lunch/break programmed by the Organizing Committee.
Symposium documents (Proceeding Book with ISSN)
and materials
Admission to the function room, lunch programmed
and scientific exposure from Pharmaceutical and
Health-Care Companies.
Certificate of Attendance with IDI Accreditation & CPD
IDAI will be issued for eligible participants at the last
day of the Symposium.
RE-REGISTRATION SERVICE
The Re-Registration will be handed out to the participants
from registration counters during the opening hours at
07.00 12.00 during the event dates.
ON SITE REGISTRATION
Applicants that not registered in event Registration List
will be treated as New Registrants and will have to register
on-site, for which only payment by Cash or Credit Card are
accepted.

Please acknowledge that Organizing Committee reserve


the right not to guarantee any on-site registrant obtain
its complete Symposium Kits that therefore we strongly
encourage to make an urge early Registration.

19

REGISTRATION PACKAGE FORM


PARTICIPANT (Kindly completed)
Full Name & Title
:____________________________________________________________________________________
Institution
:____________________________________________________________________________________
Home Address
:____________________________________________________________________________________
City / Post Code
:____________________________________________________________________________________
Phone (Mobile)
:_______________________ Fax : __________________________________________________________
Email
:____________________________________________________________________________________
SPONSOR (Kindly completed if any)
Full Name & Position :____________________________________________________________________________________
Company / City
:____________________________________________________________________________________
Phone (Mobile)
:________________________Fax : _________________________________________________________
Email
:____________________________________________________________________________________

PRE & POST SYMPOSIUM WORKSHOP REGISTRATION &PACKAGE (kindly appropriate circle/box)
PHYSICIANS WORKSHOPS

APRIL 2016

WORKSHOP ONLY

Basic Mechanical Ventilation in Newborn Infants

19

2.000.000

Trilogy of Challenges in Improving Long Term Outcome of Preterm Infants

20, 22-23

Trilogy of Challenges in Improving Long Term Outcome of Preterm Infants &


Integrated Non-Invasive Ventilation in Critically ill Neonates and Children

20-21,22-23

Advanced Modes of Mechanical Ventilator in Children

20, 22-23

Advanced Modes of Mechanical Ventilator in Children & Integrated Non-Invasive Ventilation in Critically ill Neonates and Children

20-21,22-23

Sepsis Management in Pediatric: Updated & Integrated Approach

20-21, 22-23

Fluid & Hemodynamic Management in Severe Dengue Infection

20-21, 22-23

An Introduction Course on General Movements Method: Early Detection of


Newborn Infants at High Risk for Developmental Disorder

24

PRIORITY PARTICIPANT
WITH SYMPOSIUM

OTHER PARTICIPANTS WITH


SYMPOSIUM

SPECIALISTS

4.000.000

SPECIALISTS

4.500.000

GP / FELLOW

3.750.000

GP / FELLOW

4.250.000

SPECIALISTS

6.000.000

SPECIALISTS

6.500.000

GP / FELLOW

5.750.000

GP / FELLOW

6.250.000

SPECIALISTS

4.000.000

SPECIALISTS

4.500.000

GP / FELLOW

3.750.000

GP / FELLOW

4.250.000

SPECIALISTS

6.000.000

SPECIALISTS

6.500.000

GP / FELLOW

5.750.000

GP / FELLOW

6.250.000

SPECIALISTS

5.500.000

GP / FELLOW

5.250.000

SPECIALISTS

5.250.000

GP / FELLOW

5.000.000

2.000.000

PAYMENT BY (Kindly appropriate circle)


Please note that this regulation will be applied accordingly:

1. Priority Participants are Registrants of Regular Course March 2016 Edition


2. Advances Modes of MV on Children must have certified/passed the Basic MV
in Pediatrics Workshop (2011-2016)
3. Integrated Non-Invasive Ventilation in Critically ill Neonates and Children
must have registered for Trilogy of Challenges in Improving Long Term Outcome of Preterm Infants & Advanced Modes of Mechanical Ventilator in
Children
4. Certain Workshop Participants are compulsory as Registrants of 8th Indonesian PICU NICU Update 22-23 April 2016
5. Member of Indonesian Pediatric Critical Care Foundation entitles for
10% discount

BANK TRANSFER IN FULL AMOUNT TO


OFFICIAL BANK ACCOUNT
Account Holder (Beneficiary) : GEO convex
No. Account
: 253-01-00-219005
Bank Name
: CIMB Niaga
Branch
: Kemang Branch
Address
: Jl. Kemang Raya No. 4, Jaksel
CASH TO SECRETARIAT ADDRESS
ON SITE
Confirmation to:
EX-OFFICIO SECRETARIAT
The Indonesian Pediatric Critical Care Foundation
C/O. Global Echo Organizer Convex
Jl. Kebon Sirih Timur No. 4, Jakarta Pusat 10340
Registration Hot Line : 021- 3149318/3149319/2305835
Fax
: 021- 3153392
Mobile Hotline
: 0811882080
Email
: secretariat@picunicu.org

REGISTRATION & ACCOMMODATION FORM


PARTICIPANT (Kindly completed)
Full Name & Title
:____________________________________________________________________________________
Institution
:____________________________________________________________________________________
Home Address
:____________________________________________________________________________________
City / Post Code
:____________________________________________________________________________________
Phone (Mobile)
:_______________________ Fax : __________________________________________________________
Email
:____________________________________________________________________________________
SPONSOR (Kindly completed if any)
Full Name & Position :____________________________________________________________________________________
Company / City
:____________________________________________________________________________________
Phone (Mobile)
:________________________Fax : _________________________________________________________
Email
:____________________________________________________________________________________

SYMPOSIUM ONLY REGISTRATION (kindly appropriate circle/box)


8th INDONESIAN PICU NICU UPDATE 22-23 APRIL16

BEFORE 01 MAR16-IDR AFTER 01 MAR16-IDR

Specialists

2.500.000

2.750.000

General Practitioners/Fellow

2.250.000

2.500.000

HOTEL RESERVATION
THE TRANS LUXURY HOTEL BANDUNG
Premiere
Rate in Net/Room/Night Single Basis, Include Max 2 Breakfast

RATE/ROOM ONLY/NIGHT-IDR
2.125.000,- NET

Check In Date : ____

Total Night(s) : ___

Check Out Date : ___

Total Accommodation
Payment
: IDR

PAYMENT BY (Kindly appropriate circle)


BANK TRANSFER IN FULL AMOUNT TO

OFFICIAL BANK ACCOUNT


Account Holder (Beneficiary)
No. Account
Bank Name
Branch
Address

: GEO convex
: 253-01-00-219005
: CIMB Niaga
: Kemang Branch
: Jalan Kemang Raya No. 4, Jakarta Selatan

CASH TO SECRETARIAT ADDRESS

ON SITE

____

Confirmation to:
EX-OFFICIO SECRETARIAT
The Indonesian Pediatric Critical Care Foundation
C/O. Global Echo Organizer Convex
Jl. Kebon Sirih Timur No. 4, Jakarta Pusat 10340
Registration Hot Line : 021- 3149318/3149319/2305835
Fax
: 021- 3153392
Mobile Hotline : 0811882080
Email
: secretariat@picunicu.org

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