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May 2007
Notes from the Section
- The Spring issue of the Neonatal-Pediatric Section Bulletin is ONLINE now, with the second in our two part series on surfactant and RDS and an article on beginning a respiratory consult service.
- The section web site has a great new feature: an online ARCHIVE containing past issues of the E-Bulletin.
Open Forum Deadline Coming Up June 1
The AARC International Respiratory Congress, scheduled for Dec. 1-4 in Orlando, FL, will feature 18 Open Forums, providing a great way for attendees to share the results of their original research and/or case studies. The deadline for submitting an abstract or case report for the 2007 sessions, however, is quickly approaching – June 1, 2007. So take a few moments to LEARN MORE about the online submission process, and then consider how you can share results of your work with your peers via the 2007 Open Forum.
nCPAP/Early Surfactant Strategy Shows Promise
Researchers who combined nCPAP with early or prophylactic surfactant administration in extremely premature infants find the strategy is both feasible and may lead to lower mortality rates. The study compared 29 infants who were treated with nCPAP and early surfactant to historical controls who received conventional ventilation and surfactant. All of the treated infants had clinical signs of moderate to severe respiratory distress syndrome despite nCPAP and received 100 mg.kg(-1) of a natural surfactant preparation via an intratracheal catheter during spontaneous breathing. Ventilation with manual bag was required in five infants following surfactant administration, but all the infants returned to nCPAP within minutes. Intubation was required in ten infants later on during the first three days. Mortality was 7% among infants who ultimately required intubation and 12% in the entire treated group versus 35% in historical controls. The authors believe these results warrant a prospective randomized trial of the nCPAP/early surfactant strategy. The research appeared in the April issue of Paediatric Anaesthesia. READ ABSTRACT
Admission Temperature May Predict Mortality
A new study based on data from the Neonatal Research Network suggests body temperature upon admission to the NICU can influence outcomes for low birth weight infants. The distribution of admission temperatures for the 5277 study participants was: 14.3% at < 35 degrees C, 32.6% between 35 and 35.9 degrees C, 42.3% between 36 and 36.9 degrees C, and 10.8% at > or = 37 degrees C. Admission temperature was inversely related to mortality (28% increase per 1 degrees C decrease) and late-onset sepsis (11% increase per 1 degrees C decrease). However, no link was seen between admission temperature and intraventricular hemorrhage, necrotizing enterocolitis, or duration of conventional ventilation. The authors conclude, “Whether the admission temperature is part of the casual path or a marker of mortality needs additional study.” The study appeared in the March issue of Pediatrics. READ ABSTRACT
Ancillary Testing for Asthma Common in the ED
Ancillary tests are common among children with asthma who are treated in the emergency department, conclude researchers who reviewed the charts of asthmatic children seen at the 25 EDs in the Pediatric Emergency Care Applied Research Network. Among 734 patients with an acute exacerbation of asthma, 41% had ancillary testing, with 27% undergoing chest radiographs and 14% having blood tests. Chest radiographs were more likely to be ordered if the child had a fever. Blood testing was less likely in cases where the physician had training in pediatric emergency medicine, the facility was a pediatric hospital, the patient had a higher oxygen saturation, and the patient was being discharged to home. The authors believe these results suggest “Efforts to reduce the use of chest radiographs should target the management of febrile patients with asthma, whereas efforts to reduce blood testing should target providers without subspecialty training in pediatric emergency medicine and patients treated in nonchildren’s hospitals who are more ill.” The study was published in the April 19 Epub edition of Academic Emergency Medicine. READ ABSTRACT
NIMV Beats nCPAP in Preterm Infants
Israeli researchers who compared nasal intermittent mandatory ventilation (NIMV) with nasal continuous positive airway pressure (nCPAP) in 84 preterm infants find NIMV results in a decreased need for endotracheal ventilation and an associated decrease in bronchopulmonary dysplasia (BPD). Overall, 25% of the infants on NIMV eventually required endotracheal ventilation, versus 49% of those on nCPAP, with the trend similar for smaller and larger infants in the group. The incidence of BPD was 2% in the NIMV infants and 17% in the nCPAP infants. The research appears in this month’s Journal of Pediatrics. READ ABSTRACT
Upcoming Educational Opportunities from the AARC
- AARC International Respiratory Congress: Dec. 1-4, Orlando, FL
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