June 2007

Nominate a Fellow Section Member for Specialty Practitioner of the Year
The Neonatal-Pediatrics Section recognizes one of its own every year at the AARC International Respiratory Congress with a Specialty Practitioner of the Year Award, and now is the time to submit your nominations for the 2007 honor. You can find the nomination form on the SECTION WEB SITE.

RSV Vaccine on the Horizon
Australian researchers are working on a vaccine against the respiratory syncytial virus (RSV). The recombinant vaccine is being developed using the existing hepatitis B vaccine to carry the RSV peptides, and investigators hope to ultimately be able to protect people against both hepatitis B and RSV in the same injection. The work is taking place at the Sir Albert Sakzewski Virus Research Centre and the University of Queensland’s Faculty of Biological and Chemical Sciences. READ PRESS RELEASE

Predicting VAP
Chinese researchers who conducted a retrospective study involving 259 infants who were mechanically ventilated for more than 48 hours find several factors can predict the development of ventilator-associated pneumonia (VAP). Fifty-two episodes of VAP were noted in the group. Specifically, re-intubation, duration of mechanical ventilation, treatment with opiates, and endotracheal suctioning all raised the likelihood an infant would experience an episode of VAP. The authors conclude, “VAP occurred at significant rates among mechanically ventilated NICU patients and is associated with care procedures . . . Additional studies are necessary to develop interventions to prevent neonatal VAP.” The research appears in the June 5 Epub edition of Journal of Perinatal Medicine. READ ABSTRACT

Training Falls Short of Improving Bronchopulmonary Dysplasia-Free Survival
Ohio researchers find NICU teams trained in benchmarking and quality improvement strategies do not lower the number of low birth weight infants surviving with bronchopulmonary dysplasia. The federally-funded study compared outcomes between 17 centers, three of which were deemed best performers and the other 14 of which were randomly assigned to an intervention or control group. Intervention centers implemented changes such as reduced oxygen saturation targets and reduced exposure to mechanical ventilation. Five of seven intervention centers and two of seven control centers also implemented use of high-saturation alarms to reduce oxygen exposure. Although lower oxygen saturation targets reduced oxygen levels in the first week of life, overall rates of bronchopulmonary dysplasia-free survival were about the same between the intervention and control centers and fell significantly short of outcomes noted at the three best performers. The study appeared in the May issue of Pediatrics. READ ABSTRACT

Review Looks at Mechanical Ventilation Strategies in the Neonate
A new review conducted by British researchers finds many new mechanical ventilation strategies for the neonate have emerged since 2000. Studies show:

• Assist control and synchronous intermittent mandatory ventilation (SIMV) shortens the duration of ventilation only if started in the recovery rather than the early stage of respiratory disease.
• Pressure-regulated volume control ventilation may also have no advantages if started early.
• Weaning by SIMV with pressure support is better at reducing oxygen dependency than SIMV alone.
• Volume-targeted ventilation has demonstrated significant reductions in the duration of ventilation and pneumothorax, but the trials were small and of different designs.
• Volume guarantee may provide more consistent blood gas control. The level of volume targeting appears to be crucial to the success of this technique.
• Prophylactic high-frequency oscillation has shown a modest reduction in bronchopulmonary dysplasia.
• The advantages of nasal continuous positive airway pressure seen in various non-randomized studies have not been confirmed by randomized trials.
• Inhaled nitric oxide (NO) does not improve the outcome of prematurely born infants with severe respiratory failure, but early low-dose prolonged iNO appears to have benefits that merit further testing.

The report appeared in the June 2 Epub edition of the European Journal of Pediatrics. READ ABSTRACT

Upcoming Educational Opportunities from the AARC

• Summer Meetings: July 13-17, Reno/Lake Tahoe, NV
• Asthma Educator Certification Preparation Course, August 25-26, Charlotte, NC

• AARC International Respiratory Congress: Dec. 1-4, Orlando, FL