December 2007

Section Names Specialty Practitioner of the Year
The Neonatal-Pediatric Section would like to congratulate Tiffany Mabe, RRT, on her receipt of our 2007 Specialty Practitioner of the Year Award. Tiffany was presented with the award during the AARC International Respiratory Congress in Orlando.

Section Member Shares Research on CDH
Section member Rebecca Jackvony, RRT-NPS, shares this information from a recent study in Pediatrics: The Congenital Diaphragmatic Hernia (CDH) study group is comprised of 51 centers in 8 countries. The group performed a prospective review of all alive-born CDH infants in participating centers (n=3062 over 9 years) to determine the factors that contributed to mortality. The group evaluated the impact of weight, gestational age, APGAR scores, size of the defect, associated anomalies, and length of stay on mortality. The size of the defect had the most significant impact on mortality. Patients with diaphragmatic agenisis had the worst outcomes, followed by patch repair. Lower gestational age and birth weight also had a significant impact on mortality. READ ABSTRACT

Rapid Response Team Reduces Mortality in Children’s Hospital
Stanford University researchers publishing in the November 21 issue of JAMA find mean monthly mortality rates outside of the ICU declined by 18 percent and mean monthly code rates per 1000 admissions by 71.9 percent after implementation of a rapid response team. The team consists of a pediatric ICU-trained fellow or attending physician, ICU nurse, ICU respiratory therapist, and nursing supervisor. The study is the first to establish the benefits of a rapid response team in the pediatric setting. READ ABSTRACT

Transplants May Not Help Kids with CF
In the largest study conducted to date, University of Utah researchers find lung transplantation may do children with cystic fibrosis more harm than good. The study involved 514 patients age 18 and younger who were on the transplant list in 1992-2002. Among the 248 kids who actually received a transplant, only one showed clear benefit from the procedure. Nearly two-thirds of the patients experienced a higher risk of mortality following the surgery — in some cases, 7 times higher. Further analysis linked greater harm from the procedure to older age at transplantation, the presence of S. aureus staph infection at or after transplantation, and the lack of diabetes prior to transplantation (children with diabetes fared better than those without). A fellow researcher commenting on the study called the results “startling” and called on physicians to be more judicious when referring these children for transplant. The report appeared in the November 22 edition of the New England Journal of Medicine. READ PRESS RELEASE ON STUDY    READ PRESS RELEASE ON EDITORIAL COMMENT

Jury Still Out on Value of EtCO2 in Acute Asthma
University of Birmingham researchers who studied the use of end-tidal carbon dioxide (EtCO2) values to assess children who come to the emergency department with an acute episode of asthma find bedside measurement with the noninvasive device is feasible, but more study is needed to clarify the association between EtCO2 values and other indicators of disease severity. The investigation was conducted among 100 children, with treating physicians making treatment decisions unaware of the EtCO2 values. The mean initial EtCO2 value was 35 mm Hg and the mean disposition EtCO2 value was 33.3 mm Hg. While initial EtCO2 values were lower among children admitted to the hospital, values at disposition did not differ between groups based on peak expiratory flow rate, Pediatric Asthma Severity Score, or hospital admission. The study appears in this month’s Academic Emergency Medicine. READ ABSTRACT