February 2008

Section Bulletin Online Now
The Winter edition of the Bulletin is on the SECTION WEB SITE and ready for viewing. Check it out for great articles on:

• Section goals
• Surfactant therapy
• ECMO and CPR
• 2007 Specialty Practitioner of the Year

Delayed Extubation Does No Good, but No Harm Either
French researchers publishing in this month’s Pediatric Pulmonology find no benefit — but no harm either — from the addition of another 36 hours of gentle mechanical ventilation before the first extubation attempt in infants under 28 weeks gestational age. The study involved 86 infants who were randomly assigned to either an immediate extubation group or delayed extubation after 36 hours. Both groups were ventilated with continuous tracheal gas insufflation, prophylactic surfactant administration, low oxygen saturation target, and moderate permissive hypercapnia. In addition to finding no difference in successful extubation among the groups, the researchers saw a similarly high rate of survival without bronchopulmonary dysplasia (78%). READ ABSTRACT

Stick with Inhaled Corticosteroids for Pediatric Asthma
Inhaled corticosteroids should remain the treatment of choice for pediatric asthma, report Finnish researchers who reviewed the medical literature comparing long-term treatment with leukotriene receptor antagonists and inhaled corticosteroids in asthmatic children. Five studies involving school-aged children met study criteria. All compared montelukast with inhaled fluticasone, with results showing better outcomes for FEV1 and asthma control days with fluticasone. The finding was strongest for patients with more severe disease or markers of allergic inflammation. Only about 25% of patients fared better with montelukast. “These findings support the present international recommendations for ICS as the preferred first-line controller therapy for mild to moderate persistent childhood asthma,” write the investigators. “If montelukast is selected as a monotherapy and asthma is not adequately controlled within 4-6 weeks, the treatment should be discontinued and the preferred medication initiated.” The study appeared in the Jan. 24 Epub edition of the European Journal of Pediatrics. READ ABSTRACT

HFOV Best for CDH Patients
A new study out of the United Kingdom shows high frequency oscillatory ventilation (HFOV) results in better outcomes for neonates with congenital diaphragmatic hernia (CDH). Investigators compared infants born between 1991 and 1995 who received conventional mechanical ventilation and systemic vasodilators, to infants born between 1996 and 2005 who received HFOV and nitric oxide. Results showed 38% of the infants in the first group survived, compared to 73% in the second group. The incidence of chronic lung disease in survivors was 45% and 30%, respectively. The authors conclude, “These data show significantly improved survival with elective use of HFOV and NO compared to CMV and systemic vasodilators.” The study appears in this month’s Pediatric Surgery International. READ ABSTRACT

Preemie for a Day
NICU staff at a hospital in Toronto, Canada recently took part in an innovative program aimed at helping them better understand how the care they deliver may be received by their tiny patients. The “Preemie for a Day” session calls for staff members to play the part of a premature infant, including being positioned, fed, and handled. At Sunnybrook Health Science Centre, the event was attended by physicians, nurses, and respiratory therapists, who all took their turn experiencing what their patients experience every day. The program was covered in the January issue of Hospital News. READ ARTICLE