August 2008

Notes from the Section

• The Summer edition of our Section Bulletin is online now, with 2 articles that take a hard look at treatment issues for the 23 week or lower gestation neonate. READ THE ISSUE 
• We also want to remind everyone to nominate a fellow section member for our Specialty Practitioner of the Year award. The deadline is coming up August 31, so visit the SECTION WEB SITE and fill out the online nomination form today! 

MRSA Increases Lung Function Decline in Kids with CF
Children with cystic fibrosis who acquire methicillin-resistant Staphylococcus aureus (MRSA) experience a significantly increased decline in FEV1, report Johns Hopkins investigators publishing in the July 31 Epub edition of the American Journal of Respiratory and Critical Care Medicine. They followed 17,357 children and adults with CF over an average of 5.3 years. During that time, 1,732 developed new persistent MRSA infections. These individuals were then followed for an average of 3.5 years. After adjusting for cofounders, the average rate of decline in FEV1 was 43% greater in children age 8 to 21 who had MRSA infections. MRSA infections did not impact FEV1 decline in adults. READ ABSTRACT

Respiratory Muscle Activity: Impact on Tidal Flow and End Expiratory Volume
Swiss investigators suggest noninvasive transcutaneous electromyography of respiratory muscles (rEMG) measurements, alone or in combination with lung function, can be used to provide a more comprehensive picture of pulmonary mechanics in newborns. The study was conducted among 20 spontaneously sleeping healthy neonates who were measured for the relative impact of intercostals and diaphragmatic EMG activity in direct comparison to the resulting tidal flow and FRC. Good feasibility and repeatability of intercostal and diaphragm rEMG measurements were noted in the study, providing the first quantitative measures of the temporal relationship between muscle activity and flow in sleeping neonates. The research appeared in the July 30 Epub edition of Pediatric Pulmonology. READ ABSTRACT

Proper Hand Hygiene Cuts Nosocomial Infections in VLBW Infants
Proper hand hygiene in the NICU can significantly cut the number of nosocomial infections (NIs) in very low birth weight (VLBW) infants. That’s the key finding from Italian researchers who compared infection rates before and after the initiation of a standardized hand hygiene program using antimicrobial soap and alcohol-based hand rubs. NIs were detected in 16 of 85 infants before the policy went into effect, dropping to just 5 of 80 infants following implementation of the program. The rate of central venous catheter colonization went from 16.6% to 5.8%. “In our experience, a proper hand hygiene program can save approximately 10 NI episodes/year, at a cost of $10,000 per episode,” write the authors. “Therefore, improving hand hygiene practice is a cost-effective program in the NICU.” The study appears in this month’s American Journal of Infection Control. READ ABSTRACT

The Benefits of ECMO
A new meta-analysis conducted by British researchers suggests neonatal extracorporeal membrane oxygenation (ECMO) results in significantly improved survival without increased risk of severe disability in mature infants with severe but potentially reversible respiratory failure. The authors reviewed clinical trials comparing ECMO to standard ventilatory support, including 3 U.S. trials and 1 United Kingdom trial in their analysis. All 4 showed a strong mortality benefit for ECMO, particularly for infants who were not suffering from congenital diaphragmatic hernia. The authors conclude, “Further studies are needed to consider the optimal timing for introducing ECMO; to identify which infants are most likely to benefit; and to address the implications of neonatal ECMO during later childhood and adult life.” The study was published in the July issue of the Cochrane Database of Systematic Reviews. READ ABSTRACT