February 2009

Winter Bulletin Online Now
The Winter issue of our section Bulletin is online now, with two articles that are sure to interest members: keeping up with the demand for well-trained therapists and volume-targeted ventilation strategies for premature infants. We also have a review of the AARC Congress, plus an article on our 2008 Specialty Practitioner of the Year. Go to the SECTION WEB SITE and click on “Bulletins” to read the issue.

Weaning and Extubation from HFV
Dutch researchers who set out to determine whether weaning the continuous distending pressure (CDP) below 8 cm H₂O and the Fio2 below 0.30 in preterm infants on open lung high frequency ventilation (HFV) is feasible and results in successful extubation found the answer is yes on both accounts. In a study conducted among 214 infants, the CDP, but not the Fio2, decreased significantly in the 24-hour period before extubation, resulting in a mean CDP of 6.8 +/- 1.6 cm H₂O and a mean Fio2 of 0.25 at the time of extubation. Ninety percent of the infants were successfully extubated at these settings, with birth weight the only independent variable positively associated with successful extubation in a multivariate logistic regression analysis. The authors conclude, “The value of this approach should be prospectively compared with conventional weaning and extubation strategies.” The research appeared in the January issue of Pediatric Critical Care Medicine. READ ABSTRACT

Researchers Provide Guidance on Oxygen Use
University of California, San Diego Medical Center investigators who reviewed the currently available medical evidence for clinical oxygen use in the newborn period have developed a set of recommendations they believe may be used until further studies are conducted to evaluate the effects of varied oxygen targets on long-term outcomes. According to the report:

• A reasonable approach to resuscitation would include initial resuscitation with 30-40% oxygen for very preterm infants using targeted SpO₂ values and blended oxygen during the first 10 minutes.
• For ongoing management of preterm infants, SpO₂ targets of 85-93% appear to be most appropriate, with alarm limits set within 1-2% of these targets with intermittent audits to ensure compliance.
• There is not strong evidence to support the use of altered limits for the infant who develops early evidence of retinopathy of prematurity.

The study appeared in the December 24 Epub edition of Pediatric Research. READ ABSTRACT

Supervised Care Improves Asthma
Improving asthma outcomes among schoolchildren may require a little supervision, report researchers from the University of Alabama at Birmingham Lung Health Center. They came to that conclusion after comparing results for 240 asthmatic children from 36 area schools who were randomly assigned to either usual care or school-based supervised asthma therapy. All of the children had the need for a daily controller medication and were capable of using a dry-powder inhaler and peak flow meter. At a 15 month follow up, the researchers found no differences in the likelihood of poor asthma control in the usual care group when compared to baseline. But children in the intervention group were significantly less likely to have experienced poor asthma control. “Clinicians who have pediatric patients with asthma with poor outcomes that may be attributable to nonadherence should consider supervised therapy,” write the authors. The study appears in this month’s Pediatrics. READ ABSTRACT

Timing of Birth Impacts Congenital Diaphragmatic Hernia
According to the Congenital Diaphragmatic Hernia Study Group, the timing of delivery may have a big impact on infants diagnosed prenatally with congenital diaphragmatic hernia – and earlier is better than later. Researchers looked at a retrospective cohort of 628 term infants who were diagnosed prenatally and treated between January 1995 and December 2006. All were free of major associated anomalies. Among the results:

• Early term birth (37 versus 39-41 weeks) and greater birth weight were associated independently with survival; black race was related inversely to survival.
• Infants born at early term with birth weights at or above the group mean (3.1 kg) had the greatest survival rate (80%).
• Among infants born through elective cesarean delivery, those born at 37-38 weeks of gestation, compared with 39-41 weeks, had less use of extracorporeal membrane oxygenation (22.0% versus 35.5%) and a trend toward a greater survival rate (75.0% versus 65.8%).

The study is published in this month’s Pediatrics. READ ABSTRACT