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March 2009
Notes from the Section
- Want to maximize your
section membership? Then take advantage of our SECTION WEB SITE.
The site features everything from resources you can put to use in your
practice to back issues of the Section Bulletin and even these monthly
eNews newsletters. If you haven’t signed up for the section e-mail list
yet, you can do that on the site as well.
- Speaking of the web site,
we’re in the process of making it even more valuable with the addition of
a Swap Shop where we all can share protocols, presentations, and policies
and procedures. If you have something to share, E-MAIL it to our
section chair, Brian Walsh.
- The AARC has learned that
the National Institutes of Health (NIH) will be issuing new grants for
health care research as a part of the federal government’s economic
recovery plan. The NIH Challenge Grants in Health and Science will
disburse at least $200 million for studies on a wide range of topics,
including those related to asthma, COPD, and obstructive sleep apnea. Applications
may be submitted between March 27 and April 27. READ MORE
Transpyloric Feeding
Reduces Apnea, Bradycardia in VLBW Infants
A new study out of Duke University
finds transpyloric tube feeding reduces the incidence of apnea and bradycardia
in very low birth weight (VLBW) infants with clinical signs of gastroesophageal
reflux. The research was conducted among 72 infants who received transpyloric
feeds for a median of 18 days. Apnea episodes dropped from 4.0 to 2.5 and
bradycardia episodes declined from 7.2 to 4.5 with transpyloric feeding. None
of the infants receiving human milk developed necrotizing enterocolitis
compared to 36% receiving hydrolysate-based formula. None developed late-onset
culture-proven sepsis. Seven infants died before leaving the hospital. The
authors believe these findings show transpyloric feedings, especially when
limited to human milk, can safely reduce episodes of apnea and bradycardia in
this patient population. They call for prospective randomized trials to
determine the biological impact of bypassing the stomach and further refine the
safety and efficacy of this intervention. The study appeared in the February 26
Epub edition of the Journal of Perinatology. READ
ABSTRACT
WOB at Varying Levels of
Volume-Targeted Ventilation
British researchers report low
volume-targeted levels increase the work of breathing (WOB) during
volume-targeted ventilation and suggest that, during weaning, a volume-targeted
level of 6 mL/kg avoids that increase. They arrived at these findings after
measuring the transdiaphragmatic pressure-time product, as an estimate of WOB,
in 20 infants with a median gestational age of 28 weeks who were being weaned
from respiratory support using patient-triggered ventilation either via
assist-control or synchronous intermittent mandatory ventilation. Results
showed:
- The mean
transdiaphragmatic pressure-time product was higher with volume targeting
at 4 mL/kg in comparison with baseline, regardless of the
patient-triggered mode.
- The transdiaphragmatic
pressure-time product was higher at a volume-targeted level of 4 mL/kg in
comparison with 5 mL/kg, and at 5 mL/kg in comparison with 6 mL/kg.
- The mean WOB was below
that seen at baseline only at a volume-targeted level of 6 mL/kg.
The research appears in this
month’s Pediatrics. READ
ABSTRACT
Antenatal Steroid Therapy
Ups Risk for Asthma in Young Children
Antenatal steroid therapy appears to
increase the risk for asthma in young children, report Canadian researchers
publishing in the February issue of the Journal of Asthma. They looked at
health information for 79,395 infants born in Nova Scotia between 1989 and
1998, comparing use of antenatal steroids to the development of asthma in these
children when they were 36-72 months of age. Antenatal steroid use during
pregnancy increased the risk of asthma by an adjusted odds ratio of 1.23. “Further
research into the smallest possible steroid dose required to achieve the
desired post-natal effect is needed to reduce the risk of developing childhood
asthma,” conclude the investigators. READ
ABSTRACT
Best Device for AOP
Which device is best for treating
apnea of prematurity (AOP) in preterm infants? German investigators asked that
question in a randomized crossover trial of four nasal respiratory support
systems conducted among 16 infants with a mean gestational age of 31 weeks.
Each of the infants received nasal pressure support for six hours using: (1) nasal
intermittent positive pressure ventilation (NIPPV) via a conventional ventilator,
(2) NIPPV and nasal continuous positive airway pressure (NCPAP) via a variable
flow device, and (3) NCPAP delivered via a constant flow Underwater Bubble
System. With the conventional ventilator in the NIPPV mode, the median event
rate was 6.7 per hour. With the variable flow device in NCPAP and NIPPV modes
the rates were 2.8 and 4.4 per hour, respectively. No significant difference
was noted between the NIPPV/conventional ventilator and the Underwater Bubble
System. The authors conclude, “A variable flow NCPAP device may be more
effective in treating AOP in preterm infants than a conventional ventilator in
NIPPV mode. It remains unclear whether synchronized NIPPV would be even more
effective.” The research was published in the January 8 Epub edition of Archives
of Disease in Childhood. READ
ABSTRACT
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