April 2009

Notes from the Section

• This year’s Summer Meetings in Marco Island, FL, July 16-20, will have a new twist for neonatal-pediatric RTs: a workshop at the end of the sessions on pediatrics designed for managers and educators. To add even more value, it’s been offered at 80% off the regular registration fee for all Summer Forum registrants. The program will be posted soon. LEARN MORE HERE
• A new continuing education opportunity from the AARC will soon be arriving in your mailbox. Read the “Improving Symptom Control in Patients with Chronic Respiratory Disease” booklet and then take the online POST-TEST to earn 4 FREE CRCEs. The booklet is being supported by an education grant from Sepracor.
• Do you know a section member who has gone above and beyond, either for the section or on the job? Then nominate him or her for our 2009 Specialty Practitioner of the Year Award. Nominations are being accepted now on the SECTION WEB SITE.
• Do you Facebook or Twitter? Join in. FACEBOOK TWITTER

Caffeine Improves Respiratory Muscle Strength, Weaning Outlook
British researchers publishing in the March 7 edition of the European Journal of Pediatrics find caffeine administration can improve weaning from mechanical ventilation in preterm infants. The investigators compared standard measures of respiratory muscle function before and six hours after administration of caffeine, noting significant improvements in the median Pemax, Pimax, and resistance following the treatment. “Our results suggest that caffeine administration facilitates weaning of prematurely born infants from mechanical ventilation by improving respiratory muscle strength,” write the authors. Eighteen infants with a median gestational age of 28 weeks participated in the study. READ ABSTRACT

Long Term Outcomes in CDH Patients
Respiratory therapists often help care for infants with congenital diaphragmatic hernia (CDH). How do these children fare as they get older? Dutch researchers set out to answer that question in a study that followed up on 53 survivors of CDH at the mean age of about 12, comparing their pulmonary function test results with those from a group of healthy controls. Significantly lower FEV1, FVC, FEV1/FVC, MMEF, and PEF were seen in the CDH survivors compared to healthy controls, and the RV/TLC ratio was significantly higher. However, maximal cardiopulmonary exercise testing was normal. Gastro-esophageal reflux disease was an independent determinant of reduced FEV1 and FVC. “High risk CDH survivors have mild to moderate pulmonary function abnormalities when compared to a healthy matched control group, which may be related to gastro-esophageal reflux disease in early life,” conclude the investigators. “Exercise capacity and gas exchange parameters were normal in those tested, indicating that the majority of patients do not have physical impairment.” The study was published in the March 12 Epub edition of the European Respiratory Journal. READ ABSTRACT

Significant Cough May Predict Wheezing
Do certain symptoms predict wheezing episodes in children? According to researchers from Washington University School of Medicine who surveyed 238 parents of children between the ages of 12 and 59 months who had experienced previous moderate to severe wheezing episodes, significant cough during a respiratory track infection is “the most reliable antecedent of wheezing.” In the study, significant cough had a specificity of 78% and a positive predictive value of 74%. “It may be useful to consider individualized symptom patterns as a component of management plans intended to minimize wheezing episodes,” write the authors. The study appeared in the March 24 Epub edition of the Journal of Pediatrics. READ ABSTRACT

Caring for ELBW Infants: Current Practices Vary
A new study out of the Mayo Clinic is shedding light on current practices for the management of extremely low birth weight (ELBW) infants in the first week of life. Researchers surveyed medical directors at 809 NICUs across the United States, with a response rate of about one-third. Results showed:

• Some traditional practices have changed, such as beginning resuscitation with 40% rather than 100% oxygen.
• Many practices vary based on whether neonates are cared for in private versus academic centers, including initial resuscitation method, type of ventilation used, use of intraventricular hemorrhage prophylaxis, and routine antibiotic therapy.
• Parenteral nutrition composition and the use of inhaled nitric oxide differ based on the responding center’s participation in clinical trials.
• The number of years in practice as a neonatologist does not affect practice decisions.
• The continued use of dexamethasone for corticosteroid therapy, a potentially harmful practice, was still fairly prevalent.

The authors believe these findings show “the strength of evidence does not always predict whether practices are adopted or abandoned” and suggest “further research is necessary to clarify the optimal management for this high-risk patient population.” The study was published in the March 19 Epub edition of the American Journal of Perinatology. READ ABSTRACT