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June 2009
Notes from the Section
- A Pediatrics program at
the AARC's Summer Meetings may interest you. It's 80% off with a Forum
registration. Plus "think vacation!" SUMMER
MEETINGS
- The latest issue of the
SECTION
BULLETIN is online now, with informative articles on volume-targeted
ventilation in premature infants and congenital hepatic arteriovenous
malformation.
- Nominations for our 2009
Specialty Practitioner of the Year are well underway. Visit the SECTION
WEB SITE to access the easy-to-use online nominations form.
- The AARC is letting everyone
know about a new study in Pediatrics that found positive outcomes for
a respiratory therapist-driven ventilator protocol for preterm infants.
READ
MORE
Asthma and
Pregnancy
The April 30 issue of the New England Journal of Medicine includes
an article on asthma in pregnancy, with the authors concluding
that the
disease should be actively managed to optimize the health of
both mother and child. The researchers specifically review recommendations
on asthma
assessment, management of triggering factors, medication management,
treatment of attacks, obstetric management, and patient education.
The recommendations are based on a 12 year Kaiser Permanente
study
of 1900
pregnant women and another study involving 2620 women treated
at 16 university centers around the country. READ SUMMARY
Higher Volume-Targeted
Level Associated with Lower Work of Breathing
British researchers publishing in the April issue of Pediatrics
find weaning preterm infants with a volume-targeted level of
6 mL/kg could
help avoid an increase in the work of breathing. Their study
was conducted among 20 infants with a mean gestational age
of 28 weeks
who were being
weaned via patient-triggered ventilation using either assist-control
ventilation or synchronous intermittent mandatory ventilation.
The investigators assessed work of breathing by measuring the
transdiaphragmatic
pressure-time
product. 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 work of breathing
was below that at baseline only at a volume-targeted level of 6 mL/kg.
READ ABSTRACT
Factors Leading to
Pulmonary Deterioration in Extremely Premature Infants
University of North Carolina researchers also publishing
in the April issue of Pediatrics shed light on pulmonary
deterioration
in the
first 2 postnatal weeks for preterm infants born
at 23-27 weeks gestational age. The study was conducted
among 1340 infants,
with results showing
nearly 40% experienced pulmonary deterioration during
the first 2 weeks
of life. About half went on to develop chronic lung
disease. Factors associated with this deterioration
included: lower
gestational
ages
and lower birth weights, higher scores for neonatal
acute physiology, and
treatment with more intensive modes of respiratory
support. No link was seen between pulmonary deterioration
and gender,
multifetal
pregnancy,
cesarean delivery, antenatal steroids, chorioamnionitis,
or funisitis. “Indicators
of developmental immaturity and illness severity
were associated with both pulmonary deterioration and chronic lung disease,” write the authors. “Studying the antecedents of pulmonary
deterioration might provide new insights about chronic
lung disease pathogenesis.” READ
ABSTRACT
Non-RSV Bronchiolitis
More Likely to Result in Recurrent Wheeze
Is there is difference in subsequent development
of recurrent wheeze among children under the age
of 2 who are hospitalized
with respiratory
syncytial virus (RSV) or non-RSV bronchiolitis?
Yes, report Finnish researchers who followed all
children
admitted to their
hospital
with these diagnoses
during August-December over the years 1988-2001.
Results showed 16.6% of the non-RSV bronchiolitis
children developed recurrent
wheezing
within one year of hospitalization, versus 2.5%
of those with RSV. Rates were
also higher during years 2 and 3. The finding held
true despite gender and could not be explained
by confounding seasonal patterns
or the
age difference seen in the children during the
initial hospitalization. “Children
hospitalized with bronchiolitis caused by other
viruses than RSV develop recurrent wheezing at substantially higher rates
during a 3-year follow-up
period than do children with RSV-induced bronchiolitis,” conclude the investigators. The study appeared
in the March
23 Epub edition of Allergy. READ ABSTRACT
Practice Plan Allows
for Lower Oxygen Levels During Delivery Room Resuscitation
Weill Cornell researchers who developed a practice
plan aimed at using lower levels of oxygen during
delivery room resuscitation
find
their
changes resulted in more infants with an initial
PaO2 <80
mm Hg and lower saturation values on admission.
A lower FiO2 requirement
at 24
hours was seen as well. The practice plan consisted
of initial FiO2 from 0.21 to 1.0 using blenders,
along with oxygen guided
by oximetry
to maintain
saturation between 85-95% from birth. Infants
who were treated after the plan was put into
place
were compared with those
who were treated
with 100% oxygen in the period prior to plan
implementation. The research was published in
the April 9 Epub edition
of the Journal of Perinatology. READ
ABSTRACT
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