September 2009

Notes from the Section

• National Respiratory Care Week is just around the corner—Oct. 25–31—and the section encourages everyone to get involved in the celebrations. You can find everything you need to plan your events HERE.  
• The 2009 AARC International Respiratory Congress in San Antonio, Dec. 5–8, will feature a wealth of information for neonatal-pediatric therapists. Discounts on registration are available until Oct. 31, so VISIT THE WEB PAGE and take advantage of the savings today.

School-based Asthma Programs: A Literature Review
University of California, San Francisco researchers who reviewed the medical literature on school based asthma programs conclude these programs improve knowledge of asthma, self-efficacy, and self-management behaviors. However, findings were mixed on the effect of school based programs on other measures, including quality of life, school absences, and days and nights with symptoms. The review included 25 studies involving children between the ages of 4 and 17. The report appeared in the August issue of Pediatrics. READ ABSTRACT

New Recommendations Would Up Percentage of Infants Receiving RSV Prophylaxis
New recommendations from the American Academy of Pediatrics suggest expanding the list of risk factors for respiratory syncytial virus (RSV) prophylaxis for infants 32-35 weeks gestation age to include passive smoke exposure (PSE), crowded living conditions (CLCs), and young chronological age (YCA). Researchers from Winthrop University Hospital in New York have used a budget model to predict how this expansion would increase the number of infants potentially receiving the treatment. According to their model, adding PSE to the list would increase the percentage of infants potentially prophylaxed to 29.9%, CLC to 23.9%, and YCA to 47%. Using the previous list of five risk factors, the percentage came in at about 20.2%. Adding all three of the new factors would increase the percentage to 55.6%, leading to an increase in payer costs of 9 cents per-insurance plan member-per-month. The study appeared in the Aug. 24 Epub edition of Value in Health. READ ABSTRACT

Then and Now: Changes in Neonatal Outcomes Over the Past 20 Years
A comparison of infants born at or before 30 weeks’ gestation between July 1985–June 1986 (cohort 1) and July 2005–June 2006 (cohort 2), along with sociodemographically matched term controls, reveals significant changes:

• There was a 35% increase in the number of live-born preterm births in the second cohort,  despite more than a 10% decline in total births in the region.
• Assisted fertility was responsible for 20% of pregnancies in cohort 2.
• Survival to hospital discharge increased from 82% to 93%, primarily because of higher survival for infants born at less than 27 weeks' gestation (63% vs. 88%).
• Changes in management in cohort 2 included the use of surfactant (62% of infants) and increased use of postnatal steroids (39% vs. 9%); these changes were associated with a shorter median duration of mechanical ventilation (13 vs. 21 days), but the incidence of bronchopulmonary dysplasia was higher in cohort 2 (56% vs. 35%).
• There was a significant decrease in incidence of severe ultrasound abnormalities, from 17% in cohort 1 to 7% in cohort 2.
• At 24 months of age, 7% of cohort 1 and 5% of cohort 2 had an abnormal neurologic exam.
• Bayley cognitive scores were improved in cohort 2 (significantly closer to the mean of their controls). As a result, survival without severe neurodevelopmental impairment increased from 62% in cohort 1 to 81% in cohort 2.

The study appeared in the Aug. 24 Epub edition of Pediatrics. READ ABSTRACT

HFNC Improves Outcomes for Infants and Children with Respiratory Distress
Researchers publishing in the Aug. 23 Epub edition of the Journal of Intensive Care Medicine find good results for high-flow nasal cannula (HFNC) therapy in infants and children with respiratory distress. The study was based on 46 patients who were assessed with standard measures before and after receiving the therapy. Results showed HFNC improved the respiratory scale score, the oxygen saturation, and the patient's COMFORT scale. READ ABSTRACT