January 2010

Notes from the Section

• We’d like to take this opportunity to congratulate Cynthia White, BA, RRT-NPS, AE-C, for receiving our 2009 Specialty Practitioner of the Year award. Cynthia was honored at the AARC International Respiratory Congress in San Antonio in December. Among other accomplishments, Cynthia is currently serving as co-editor of our section Bulletin.
• The section has just launched a SWAP SHOP aimed at helping members share policies and procedures, protocols, and other tools they’ve found helpful in their organizations. Check it out and share a tool today!

Small Baby Guidelines Improve Outcomes
A new study out of Nationwide Children’s Hospital suggests using a unified approach to the care of extremely premature infants in the first week of life can markedly improve outcomes. The unified approach was developed by a multidisciplinary team of physicians, nurses, therapists, nutritionists, pharmacists, and social workers, who came up with small baby guidelines in 11 different focus areas. In a study comparing 37 infants cared for via the guidelines with 40 who received usual care, the investigators noted a 24% higher survival rate without bronchopulmonary dysplasia and a 65% higher survival rate without severe intraventricular hemorrhage. “By adopting a unified approach, we were able to significantly improve the outcome of these babies,” study author Leif Nelin, MD, was quoted as saying. “The key point is that the staff is educated and does things in the same way in the caregiving of these premature infants.” The research appeared in a recent issue of Acta Paediatrica. READ PRESS RELEASE

Bi-Level NCPAP Beats NCPAP in Preterm Infants with RDS
Italian researchers who compared nasal CPAP (NCPAP) with bi-level nasal CPAP (Bi-Level NCPAP) in preterm infants with moderate respiratory distress syndrome found Bi-level NCPAP led to better respiratory outcomes and earlier hospital discharge while inducing the same changes in cytokine levels. The study was conducted among 40 infants born at 28-34 weeks gestational age who were randomized to one of the two groups. All the infants survived and there were no instances of neurological disorders. Bi-level NCPAP was considered safe and well tolerated by the infants. The study was published in the Nov. 29 Epub edition of the Archives of Disease in Childhood: Fetal and Neonatal Edition. READ ABSTRACT

Brief ED Screen Identifies Asthma Problems
Investigators at the Children’s Hospital of Philadelphia have developed short screening instruments they believe could be used in the emergency department to identify children who could benefit from additional interventions to improve asthma control. They tested a 6 item screen for persistent symptoms on parents of children between the ages of 1 and 18 who came to the ED for their asthma. An 8 item asthma-related quality of life (ARQOL) instrument was used as well. The screens were repeated one month after discharge via a telephone follow up. Sixty-nine percent of the children continued to report persistent symptoms. Patients with persistent symptoms had significantly worse ARQOL scores at both the ED visit screen and the follow up screen. The study was published in the Dec. 23 Epub edition of Pediatric Emergency Care. READ ABSTRACT

HFNC Lowers Intubation Rate for Bronchiolitis
Can heated humidified high-flow nasal cannulae (HFNC) therapy improve outcomes for infants being treated for bronchiolitis? Yes, report researchers from Tufts University School of Medicine, Baystate Children’s Hospital. They compared outcomes for infants under 24 months who were treated in the season prior to the implementation of HFNC to those for infants treated in the season following implementation of HFNC. Prior to HFNC, 23% of the infants required intubation versus 9% after HFNC was implemented. The 68% reduction held true even after the results were adjusted to take other factors into account. Median PICU length of stay dropped as well, from 6 to 4 days. The authors believe HFNC reduces the need for intubation by decreasing the respiratory rate and work of breathing. The study appeared in the Dec. 24 Epub edition of the Journal of Pediatrics. READ ABSTRACT