February 2010

Winter Bulletin Online Now
The Winter edition of our section Bulletin is ONLINE now, with a provocative look at pediatric end-of-life care that’s a must read for anyone involved in caring for terminally ill children.

Pediatric Posttracheostomies
A new study out of the University of Tennessee sheds some light on pediatric posttracheostomy patients. Investigators followed 141 patients age one month to 20 years, finding:

• The length of in-hospital stay ranged from 14 to 280 days.
• The most common indications for tracheostomy were ventilation of chronic lung disease, subglottic stenosis, or combination (44.7% of the cases), followed by neurological cases (26.2%).
• Patients requiring prolonged stay were more likely to have pulmonary hypertension, gastrointestinal reflux, prior episodes of failure to thrive, feeding failure requiring feeding tube, and tracheitis.
• The chances for home ventilation requirement increased with long preoperative in-hospital ventilation time and high ventilator respiratory rate on the day of tracheostomy.
• The survival rate was 98.9% for the first 30 days and 78% afterward.

The report appeared in the Jan.–Feb. issue of the Journal of Intensive Care Medicine. READ ABSTRACT

Motavizumab Outperforms Palivizumab for RSV Prevention
Spanish researchers publishing in the January issue of Pediatrics find motavizumab is more effective in reducing respiratory syncytial virus (RSV) infections in premature children compared to palivizumab. Overall, children on motavizumab had a 50% reduction in RSV infections treated in the outpatient setting, 2% versus 3.9%. However, hospitalization rates for RSV in the children were about the same regardless of which drug they were taking; 1.4% for children on motavizumab versus 1.9% for those on palivizumab. The study was conducted among 6,513 children under the age of two who were suffering from chronic lung disease due to premature birth. READ ARTICLE

CF Patients Benefit from Breath-activated Video Game
Could cystic fibrosis (CF) patients benefit from a breath-controlled video game? Yes, report researchers who developed a game using a digital spirometer aimed at promoting awareness of breathing techniques. They tested the game on ten children hospitalized for CF exacerbations. Each child played the game, which challenged them to track a moving target using their breath, five times for at least 15 minutes each time. Results showed improvement in eye-breath coordination over the five sessions. The authors conclude, “an electronic breath game is safe and can improve breath awareness among children with CF.” They also believe the game could help raise awareness of respiratory symptoms among these children and foster social ties between kids suffering from the disease. The study was published in the Jan. 28 Epub edition of Clinical Pediatrics. READ ABSTRACT

H1N1 in the NICU
Influenza rarely strikes premature infants in the NICU, but Israeli researchers outline just such a case in the Jan. 20 Epub edition of the American Journal of Perinatology. H1N1 flu was diagnosed in a 50-day-old, very low birth weight infant in their care, despite any obvious epidemiological conditions in the NICU. According to the authors, apnea was the unique presenting symptom, and treatment consisted of nasal intermittent positive pressure ventilation. “Due to the current pandemic, neonatologists should be aware of possible infection of neonates with novel A/H1N1 influenza virus,” they write. READ ABSTRACT