March 2010

Coming Soon: New and Improved Section Listserve
The AARC is getting ready to launch an exciting new social networking site for members called AARC Connect, and our section’s listserve will be moving to the new site as soon as it’s up and running. Now we’ll not only be able to communicate with each other in real time, we’ll also be able to view specific threads with ease, view posts by specific members, and much, much more.

Primary Caregivers Lack Knowledge of Home Mechanical Ventilation
Investigators from UCLA recently surveyed 152 primary caregivers of children on home mechanical ventilation — including 108 parents and 44 nurses — to gauge their knowledge of the therapy. While the mean score for the group was 81%, a closer look at the findings reveals significant gaps in knowledge:

• 63% did not know that the low pressure ventilator alarm would not sound if the tracheostomy tube decannulated while still connected to the ventilator.
• 52% failed to understand high pressure alarm sounds and mucous plugging.
• 43% did not know how much power a battery stored after the suction machine was fully charged.
• 40% did not know when the low pressure or low minute volume alarm sounds.
• 37% relied on the ventilator alarm to determine the presence of mucous plugs.

Scores did not differ with the use of continuous flow ventilators, and professional training did not give the nurses an advantage over the parents in the study. Similar results were also seen for English-speaking and Spanish-speaking caregivers. The report appears in this month’s Pediatric Pulmonology. READ ABSTRACT

Early Postnatal Corticosteroids: Benefits and Risks
Do the benefits outweigh the risks of early postnatal corticosteroids to help prevent chronic lung disease (CLD) in preterm infants? Irish researchers asked that question in a review of 28 randomized controlled trials of postnatal corticosteroid therapy conducted among 3740 patients. Their meta-analysis found significant benefits in terms of earlier extubation and decreased risks of CLD at both 28 days and 36 weeks’ postmenstrual age (PMA), death or CLD at 28 days and 36 weeks’ PMA, patent ductus arteriosus, and retinopathy of prematurity (ROP), including severe ROP. No significant differences were seen in the rates of neonatal or subsequent mortality, infection, severe intraventricular haemorrhage, periventricular leucomalacia, necrotising enterocolitis, or pulmonary hemorrhage. However, adverse events were noted, including gastrointestinal bleeding and intestinal perforation, and the risks of hyperglycemia, hypertension, hypertrophic cardiomyopathy, and growth failure were also increased. The investigators question whether these risks outweigh the benefits and call for more study, particular on long term neurological and developmental outcomes. The study was published in the Jan. 20 issue of the Cochrane Database of Systematic Reviews. READ ABSTRACT

Flu Shots Okay for Young Infants
Infants as young as 6 to 12 weeks could benefit from the seasonal influenza vaccine, report researchers from the University of Washington in Seattle. They randomly assigned 1375 healthy infants to receive either two doses of the standard trivalent seasonal flu vaccine or an inactive placebo vaccine, given one month apart in combination with standard vaccines. Nearly half of the infants who received the active vaccine developed antibodies to at least two of the three influenza strains included in the vaccine. No differences in side effects or adverse events were seen between the two groups, with about 11% of those in both developing a fever within three days of vaccination. There was no evidence that the flu vaccine interfered with the other childhood vaccines given at the same time, and serious adverse events related to the study vaccine were rare. The study appeared in the February issue of the Pediatric Infectious Disease Journal. READ PRESS RELEASE

Surfactant Standard Not Being Met
Despite a locally developed standard of care in New York City recommending surfactant treatment within two hours of birth for premature infants with respiratory distress syndrome (RDS), many infants are still going without the treatment. That’s the take home message from Mount Sinai School of Medicine researchers who reviewed surfactant use in three New York City hospitals. Among 227 infants meeting criteria for treatment according to the standard, 37% received it within two hours and 70% received it within four hours. Treatment varied by race, with 85% of white infants receiving the treatment within four hours versus 61% of African American infants and 67% of Latino infants. “If these data can be generalized, there is a large opportunity to reduce infant morbidity from RDS and to reduce racial/ethnic disparities in birth outcomes by increasing the rate and speed with which surfactant is delivered to these infants,” write the authors. The research was published in the Feb. 25 Epub edition of the Journal of Perinatology. READ ABSTRACT