April 2010

Notes from the Section

• Each year our section honors a member who has gone above and beyond, either for the section or on the job, with a Specialty Practitioner of the Year award. Nominations are being accepted now through Aug. 31, so start brainstorming deserving members and then use our ONLINE nomination form to nominate them for this prestigious honor.
• Wondering how much your AARC membership is really worth? Now you can find out. Our new SAVINGS CALCULATOR is a quick and easy way to attach a dollar value to the benefits and services that mean the most to you.

Strategy May Reduce Surfactant Use in VLBW Infants
A new study out of Switzerland found good results for a strategy to reduce surfactant use in very low birthweight infants (VLBW) with respiratory distress syndrome. The researchers conducted a deliberate early lung recruitment (ELR) maneuver in infants with an optimal continuous distending pressure finding during high frequency oscillatory ventilation (HFOV). Surfactant was administered only when an unsatisfactory oxygenation response to lung recruitment was observed. Among the 144 infants, 84 (58.3%) received surfactant and 60 (41.7%) did not. Infants who did not receive surfactant had a shorter duration of required oxygen supplementation and respiratory support. A similar incidence and severity of bronchopulmonary dysplasia was seen in the two groups, and no differences in survival rates were noted. Similar results were seen in a subgroup analysis of infants of less than 28 weeks of gestation. The study appeared in the Mar. 16 Epub edition of Intensive Care Medicine. READ ABSTRACT

New Way to Apply Surfactant Bypasses Intubation
Another study from German investigators suggests there may be a way to administer surfactant to VLBW infants without intubation. The authors report data from the first multicenter study to evaluate the use of a thin endotracheal catheter to apply surfactant to 319 spontaneously breathing infants on nasal continuous positive airway pressure. Outcomes were compared among these infants and 1222 infants receiving standard care. The need for mechanical ventilation during the first 72 hours was 29% for the treatment group vs. 53% for the control group, and the rate of bronchopulmonary dysplasia defined as oxygen at 36 weeks of postmenstrual age was 10.9% vs. 17.5%. The rate of death was significantly lower in the treatment group as well. “A new method of surfactant application was associated with a lower prevalence of mechanical ventilation and better pulmonary outcome. A prospective controlled trial is required to determine whether this approach is superior to standard care,” conclude the investigators. The study was published in the Jan.-Feb. issue of Klinische Padiatrie. READ ABSTRACT

Exhaled Breath Temperature May Be a Marker of Airway Inflammation
Could exhaled breath temperature (EBT) be a marker of airway inflammation in asthma? Yes, report Greek researchers publishing in this month’s International Archives of Allergy and Immunology. They compared EBT among children who presented with a common cold and/or mild exacerbation of asthma with those who had been free of cold or asthma symptoms for the past six weeks, finding EBT values were significantly higher for cases (34.91 ± 0.62 degrees C) than controls (34.18 ± 1.1 degrees C). “Changes in airway inflammation during virus-induced asthma exacerbations are reflected in EBT changes,” write the authors. “These preliminary data suggest a possible role of EBT measurements in the assessment of airway inflammation in children with virus-induced asthma.” READ ABSTRACT

GERD-Asthma Link Needs More Study
The jury is still out regarding the association between gastroesophageal reflux disease (GERD) and asthma in children, conclude Baylor College of Medicine researchers who reviewed the medical literature on the topic. While they did find 20 studies involving 5706 patients that met their study criteria, and the average prevalence of GERD was 22% among children with asthma vs. 4.8% for controls, the authors note that “because of methodologic limitations of existing studies, the paucity of population-based studies, and a lack of longitudinal studies, several aspects of this association are unclear.” The report appears in this month’s Pediatrics. READ ABSTRACT