May 2010

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Spring Bulletin Online Now
The Spring issue of our Section Bulletin is ONLINE now, so click over to read two great articles on spinal muscular atrophy—the first is an overview of the condition by an RT and the second is a parent’s perspective on the condition.

Delivery Room Videos with a Clinical Purpose
Ten years worth of video reviews of neonatal resuscitations in the delivery room are helping to inform changes at the University of California San Diego. The videos began in 1999, revealing that many times multiple people were trying to perform the same task, that bag and mask ventilation was almost exclusively performed by RTs and was not performed well by any other clinician, and that low birth weight infants were often hypothermic on admission. Changes in the ensuing years have included warming the room, the use of occlusive wrap, determining the effectiveness of bag and mask ventilation with colorimetric CO2 detectors, and the introduction of crew resource management to develop consistent and effective communication. Now the investigators are looking at how these changes are affecting outcomes in the delivery room and beyond. They published their findings in the March issue of Clinics in Perinatology. READ ABSTRACT

How Oxygen Impacts VLBW Infants without Bronchopulmonary Dysplasia
Studies have shown conflicting results on whether neonatal oxygen exposure leads to later morbidity in very low birth weight (VLBW) infants without bronchopulmonary dysplasia. New York researchers believe difficulties in accurately quantifying the oxygen exposure may be to blame and decided to research the area, hypothesizing that cumulative oxygen exposure in the neonatal period summarized using an area under the curve analysis (Oxygen(AUC)) would predict later pulmonary symptoms. Results showed:

• The prevalence of pulmonary symptoms after NICU discharge was 48% (36 of 75 patients).
• Oxygen(AUC) as early as 72 hours of age predicts respiratory symptoms and respiratory-related health service and medication use during infancy in a dose dependent manner.
• Oxygen(AUC) is a stronger predictor of later respiratory symptoms than is the number of days of supplemental oxygen, positive pressure respiratory therapy, or integrated mean airway pressure.

The authors conclude, “Supplemental oxygen therapy should be monitored carefully to minimize oxygen exposure and risk of later respiratory symptoms in VLBW infants.” The study appeared in the April issue of Pediatric Pulmonology. READ ABSTRACT

Comparing LRTIs: H1N1 vs. Other Viruses
A new study out of Argentina takes a look at 30 patients admitted to PICUs with acute lower respiratory tract infections (LRTIs) attributed to H1N1, comparing them to 62 patients admitted with LRTIs attributed to other viruses. Results showed patients in the H1N1 group were older and more likely to have pneumonia, acute respiratory distress syndrome, and shock at the time of PICU admission. However, length of stay and mortality were similar in the two groups. The study appeared in the April 28 Epub edition of Pediatric Critical Care Medicine. READ ABSTRACT

Two Government Initiatives
The federal government is spearheading two new programs that may be of interest to neonatal-pediatric RTs:

• A new workbook from the Centers for Disease Control and Prevention identifies the steps pediatric facilities need to take to coordinate care in a flu pandemic. Coordinating Pediatric Medical Care During an Influenza Pandemic includes a section on ensuring adequate numbers of essential staff are in place, including respiratory therapists. DOWNLOAD WORKBOOK
• Text4Baby is a free service that invites pregnant women and/or new moms to sign up to receive three text messages a week targeted to their stage of pregnancy or the age of their newborn. These messages reinforce important topics like immunizations, nutrition, seasonal flu, mental health, smoking and alcohol, oral health, and safe sleep. Moms can participate by texting BABY (or BEBE in Spanish) to 511411. The service also connects women to local clinics and support services for prenatal and infant care. READ BLOG or go to the text4baby WEBSITE to learn more.