July 2010

Specialty Practitioner of the Year Nominations Due Aug. 31
Know a fellow section member who goes above and beyond, either for the section or on the job? Then nominate him or her for our 2010 Specialty Practitioner of the Year award. Nominations are due by Aug. 31 and may be made via our online NOMINATIONS FORM.

Surfactant Administration Changes—Including the Addition of an RT to Delivery Room Team—Improve Outcomes
North Carolina researchers who revised their surfactant administration procedures for extremely low birth weight infants to include administration in the delivery room and the addition of a respiratory therapist to the delivery room team noted significant improvements. Specifically, 95% of eligible infants received surfactant in the delivery room, and time to the first dose following delivery was reduced from a mean of 26 minutes to a mean of 10.2 minutes. The outcomes were compared between a pre-intervention and post-intervention period. Infants born at less than 27 weeks gestation were included in the analysis. The study was published in the July 1 Epub edition of Quality & Safety in Health Care. READ ABSTRACT

RTs Included in Multidisciplinary Crisis Resource Management Course
A multidisciplinary Crisis Resource Management training course involving physicians, nurses, respiratory therapists, and nurse practitioners got high marks from participants, who noted a significant improvement in their ability to function as code team members for pediatric cardiac patients. The course included pediatric cardiac ICU scenarios and also involved unit-specific resuscitation equipment, including an extracorporeal membrane oxygenation circuit. Video-based debriefing took place after each scenario to review teamwork principles and technical resuscitation skills. “Further work is needed to determine whether participation in the Crisis Resource Management program objectively improves team function during real resuscitations,” write the Children’s Hospital Boston investigators. The report appeared in the June 4 Epub edition of the Journal of Thoracic and Cardiovascular Surgery. READ ABSTRACT

Deregionalization of Perinatal Care May Be Upping Mortality Rates
The deregionalization of perinatal care that has occurred in California may be increasing the mortality rate among premature infants. That’s the key finding from University of California, Irvine, researchers publishing in this month’s Medical Care. They looked at maternal-infant discharge data from 1997 to 2002, comparing mortality rates according to hospital level of neonatal ICU and volume of very low birth weight (VLBW) infants. After risk adjustment, lower level units that saw fewer infants had higher mortality rates. The highest rates were found in level 1 units that treated ten or fewer VLBW infants a year. Further analysis found low volume to be a more important factor than level of ICU. “Although deregionalization of perinatal services may increase access to care for high-risk mothers and newborns, its impact on hospital volume may outweigh its potential benefit,” write the authors. READ ABSTRACT

Identifying “Problematic Severe Asthma” in Kids
Swedish researchers offer a three step approach to separating difficult-to-treat asthma in children from a new category they are calling “problematic severe asthma.” The latter form of the condition is intended to capture those patients who are still having significant problems despite every therapeutic effort. The three steps to separate the two types of asthma are:

• A complete diagnostic reevaluation to confirm that the problem is really due to asthma.
• The exclusion by the pediatrician of comorbidity, as well as personal or family psychosocial disorders.
• A reevaluation of medication adherence, inhaler technique, and the child’s environment.