August 2010

Summer Bulletin Online Now
The Summer edition of our Section Bulletin is ONLINE now, with great articles on premedication of neonates for elective intubation, part one of a two part series on bronchopulmonary dysplasia, and a look at a POC Scholar Research Program.

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PRAM and PASS Help Predict Asthma Outcomes in Kids Presenting to the ED
Two clinical asthma scores appear to be effective in predicting an ED length of stay (LOS) of greater than six hours or a hospital admission among young children presenting to the ED with an acute exacerbation, report Canadian researchers who studied the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS) in 283 children between the ages of 18 months and seven years. A respiratory therapist assessed the clinical findings and components of the PRAM and PASS at the start of the ED visit and 90 minutes following treatment. Moderate levels of discrimination were found between the two asthma scores as calculated at the start of the ED visit and a LOS of >6 hours and/or admission. Significant similar correlations were seen between PRAM and PASS and the physician’s judgment of severity. The study was published in the June issue of Academic Emergency Medicine. READ ABSTRACT

ROP: When Low Oxygen Saturation is Best but High is Better
A new study out of Floating Hospital for Children at Tufts Medical Center reviews the medical literature on oxygen saturation and risk of severe retinopathy of prematurity (ROP) in preterm newborns. Ten studies were included in the review, and researchers used a random-effects model to calculate a summary-effect estimate. “Among preterm infants with a gestational age of < or = 32 weeks, early low and late high oxygen saturation were associated with a reduced risk for severe ROP,” the authors write. “We feel that a large randomized clinical trial with long-term developmental follow-up is warranted to confirm this meta-analytic result.” The study appeared in the June issue of Pediatrics. READ ABSTRACT

Early Nasal CPAP Results in Better Outcomes for Preterm Infants
German investigators publishing in the June 28 Epub edition of the Archives of Disease in Childhood: Fetal and Neonatal Edition find early CPAP leads to better outcomes for preterm infants. They randomized 39 spontaneously breathing infants to either nasal CPAP immediately following birth or intubation, surfactant treatment, and mechanical ventilation. Mechanical ventilation days were lower in the CPAP group, 4 vs. 7.5, and these infants also needed less total respiratory support, 30 vs. 47 days. A lower respiratory rate was also seen in the CPAP group, 41 vs. 48/min, and they also had lower minute ventilation, 223 vs. 265 ml/min/kg; better respiratory compliance, 0.99 vs. 0.82 ml/cm H2O/kg; and improved elastic work of breathing. FRC did not differ between the groups. “Early CPAP is feasible, shortens the duration of respiratory support and results in improved lung mechanics and decreased work of breathing,” conclude the investigators. READ ABSTRACT

SMA Type I: Treatments That Work
British researchers outline the respiratory management of 13 infants with spinal muscular atrophy (SMA) type I who were referred to their facility for treatment, noting noninvasive positive pressure ventilation (NIPPV) was provided to three children for continuous positive airways pressure flow driver dependency, to three for nocturnal hypoventilation, to two to enable successful extubation, to three in anticipation of respiratory decompensation, and to two for oxygen dependency/decompensation. Nine children who underwent successful protocol-led extubations benefited from both NIPPV and mechanical insufflation/exsufflation MI-E. However, these treatments were not used for three other non protocol-led extubations that were also successful. NIPPV was considered essential for discharge home in seven patients with ventilatory dependency and was used for palliation of respiratory symptoms in four. Chest wall shape improved with NIPPV. Among the five children who died, parents were positive about the use of these techniques. The study was published in the June 23 Epub edition of the Archives of Disease in Childhood.

You can read more about SMA Type 1 in the SPRING ISSUE of our Section Bulletin.