January 2011

Get Connected in 2011
The New Year is a great time for resolutions, and if you’re looking for one that will enhance your professional career, look no further than the AARC’s new social networking site, AARConnect. If you’re on the section discussion list, you already know a little about the new site and how it can help you connect with fellow members. But the section list is really just one facet of this rich networking environment. So if you’ve yet to become an AARConnect fan, click on the link and check out all the features, from blogs to resource libraries and more. And be sure to visit your own profile page while you’re there (every AARC member has one on the site) and upload a picture of yourself and provide a little information to let your colleagues know about your background and interests. GET STARTED HERE

High Levels of GFAP May Predict Brain Injury in ECMO Patients
Johns Hopkins researchers who followed 22 children age two days to nine years who were on ECMO have found that those with abnormally high levels of a protein commonly found in the central nervous system were 13 times more likely to die and 11 times more likely to suffer brain injury than children with normal levels. Among the seven children who developed brain bleeding or swelling, five of whom subsequently died, median glial fibrillary acidic protein (GFAP) levels were 5.9 nanograms per milliliter of blood compared to 0.09 among children without brain bleeding or swelling. High median levels of GFAP—3.6 ng/ml—were also seen in eight of the 22 children who had poor neurologic outcomes after ECMO. Children with good neurologic outcomes had median GFAP levels of 0.09. The investigators hope to use these findings to develop a test to measure for and prevent brain damage in children on ECMO. The study appeared in the Nov. 4 issue of Pediatric Critical Care Medicine. READ PRESS RELEASE

In Search of Optimal Oxygen Saturation
A new study out of Norway reviews ten previous studies that compared high vs. low oxygen saturation during the first weeks of life to determine which strategy produces the best outcomes for very low and extremely low birth weight infants. Eight of the studies had retinopathy of prematurity (ROP) and eight had bronchopulmonary dysplasia/lung problems as outcomes. Survival data was reported in two of the studies. Results from the combined studies showed a 50% reduction in severe ROP with a low oxygen saturation approach, 9.5% vs. 20.9%, and a 25% reduction in bronchopulmonary dysplasia/lung problems, 29.7% vs. 40.8%. The authors call for further study to “assess whether reducing oxygen saturation has an impact on mortality among very and extremely low birth weight infants.” The study appeared in the Dec. 9 Epub edition of Neonatology. READ FULL PAPER

Blood Protein May Predict Bronchopulmonary Dysplasia
U.S. investigators believe they have found a blood protein that could predict bronchopulmonary dysplasia (BPD) among extremely low gestational age newborns (ELGANs). The research was conducted among 932 ELGANs who underwent blood sampling on postnatal days 1–3, 5–8, and 12–15. Among the findings:

• Increased risk of BPD was associated with elevated blood concentrations of a variety of pro-inflammatory cytokines, adhesion molecules, and proteases.
• Reduced risk was prominently associated with increased concentrations of one chemokine, RANTES.
• Elevations of inflammatory proteins associated with BPD risk occurred during the first days following birth, and inflammation intensified thereafter; therefore, exposures that promote inflammation after the first postnatal days may be more critical in the pathogenesis of BPD.
• Fetal growth restriction, a known BPD risk factor, was not accompanied by protein elevations and therefore does not appear to be mediated by systemic inflammation.
• Mechanical ventilation altered protein levels and may be associated with systemic inflammation.

The study was published in the Dec. 9 Epub edition of Pediatric Research. READ ABSTRACT

Too Many Chest Radiographs?
Do children on home mechanical ventilation (HMV) receive unnecessary chest radiographs when admitted to the hospital for pneumonia? They might, report Children’s Hospital of Los Angeles researchers publishing in the Care Management Journals. They reviewed all HMV patients admitted for pneumonia to their hospital between July 2007 and June 2008, finding these patients averaged five chest radiographs per admission. However, two-thirds of the radiographs did not prompt subsequent changes in respiratory therapy, and more than a third found no interval changes. Most of the discharges were not contingent on resolution of the chest radiograph findings. The authors conclude, “We speculate that the frequency of chest radiographs could be less and that chest radiographs were not the sole predictors of changes in respiratory treatment or the decision to discharge.” READ ABSTRACT