February 2011

Winter Bulletin Online Now
The Winter edition of our Section Bulletin is online now, with great articles on whole lung lavage in MAS patients and pulmonary complications in children undergoing bone marrow transplantation. Our new section chair, Cyndi White, reviews the neo-peds presentations at the AARC Congress and other issues as well, and we round out the issue with a profile of our 2010 Specialty Practitioner of the Year.

T-Piece, Self-Inflating Bag Both Effective in the Delivery Room
Australian researchers publishing in the Jan. 14 Epub edition of the Journal of Pediatrics find no difference in oxygen saturation five minutes after birth among infants who received positive pressure ventilation (PPV) via a T-piece or self-inflating bag. The study was conducted among 80 infants born at <29 weeks gestation who were randomly assigned to receive PPV with a T-piece or a self-inflating bag. While infants in the T-piece group were more likely to receive oxygen in the delivery room, no differences were seen in the use of CPAP, endotracheal intubation, or administration of surfactant in the delivery room. READ ABSTRACT

Inhaled Nitric Oxide Shows Little or No Benefit
Inhaled nitric oxide (iNO) may not make any difference in outcomes for premature infants, report researchers from Johns Hopkins, and should not be used outside of clinical trials. According to their review of 22 clinical trials that analyzed the effect of iNO on infants born before 34 weeks gestation, the treatment does not affect mortality or the development of chronic lung disease of prematurity, cerebral palsy, or neurological or cognitive impairments. However, when some of the data were analyzed separately, a slight advantage was seen for the prevention of either dying or developing lung disease. Specifically, in that analysis, there was a 7% reduction in the risk of the composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 weeks for infants treated with iNO compared with controls, but no reduction in death alone or BPD. “We can’t say whether this small difference signals a true clinical benefit, but we have to at least allow for the possibility that it might portend better outcomes for at least some babies,” senior investigator Marilee Allen, MD, was quoted as saying. The study appears in this month’s Pediatrics. READ ABSTRACT READ PRESS RELEASE 

Racemic Albuterol Beats Levalbuterol in ED Study
Racemic albuterol (RAC) outperformed levalbuterol (LEV) in a new study conducted among 99 children who presented to the emergency department with an asthma exacerbation. The participants received either 7.5 mg of RAC or 3.75 mg of LEV in continuous form over one hour, along with standard asthma therapies. Following one hour of continuous treatment, children in the RAC group had a greater improvement in their FEV1 and asthma scores than those in the LEV group. The greater improvement in asthma scores was maintained after a second hour of continuous therapy in the RAC group. Changes in heart rate, respiratory rate, and oxygen saturation did not differ between the groups, nor was any difference seen in the rate of hospital admissions or in the side-effect profile. The study was conducted by investigators from Dell Children’s Medical Center of Central Texas and published in the Jan. 29 Epub edition of the Journal of Asthma. READ ABSTRACT

Low Levels of H Antigen Lead to Poor Outcomes in Preemies
A new study out of Cincinnati Children’s Hospital Medical Center suggests low levels of H antigen, a substance controlled by the secretor gene FUT2, may lead to poorer outcomes in premature infants. The investigators measured H antigen levels in 410 infants born at or before 32 weeks gestation. Among this group, 26 died, 30 developed necrotizing enterocolitis, and 96 were diagnosed with sepsis. Fifteen percent of the infants with low H antigen levels died, compared to just 2% of those with high levels, and low levels were also linked to higher odds of developing necrotizing enterocolitis, along with higher odds of death from both necrotizing enterocolitis and sepsis. Gram negative sepsis was linked to the secretion of no H antigen. The researchers are now working to determine whether intestinal colonization relates to this FUT2 genotype. Other studies are looking at human milk oligosaccharide, a complex carbohydrate made by enzymes of the FUT2 gene, to see if it would benefit these infants. The study appeared in a recent issue of the Journal of Pediatrics. READ PRESS RELEASE