May 2011

Spring Bulletin Online Now
The Spring edition of our Section Bulletin is ONLINE now, with great articles on caring for special needs kids in the hospital setting and the role of hypertonic saline in the treatment of bronchiolitis. Section Chair Cyndi White also updates us on recent section activities in her “Notes” column.

New Monitoring Method Characterizes Hypoxemic Episodes During HFOV
Israeli researchers have identified a new method for monitoring chest wall movement in newborn infants undergoing high frequency oscillatory ventilation (HFOV). The method consists of three miniature motion sensors attached to both sides of the chest and to the epigastrium to measure the local tidal displacement (TDi) at each site. A deviation from baseline was defined as a >20% change in TDi. The researchers tested the method in eight premature infants who were monitored during ten sessions that included 21 hypoxemic events. Three types of events were noted: a decrease in TDi that preceded hypoxemia; a simultaneous decrease in TDi and SpO2; and a decrease in SpO2 without changes in TDi. In the 11 events detected in the first group, decreases in TDi were found 22.4 ± 18.7 min. before hypoxemia and were credited to airway obstruction by secretions or decline in lung compliance. The six events recorded in the second group resulted from apnea or severe abdominal contractions. In the four events noted in the third group, hypoxia followed a decrease in FiO2. The study was published ahead of print by Intensive Care Medicine on April 29. READ ABSTRACT

Breathmobiles Result in Good Outcomes for Inner City Kids
Breathmobiles aimed at providing state-of-the-art asthma care to inner city children who otherwise might not receive proper care for their asthma get the job done, report California researchers publishing ahead of print in the Journal of Allergy and Clinical Immunology on April 29. They evaluated time to achieve control, maintenance of control, and factors associated with well controlled asthma for 7822 pediatric patients with asthma who made 34,339 visits to Breathmobiles around the country between 1998 and 2008. A comparison of pre-and post-year data for children who had been enrolled in the program for at least a year revealed:

The percentage of patients reporting emergency department visits dropped by a mean of 66%.
Hospitalizations declined by a mean of 84%.
The percentage of children missing five or more school days per year dropped by a mean of 78%.
Well controlled asthma was achieved by the third visit for an estimated 80% of patients.
Factors contributing to well controlled asthma included non-African American race, visit interval <90 days, and adherence to prescribed therapy.

READ ABSTRACT

Changes in Lung Volume and Ventilation During Surfactant Treatment
Dutch investigators who set out to assess regional changes in lung volume, mechanics, and ventilation during and after surfactant administration in preterm infants with respiratory distress syndrome who were on HFOV find the treatment causes a rapid increase and subsequent stabilization of lung volume that is most prominent in dependent lung regions. The treatment also increased maximal compliance, but only at lower airway pressures. The trial was conducted among 15 preterm infants using electrical impedance tomography to continuously measure changes in lung volume during a stepwise recruitment procedure before, during, and after surfactant. The authors published their findings ahead of print in the American Journal of Respiratory and Critical Care Medicine on April 14. READ ABSTRACT

Gauging the Costs of RSV LRI
A new study out of Thomson Reuters Outcomes Research finds high costs for infants who develop respiratory syncytial virus lower respiratory tract infection (RSV-LRI) or unspecified bronchiolitis/pneumonia (UBP) in the first year of life. Among the results—

Most infants were diagnosed with RSV-LRI/UBP after 90 days of chronologic age.
Early-preterm infants had the greatest mean number of inpatient, outpatient, and emergency department visits after an RSV-LRI/UBP episode.
The marginal costs among infants with RSV-LRI compared with controls were $34,132 and $3869 among inpatients and outpatients, respectively.
Among late-preterm infants, the marginal costs were $17,465 and $2158 among inpatients and outpatients, respectively.
Full-term infants had the lowest marginal costs, $9151 for inpatients and $1428 for outpatients.
Inpatients with RSV-LRI/UBP had higher costs than outpatients, suggesting that increased downstream costs are associated with severity of RSV-LRI/UBP disease.

The study was based on Medicaid data and published ahead of print by the Journal of Medical Economics on April 27. READ ABSTRACT