March 2012

Nominate a Peer for Neonatal-Pediatrics Specialty Practitioner of the Year

We’re accepting nominations for our 2012 Specialty Practitioner of the Year Award now through July 31, so take a few moments to brainstorm deserving candidates and then nominate them via our online NOMINATION FORM. It’s a great way to recognize a fellow section member who you believe has gone above and beyond for our specialty.

Bundle Helps Prevent TRPUs

A new study out of Cincinnati Children’s Hospital Medical Center finds good results for a clinical bundle aimed at preventing tracheostomy-related pressure ulcers (TRPUs). The bundle includes frequent skin and device assessments, a moisture-reducing device interface, and a pressure-free device interface. All TRPUs in an 18-bed pediatric ventilator unit were staged by a wound care expert within 24 hours, and clinicians recorded TRPU stage and description, number of days each TRPU persisted, and bundle compliance in real time. The rate of patients who developed a TRPU went from 8.1% in the pre-intervention period to 2.6% during bundle development to 0.3% after bundle implementation. A marked difference was seen between standard and extended tracheostomy tubes in TRPU occurrence, 3.4% vs. 0%, and days affected by a TRPU, 5.2% vs. 0.1%, as well. The study was published ahead of print by Pediatrics on Feb. 20. READ ABSTRACT

PPI Treatment Does Not Improve Asthma Symptoms in Kids

Adding a proton pump inhibitor (PPI) to standard inhaled steroid treatment for children with uncontrolled asthma does not improve outcomes and may increase the risk for upper respiratory infections and other adverse events. That’s the take home message from Johns Hopkins researchers who led a randomized, placebo-controlled clinical trial to compare the PPI lansoprazole with placebo in 306 children with poorly controlled asthma who were receiving inhaled corticosteroid treatment. Asthma Control Questionnaire (ACQ) scores were not statistically different between children who received the PPI and those who did not, and in a subgroup of children who had positive results for gastroesophageal reflux, there was no significant effect of lansoprazole treatment on any of the study outcomes, including asthma-related quality of life or lung function. However, treatment with lansoprazole was associated with a greater prevalence of upper respiratory tract infections, sore throats, and episodes of bronchitis. “Our study raises important questions about adverse effects of lansoprazole treatment of children with asthma,” the authors write. The study was published in the Jan. 25 edition of JAMA. READ PRESS RELEASE

Antenatal Corticosteroids Don’t Impact Respiratory Outcomes in Subsequent Pregnancies

Previous treatment with antenatal corticosteroids doesn’t appear to affect neonatal respiratory outcomes in women who subsequently have a late-preterm infant. U.S. researchers arrived at that conclusion after conducting a secondary analysis of data from a multicenter observational study on the mode of delivery after previous cesarean delivery. Among the group, 550 received antenatal corticosteroids during the initial pregnancy and 5374 did not. While unadjusted results indicated a greater need for neonatal ventilatory support, respiratory distress syndrome, and resuscitation in the delivery room among infants born to mothers who had taken antenatal corticosteroids, researchers found no differences in these outcomes after confounding factors were taken into consideration. The study appears in this month’s Obstetrics and Gynecology. READ ABSTRACT

Lower BUR Allows for Greater Triggering of Ventilator Inflations

A lower back-up ventilation rate (BUR) allows for greater triggering of ventilator inflations in preterm infants, report Australian researchers. Their crossover trial was conducted among 26 stable preterm infants who were assessed at BUR settings of 30, 40, and 50 minutes, with inflation rate, triggering, and cardiorespiratory measures of stability compared during 20 minute epochs with ten minute washout periods. Results showed:

• At BURs of 30, 40, and 50 minutes, the proportions of inflations that were triggered were mean 85% (11), 75% (19), and 61% (25), respectively.
• Total delivered inflation rates were 56 (8), 58 (9), and 62 (8) minutes, respectively.
• Cardiorespiratory parameters did not vary between the settings.

The study was published in the February issue of the Journal of Perinatology. READ ABSTRACT