Neonatal-Pediatrics Section Newsletter

June 2012

Specialty Practitioner of the Year: Deadline Quickly Approaching!

There are only a few weeks left to nominate a fellow section member for our 2012 Specialty Practitioner of the Year Award, so take some time today to consider who among your colleagues you feel is deserving of this prestigious honor. The nomination deadline is July 31, and nominations may be made via our online NOMINATION FORM.

Early Caffeine Therapy May Improve Outcomes in Extremely Preterm Infants

Researchers from Emory University School of Medicine/Children’s Healthcare of Atlanta report good results for the use of early caffeine (EC) therapy in extremely preterm infants. The investigators compared outcomes for 140 neonates who received EC therapy before three days of life or late caffeine (LC) therapy at three days of life or after. Twenty-five percent of the EC infants died or developed bronchopulmonary dysplasia, compared to 53% of the LC infants. Patent ductus arteriosus treatment was required in 10% of EC infants vs. 36% of LC infants, and duration of mechanical ventilation was shorter in the EC infants, six days vs. 22 days. The authors conclude, “Further studies are needed to determine if caffeine prophylaxis should be recommended for preterm infants.” The study was published ahead of print by the Journal of Perinatology on April 26. READ ABSTRACT

BP-NCPAP: A Possible Alternative to NCPAP for Preemies?

A new study published ahead of print in BMC Pediatrics on April 4 suggests biphasic nasal continuous positive airway pressure (BP-NCPAP) might be an alternative to infant flow NCPAP in facilitating extubation from mechanical ventilation in preterm infants born at <1250 grams. The research involved 67 infants who received BP-NCPAP and 69 who received NCPAP. While the trial was stopped short of the calculated sample size of 141 infants per group due to increased use of noninvasive ventilation from birth, the researchers noted no statistical differences in sustained extubation in the two groups (67% for BP-NCPAP vs. 58% for NCPAP). The incidence of adverse events was generally similar as well, although retinopathy of prematurity was higher in the BP-NCPAP group. The authors call for a larger study to confirm the safety and effectiveness of BP-NCPAP to facilitate extubation from mechanical ventilation in this patient population. READ ABSTRACT

What’s Going on in Pediatric and Neonatal ECLS?

Penn State investigators recently surveyed all 125 extracorporeal life support (ECLS) centers in the U.S. to gauge their implementation of new technology. The response rate was 75%, and 34 states were represented in the poll. A little over half of the respondants were ECLS center coordinators. Results showed:

Respiratory diagnosis is the predominant indication for ECLS at any age.
Over 40% of centers are using a hollow-fiber oxygenator for neonates and for 80% of pediatric patients.
Roller pumps are used in 70% of neonatal and pediatric ECLS cases.
42% of centers changed the oxygenator type within the past three years, while 30% changed both the oxygenator and pump.
Less than 10% of centers reported problems with either oxygenator or pump in both neonates and pediatric ECLS.
46% of respondents that changed oxygenators cited that the primary reason for changing was “clinical preference/experience,” while the other half was split between “FDA approval” and “research results.”
In 40% of centers, a multidisciplinary group made decisions on changing technology.

The study was published ahead of print in Artificial Organs on May 25. READ ABSTRACT

Weaning from CPAP: One Method May be Best

Australian investigators who compared three different methods of weaning preterm infants from CPAP find one stands out from the crowd. The study was conducted among 177 infants <30 weeks gestational age who were randomized to either:

Method 1: Taken ‘“OFF” CPAP with the view to stay “OFF.”
Method 2: Cycled on and off CPAP with incremental time “OFF.”
Method 3: Cycled on and off CPAP but during “OFF” periods were supported by 2 mm nasal cannula at a flow of 0.5 l/min.

A significantly shorter time to wean was seen for Method 1, and these infants also spent less time on CPAP overall. Oxygen duration and length of admission were shorter with Method 1 as well, and Method 1 infants were less likely to develop bronchopulmonary dysplasia. The study was published ahead of print in the Archives of Disease in Childhood: Fetal and Neonatal Edition on May 18. READ ABSTRACT