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The objective of this study was to determine the minimal tidal volume in a newborn to cause a color change on 2 different colorimetric carbon dioxide detectors (Pedi-Cap vs. Mini-StatCO2) labeled for use for neonates in the United States. Colorimetric detectors are a noninvasive method of measuring ETCO2 after a successful intubation in 1-15 kg infants with adequate perfusion. In order to analyze their hypothesis, the authors created an artificial lung and ventilated this artificial lung with either mechanical or T-piece ventilators. They determined that the threshold tidal volumes for both modes of ventilation for the Mini-Stat and Pedi-Cap detectors were 0.83 mls and 1.08 mls, respectively. These volumes are less than the expected tidal volume of a 400 g infant whose tidal volume is expected to be 3 mls/kg. Therefore, both detectors should be sensitive enough to detect respirations in any intubated infant. Thus, the study confirms that both detectors are adequate for use in any viable newborn with adequate perfusion, regardless of the weight.

The objective of this study was to determine whether initiating preterm resuscitations with room air adjusted on the basis of SpO2 levels or 100% oxygen was more effective in achieving a target oxygen saturation. Preterm infants between 23 weeks and 32 weeks GA were included in this randomized prospective study involving two medical centers. Twenty three infants were randomized to the oxygen group. Eighteen infants were included in the room air group. Pulse oximetry was recorded on the right wrist. For the room air group. room air was used for a goal O2 sat of 80-85% at 5 minutes of life and 85-90% at 7 minutes of life. If the patient needed chest compressions or if the HR was <100 at 2 minutes of life, the baby was immediately placed on 100% oxygen. For the 100% oxygen group, oxygen was weaned if the O2 sat was >95% consistently. The study showed that every patient in the room air group met criteria for an increase in Fi02 by 3 minutes of life. Heart rates and secondary outcomes did not differ between the two groups. The study concluded that initial resuscitation with room air is inappropriate for preterm infants.

This study examined a method to screen children who have been in close contact to adults with TB on a symptomatic basis. In a highly endemic area of South Africa, screening of close household contacts was performed using usual practices. Information on symptomatology, including cough, fever, and failure to thrive, was collected and compared to those who had been treated for TB. This study found that in close household contacts, a negative screen for symptoms had a 95% negative predictive value in a population with a TB prevalence of about 20%. Sensitivity and specificity were only around 75%.

B-type natriuretic peptide has been used in the adult population as a screening tool for cardiac disease, but there is little data on BNP levels in heart disease in the pediatric population. This study looked at 2 cohorts of patients enrolled from 2005-2007 in Atlanta, GA. The 1st cohort of 33 patients were those with newly diagnosed congenital or acquired cardiac disease who were admitted to the PICU, and the 2nd cohort of 70 patients were those without cardiac disease who presented to the ED with respiratory or infectious diseases. The cardiac cohort had markedly elevated BNP levels with a mean BNP level of 3290 (+/- 1609) compared to the noncardiac cohort with a mean BNP of 17.4 (+/- 20). The weaknesses in the study include the fact that the cardiac cohort included patients who were more critically ill than in the noncardiac group, BNP levels were drawn at the time of diagnosis and not prior so it can't be evaluated as a screening tool, and that all the cardiac patients were in the ICU so results can't be generalized to milder forms of heart disease. The authors concluded that BNP level is a useful diagnostic marker in pediatric critical heart disease in a critical care setting, but further studies need to be done in using it as a screening tool in the pediatric population.

This study was done to evaluate the efficacy and safety of Hypericum perforatum (St. John’s Wort) in the treatment of attention-deficit/hyperactivity disorder (ADHD). It was a randomized, double-blind, placebo-controlled trial that was conducted and included 54 children aged 6-17 with a mean age of 9.7 and 9.9 (placebo and treatment groups, respectively). It lasted 8 weeks and patients in the control group were given 300 mg of H perforatum three times daily. Each dose contained 0.3% hypericin, the substance believed to be the active ingredient in St. John’s Wort. An ADHD rating scale called the Clinical Global Impression Improvement Scale was used to assess usefulness, and adverse reactions/events were also recorded. Results showed no significant improvement over the 8 week time period with St. John’s Wort versus placebo. There were a few limitations of this study. Participants with co-morbid psychiatric diagnoses were excluded. The sample size was small. There was a thought that St. John’s Wort may work synergistically with other medications. The amount of active ingredient in the St. John’s Wort was relatively small and focus is now being placed on another component called hyperforin that may be the more active ingredient. It was a short duration of time in which the study was conducted and the study group may have been too small to evaluate for adverse events.

Noting that pediatric obesity has continued to rise despite early interventions that have been attempted, the authors of this paper sought to study a new model produced by the Philadelphia public school system. Their sample was taken from schools where <50% of students were eligible for free or reduced-price meals in an attempt to identify the highest rate of obesity (authors worked off of the premise that obesity is higher in lower SES groups). Goal of the program was to reduce the incidence (or new cases) of obesity over a 2-year span. They began by continuing the suggested program by the school district by providing students with 50 hours of nutrition education per year (teachers were 10 hours), by limiting foods to health standards imposed by the CDC, removing high-sugar high-fat snacks and drinks from vending machines, encouraging physical activity and most importantly instituting basic principles of strategic marketing to make the entire project appealing to their age group (4th-6th grade). Authors found a 50% reduction in the incidence of overweight children in the intervention group when compared to control schools. Further, though a secondary outcome, the authors also witnessed a 30% reduction in prevalence of overweight children. There was no effect on obese children (>95th percentile), only on overweight children (>85th percentile). Power of this study is introducing a community-based program that is multifaceted and truly attempted to market their product or idea to kids specifically.

The Gardos channel contributes to loss of potassium from sickle blood cells. Dehydration of these cells partially results from this potassium loss. Senicapoc (ICA-17043) is a selective Gardos channel blocker that limits water loss and preserves sickled cell hydration. This paper presents a phase 2 study of Senicapoc evaluating its effects on hemoglobin, markers of hemolysis, red cell indices, patient symptoms and safety. The multicenter, randomized, double blind study treated 80 patients with hgb SS age 18-60 y/o over 12 weeks using placebo, low and high doses of Senicapoc. An end of treatment open label extension study was offered. Results revealed statistical increase in hgb (only 0.68g/dL) of high dose compared to placebo. Retic, LDH, indirect bili and dense rbc were lower in high and low dose compared to placebo. However, no differences in overall pain crises were noted. Pharmacokinetics confirmed dose dependent effect of the drug on the channel. Overall, the drug appeared well tolerated with most common side effects being nausea and diarrhea which was dose related. Serious adverse events included crisis then pneumonia and acute chest syndrome. These events could not be attributable to Senicapoc as similar incidence with placebo was noted. The authors concluded that: 1.Senicapoc appears well tolerated 2.The increased hgb and decrease in markers of hemolysis may not translate to benefit as measured by the decreased pain crises 3.However, Gardos channel inhibition may be a new potential therapy in patients with SCD and may have other clinical benefits (other than improving pain) possibly with complications such as pulmonary hypertension.

The objective of this study was to determine the effectiveness of long-term antibiotics for the prevention of acute pyelonephritis in patients with VUR. 100 patients younger than 30 months with VUR grades 2-4 were randomly assigned to receive or not receive antibiotic prophylaxis with bactrim for 2 years. The primary outcome was recurrence of pyleo in the following 4 years. In the end, the occurence of renal scarring was the same in both populations. This was a small sample size with only one outcome but it does make an argument against the use of prophylactic antibiotics in VUR.