In the spotlight
High-Flow Nasal Cannulae in Very Preterm Infants after Extubation
A recent multicenter trial by Manley et al, published in NEJM investigated the use of high-flow nasal cannulae compared to nasal continuous positive airway pressure (CPAP) for noninvasive respiratory support of very preterm infants (gestational age, <32 weeks) after extubation. Infants received treatment with either high-flow nasal cannulae (5 to 6 liters per minute) or nasal CPAP (7 cm of water) after extubation. The primary outcome was treatment failure within 7 days. The efficacy of high-flow nasal cannulae was similar to that of CPAP as respiratory support for very preterm infants after extubation.
IN THE NEWS
Catheter Dwell Time and CLABSIs in Neonates With PICCs: A Multicenter Cohort Study
To determine whether the daily risk of central line-associated bloodstream infections (CLABSIs) increases over the dwell time of peripherally inserted central catheters (PICCs) in high-risk neonates, a multicenter retrospective cohort study by Milstone et al in Pediatrics found the average predicted daily risk of CLABSIs after PICC insertion increased during the first 2 weeks after PICC insertion and remained elevated for the dwell time of the catheter. There was an increased risk of CLABSIs in neonates with concurrent PICCs and the incidence of Gram-negative CLABSIs was greater in PICCs with dwell times >50 days. The authors concluded clinicians should review PICC necessity daily, optimize catheter maintenance practices, and investigate novel CLABSI prevention strategies in PICCs with prolonged dwell times.
Scottsdale Spring Meeting
April 4-6, 2014
Workshop on Perinatal Practice Strategies-Innovation with Evidence
The Workshop on Perinatal Practice Strategies was created to provide a forum for addressing practice issues in neonatal/perinatal medicine.
You should attend the workshop if you are a…
• Practicing neonatologist
• NICU medical director or division chief
• Teaching program director
• Resident or fellow
• Advanced practice nurse
• Other pediatric professional responsible for the delivery of care to the fetus and newborn
It’s not too late! Registration is still open for NeoPREP 2014. This course is for those preparing to take the American Board of Pediatrics Neonatal-Perinatal Medicine certifying exam for the first time. It is also excellent preparation for those needing to re-certify. Many of the attendees are also those who want to attend an outstanding neonatology review course and learn the latest EBM related to the entire field of neonatology. The conference will be held January 11-17, 2014 in San Diego, CA. As always, outstanding faculty and interactive audience participation are the highlights of this conference.
Perinatal Asphyxia with Hyperoxemia within the First Hour of Life Is Associated with Moderate to Severe Hypoxic-Ischemic Encephalopathy
In a recent Journal of Pediatrics publication by Kapadia et al, to determine whether early hyperoxemia in neonates with severe perinatal acidemia is associated with the development of hypoxic-ischemic encephalopathy (HIE), infants with perinatal acidosis with a PaO2 measurement during the first hour of life, were divided into infants with hyperoxemia (PaO2 >100 mmHg) and those without hyperoxemia (PaO2 <100 mmHg). Infants with hyperoxemia had a higher incidence of HIE than those without hyperoxemia and admission hyperoxemia was associated with a higher risk of HIE. Among neonates with HIE, admission hyperoxemia was associated with abnormal brain magnetic resonance imaging findings. The judicious use of oxygen during and after resuscitation is warranted according the authors.
Active Cooling Improves Transport of Infants With Hypoxic-Ischemic Encephalopathy
Newborns with hypoxic-ischemic encephalopathy (HIE)
do better with active cooling during transport in a recent Pediatrics publication by Chaudhary et al. Servo-controlled active cooling during transport of full-term infants with HIE improved their temperature stability and reduced their transfer time in comparison to passive cooling, researchers said. All babies cooled using the active approach were within the target temperature range when they arrived at the regional unit for treatment, versus 39% of the passively controlled infants.
Read the article »
AAP Perinatal Coding Expert, Gil Martin, and others
answer your questions.
A Coding Question from Dr. Satyan Lakshminrusimha
I need some input regarding initial care coding from institutions that do not mandate attending physicians to stay in house for night call.
For example, a 24-week infant is born at 10pm on 8/29/13 and is managed by a fellow overnight. The attending physician comes in at 730am on 8/30/13, examines the baby and reviews the chart and puts in an admit note. Does the attending physician bill initial critical care (99468) for 8/30 or 8/29 or not at all (and bill only subsequent critical care - 99469 for 8/30)?
what is the Section on perinatal pediatrics?
The Section on Perinatal Pediatrics is the home organization for specialists in Neonatal-Perinatal Medicine and also welcomes affiliate members working in related disciplines. At a membership of nearly 3,500, the Section is the largest specialty subgroup of the American Academy of Pediatrics. The Section's highest priority is to ensure optimal health and well-being of babies and mothers and this is accomplished through the Section's core activities in the realms of advocacy, education, outreach and support of clinicians and researchers.
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