INFANT FLOW CPAP FOUND TO BE AS EFFECTIVE AS CONVENTIONAL CPAP IN EXTREMELY LOW BIRTH WEIGHT INFANTS
Stefanescu BM, Murphy WP, Hansell BJ, Fuloria M, Morgan TM, Aschner JL. A randomized, controlled trial comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants. Pediatrics. 2003;112:1031-1038.
Extremely low birth weight (LBW) infants are often placed on continuous positive airway pressure (CPAP) following extubation from ventilator systems. This has been shown to reduce the incidence of bronchopulmonary dysplasia in these infants. Looking toward these ends, two types of CPAP have emerged in the marketplace:
* the infant flow CPAP system (IF) and
* the conventional CPAP which uses INCA prongs.
This research compared the clinical outcomes of two groups of extremely LBW infants who were randomly assigned to one of two groups based on which type of CPAP they received. Between July 1997 and November 2000, 162 infants <1000 g in birth weight were followed during their neonatal intensive care unit course. Each was randomly assigned to the CPAP groups. Once an infant was deemed fit to be extubated, the infant either received IF or CPAP. Data were gathered on the demographic characteristics of the infants as well as on whether they had to be reintubated.
The results showed that there were no differences in the ages, birth weights, or reintubation rates between the two groups. In fact, it was found that the only difference between the groups was that the infants on IF were on supplemental O2 for a shorter length of time and that their time in the hospital was also shorter when compared to the infants on the conventional CPAP. In infants who had to be reintubated (roughly 40% of infants), it was found that it was largely due to apnea/bradycardia; again a similar finding for both groups.
Because no differences were found in the health outcomes of extremely LBW infants on the two types of CPAP, the researchers agreed that either of these two methods are beneficial to the extremely LBW infant.
IPECAC SYRUP NOT RECOMMENDED BY POISON CONTROL CENTERS
Bond GR. Home syrup of ipecac use does not reduce emergency department use or improve outcome. Pediatrics. 2003;112:1061-1064.
Conventional wisdom on poisoning of children is to have syrup of ipecac on hand in the home in case poisoning occurs and that the poison control center advises parents to use it to stimulate vomiting in the affected child. This supposition was tested in a retrospective study of data from the American Association of Poison Control Centers' Toxic Exposure Surveillance System (TESS). Data were gathered from the organization for the years 2000 to 2001 related to whether ipecac was recommended to be used or whether parents were told to take their child to the emergency room (ER) so that the poisoning could be treated.
During 2000 to 2001, there were 754,602 telephone calls to the poison control centers. Of these, only 9% were referred to the ER for treatment. Recommendations to use ipecac syrup were 1.8%. Further analysis showed that use of ipecac did not correlate with ER use. Therefore, it was shown that the rate of use of ipecac was extremely low in instances of poisoning.
This study was limited in that data were only collected relating to calls to the poison control centers for pharmacological poisonings. Episodes of poisoning related to nonpharmacological chemicals such as mushrooms, cosmetics, cleaning substances, etc. were not compared. However, the researcher noted that the use of ipecac cannot be defended because few poison control centers recommended its use. The researcher called on the American Academy of Pediatrics to reconsider its recommendations on use of ipecac for pediatric poisonings.