Rapid cycle deliberate practice improves resident performance during ELBW resuscitation.

BACKGROUND: Neonatal Resuscitation is a required competency for pediatric and family medicine residency programs. Simulation-based training can be used to supplement clinical experience. Rapid Cycle Deliberate Practice (RCDP) has been validated as an effective education model and is gaining favor over traditional simulation models. The aim of this study was to evaluate the effectiveness of a simulation-based rapid cycle deliberate practice (RCDP) intervention on extremely low birth weight (ELBW) infant resuscitation. METHODS: Pediatric and family practice residents were randomized to control and intervention groups and participated in pre- and post-NICU rotation simulations. The intervention group received one RCDP session. Simulations were scored by blinded video review for overall performance, positive pressure ventilation (PPV), endotracheal intubation and behavioral skills. Surveys assessed confidence in ELBW resuscitation. RESULTS: Forty-one residents participated in the study. The RCDP group performed better than the control group at post-rotation evaluation for overall resuscitation performance (65% vs 87%, p = 0.004), administering PPV (63% vs 88%, p = 0.006), and validated behavior skills (1.4 vs 2.0, p = 0.019). Residents in the RCDP group reported greater confidence with ELBW resuscitation. CONCLUSION: An educational intervention using RCDP was associated with improved resident performance and confidence in ELBW resuscitation. RCDP should be considered for NRP and ELBW resuscitation training.

Comparison of the GMFM-66 and the PEDI Functional Skills Mobility domain in a group of Chinese children with cerebral palsy.

BACKGROUND: Previous research has suggested there is a high level of comparability between the Gross Motor Function Measure-66 (GMFM-66) and the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Mobility domain. However, there are only a few studies that have examined the correlations between these instruments. The purpose of this study was to determine the correlation between the GMFM-66 and the PEDI Functional Skills Mobility domain scaled scores in a group of Chinese children with spastic cerebral palsy, at the ages of 12-70 months, in order to explore the feasibility of using them interchangeably. METHODS: Secondary data analysis was conducted of data collected during a prospective international collaborative study that used the GMFM-66 and the PEDI to examine the impact of treatment. This study examined the Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain at six time points over the course of 28 consecutive weeks for 115 Chinese children who participated at baseline. RESULTS: Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain ranged from 0.83 to 0.90 for the six time points of data collection, with statistically significant P-values <0.0001 for each correlation. CONCLUSIONS: These results support previous research that the GMFM-66 and the PEDI Functional Skills Mobility domain are complementary assessments that may be used interchangeably when it is not possible to administer both.

Immunosuppressive properties of surfactant in alveolar macrophage NR8383.

OBJECTIVE: To evaluate the anti-inflammatory effects of exogenous surfactants and surfactant phospholipid without surfactant proteins (SP-A and SP-D) on the lipopolysaccharide- (LPS) stimulated rat alveolar macrophage (AM) cell line NR8383. METHODS: Exogenous surfactants (beractant, calfactant or colfosceril) and surfactant phospholipid (dipalmitoyl phosphatidylcholine, DPPC), standardized to phospholipid content of 25-1,000 microg/ml were incubated with LPS- (1 microg/ml) stimulated NR8383 AMs. RESULTS: TNF-alpha and IL-1beta secretion and nitric oxide (NO) formation following LPS stimulation were inhibited by treatment with surfactants or DPPC. Furthermore, LPS-dependent NO production and iNOS protein levels were significantly suppressed in cells pretreated for one hour with beractant compared to beractant added simultaneously with or following LPS. Additionally, LPS-stimulated oxidative burst, measured by flow cytometry, was significantly decreased by beractant. Finally, beractant inhibited the translocation of NF-kappaB from cytoplasmic into nuclear extract in LPS-stimulated NR8383 AMs. CONCLUSIONS: Exogenous surfactants and surfactant phospholipid inhibit secretion of proinflammatory cytokines and NO in NR8383 AMs. The inhibitory effects of beractant on oxygen radical and LPS-induced NO formation may result from unique mechanisms of decreasing cell signaling. The anti-inflammatory activity of surfactant products used in the treatment of neonatal respiratory distress syndrome (RDS) may depend upon the specific preparation or dose used.

The impact of CD14 polymorphisms on the development of soluble CD14 levels during infancy.

CD14 is a receptor involved in the recognition of lipopolysaccharide and other bacterial wall components that may be involved in the balance between infectious and allergic disease and the early polarization towards TH1. Our group has shown an association between polymorphisms in the 5' flanking region of the CD14 gene and plasma soluble CD14 (sCD14) levels at 11 years of age. However, whether this association is present at birth and in infancy remains to be determined. In this study, we measured sCD14 levels in plasma from the umbilical cord (n = 387) and at 3 months (n = 357) and 1 year (n = 312) of age in non-selected healthy infants to assess their relationship with CD14 genotypes at -4190, -2838, -1720 and -260 (relative to translation start site). There was no relation of CD14 genotypes with sCD14 at birth. However, there was a significant association between CD14 genotypes and sCD14 as early as 3 months. Longitudinal analysis suggests that CD14 polymorphisms modulate sCD14 levels up to 1 year of age. This association early in life may have an impact on TH1 polarization and subsequent protection against allergic disease.