Systematic use of the RAM nasal cannula in the Yale-New Haven Children's Hospital Neonatal Intensive Care Unit: a quality improvement project.

OBJECTIVE: To evaluate the clinical efficacy of the RAM nasal cannula (NC) with different modes of non-invasive ventilation (NIV) in the neonatal intensive care unit (NICU). METHODS: A single center prospective, observational study of infants placed on RAM NC. A small trial (Study 1) was completed in 16 infants on NIV via the RAM NC over a 48-h period to create Summary Statement recommendations. Next, over a 10-month period (Study 2), data were prospectively collected for the outcome of all infants receiving respiratory support with the RAM NC. Outcomes were compared between different modes of NIV and whether the recommendations were followed. RESULTS: The Study 2 population consisted of 88 infants of whom 67 infants received nasal continuous positive airway pressure ventilation (NCPAP) and 21 received nasal intermittent positive pressure ventilation (NIPPV) via the RAM NC. The NIPPV group tended to be younger, smaller and stayed on the RAM NC longer. The overall success rate in weaning off the RAM NC, if our guidelines were followed, was 63%. CONCLUSION: RAM NC use with NIV was well tolerated in the neonatal population with the use of our guidelines. We speculate that use of our guidelines will lead to a more systematic use of the RAM NC in the NICU.

Neutrophil CD64 with hematologic criteria for diagnosis of neonatal sepsis.

OBJECTIVE: To assess the sensitivity and specificity of neutrophil CD64 as a diagnostic marker for clinical sepsis (based on a hematologic score) and as an additional marker with hematologic parameters for culture-proven sepsis in neonates. STUDY DESIGN: Prospective observational cohort over 18 months in a single-center neonatal intensive care unit. RESULTS: Hematologic and CD64 data were available on 1,156 sepsis evaluations done in 684 infants, of which 411 (36%) instances of positive clinical sepsis were identified. The CD64 index for clinical sepsis had an overall area under the receiver operating characteristic curve of 0.71. An optimum CD64 cut point value of 2.19 for late-onset clinical sepsis was calculated with a sensitivity of 78%, a specificity of 59%, and a negative predictive value of 81%. The birth weight-specific CD64 cut point for early onset clinical sepsis was 3.13, 2.34, and 2.05 for very low, low, and normal birth weight, respectively. Neutrophil CD64, in combination with the absolute neutrophil count or the absolute band count, had the highest sensitivity (91%) and specificity (93%), respectively, to diagnose culture-proven sepsis. CONCLUSION: We conclude that neutrophil CD64 index can be incorporated with specific hematologic criteria as an additional marker for diagnosis of neonatal sepsis.

Neutrophil CD64 as a diagnostic marker in neonatal sepsis.

We assessed neutrophil CD64 as a diagnostic marker for neonatal sepsis. For early-onset sepsis, the CD64 index with a cut-point value of 2.38 had sensitivity, specificity and negative predictive values of 100%, 68% and 100%, respectively. For late-onset sepsis, the respective values were 3.62, 75%, 77% and 96%. Neutrophil CD64 index can be incorporated as a valuable marker for excluding neonatal sepsis.

Potential for Integrated Management of Soybean Virus Disease.

The recent introduction of the colonizing soybean aphid (Aphis glycines) to soybean in the northern United States has raised concern for potential increased disease caused by the nonpersistently aphid-transmitted Soybean mosaic virus (SMV). This study was conducted to examine the potential integration of host plant resistance and insecticide tactics for control of virus disease. Research from four location-years demonstrated that foliar application of the pyrethroid insecticide lambda-cyhalothrin (Warrior) or the organophosphate chlorpyrifos (Lorsban 4E) timed to suppress soybean aphid populations does not reduce SMV. Therefore, the introduction of a colonizing aphid to the array of migratory noncolonizing aphids that transmit SMV does not result in potential for disease control through vector suppression by foliar insecticides. Treatment also did not result in management of Bean pod mottle virus (BPMV), transmitted by the bean leaf beetle (Cerotoma trifurcata), presumably because of issues related to different phenologies of the insect vectors. Soybean cultivars with the lowest virus titer in seed produced the highest grain yield and, thus, were rated as field tolerant compared with cultivars with the highest virus titer in seed. Host plant resistance, not vector control, is the most effective tactic to control SMV.