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Course Title |
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New Directions in Neonatal Respiratory Critical Care |
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Faculty |
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Martin Keszler, MD
Professor of Pediatrics, Brown University
Women and Infants Hospital
Providence, RI
Thomas H. Shaffer, MS.E., PhD
Professor of Physiology and Pediatrics
Nemours /Alfred I. DuPont Hospital for Children
Thomas Jefferson School of Medicine
Temple University School of Medicine
Philadelphia, PA
Jan Mazela, M.D., Ph.D.
Associate Professor, Medical Director
Department of Neonatology and Infectious Diseases
Poznan University of Medical Sciences, Poland |
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Program Overview |
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Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in preterm infants. Over the last few years, a number of clinically important topics have emerged surrounding the use of surfactants. A wide variety of animal and synthetic surfactants are now available for use commercially in the US. While both have been demonstrated effective as therapy of RDS in preterm infants, it is unclear whether significant differences in clinical outcomes exist between the available animal-derived and synthetic products.
Avoidance of intubation from the first minutes of life is a goal for all neonatal teams. Real-life experience has taught us that achieving it might be very difficult. There are human factors such as learning experience, clinical management details such as providing appropriate medications, as well as prenatal factors which influence the final result of “being less invasive”.
While survival of extremely low gestational age newborns has improved substantially over the past two decades, the incidence of bronchopulmonary dysplasia remains high. New approaches to respiratory support aimed at reducing neonatal lung injury continue to be explored. Closed loop ventilation strategies have become commonplace in adult medicine but are only slowly gaining traction in neonatology. Volume guarantee has not been adopted as rapidly in North America as available evidence suggests it should. Sustained inflation is a physiologically attractive intervention in the delivery room designed to help clear lung fluid and rapidly achieve uniform lung aeration, however a definitive trial is only just getting underway with this approach.
This program will tackle these issues utilizing thought leader presentations and debate to provide clarity for the practicing physician. |
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Learning Objectives |
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At the completion of this activity, participants will be better able to:
• Discuss the issues regarding the comparison of animal-derived and synthetic surfactants.
• Summarize the issues surrounding improving the efficiency of pulmonary drug delivery.
• Describe current recommendations and discrepancies between them and real-life early clinical management.
• Identify prenatal risk factors leading to nCPAP failure.
• Maximize success of non-invasive ventilator support and less invasive surfactant therapy.
• Compare potential advances in aerosolized surfactants including the problems and potential solutions.
• Discuss the unique aspects of neonatal respiratory physiology and the complexity of patient-ventilator interactions during synchronized mechanical ventilation.
• Describe the basic concepts surrounding volume guarantee ventilation and closed loop systems of respiratory support, and know the available evidence of the benefits of each.
• Summarize the rationale for the sustained inflation maneuver and be familiar with the evidence for its effectiveness, as well as the gaps in current knowledge. |
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Format |
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Flash Player
NICUniversity has just issued a free iPad app that allows you to view this lecture on your iPad. Download this app from the iTunes store. |
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Commercial Support |
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This enduring internet activity is supported through an independent educational grant from Discovery Laboratories, Inc. |
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Credit Designation Statement(s) |
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Physicians
Nemours is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Nemours designates this enduring material for a maximum 1.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in this activity.
Nurses
Education Review Systems is an approved approver of continuing nursing education by the Alabama State Nursing Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Provider # 5-115. This program is approved for 1.75 hours of continuing nursing education.
Educational Review Systems is also approved for nursing continuing education by the state of California, the state of Florida and the District of Columbia.
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Disclosure Statement |
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As a provider accredited by the ACCME, Nemours must ensure balance, independence, objectivity and scientific rigor in its educational activities. All faculty involved in the development of CME content are required to disclose to Nemours their relevant financial relationships. An individual has a relevant financial relationship if he/she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Nemours has policies in place to resolve potential financial conflicts of interest. Relevant financial relationships will be disclosed to the activity audience. |
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Faculty Disclosure |
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Dr. Shaffer has been a consultant with Discovery Laboratories, Inc.
Dr. Mazela has been a consultant with Discovery Laboratories, Inc.
Dr. Keszler has been on the Advisory Board of Discovery Laboratories, Inc. and Medipost America. Dr. Keszler has also been a consultant and conducted research for Draeger Medical. |
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Planners and Managers Disclosure List |
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Pamela Arn, MD has nothing to disclose.
Jay Greenspan, MD has nothing to disclose.
Jennifer Valdivia has nothing to disclose.
Sylvia Kyle has nothing to disclose.
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Content Review Disclosure |
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Alexandra Novitsky, MD has nothing to disclose.
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Disclaimer |
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The information on this website is provided exclusively for educational purposes. Information about medicine is ever changing. As new research and clinical experience broadens knowledge, changes in treatment and procedures will be necessary. Nemours has consulted with sources believed to be reliable in order to provide information that is comprehensive and in accord with standards of care at the initial time of publication. However, Nemours disclaims any duty to update the information and encourages readers to do so. Nemours makes no warranties, either implied or expressed, that the information contained herein is accurate or complete. Nemours is not responsible for any errors or omissions with respect to the information or for the results obtained from the use of the information. Readers are encouraged to confirm the information with other sources. |
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Additional Resources |
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Presentation Slides |
Bibliographic Resources |
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Fee Statement |
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This activity is FREE to all participants |
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Instructions for Completion |
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To receive credit for this unit, view the presentation. It will take approximately 1 hour 30 minutes to complete. When you have finished, complete the evaluation. Upon completion of the evaluation form you will be able download your CME/CE certificate.
Clinicians who are not physicians or nurses will be provided a certificate of completion to submit for credit in accordance with their state board, specialty society, or other professional association. |
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Technical Requirements |
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A computer with broadband internet access with cookies enabled, sound card and speakers are required. Our educational activities require the Adobe Flash Player. This browser plug-in is free, and available from the Adobe web site. Adobe PDF Reader is necessary to print your CME certificate. This browser plug-in is also free and available from the Adobe web site.
NICUniversity has just issued a free iPad app that allows you to view this lecture on your iPad. Download this app from the iTunes store. |
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