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cME/cE iNFoRMATioN _ pRoGRAM BEGiNS BELow AccREDiTATioN STATEMENTS physicians This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Nurses The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity Respiratory Therapists Respiratory therapists should visit this page to confirm that AMA PRA Category 1 Credit(s) are accepted toward fulfillment of RT requirements. cREDiT DESiGNATioNS physicians eNewsletter: The Johns Hopkins University School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Podcast: The Johns Hopkins University School of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurses eNewsletter: The 1 contact hour educational activity is provided by The Institute for Johns Hopkins Nursing. Each newsletter carries a maximum of 1 contact hour or a total of 8 contact hours for the eight newsletters in this program. Podcast: This 0.5 contact hour educational activity is provided by The Institute for Johns Hopkins Nursing. Each podcast carries a maximum of 0.5 contact hours or a total of 4 contact hours for the eight podcasts in this program. To obtain contact hours, you must complete this Educational Activity and post-test by October 30, 2015. Respiratory Therapy For United States: Visit this page to confirm that your state will accept the CE Credits gained through this program. For Canada: Visit this page to confirm that your province will accept the CE Credits gained through this program. SUccESSFUL coMpLETioN To successfully complete this activity, participants must read the content, and then link to the Johns Hopkins University School of Medicine's CME website, or the Institute for Johns Hopkins Nursing to complete the post–test and evaluation. Once you receive a passing grade, you can access and print your certificate of credit. NOTE: If you have already registered for other Hopkins CME programs on their prospective websites simply enter the requested information when prompted. There are no fees or prerequisites for this activity. This activity is supported by educational grants from Abbott Nutrition, Cornerstone Pharmaceuticals, Ikaria, and Mead Johnson Nutrition. LAUNch DATE June 21, 2012; activities expire two years from the date of each publication. iNTERNET cME poLicy The Office of Continuing Medical Education (OCME) at the Johns Hopkins University School of Medicine is committed to protecting the privacy of its members and customers. Johns Hopkins University SOM CME maintains its Internet site as an information resource and service for physicians, other health professionals and the public. Continuing Medical Education at the Johns Hopkins University School of Medicine will keep your personal and credit information confidential when you participate in a CME Internet– based program. Your information will never be given to anyone outside of the Johns Hopkins University School of Medicine's CME program. CME collects only the information necessary to provide you with the services that you request. DiScLAiMER STATEMENT The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Johns Hopkins University School of Medicine name implies a review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients. STATEMENT oF RESpoNSiBiLiTy The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. STATEMENT oF NEED Through discussions with expert physician/educators, a survey of practicing neonatologists, and a review of the current literature, including national and regional guidelines and quality-ofcare measures, the following core learning gaps have been identified: n In addition to cognitive, educational, and behavioral impairments later in life, former premature infants with BPD also suffer higher rates of long-term airway obstruction and mild exercise intolerance, potentially preventable with better NICU and post-discharge care. n Protocols for noninvasive methods of pulmonary support are underused or misused in many neonatal care settings, resulting in higher rates of lung injury in preterm infants from mechanical ventilation. n Neonatologists need a consistent and precise approach to the diagnosis and treatment of ventilator-acquired pneumonia (VAP) to minimize ineffective empiric antibiotic treatment. n Although major reductions in the burden of CLABSI in NICUs have been achieved, variable rates of sepsis in different NICUs indicate that adherence to best practices and vigilant preventive interventions are not as uniform as they could and should be. n Too few of the ≈90% of premature infants discharged with nutritional deficiencies receive calorie- and protein-enriched formulas that prevent near-term developmental deficits and long-term damaging health effects, such as metabolic syndrome. n Neonatologists are not fully aware of the comparative merits of IV soybean oil-based lipid emulsions and parenteral omega-3 lipid emulsions in the PNALD setting. iNTENDED AUDiENcE This activity has been developed for neonatologists, respiratory therapists, neonatal nurses and nurse practitioners, and others involved in the care of patients in the NICU. DiScLoSURES As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) to require signed disclosure of the existence of financial relationships with industry from any individual in a position to control content of a CME activity sponsored by OCME. Members of the Planning Committee are required to disclose all relationships, regardless of their relevance to the activity content. Faculty are required to disclose only those relationships that are relevant to their specific presentations. No planners have indicated that they have any financial interests or relationships with a commercial entity. Guest Author Disclosures coNFiDENTiALTy DiScLAiMER FoR coNFERENcE ATTENDEES I certify that I am attending a Johns Hopkins University School of Medicine CME activity for accredited training and/or educational purposes. I understand that while I am attending in this capacity, I may be exposed to "protected health information," as that term is defined and used I Hopkins policies and in the federal HIPAA privacy regulations (the Privacy Regulations). Protected health information is information about a person’s health or treatment that identifies the person. I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is Johns Hopkins Privacy Officer, telephone: 410–735–6509. Email: HIPAA@jhmi.edu. “The Office of Continuing Medical Education at The Johns Hopkins University School of Medicine, as provider or this activity, has relayed information with the CME attendees/participants and certifies that the visitor is attending for training, education and/or observation purposes only.” For CME questions, please contact the CME Office at (410) 955-2959 or email cmenet@jhmi.edu. For CME certificates, please call (410) 502–9634. Johns Hopkins University School of Medicine Office of Continuing Medical Education Turner 20/720 Rutland Avenue Baltimore, Maryland 21205–2195 Reviewed and Approved by General Counsel, Johns Hopkins Medicine (4/1/03) Updated 4/09 hARDwARE & SoFTwARE REqUiREMENTS Pentium 800 processor or greater, Windows 98/NT/2000/XP/7 or Mac OS 9/X, Microsoft Internet Explorer 5.5 or later, 56K or better modem, Windows Media Player 9.0 or later, 128 MB of RAM, sound card and speakers, Adobe Acrobat Reader, storage, Internet connectivity, and minimum connection speed. Monitor settings: High color at 800 x 600 pixels. eNeonatal Review Podcast Transcript, Volume 9: Issue 14
eNEoNATAL REviEw poDcAST TRANScRipT MR. BoB BUSKER: Welcome to this eNeonatal Review Podcast. eNeonatal Review is presented by the Johns Hopkins University School of Medicine, and the Institute for Johns Hopkins Nursing. This program is supported by educational grants from Abbott Nutrition, Cornerstone Pharmaceuticals, Ikaria, and Mead Johnson Nutrition. Today’s program is a companion piece to our eNeonatal Review newsletter issue: Optimizing Nutritional Support with Protein and Energy for Very Low Birth Weight Infants. Our guest today is one of that issue’s authors, Dr. David Adamkin, from the University of Louisville. This activity has been developed for neonatologists, respiratory therapists, nurse practitioners, neonatal nurses, and others who work in the NICU. There are no fees or prerequisites for this activity. The Accreditation and Credit Designation Statements can be found at the end of this podcast. For additional information about accreditation, Hopkins policies, and expiration dates and to take the posttest to receive credit online, please go to our website newsletter archive, www.eneonatalreview.org, and click the Volume 9, Issue 14 podcast link. Learning objectives for this audio program are, that after completing this activity, the participant will demonstrate the ability to: n Describe the importance of starting parenteral nutrition in the first hours of life, even in the face of critical illness in VLBW infants; n Evaluate the role of parenteral amino acids in glycemic control, as well as lipids in relation to lung dysfunction, in VLBW infants; and, n Discuss the role of donor-fortified milk in VLBW infants. I’m Bob Busker, managing editor of eNeonatal Review. On the line we have with us Dr. David H. Adamkin, Professor of Pediatrics, Director of the Division of Neonatal Medicine, and Rounsavall Endowed Chair of Neonatology, at the University of Louisville. Dr. Adamkin has indicated that he has no financial interests or relationships with any commercial entity whose products or services are relevant to the content of this presentation, and his discussion today will not reference the unlabeled or unapproved uses of any drugs or products. Dr. Adamkin, welcome to this eNeonatal Review podcast. DR. DAviD ADAMKiN: Thank you very much, Bob. MR. BUSKER: In your newsletter issue, Doctor, you reviewed studies describing the importance of enhancing nutrition in very low birth weight infants — that would be babies weighing less than 1500gm— to decrease morbidities and promote improved neurodevelopmental outcomes. What I’d like to do today is expand on that information, and discuss how it can actually be applied in the NICU. So if you would, doctor — start us out with patient scenario. DR. ADAMKiN: The case that we’re discussing is a 610 gm, small for gestational age, 26-week infant, delivered by emergency C-section because of placental abruption and fetal distress. Baby’s Apgar scores were 2, 4, 6, and 8, at 1, 5, 10, and 15 minutes, respectively. Infant received positive pressure ventilation in the delivery room and was intubated and given surfactant. The cord blood pH is 7 with a base excess of -10. The infant is started on intravenous fluids of D10W through a UVC and D5W in the UAC for total fluids of 80 cc/kg/daycc/kg/day. So this is a tiny baby that’s growth-restricted with a difficult initial course, including fetal acidosis, and is started on D10 and D5 through the UVC and the UAC. At 12 hours of age the morning labs include a plasma glucose of 180mg/dLmg/dL after two ACCU-CHEKs revealed 140 and 160, and the potassium is 7.3 mEq/L. The infant’s urine output has been 1.5 cc/kg/hr, the BUN is 15, and the creatinine is 0.7. MR. BUSKER: Why wasn’t this baby started on early TPN? DR. ADAMKiN: It’s possible, because of the baby’s condition at birth, the fetal hypoxia acidosis, that the clinicians were concerned about the baby’s ability to metabolize TPN and that may have been why the clinicians chose not to start TPN. Let’s delve into eNeonatal Review Podcast Transcript, Volume 9: Issue 14 1
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