This year’s 27th Annual Neonatal International Symposium focused on educating physicians about respiratory problems of premature infants and improving outcomes.

By C.A. Wolski

For the past 26 years, the University of Miami’s School of Medicine has been host to neonatologists from around the world, who come to Florida to discuss the respiratory problems facing newborns. This year’s 27th Annual Neonatal International Symposium, which was held on November 13-16, 2003 in Key Biscayne, focused on mechanical ventilation. “The main conference is on neonatology with emphasis on respiratory problems, so the idea is to give an update on what is new in respiratory diseases and their management,” says Eduardo Bancalari, MD, professor of pediatrics, obstetrics, and gynecology, director of the Division of Neonatology, and chief of the Newborn Service at the Department of Pediatrics, University of Miami School of Medicine, and one of the founders of the symposium. Neonatologists, nurses, and RTs make up the bulk of attendees.

In addition to the standard lectures, the conference also included roundtable discussion sections, and for the second straight year, a group of hands-on workshops specifically designed to help the neonatologists put new, theoretical knowledge to practical use. Among the symposium topics were “Minimal Enteral Feeding,” “Adaptive Control of Neonatal Gas Exchange,” “Weaning Infants From Mechanical Ventilation: Art, Science, or Magic,” and “Role of Nitric Oxide in Airway Function and Neonatal Lung Injury.” Speakers included Carol Lynn Berseth, MD, Vihod Bhutani, MD, Steven Donn, MD, John Hauth, MD, Margaret K Hostetter, MD, Richard Martin, MD, Lawrence Shapiro, MD, Marianne Thoresen, MD, and Andrew Whitelaw, MD.

Bancalari has found that interest in the University of Miami symposium has continued to grow over the years because respiratory problems of premature infants are the number one issue that has to be addressed by neonatal intensive care units (NICUs). The importance of this issue is reflected in the symposium’s growing attendance. Last year there were about 400 attendees, and this year there were over 500, making it one of the largest conferences dealing with neonatal respiratory problems. Although the attendees are from all over the world, many of the international visitors are from Latin America.

That the University of Miami School of Medicine has been hosting the symposium for so long is not an accident. The respiratory problems of newborns are a specific interest of Bancalari’s staff at Jackson Memorial Hospital, the teaching hospital for the University of Miami School of Medicine. “Most of the faculty in our group are specifically interested in respiratory care, not only taking care of kids with respiratory failure; most of the research that’s going on in our unit is also related to respiratory care, so we have a long track record of experience in clinical care and research, as well as teaching,” Bancalari says. “We also have neonatal fellows who train here.” Jackson Memorial Hospital’s 126-bed neonatal special care unit sees about 2,000 admissions per year. The unit is a referral center for Florida and for Central and South America.

Symposium lectures are 30 minutes long followed by discussion sessions that allow attendees to ask particular questions of the speaker. There are also roundtable sessions in which the attendees can question the speakers, allowing the two groups to develop a dialogue.

One-on-One Interaction

Last year, Bancalari and his colleagues took this dialogue to a new level thanks to Viasys Healthcare, Yorba Linda, Calif. The respiratory company sponsored a workshop to allow the symposium attendees to have an opportunity for hands-on interaction with unfamiliar technology and individual help from experts in the field. The workshops are of particular value to the international attendees. “We have a very large number of participants from countries where the stages of development of NICUs are not at the same level as they are here,” Bancalari says. “We felt it was very important not to just give the theory, but to do practical demonstrations. In doing those demonstrations, we realized how many things that one may take for granted and may not even address during a formal lecture become real issues when talking on a one-to-one basis or with a smaller group.” The practical demonstrations were an immediate hit. Last year, according to Bancalari, interest exceeded capacity with potential attendees being turned away at the door. This year was no different with the workshop being “sold out” for several weeks before the symposium began. More than 200 people attended the workshop.

The popularity of the practical workshops is not surprising for another reason. “It gives the audience a chance to have one-on-one contact with the [speakers], something you don’t usually have in a large conference,” says Nelson Claure, MS, the member of the research faculty in the Division of Neonatology, University of Miami School of Medicine, who administered the demonstrations.

For Viasys, the demonstrations have a practical business side to them. “We have a fairly substantial market share [in Latin America] and we wanted to make a strong commitment in terms of education,” says Becky Mabry, vice president of marketing for Viasys Critical Care. “There’s not a lot of hands-on training available in Latin America for ventilators. For us, I think it was an opportunity to provide additional training and also provide exposure to our technology.”

The practical side of the symposium is made up of six stations, which include synchronized ventilation, lung mechanics evaluation using respiratory graphics in babies who are ventilated, high frequency ventilation, volume targeted ventilation, nasal continuous positive airway pressure, and airway management and the conditioning of inspired gas. Each participant spends 30 to 35 minutes at each station. To accommodate international attendees, at least one Spanish translator is hovering nearby to facilitate the one-on-one interaction. Helping to keep the material fresh in the minds of attendees, Viasys provides a CD of the workshop’s PowerPoint presentations to every participant.

Sponsoring the workshop was important to Viasys, says Mabry, because of its corporate responsibility to its customers. “You can’t just put technology out there and not provide training,” she says. “And training has to go beyond learning how to push the right buttons. People need to understand the different disease processes and how the technology can address those processes in order to effectively use the technology.”

Value of Information

Though attendance at the symposium has been climbing over the years, how it is impacting the way care is given is harder to measure. “We certainly hope that we are also a significant part of the change that is occurring [in countries around the world],” Bancalari says. “[Attendees are told about] all the more recent advances in neonatal respiratory care by leaders not only from this country but from all over the world in a conference where things are very well structured, and it’s all done in a nice environment. I think people who attend the meeting get a lot; that’s why the attendance has increased every year.”

Bancalari adds that whether his symposium has had an impact on the changing face of neonatal care, statistically, care is getting better. “We have better survival and lower rates of complications, so there’s no question that things are improving,” he says. “There’s still a long way to go in terms of reducing morbidity, but the outcomes are much, much better now than they were 10 or 20 years ago without any doubt.”

C.A. Wolski is associate editor of RT Magazine.