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    Best new tech products

    Thirty years ago, I completed my residency and began pediatric practice at an Air Force hospital/clinic in North Dakota. Having survived the rigors of training and armed with only my trusty stethoscope, I quickly learned what it meant to have hundreds of families count on you to help raise their children.

    It was not until 4 years later in private practice that I was introduced to what were, at the time, fantastic new innovations in pediatric care—rapid strep tests, ear thermometers, and a quiet, 30-second hemoglobin-testing device. In a manner of months, I was convinced that advances in technology could do much to improve pediatric practice and have been a connoisseur of medical innovation ever since.

    Over the past 3 decades, dozens of medical devices have been introduced that are now assimilated into our routine practice. Electronic health records (EHRs) are replacing paper charts, electronic stethoscopes can record heart and breath sounds, and pediatricians can use technologies that identify children with hearing and vision problems in mere minutes.

    Each year, new devices and technologies are introduced that, if eventually proven useful and reliable, help pediatricians provide the best care and add to our repertoire of high-tech equipment.

    I continue to be amazed by the new devices that I get to review and discuss. This past year provided terrific innovation—let's take a look at the best products of 2012.

    The return of home phototherapy

    Back in the day (meaning 25 or so years ago), pediatricians frequently used home phototherapy to treat low-risk newborns for hyperbilirubinemia. Guidelines recommended that home phototherapy be used for term babies without hemolytic disease.1 It was a cost-effective and family friendly alternative to hospital admission for phototherapy because, back then, home phototherapy cost about $100 per day compared with $1,000 or more per day for the same service provided in the hospital setting.

    Unfortunately, low reimbursement by insurance companies eventually made it cost prohibitive for durable medical equipment companies to provide this service, and the lights gradually went out on home phototherapy.

    I am very pleased that Physician Engineered Products has just introduced their new disposable home therapy system called Bright Embrace. This is a wraparound phototherapy system that uses light-emitting diode (LED) lights to provide high levels of irradiance in the 430 nm to 490 nm (blue) band (30 μW/cm2/nm or higher) delivered to as much of the infant's surface area as possible. Bright Embrace meets the American Academy of Pediatrics (AAP) 2011 revised policy on the management of newborn hyperbilirubinemia.2

    The device operates for 60 hours, usually sufficient for providing a full course of high-intensity phototherapy for an infant. It sells for $250 per unit, and pediatricians can sell the unit to parents either at cost or at a reasonable markup to cover office expenses. This is particularly useful in our current economy, because many parents have high insurance deductibles, and the cost of 2 days of hospitalization could easily exceed $4,000.

    Included with the Bright Embrace system is a new see-through goggle system that protects baby's eyes from the high-intensity light. Welcome back home phototherapy—we missed you!

    New flu tests

    If you are a regular reader of my blog on the Contemporary Pediatrics Web site, you know that I am a big advocate of point-of-care testing. The "point" of point-of-care testing is that such tests can expedite office visits by providing a diagnosis and treatment plan at the time of the office visit—eliminating the need for contacting parents when results become available from an office lab hours or days later.

    Last year I detailed a new rapid influenza test introduced by BD Diagnostics—the BD Veritor system that uses a proprietary cartridge reader and visually displays results on a liquid crystal display (LCD) screen.

    The sensitivity of the device for detecting influenza A and B exceeds 90%—much better than traditional rapid influenza tests that depend on visual interpretation by the person performing the test. According to the Centers for Disease Control and Prevention (CDC) Web site, traditional rapid influenza kits have a sensitivity of 70% or less for influenza A and B detection.

    This year, Quidel Corporation has introduced a new influenza A and B testing device based on fluorescent antibody technology called the Sofia Influenza A+B FIA. The device and testing cartridges significantly improve the accuracy of the device by automating the test procedure and interpretation. The Sofia Influenza A+B FIA uses a fluorescence detector with an ultraviolet LED energy source and retains all test results on a transportable memory card.

    Specimens may include nasal swab, nasopharyngeal swabs, or a nasopharyngeal wash. The swab is placed into a tube with reagents, and a minute later the solution is placed into a cartridge. The cartridge is inserted into the analyzer, and results are available 15 minutes later. According to Quidel, the Sofia analyzer has a sensitivity of 97% for influenza A and 90% for influenza B when nasopharyngeal swabs are used.

    With this degree of accuracy, office testing for flu can help the clinician in several ways. First, by correctly identifying influenza, it will help to avoid the temptation to prescribe antibiotics, unless a secondary bacterial infection is suspected.

    In addition, if influenza is identified within 48 hours of onset, one can consider treating high-risk patients (children aged younger than 2 years or those children with underlying medical conditions) with antiviral agents such as oseltamivir.

    The test cartridges cost about $25 each; the Sofia analyzer is free. Currently, Sofia respiratory syncytial virus and group A streptococcus tests are available in Europe, but as of this writing they have not been approved for use in the United States.

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...


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