Pre-Vent Apnea

项目摘要 这个名为“预防呼吸暂停”的应用程序汇集了加州大学的资深研究人员 阿拉巴马州伯明翰分校(UAB；临床网站)，擅长新生儿临床和翻译研究 在马萨诸塞大学医学院(马萨诸塞州大学；分析核心) 在生理系统的呼吸控制和信号处理方面的专业知识。《公约》的总体目标 当地的项目是利用UAB的200名早产儿和29周妊娠的预期队列来 前瞻性地定义和验证与抗病能力或风险相关的呼吸机制 36周月经后年龄(BPD的生理学定义)和 使用多参数生理监测和密集数据进行随访(校正年龄为3个月) 在三个不同的时间段收集(每个96小时)：出生后2周，月经后32周 年龄(PMA)，36周PMA，以及连续心率、呼吸频率和脉搏血氧饱和度测量 从出生后不久入伍到出院的波形记录。 我们将通过以下具体目标来实现这一目标： 具体目标1--个性化呼吸模式数学模型的开发和验证 基于多参数生命体征监测和信号分析方法，以(A)预测低氧血症和/或 个别婴儿在发生之前出现心动过缓发作，(B)确定呼吸异常的模式 伴和不伴肺动脉高压的BPD，以及伴或不伴呼吸系统疾病的BPD 在矫正的3个月龄时喂养支持。 具体目标2-确定迟发性(在出生后14天或之后)轻度允许性高碳酸血症是否相关 呼吸暂停、心动过缓和低氧发作减少，氧合稳定性提高。 具体目标3-确定伺服控制的氧气环境是否与减少 与鼻腔给氧相比，低氧发作和改善的氧合稳定性 插管。 此外，对于多中心协作项目，我们将与其他临床研究进行协作 中心和领导力和数据协调中心(LDCC)的多中心协议 探讨氧合不稳定及急、慢性转归的呼吸机控制机制 发病率。 我们参与这个项目的最终目的是为了更深入地了解糖尿病的发病机制。 极早产儿的呼吸障碍与新的防治靶点的发现 改善非常脆弱儿童在生命之初的结局的战略。

Project Summary This “Pre-Vent Apnea” application brings together established investigators at the University of Alabama at Birmingham (UAB; Clinical Site) with expertise in neonatal clinical and translational research and at the University of Massachusetts Medical School (UMASS; Analytical Core) with complementary expertise in control of breathing and signal processing in physiological systems. The overall objective of the local project is to use a prospective cohort of 200 preterm infants <29 weeks gestation at UAB to prospectively define and validate ventilatory mechanisms associated with resilience against or risk for development of impaired oxygenation at 36 weeks' postmenstrual age (physiologic definition of BPD) and at follow-up (corrected age of 3 months) using multiparametric physiologic monitoring and intensive data collection (96 hours each) at three distinct time frames: 2 weeks postnatal age, 32 weeks post-menstrual age (PMA), 36 weeks PMA, in addition to continuous heart rate, respiratory rate, and pulse oximetry waveform recording from enrollment soon after birth until discharge. We will address the objective by the following Specific Aims: Specific Aim 1- Development and validation of mathematical models of personalized ventilatory patterns based on multiparametric vital signs monitoring and signal analysis methods to (a) predict hypoxemic and/or bradycardic episodes in individual infants before they occur, (b) identify patterns of ventilatory abnormalities associated with BPD with and without pulmonary hypertension, as well as with and without respiratory or feeding support at 3 months corrected age. Specific Aim 2 - Determine if late (at or beyond postnatal day 14) mild permissive hypercapnia is associated with reduction in apnea, bradycardia, and hypoxemic episodes and with improved stability of oxygenation. Specific Aim 3 – Determine if servo-controlled oxygen environment is associated with reduction in hypoxemic episodes and improved stability of oxygenation, as compared to oxygen administered by nasal cannula. In addition, for the multicenter collaborative project, we will collaborate with other clinical research centers and a Leadership and Data Coordinating Center (LDCC) on a multicenter protocol that will investigate ventilatory control mechanisms in outcomes of instability of oxygenation and acute and chronic morbidity. The ultimate goal of our participation in this project is to gain greater insight into the pathogenesis of respiratory disorders in extremely preterm infants and discover targets for new prevention and treatment strategies to improve outcomes for very vulnerable children at the beginning of life.