Real Time Predictive Analytics of Hemodynamic Clinical Deterioration during the Preterm Transition to Extra Uterine Life

早产儿过渡到宫外生命期间血流动力学临床恶化的实时预测分析

• 批准号: 9012981
• 负责人: DANIELLE RAE RIOS
• 金额: $ 18.18万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9012981
• 关键词: Address; Advisory Committees; Affect; Anesthesiology; Applications Grants; Award; Beds; Birth Weight; Blood Pressure; Bolus Infusion; Cardiac; Caring; Cerebrum; Child; Childhood; Clinical; Clinical Medicine; Common Ventricle; Complex; Creatinine clearance measurement; Data; Data Analytics; Databases; Decision Making; Deterioration; Development; Doppler Ultrasound; Echocardiography; Effectiveness; Engineering; Equipment; Etiology; Event; Extremely Low Birth Weight Infant; Face; Feeds; Funding; Future; Goals; Health; Heart Arrest; Heart Diseases; Hematological Disease; Hospitalization; Hour; Incidence; Individual; Infant; Intervention; Intestinal Perforation; Journals; K-Series Research Career Programs; Kidney; Knowledge; Left; Life; Liquid substance; Logistic Regressions; Lung diseases; Manuscripts; Master of Science; Measurement; Measures; Medicine; Mentors; Mentorship; Methodology; Methods; Mission; Modality; Modeling; Monitor; National Heart, Lung, and Blood Institute; Near-Infrared Spectroscopy; Necrotizing Enterocolitis; Neonatal; Neonatology; Organ; Outcome; Pathway interactions; Patient Care; Patients; Pediatric Hospitals; Pediatric cardiology; Pediatrics; Peer Review; Periventricular Leukomalacia; Personal Satisfaction; Pharmaceutical Preparations; Physiologic Monitoring; Physiological; Physiology; Population; Predictive Analytics; Premature Birth; Premature Infant; Prevention; Process; Public Health; Publishing; Quality of life; Randomized Controlled Trials; Recovery; Relative Risks; Reporting; Research; Research Personnel; Research Project Grants; Research Support; Resolution; Resources; Scientist; Series; Survivors; Texas; Time; Training; Training Activity; Training Programs; United States National Institutes of Health; Validation; Work; adverse outcome; base; career; career development; clinically relevant; cohort; college; cost; disability; education research; experience; extreme prematurity; gastrointestinal; hemodynamics; improved; improved outcome; indexing; innovation; insight; interest; intraventricular hemorrhage; knowledge base; news; novel; prevent; professor; programs; public health relevance; response; responsible research conduct; signal processing; skills; statistics; success; treatment response

 DESCRIPTION (provided by applicant): The candidate applying for this award is an Assistant Professor of Pediatrics at Baylor College of Medicine (BCM). She has obtained a Master's of Science degree through the BCM Clinical Scientist Training Program and has published several first-author manuscripts in well-respected peer-reviewed pediatric journals. Her research focus is the hemodynamic status of extremely low birth weight (ELBW) infants. Extreme prematurity is an important public health problem in the U.S. because these infants are disproportionately affected by moderate to severe long-term disabilities, which are quite costly. There is little information, however, on the prevention of the short-term outcomes that result in disabilities in ELBW infants, most of which likely have their genesis from hemodynamic clinical deterioration during the first week of life. The overall objective of this proposed NHLBI Career Development Award application is to develop a series of multivariate clinical deterioration indices (CDIs) which will provide, in real-time, continuous and calibrated measurements of the likelihood of experiencing certain debilitating outcomes (and 1 clinical variable and 1 milestone) in ELBW infants and depict whether the responses to clinical interventions were successful. This will be accomplished through 3 specific aims, which are to: 1) Create independent CDIs from analysis of the physiologic inputs during the first week most associated with short-term outcomes (or the clinical variable/milestone) in ELBW infants; 2) Measure changes in each CDI prior to and after interventions used to treat hemodynamic clinical deterioration; and 3) Validate each CDI prospectively in a separate cohort of ELBW infants. In Aim 1, CDIs will be developed based on normalized logistic regression models. Separate models will be developed for each of 6 specific outcomes/clinical variable/milestone (intraventricular hemorrhage, periventricular leukomalacia, maternal creatinine clearance, necrotizing enterocolitis, intestinal perforation, and time to reach full feeds). For Aim 2, in the subset of this cohort who received interventions (e.g. fluid boluses or vasoactive medications), the CDI will be analyzed prior to and after each intervention to evaluate responses to treatment of perceived hemodynamic clinical deterioration. The final portion (Specific Aim 3) of the proposed research is validation of the CDIs in a separate cohort. Upon completion of the proposed research, the CDIs can be used in real-time to manage therapies with an evidence- and physiology-based approach never before available to clinicians or researchers. This will promote a shift from population-centric to individualized data- driven approaches, providing more effective care and surveillance for complex patients. The candidate will acquire important skills on her pathway to independence. Training activities during the award period include coursework and training in targeted neonatal echocardiography, training and practice in near-infrared spectroscopy and cerebral Doppler ultrasound, training in physiologic waveform analysis and predictive analytics, and training in the responsible conduct of research. Immediate career goals include becoming an expert in targeted neonatal echocardiography and proficient in the other monitoring modalities. The candidate is fortunate to have the facilities and resources available to her at BCM and Texas Children's Hospital (TCH). BCM had total research support of nearly $200 million from NIH in 2014 and is ranked # 1 in Texas for NIH funding. TCH is an internationally recognized 650-bed pediatric hospital affiliated with BCM. The mission of TCH, which is ranked nationally in all 10 pediatric subspecialties in the 2014-15 U.S. News & World Report, is to support excellence in patient care, education, and research with a commitment to enhance the health and well-being of children locally, nationally, and internationally. U.S. News & World Report ranked both the Neonatology Section and the Section of Pediatric Cardiology at TCH as #2 of U.S. programs in 2014-15. The candidate has assembled a scientific advisory committee with complementary intellect and content expertise that can guide her throughout the award period. The committee combines clinical insights from investigators in neonatology, pediatric cardiology, and pediatric anesthesiology with engineering and mathematical expertise in both physiologic signal processing and data analytics. The innovative approach in this proposal uses multiple monitoring methods, automated data capture, and real- time analysis to address a significant public health need for improving the knowledge base required to prevent common, costly, debilitating outcomes of ELBW infants. The proposed award is consistent with the NHLBI mission to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer and more fulfilling lives. The exceptional resources and institutional support at BCM and TCH, outstanding multi-disciplinary mentorship team, and the proposed career development activities, will allow the candidate to achieve her long-term goal of becoming an independent investigator and nationally recognized expert in neonatal hemodynamics.

 描述(申请人提供)：该奖项的申请者是贝勒医学院儿科学助理教授。她通过BCM临床科学家培训计划获得了理学硕士学位，并在备受尊敬的同行评议的儿科杂志上发表了几篇第一作者手稿。她的研究重点是极低出生体重(ELBW)婴儿的血液动力学状态。在美国，极度早产是一个重要的公共卫生问题，因为这些婴儿不成比例地受到中到重度长期残疾的影响，这是相当昂贵的。然而，关于预防导致极低出生体重儿残疾的短期结果的信息很少，他们中的大多数可能是由于出生后第一周血液动力学临床恶化而产生的。这项拟议的NHLBI职业发展奖申请的总体目标是开发一系列多变量临床恶化指数(CDI)，该指数将实时、连续和经过校准地测量ELBW婴儿经历某些衰弱结果(以及1个临床变量和1个里程碑)的可能性，并描述对临床干预的反应是否成功。这将通过三个具体目标来实现：1)通过分析第一周与ELBW婴儿的短期结果(或临床变量/里程碑)最相关的生理输入来创建独立的CDI；2)测量用于治疗血流动力学临床恶化的干预措施前后每个CDI的变化；以及3)在ELBW婴儿的单独队列中前瞻性地验证每个CDI。在目标1中，将根据归一化Logistic回归模型开发CDI。将分别针对6个特定结果/临床变量/里程碑(脑室出血、脑室周围白质软化、母体肌酐清除、坏死性小肠结肠炎、肠穿孔和到达时间)建立不同的模型 完整馈送)。对于目标2，在接受干预(例如液体丸剂)的该队列的子集中 或血管活性药物)，CDI将在每次干预前后进行分析，以评估对感觉到的血流动力学临床恶化的治疗反应。拟议研究的最后部分(具体目标3)是对单独队列中的疾病预防控制指标进行验证。在拟议的研究完成后，CDI可以实时使用，以临床医生或研究人员前所未有的基于证据和生理学的方法管理治疗。这将促进从以人口为中心向个性化数据驱动的方法转变，为复杂的患者提供更有效的护理和监测。候选人将在她独立的道路上获得重要的技能。获奖期间的培训活动包括有针对性的新生儿超声心动图的课程作业和培训，近红外光谱和脑多普勒超声的培训和实践，生理波形分析和预测分析的培训，以及负责研究工作的培训。近期的职业目标包括成为目标新生儿超声心动图方面的专家，并精通其他监测方式。候选人很幸运地拥有BCM和德克萨斯儿童医院(TCH)为她提供的设施和资源。2014年，BCM从NIH获得了近2亿美元的研究支持，在NIH的资金来源中，BCM在德克萨斯州排名第一。TCH是一家国际公认的拥有650张床位的儿科医院，隶属于BCM。在2014-2015年度《美国新闻与世界报道》中，TCH在全国所有10个儿科亚专业中排名靠前，其使命是支持卓越的患者护理、教育和研究，致力于提高当地、国家和国际儿童的健康和福祉。《美国新闻与世界报道》将TCH的新生儿科和儿科心脏科列为2014-15年度美国项目的第二名。候选人已经组建了一个科学咨询委员会，该委员会拥有互补的智力和内容专业知识，可以在整个获奖期内指导她。该委员会将新生儿学、儿科心脏病学和儿科麻醉学研究人员的临床见解与生理信号处理和数据分析方面的工程和数学专业知识结合起来。该提案中的创新方法使用多种监测方法、自动数据捕获和实时分析，以满足重大的公共卫生需求，即改善所需的知识库，以防止常见的、昂贵的、使人衰弱的低出生体重儿结局。拟议的奖项符合NHLBI的使命，即促进心肺和血液疾病的预防和治疗，并增强所有人的健康，使他们能够活得更长、更有成就感。BCM和TCH的特殊资源和机构支持，杰出的多学科指导团队，以及拟议的职业发展活动，将使应聘者实现她的长期目标，即成为一名独立的研究人员和全国公认的新生儿血流动力学专家。