Non-invasive oscillometry to measure lung mechanics, response to treatments, and predict longer-term pulmonary outcomes among preterm infants: a prospective cohort study

总结 这个指导以患者为导向的研究职业发展奖（K23）的目的是提供 科尔姆特拉弗斯，医学博士，与导师，培训和研究经验，需要成为一个 独立的临床科学家和新生儿肺部结局研究的领导者。他的长期职业生涯 目标是减轻360，000名早产幸存者呼吸道疾病日益加重的负担 通过新型观察性和干预性研究以及大规模多中心临床研究， 减少肺损伤的干预试验。为了实现这些目标和过渡到独立，博士。 特拉弗斯和他的导师制定了一个全面的研究和职业发展计划，其中包括 来自具有良好指导记录的杰出科学家团队的指导;密集的教学 培训，包括完成成果研究公共卫生硕士学位;以及研究 计划是有目的地设计，以提供先进的研究方法的经验学习，以研究 早产儿的肺部预后。早产的幸存者患喘息的风险增加， 哮喘和儿童期肺功能检查异常（PFT）。早产儿肺功能的研究 婴儿一直受到完成婴儿PFT的困难的限制，限制了测量的能力， 疾病严重程度，评估对治疗的反应，并了解发育中的肺部健康轨迹。博士 Travers最近完成了两项前瞻性队列研究，使用了一种创新的非侵入性测量方法， 技术量化肺力学在自主呼吸足月儿和早产儿。他早期 工作观察到，足月儿和早产儿之间的肺力学差异可以重现， 测量并持续至出院。在K23提案中概述的研究计划中，特拉弗斯博士将 扩展这一新的工作，他的具体研究目标直接与他的培训计划， （1）确定健康足月儿肺力学差异的程度， 出生后有或无肺部疾病的早产儿持续到出院或40周后， 经后年龄，（2）量化接受药物治疗的早产儿肺力学的变化 肺疾病，（3）以确定在何种程度上异常的肺力学检测 出院前持续存在，并预测24个月时的长期肺结局。的非侵入性方法 在出院前测量肺力学并预测长期肺结果， 从根本上改变我们对出生后早期肺发育对肺功能影响的认识 在早产儿中。此外，还提供了一种非侵入性床边设备，其客观地测量对 治疗方法将成为重要的研究和临床工具。在获得的技能和见解的基础上 通过拟议的培训和研究计划，特拉弗斯博士将申请R 01，以确定效果 早期干预和治疗对儿童早期肺力学和肺健康的影响。

SUMMARY The purpose of this Mentored Patient-Oriented Research Career Development Award (K23) is to provide Colm Travers, MD, with the mentorship, training, and research experience needed to become an independent clinician scientist and leader in neonatal pulmonary outcomes research. His long-term career goal is to reduce the increasing burden of respiratory morbidity among the 360,000 survivors of preterm birth per year in the US through novel observational and interventional studies and large scale multi-center clinical trials of interventions that reduce lung injury. To achieve these goals and transition to independence, Dr. Travers and his mentors developed a comprehensive research and career development plan that includes mentorship from an exceptional team of scientists with proven track records of mentorship; intensive didactic training including completion of a Master of Science in Public Health in Outcomes Research; and a research plan that is purposefully designed to provide experiential learning in advanced research methods to study pulmonary outcomes among preterm infants. Survivors of preterm birth are at increased risk for wheeze, asthma, and abnormal pulmonary function tests (PFTs) during childhood. Studies of lung function in preterm infants have been limited by the difficulties with completing infant PFTs, restricting the ability to measure illness severity, assess response to treatments, and understand developmental lung health trajectories. Dr. Travers recently completed two prospective cohort studies using an innovative non-invasive oscillometry technique to quantify pulmonary mechanics in spontaneously breathing term and preterm infants. His early work observed that differences in lung mechanics between term and preterm infants can be reproducibly measured and persist until discharge. In the research plan outlined in this K23 proposal, Dr. Travers will expand upon this novel work, and his specific research aims are directly aligned with his training plan as follows: (1) To determine the extent to which differences in lung mechanics between healthy term infants and preterm infants with and without lung disease after birth persist until discharge from hospital or 40 weeks’ postmenstrual age, (2) To quantify changes in lung mechanics among preterm infants receiving medications for lung disease, and (3) To determine the extent to which abnormalities in pulmonary mechanics detected before discharge persist and predict longer-term pulmonary outcomes at 24 months. A non-invasive method to measure lung mechanics and predict longer-term pulmonary outcomes before discharge from hospital can fundamentally change our understanding of the effect of early postnatal lung development on lung function in preterm infants. In addition, a non-invasive bedside device that objectively measures response to treatments would be both a vital research and clinical tool. Building upon the skills and insights acquired through the proposed training and research plan, Dr. Travers will apply for an R01 to determine the effects of early interventions and therapies on lung mechanics and pulmonary health in early childhood.