Digital Auscultation and Pulmonary Function Testing Among Rural Bangladeshi Infants

项目概要： 这是国家环境健康科学研究所R21奖的重新提交，旨在 全面评估孟加拉国婴儿的数字听诊和肺功能测试， 创新的呼吸结果，为未来的空气污染研究在中低收入国家（LMICs）。 家庭空气污染（HAP）是全球范围内和预防性死亡的头号环境原因 影响孟加拉国等中低收入国家农村妇女和儿童的健康。不溶性微粒 空气动力学直径<2.5 µm（PM2.5）是主要由生物质产生的重要室内污染物 在烹饪、取暖和照明过程中使用燃料。PM2.5暴露水平升高与 儿童肺炎死亡的风险大幅增加，这是儿童感染性死亡的主要原因 儿童哮喘发病率是全世界儿童中最高的慢性肺病。到 旨在评估与PM2.5暴露相关的儿童呼吸结果的LMIC HAP研究 重点关注世界卫生组织定义的肺炎的急性终点， 对于研究HAP对儿童呼吸健康的影响，其准确性较差且高度非特异性。 我们的目标是生成支持数字听诊和肺功能测试可行的证据， 创新和诊断准确的儿科呼吸健康结果，以纳入未来的LMIC HAP 在受HAP影响最严重的农村社区进行研究。为了实现这一总体目标，我们将开展一项 对400名孟加拉国农村孕妇及其婴儿进行的纵向出生队列研究， 两个月对于目标1，我们将按社区系统地评估肺音记录质量 卫生工作者在护理孟加拉国农村婴儿时使用新型数字听诊器。我们 假设>90%的声音将满足质量标准，则将实现较高的解释一致性 以及自动化计算机分析和人类之间的关系， 产前PM2.5浓度将与异常数字记录肺的发生率较高相关 婴儿的声音。对于目标2，我们将创建人口参考值并评估可行性 孟加拉国农村两个月大婴儿非侵入性、非镇静肺功能测试的有效性 婴儿。我们假设>90%的测量结果将符合国际验证标准，婴儿肺 功能测试将是可行的，产前暴露于PM2.5浓度升高将与 婴儿肺功能较低 成功完成本申请中描述的研究将极大地推进方法学 为未来LMIC HAP研究准确评估急性和慢性儿童呼吸结果，以及 也可以作为横切方法，适用于资源丰富的环境和低收入国家的非HAP研究。

PROJECT SUMMARY: This is a re-submission for a National Institute of Environmental Health Sciences R21 award aiming to comprehensively evaluate digital auscultation and pulmonary function testing among Bangladeshi infants as innovative respiratory outcomes for future air pollution research in low-middle income countries (LMICs). Household air pollution (HAP) is the number one environmental cause of death worldwide and disproportionally affects the health of rural women and children in LMICs like Bangladesh. Particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) is an important indoor pollutant that is primarily generated by biomass fuel use during cooking, heating, and lighting. Elevated PM2.5 exposure has been associated with a substantially increased risk of child pneumonia mortality, the leading cause of infectious death in children globally, and childhood asthma incidence, the number one chronic lung disease among children worldwide. To date LMIC HAP research aiming to evaluate respiratory outcomes in children associated with PM2.5 exposure has focused on the acute endpoint of World Health Organization-defined pneumonia, a diagnosis known as poorly accurate and highly non-specific for studying pediatric respiratory health effects attributable to HAP. We aim to generate evidence supporting digital auscultation and pulmonary function testing as feasible, innovative, and diagnostically accurate pediatric respiratory health outcomes for inclusion in future LMIC HAP research within the rural communities most affected by HAP. To accomplish this overall goal we will conduct a longitudinal birth cohort study among 400 rural Bangladeshi pregnant women and their infants until the age of two months. For Aim 1 we will systematically evaluate lung sound recording quality by community health workers using a novel digital stethoscope during their care of rural Bangladeshi infants. We hypothesize that >90% of sounds will meet quality criteria, high interpretation agreement will be achieved between human listeners and also between automated computer analysis and humans, and that elevated prenatal PM2.5 concentrations will be associated with a higher incidence of abnormal digitally recorded lung sounds among infants. For Aim 2 we will create population reference values and evaluate the feasibility and validity of non-invasive, unsedated lung function testing of rural Bangladeshi two month old infants. We hypothesize that >90% of measurements will meet international validation criteria, infant lung function testing will be feasible, and that prenatal exposure to elevated PM2.5 concentrations will be associated with lower infant lung function. Successful completion of the research described in this application will dramatically advance the methodology for accurate assessment of acute and chronic child respiratory outcomes for future LMIC HAP research, and can also serve as crosscutting methods suitable for resource-rich settings and non-HAP research in LMICs.