Effect of Thickened Feeds on Swallow Physiology and Clinical Outcomes in Children with Brief Resolved Unexplained Event

项目总结 短暂解决的未解释事件(Brue)是一种可怕的事件，其特征是出现 婴儿窒息、发紫和四肢无力，危及生命。这些常见事件需要大量资源，而且 目前的管理不足以应对持续的症状。患有布鲁斯的婴儿通常会有 口咽吞咽困难伴吸入，这是持续性症状的一个可改变的危险因素，但有 是否没有研究确定这种吞咽功能障碍背后的机制，以及吞咽干预是否会减少 发病率。口咽部吞咽困难对疾病负担贡献的系统研究 人口是迫切需要的，因为这种方法具有优化临床结果、改善 提高生活质量，降低医疗保健利用率。丹尼尔·邓肯，医学硕士，哈佛医学院讲师 他是波士顿儿童医院(BCH)空气消化中心的一名专家。他有 在医学培训期间获得了丰富的临床研究经验，并表现出敬业精神 致力于以病人为中心的研究的学术生涯。他的职业目标是指导一个临床研究项目 重点是确定以证据为基础的、最先进的口咽部吞咽困难和 空气消化障碍改变了对这一脆弱的儿科人群的临床护理。 这项职业发展奖将在以下方面提供更多的指导培训和研究机会 高分辨率阻抗测压和决策分析为邓肯博士提高他的定量 研究技能，同时解决目前与吞咽功能障碍机制相关的知识差距 布鲁。拟议的创新研究将系统地确定增稠饲料的机理 调节吞咽功能，并在更大的队列中确认这些发现，这将允许推导出 改进的布鲁护理算法。他将研究液体粘度的变化对上食道的影响 使用咽阻抗测压技术，跟踪前瞻性队列以确定影响运动能力的因素 对增厚的反应，并使用决策分析来识别可以接受经验性增厚的患者。 这一职业发展奖所提供的指导和科学培训将对Dr。 邓肯的学术发展。他的主要导师罗森博士是空气消化专家。他的合作导师， Jadcher la和Omari博士是新生儿吞咽障碍和阻抗测压方面的专家；他们都是 杰出的临床研究人员，致力于指导工作。他将得到奖学金的支持 由Snapper、Nurko、Landrigan和Stamoulis博士组成的咨询委员会，他们提供内容-区域 专业知识。他的正规培训包括在哈佛公共学院学习决策分析方面的高级课程 健康，关于食道运动和决策分析的个人指导，以及职业发展 课程。他的培训和研究活动将在无与伦比的学术环境中进行 BCH和HMS，这两家公司坚定地致力于邓肯博士成功过渡到独立。

PROJECT SUMMARY Brief resolved unexplained events (BRUE) are frightening episodes characterized by appearance of life-threatening choking, cyanosis, and limpness in infants. These common events are resource-intensive and current management inadequately addresses persistent symptoms. Infants with BRUE commonly have oropharyngeal dysphagia with aspiration, which is a modifiable risk factor for persistent symptoms, but there are no studies determining the mechanism behind this swallow dysfunction and if swallow interventions reduce morbidity. Systematic investigation of the contribution of oropharyngeal dysphagia to disease burden in this population is urgently needed, as this approach has vast potential to optimize clinical outcomes, improve quality of life and reduce healthcare utilization. Daniel Duncan, MD MPH is an Instructor at Harvard Medical School (HMS) and a subspecialist within the Aerodigestive Center at Boston Children’s Hospital (BCH). He has gained substantial clinical research experience during his medical training and has demonstrated commitment to an academic career in patient oriented research. His career goal is to direct a clinical research program focused on identifying evidenced-based, state of the art interventions for oropharyngeal dysphagia and aerodigestive disorders that transform clinical care for this vulnerable pediatric population. This Career Development Award will provide additional mentored training and research opportunities in high resolution impedance-manometry and decision analysis for Dr. Duncan to advance his quantitative research skills while addressing the current knowledge gap related to mechanisms of swallow dysfunction in BRUE. The proposed innovative studies will systematically determine mechanisms by which thickened feeds modulate swallow function and confirm these findings in a larger cohort, which will allow for derivation of an improved algorithm for BRUE care. He will study effects of alterations in liquid viscosity on upper esophageal motility using pharyngeal impedance-manometry, follow a prospective cohort to determine predictors of response to thickening, and use decision analysis to identify patients that could receive empiric thickening. The mentorship and scientific training afforded by this career development award will be critical for Dr. Duncan’s academic development. His primary mentor, Dr. Rosen, is an aerodigestive expert. His co-mentors, Drs. Jadcherla and Omari, are experts in neonatal swallow dysfunction and impedance-manometry; all are outstanding clinical researchers with deep commitment to mentorship. He will be supported by his Scholarship Advisory Committee consisting of Drs. Snapper, Nurko, Landrigan, and Stamoulis, who lend content-area expertise. His formal training includes advanced coursework in decision analysis at Harvard School of Public Health, personal instruction on esophageal motility and decision analysis, and professional development courses. His training and research activities will be conducted in the unparalleled academic environments of BCH and HMS, which are firmly committed to Dr. Duncan’s successful transition to independence.