Neonatal apnea: Online risk score from new analyses of bedside monitor waveforms

描述（由申请人提供）：新生儿呼吸暂停，或早产呼吸暂停，是新生儿重症监护病房（NICU）早产儿最常见的严重疾病。在其定义、文件和管理方面的知识存在重大差距。例如，尽管在新生儿重症监护室进行了持续的电子监测，但呼吸暂停发作的诊断仅基于临床判断，并且只能手工记录在床边的流程单上。缺乏定量和标准化的呼吸暂停指标阻碍了了解其自然史、治疗方法及其与婴儿猝死综合征（SIDS）这一主要公共卫生问题之间关系的努力。我们的长期目标是通过为医生和护士提供亚急性、潜在灾难性疾病的实时风险评估来改变新生儿重症监护病房的做法。在这里，我们的具体目标是开发和验证多变量预测模型，用于使用NICU床边监护仪记录的波形和生命体征的新旧数学测量来连续监测新生儿呼吸暂停。我们将提供短期呼吸暂停指数和累积呼吸暂停负担作为管理和研究工具，适用于机制见解和随机治疗试验。该项目是响应大机会奖助金计划的范围和要求。我们计划一个大规模和加速程序，以产生一个大型数据库的新生儿临床和监测波形数据，并开发监测算法。该数据库为其他研究人员提供了丰富的资源，该算法将成为解决当前新生儿重症监护病房数据解释障碍的创新解决方案，并有望改善婴儿健康。新的大规模计算硬件和软件已经开始运行。我们的团队在为新生儿重症监护室开发新的监测算法方面具有独特的经验，代表了临床、工程和数学学科。没有其他实体可能构思或执行这项工作，似乎也没有其他资金来源。

DESCRIPTION (provided by applicant): Neonatal apnea, or apnea of prematurity, is the most common serious disorder of premature infants in the neonatal intensive care unit (NICU). There are significant gaps in knowledge in its definition, documentation and management. For example, despite continuous electronic monitoring in the NICU, apnea episodes are diagnosed based only on clinical judgment and recorded only by hand on bedside flow sheets. The lack of quantitative and standardized apnea metrics has stalled efforts to understand its natural history, its therapy, and its relationship to the major public health problem of sudden infant death syndrome, or SIDS. Our long term goals are to change NICU practice by providing doctors and nurses with real time risk assessment for subacute, potentially catastrophic diseases. Here, our Specific Aim is to develop and validate multivariable predictive models for continuous monitoring of neonatal apnea using old and new mathematical measures of waveforms and vital signs recorded on NICU bedside monitors. We will deliver a short-term apnea index and a cumulative apnea burden as management and research tools suitable for mechanistic insights and for randomized therapeutic trials. The project is responsive to the scope and requirements of the Grand Opportunities grants program. We plan a large-scale and accelerated program to generate a large database of neonatal clinical and monitor waveform data, and to develop monitoring algorithms. The database is a rich resource for other researchers, and the algorithms will be innovative solutions to current barriers to data interpretation in NICUs, and promise improved infant health. New large scale computing hardware and software is already running. Our team has unique experience in developing new monitoring algorithms in the NICU, and represents clinical, engineering and mathematical disciplines. No other entity is likely to conceive or to execute this work, and no other funding source seems likely. PUBLIC HEALTH RELEVANCE: Apnea of prematurity (AOP) is a common life-threatening disorder that often extends expensive hospitalization of premature babies. While methods for detecting, recording, and classifying AOP currently depend on highly unreliable nursing observations, computer technology and storage capacity are now readily available to permit continuous on line analysis of existing signals from routine bedside monitors to predict apnea risk. We have the technology, expertise, and existing network to develop and verify a sensitive measure of apnea risk which could be widely implemented in other NICUs to save substantial hospital costs through earlier safe hospital discharge, as well as to contribute valuable knowledge about maturation of respiratory control and provide a useful tool and database for future studies of AOP and Sudden Infant Death Syndrome (SIDS).