The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare Elizabeth E. Foglia, MD, Instructor of Pediatrics at the University of Pennsylvania for her long-term goal of becoming an independent clinical investigator. Her long-term career objectives are to evaluate delivery room interventions to reduce morbidity and mortality in preterm infants and to translate effective interventions into resuscitation recommendations and clinical practice. Her immediate goal is to obtain the training, mentorship, and research experience necessary to successfully compete for R01 grants supporting intervention studies in this area. To meet this goal, Dr. Foglia and her mentors have developed a comprehensive career development plan with the following components: (a) intensive mentorship from a team with whom she have a proven track record of collaboration and scholarship, (b) advanced training in longitudinal and clustered data analysis, survival data analysis, and clinical trials, (c) experience in acquisition and interpretation of respiratory funcion monitoring, (d) participation in research seminars and collaborative investigators meetings with national and international experts in clinical effectiveness research and particularly neonatal resuscitation (e) an innovative research plan to investigate the respiratory parameters that are most associated with lung aeration after birth and to test whether a simplified respiratory function monitor display improves provider performance of goal-directed PPV. Bronchopulmonary dysplasia (BPD) is a major clinical problem with enormous societal burden and cost, affecting half of surviving extremely premature infants. Preventing BPD requires strategies to reduce acute lung injury, particularly after birth when the immature lung is highly susceptible to damage. Currently available technology is inadequate for monitoring the safety and efficacy of positive pressure ventilation (PPV) performed in the delivery room, putting preterm infants at risk for acute lung injury immediately after birth. Easily interpretable monitoring of respiratory characteristics may allow for goal-directed PPV to facilitate lung aeration and to reduce lung injury after birth in preterm infants. Dr. Foglia aims to refine a respiratory function monitor as an effective tool for goal-directed PPV in preterm infants. This requires first identifying the proper targets for goal-directed PPV, and then testing the optimal method of displaying these data for easy interpretation and use. Dr. Foglia has outlined a plan to perform both of these steps in this proposal. She will leverage the opportunity to study respiratory function parameters in a large cohort of preterm infants enrolled in the NICHD funded multicenter SAIL trial. She will use these data to (1) identify the critical target respiratry values that are associated with lung aeration during PPV after birth in preterm infants, and (2) determine which of these respiratory parameters are most essential to achieve lung aeration. Finally, in a randomized simulation trial, Dr. Foglia will (3) determine whether a simple display versus the current complex display for the respiratory function monitor results in improved simulated provider PPV performance. The findings will provide evidence to support and inform future R01 proposals focused on assessing the impact of goal-directed PPV in the delivery room on clinically relevant outcomes in extremely preterm infants. The research and career development activities outlined above will take place in the collaborative academic environment of the University of Pennsylvania, the Children's Hospital of Philadelphia, and the Hospital of the University of Pennsylvania with the support of an internationally-recognized team of mentors and advisors, assuring Dr. Foglia's success.

Public Health Relevance

Chronic Lung Disease, or bronchopulmonary dysplasia (BPD) affects 50% of surviving extremely preterm infants and results in long-standing respiratory and neurologic disability. Assisted breaths required by preterm infants after birth are currently inadequately monitored and often result in acute lung injury, which predisposes to BPD. This proposal seeks to improve the safety of monitoring assisted breaths after birth in preterm infants by determining two essential elements for a respiratory monitor: identifying the respiratory measurements that should be monitored and targeted during assisted breathing, and testing simple ways of displaying respiratory measurements for clinicians to easily use.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute of Child Health and Human Development Initial Review Group (CHHD)
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Koso-Thomas, Marion
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University of Pennsylvania
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Pouppirt, Nicole R; Nassar, Rula; Napolitano, Natalie et al. (2018) Association Between Video Laryngoscopy and Adverse Tracheal Intubation-Associated Events in the Neonatal Intensive Care Unit. J Pediatr 201:281-284.e1
Katz, Trixie A; Weinberg, Danielle D; Fishman, Claire E et al. (2018) Visual attention on a respiratory function monitor during simulated neonatal resuscitation: an eye-tracking study. Arch Dis Child Fetal Neonatal Ed :
Foglia, Elizabeth E; Roberts, Robin S; Stoller, Jason Z et al. (2018) Effect of Prophylactic Indomethacin in Extremely Low Birth Weight Infants Based on the Predicted Risk of Severe Intraventricular Hemorrhage. Neonatology 113:183-186
Jensen, Erik A; Foglia, Elizabeth E; Schmidt, Barbara (2018) Association between prophylactic indomethacin and death or bronchopulmonary dysplasia: A systematic review and meta-analysis of observational studies. Semin Perinatol 42:228-234
Fishman, Claire E; Weinberg, Danielle D; Murray, Ashley et al. (2018) Accuracy of real-time delivery room resuscitation documentation. Arch Dis Child Fetal Neonatal Ed :
Foglia, Elizabeth E (2018) Can we make informed consent forms more informative? Arch Dis Child Fetal Neonatal Ed 103:F398-F399
Foglia, Elizabeth E; Te Pas, Arjan B (2018) Effective ventilation: The most critical intervention for successful delivery room resuscitation. Semin Fetal Neonatal Med 23:340-346
Foglia, Elizabeth E; Langeveld, Robert; Heimall, Lauren et al. (2017) Incidence, characteristics, and survival following cardiopulmonary resuscitation in the quaternary neonatal intensive care unit. Resuscitation 110:32-36
Bonafide, Christopher P; Jamison, David T; Foglia, Elizabeth E (2017) The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors. JAMA 317:353-354
Foglia, Elizabeth E (2017) Establishing ventilation in the delivery room: T-piece resuscitator versus self-inflating bag. Acta Paediatr 106:684

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