Summer Students present at the Annual Pediatric Academic Societies' and Asian Society for Pediatric Research Meeting in Vancouver in May 2014
[4109.224] APS/SPR Student Research Program – Seema Anandalwar: Changes in Epidemiology and Outcomes in Infants With Pulmonary Hypertension and Bronchopulmonary Dysplasia
Seema P. Anandalwar, Lawrence M. Rhein, Mary P. Mullen. Newborn Medicine and Pediatric Pulmonary, Boston Children's Hospital, Boston, MA; Cardiology, Boston Children's Hospital, Boston, MA.
BACKGROUND: Recent studies have increased awareness of pulmonary hypertension (PH) as a common complication of bronchopulmonary dysplasia (BPD), with potential significant morbidity and mortality. Various outcomes have been described for infants with PH, from early resolution to significant mortality. Despite rising awareness of PH in BPD, information describing recent epidemiology and outcomes is lacking.
OBJECTIVE: To describe epidemiology and outcomes of infants with BPD-associated PH.
DESIGN/METHODS: We identified infants at a large tertiary care hospital, with birth gestational age ≤ 32 weeks, birth between 1998-2012, BPD diagnosis, and initial PH diagnosis (by echocardiogram) at ≥ 2 months of age. Echocardiograms were followed until documented PH resolution or death. Demographics and details of respiratory and PH management were extracted from the medical records.
RESULTS: 102 patients were identified. The early cohort included 46 patients born from January 1, 1998 to February 1, 2006; the late cohort included 56 patients born from February 2, 2006 to December 31, 2012. There were no differences between cohorts in gender, birth weight, gestational age, days on ventilator, severity of BPD, or treatment with sildenafil or nitric oxide. The late cohort had more patients treated with post-pyloric feeds (p=0.05) and tracheostomy (p=0.007). The late cohort had a younger mean age at PH diagnosis (285 vs 176 days, p=0.11), shorter time to PH resolution (p<0.03), and lower mortality rate.
CONCLUSIONS: Compared to earlier cohorts, more recent cohorts of infants with BPD and PH are more likely to be treated with aggressive respiratory management, exhibit shorter times to PH resolution, and have lower mortality.
First Author is a Medical Student
[2940.555A] APS/SPR Student Research Program – Eilann Santo: Efficacy of Bronchodilator Use in the Newborn Intensive Care Unit
Eilann C. Santo, Bridget K. Hughes, Lawrence M. Rhein. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; University of Rochester School of Medicine and Dentistry, Rochester, NY; Newborn Medicine and Pediatric Pulmonology, Boston Children's Hospital, Boston, MA.
BACKGROUND: Bronchodilators (BD) have been used for over 30 years in preterm infants with bronchopulmonary dysplasia (BPD). While some data is available on its role in short-term pulmonary compliance, little data exists regarding efficacy of BD for clinical respiratory outcomes.
OBJECTIVE: To assess efficacy of BD in improving pulmonary status of preterm infants within 48 hours of use, and to determine correlation with Newborn Intensive Care Unit (NICU) length of stay.
DESIGN/METHODS: We identified infants born between 2002 and 2013, who received BD treatment at any point during the initial hospitalization at a Level 3 NICU. We selected controls matched for birth gestational age week, birth year, race, and gender. Exclusion criteria included lack of control patient with matching criteria (n=6) or lack of information to allow calculation of the pulmonary score for either index or control patient (n=16). Pulmonary scores were calculated from clinical data (Madan et al, Pediatrics 2005) on the day prior to first BD exposure, and at 24 and 48 hours post treatment. Higher scores reflect worse lung disease. Pulmonary scores for controls were calculated on the same day of life corresponding to the day of first BD exposure for the matched patient. Demographic and clinical variables were extracted from medical records.
RESULTS: Infants who received BD had lower pulmonary scores at baseline pre-1st BD dose (2.23 v 0.18, p<0.0001), 24 hrs (1.09 v 0.10, p<0.0001) and 48 hrs (1.16 v 0.10, p<0.0001) compared to matched controls. Infants treated with BD showed greater improvement from baseline at both 24 (p<0.0001) and 48 hours (p<0.0001) than those who did not receive BD. NICU length of stay was increased in infants who received BDs compared to controls (p<0.0001).
CONCLUSIONS: Infants treated with BD showed greater improvement in respiratory function both 24 and 48 hours post BD administration compared to infants who did not receive BD. Infants who received BD had more severe lung disease at similar ages compared to matched controls, and despite short-term improvement in pulmonary score, had longer NICU length of stay. Prospective studies are needed to evaluate the role of BD in improving clinical respiratory outcomes.
The Experience -- Student feedback about the program
- "The Program did a good job introducing us to the full spectrum of newborn medicine by showing us what occurs in normal delivery and care, as well as special circumstances in the NICU and Infant Follow-Up."
- "I really enjoyed that both research and clinical work were the focus of this Program. I now have a better understanding of the clinical practice of neonatology and the direction in which neonate research is going."
- "The Program is a fantastic mix of clinical experience and research experience."
- "Most of my peers in other programs were solely exposed to either research or clinics. That was what I thought was so great about this Program. The research was intense; however, I also got clinical exposure in a field of medicine that most medical students don’t see until residency. The clinical exposure added an extra dimension to an already abstract experience, allowing us to see why the research we were taking part in was so important."
- "The research was intense, and I was able to complete a project which is something I have never done before."
- "I loved the case presentations every Wednesday, the shadowing opportunities, the binder chock-full of information…everything! It was all so well organized and put together, and I learned so much!"
- "Loved the clinical aspect of the Program! I really enjoyed the weekly conferences and all the learning that took place."
- "I always had an interest in pediatrics, but I had never been exposed to neonatology. This Program has helped me learn more about neonatology and I now consider it a field to pursue in the future."
- "The Program has exposed me to other areas of pediatrics, such as developmental pediatrics, that I would like to pursue. Also, it has sold me on Boston as a place to train."
- "Before this Program I was still deciding if I should apply for an M.D. or Ph.D. However, after this Program, I realized how much more I enjoy the clinical setting and how the M.D. path is definitely one that I should pursue."
- "This Program has given me tremendous exposure to the field of neonatology. With that exposure and first hand experience, I will be more able to make an informed career decision when the time comes."
- "This Program solidified my interest in pursuing a career in pediatrics and especially in engaging in clinical research."
- “Through my experiences with the SSRP, I know now that I want to pursue a career as pediatric research physician, and spend the rest of my life caring for children.”
- “My research project coupled with clinical experiences with my mentor have sparked my interest/passion for neonatology, and I am looking forward to the direction this takes me.”
- “I really enjoyed meeting the other summer students and learning about their work; as well, it was enjoyable working in teams on cases and learning from other students’ knowledge and skill sets.”
- “I really enjoyed the autonomy I received during the program’s duration. I was able to meet with my post-doc and work with him to essentially design experiments from scratch. That aspect of the program was irreplaceable.”
Let us know where you are now
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