Karen Fairchild, MD
Early warning systems for Sepsis in the Neonatal Intensive Care Unit
(HeRO and beyond)
Babies in the NICU are at high risk for severe infection, or sepsis, which is life-threatening. About 1 in 5 premature babies develops sepsis, and 1 out of 5 babies with sepsis dies despite treatment with antibiotics and intensive care. The goal of predictive monitoring is to detect and treat sepsis early, before the baby appears sick, to reduce mortality. Vital signs such as heart rate and respiratory rate are continuously monitored on all babies in the NICU, and there are often subtle, complex changes in vital signs hours or even days before doctors recognize signs of sepsis in the baby.
Researchers at UVA developed a monitor, the HeRO or Heart Rate Observation monitor, that analyzes the electrocardiogram (ECG) signal on the bedside monitors and detects abnormal patterns that may indicate impending sepsis. Low variability and decelerations of the heart rate make the score go up and indicate to NICU caregivers that they need to closely examine the baby and decide whether to start antibiotics. Use of the HeRO monitor was shown, in a randomized clinical study of 3003 preterm infants, to reduce all-cause mortality >20% and to reduce sepsis-associated mortality 40%.
Dr. Fairchild has done research in both preclinical models and in babies in the NICU to understand how sepsis and other diseases cause changes in heart rate characteristics. Currently she leads an NIH-sponsored study that is a collaboration between UVA, Columbia University, and the College of William & Mary discovering newer, better ways to analyze vital signs and develop early warning systems for sepsis and necrotizing enterocolitis, another complication of prematurity for which early detection may lead to increased survival and better long-term neurologic outcomes.
Apnea in Preterm Infants
UVA is a leading center in research on apnea of prematurity, which affects nearly all preterm babies born at <1.5 kg (less than about 3 pounds). Dr. Fairchild currently leads the Apnea Research Group which is working to develop real-time bedside displays of the amount and severity of apnea and other immature breathing patterns of preterm infants in the NICU. These displays could help nurses and doctors intervene to reduce morbidity (low oxygen levels that could lead to brain damage) and mortality (apnea can be an indicator of sepsis or other life-threatening conditions).
Helping premature babies breathe during delayed cord clamping (VentFirst)
Delayed clamping of the umbilical cord after birth can benefit premature babies, lowering the risk of bleeding in the brain and other complications. However, many very preterm babies do not breathe well on their own so many obstetricians cut the cord early to allow the neonatology team to assist breathing. Dr. Fairchild and Dr. John Kattwinkel are leading a clinical study that involves helping premature babies breathe while they are attached by the umbilical cord to the placenta. The study was begun in 2014 at UVA and funding is being solicited from NIH for a multicenter clinical trial of nearly 1000 premature babies nationwide to determine whether “VentFirst” (assisting breathing or ventilation before cutting the cord) increases survival without brain hemorrhage.