Helman, Stephanie
(2023)
Significant Complications and Predictors Associated with Persistent Hypothermia after Neonatal Cardiopulmonary Bypass Surgery.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Neonates (infants ≤ 28 days), especially those with congenital heart defects (CHD), are among the most vulnerable populations cared for by critical care nurses. The focus of this thesis is to build a trajectory of research that targets the care of hospitalized neonates with CHD through use of predictive analytics and machine learning to improve outcomes and prognostication in this population. Hypothermia will be the overarching topic evaluated because an immature integumentary system with poor thermal regulation is one of many mechanisms known to place neonates at risk. Approximately, two out of three CHD neonates experience unintentional hypothermia after cardiopulmonary bypass (CPB). Unintentional hypothermia impairs cellular function (alters cellular integrity and membrane stability), which can be linked to poor outcomes frequently reported in this population. To date, there are no studies examining the association between the burden of unintentional hypothermia and clinical outcomes in neonates with CHD. This knowledge could render future opportunities to improve nursing care and prevent avoidable safety events in these vulnerable neonates. With that said, in my thesis and dissertation I hope to accomplish the following: (1) synthesize evidence related to machine learning methods currently used in neonatal / pediatric cardiology research, (2) investigate longitudinal temperature patterns in neonates after CPB, their unique clinical characteristics, and associations with outcomes, as well as (3) explore alternative data driven methods that may also discover distinct patterns in temperature data. Since the main focus of this dissertation is to evaluate postoperative temperature patterns neonates after CPB, we accessed retrospective data from CardioAccess (database local to the Children’s Hospital of Philadelphia [CHOP]), which includes one of the largest repositories of neonatal cardiac surgery data available to date (Pediatric Cardiac Critical Care Consortium [PC4]), as well as the electronic health record (EHR). Using data from 450 neonates who have undergone CPB between 2015 and 2019, we quantified the time course of hourly temperature trajectories within the initial 48 hours after CPB and evaluated their relation to key clinical outcomes.
We specifically studied the temporal trends of unintentional hypothermia burden (temperature depth and duration). This challenges current practice where care is based on maintaining a single preselected temperature threshold that is driven by consensus rather than evidence. Single threshold values are not dynamic representations of the complexity that makes up temperature. A more robust output, such as an accumulative hypothermia burden index is needed to assist clinicians with interpretation of this dynamic indicator of overall health. But first, we need to understand the patterns of temperature instability in this population which will help to define burden. This definition of burden will be used in future studies to create a prospective monitoring tool that will alert clinicians of impending unintentional hypothermia before adverse clinical sequalae occur.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
18 December 2023 |
| Date Type: |
Publication |
| Defense Date: |
6 November 2023 |
| Approval Date: |
18 December 2023 |
| Submission Date: |
8 December 2023 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
134 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Nursing > Nursing |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
neonates, CHD, persistent hypothermia |
| Date Deposited: |
18 Dec 2023 15:52 |
| Last Modified: |
18 Dec 2023 15:52 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/45634 |
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