The Incubator

🟠 CHNC 2023 COVERAGE - Open Mic w CHNC Mentored fellows - Kylie Bushroe and Erica McArthur

October 13, 2023 Ben Courchia & Daphna Yasova Barbeau
The Incubator
🟠 CHNC 2023 COVERAGE - Open Mic w CHNC Mentored fellows - Kylie Bushroe and Erica McArthur
Show Notes Transcript Chapter Markers

Join us on an enlightening exploration through the intricate world of neonatology research with our esteemed fellows, Kylie Bushroe and Erica McArthur.  Kylie gives an in-depth account of her ground-breaking research on tracheostomy placement for babies with severe BPD, a study that covered almost 900 cases over a span of five to six years. She also shines a light on the social determinants that significantly impact the timing of this essential procedure. Simultaneously, Erica delves into the complex issue of pulmonary vein stenosis in preterm infants, based on a database of over 100 infants. Hear them share their experiences, the invaluable mentorship, and the lifelong connections they've made across the country as part of their fellowship. 

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.

Enjoy!

Speaker 1:

Hello everybody, welcome back to the podcast. We are joined by Kylie Bushrow and Erica McArthur. Kylie, Erica, thank you so much for coming on the show.

Speaker 2:

Yeah, thank you for having us. Thanks for having us.

Speaker 3:

Well, tell us where you're coming from and what your areas of interest are and what you've been studying as a mentored fellow for this agency.

Speaker 2:

Yeah, so I'm Kylie. I'm a third year fellow, a neonatology fellow, at St Louis Children's Hospital, washington University in St Louis. Most of my I have a few projects in fellowship that have been around tracheostomy placement for babies with severe BPD and you know BPD care in the NICU and so through the Mentored Fellowship Award I was able to look at, you know, almost 900 babies a severe BPD that received tracheostomies in the last five to six years, studying the social determinants of health and how those may impact timing to tracheostomy placement.

Speaker 1:

So just let's sync, let's let that sink in for a second.

Speaker 3:

It is a fellow's dream, right. You have to start with a tiny project and that may let you into the, you know.

Speaker 1:

But if you've studied anything related to BPD. You said 900 babies in the span of five years, all who have received tracheostomy.

Speaker 3:

Yes, it's incredible With severe BPD.

Speaker 1:

Yeah, I mean yeah, hopefully, hopefully they are severe if they have undergone tracheostomy. But I mean it's still incredible that we're able to actually do that kind of research today thanks to that collaborative.

Speaker 3:

And so and no, but to your point, it's. It's not the Coenalatrygia, it's yeah, it's nothing anatomy, it's even more so, it's just BPD. It's incredible.

Speaker 1:

And so so, what was the early late?

Speaker 3:

What do we do?

Speaker 1:

When should we time the? Can you give us? When should we book the OR basically?

Speaker 2:

Well, we found that the median age post menstrual age for tracheostomy placement across all of the CH&C centers, for all the babies was 48 weeks and discharge from the NIC US 58 weeks. There was a trend, so we used mom's zip code from the CH&D and correlated that with Census, us Census Bureau data, and so it was, you know, a general area. We didn't have access to addresses, so it's not more granular data. We did find a trend of later trach placement for lower socioeconomic groups, but when you know, using an adjusted model for other factors, ultimately the social determinants of health did not significantly impact the timing. The center effect was significant.

Speaker 1:

Yeah, it's great to hear.

Speaker 3:

So what do you think are those? You know challenges. You said there's some center differences.

Speaker 2:

I think that there are. There's so many factors that play into a timing for trach placement that it's hard to tease out all those intricacies, and so there's definitely more steps that we're going to take after to kind of investigate this a little further. You know what is leading to those center differences and then potentially comparing. You know we were just looking at babies that received trachs and comparing them against each other, but comparing what you know the other babies, a severe BPD that did not receive trachs and seeing if we see an effect. So I think, more to come, that's right.

Speaker 3:

That's right. Okay, and tell us what you've been up to.

Speaker 4:

Yeah, so I'm Erica, coming from Emory. I feel super lucky that I got this award with Kylie. We were just really excited in our first year to hear about this. It's kind of like what you guys were saying, like a fellow stream to get data from this database. So I studied pulmonary vein stenosis in preterm infants and fellowship. I was really interested in cardiopulmonary disease in our preterm babies. So the database had 109 infants with pulmonary vein stenosis who also were less than 32 weeks with severe BPD, and we found significant associations with SGA, neck and ASD. And then there was a strong association with pulmonary hypertension and pulmonary vein stenosis, which I think is expected. But it was really exciting to get to look at all of these infants in this database because this is obviously a very rare disease but we're still investigating a lot about who's at risk and things like that. So it's really exciting.

Speaker 3:

Yeah, I mean it's particularly interesting because it's kind of like an up and coming topic, right that we we're just starting to realize that this is a big deal.

Speaker 1:

That's right.

Speaker 3:

How it's affecting babies, yet not even something we were looking at before and now I think we'll become part of our management, especially for those complicated cases.

Speaker 1:

So what does that mean to be a mentored fellow? What does that I mean? Aside from being able to leverage the CHND? What other aspects of that award are you guys leveraging?

Speaker 4:

Yeah, I think something that. So the CHNDC we use a lot at Emory and we Dr Piazza has always told fellows that they're welcome to join focus groups and different things like that. But I think the thing that was most helpful, beyond getting to use the database, was having mentors from across the country. So, being a part of the cardiac and severe BPD focus groups, I got feedback on this project from centers all across the US and have mentors from places all across the US. So I think that was really fantastic and a bunch of people not only helped me with the initial ideas of the study but actually gave me feedback on my slides and helped with that presentation, so I've had really great mentors.

Speaker 2:

And I think that we as fellows hear about the CH&C and generally know what it is, but at least at our program it's not many get involved.

Speaker 1:

It happens in the stratosphere. There's like, yeah, yeah.

Speaker 2:

And so this is the way that we both were invited to join the severe BPD focus group and attend the meetings and get to know, you know, meet the anecdologists all across the country. Like Erica said, I think that that was an amazing opportunity that I wouldn't have normally had.

Speaker 1:

And then what does that provide you in terms of being better researchers? In terms of methodology, I think that's also something that we tend to leave medical school residency, and unless you've actively pursued your interest in becoming a better researcher and learning about data science and stuff like that, it's still very much something you have to learn on the fly. So are you getting any help when it comes to study design and methodology from the CH&C people?

Speaker 2:

Yeah, I think when we are going through the process and having our monthly meetings or whatever, end up being hearing the different ideas from other neonatologists was great. It was more ideas than just my two mentors at my institution and then working with the statistician closely over the last month or two has been a great learning experience for me at least that's something you find as a fellow that a statistician is the scarer One of the commodities.

Speaker 1:

That is the hardest to come about. Every valuable. I'm in this university center with people learning statistics, and yet there's no one that can help me with my study.

Speaker 2:

She was amazing, that's awesome.

Speaker 3:

I think you guys bring up such an important point, especially in advocating for trainees to get involved in consortium and collaboratives, because it's that mentorship what are the days where really fellows are picking institutions primarily for a research mentor? I mean, that still happens sometimes, but being able to say this is something I'm interested. I want to study, but the people doing that aren't at my institution. I think this opens up a lot of opportunities for fellows everywhere to be able to work on things that interest them.

Speaker 1:

How long is this mentored fellowship for?

Speaker 4:

I think, throughout fellowship, essentially because we found out about the award in our first year and we're now third years. But our project is we got our data and so now we're working on the manuscript and I suspect that hopefully these mentorship relationships will continue.

Speaker 1:

I think that's the key too. I was hoping that somebody was going to mention that, because I think you're building relationships that maybe will morph into mentorship, to collaboration. I think if the area that you're studying with this agency as a fellow is still something you're interested in past fellowship then, hopefully that continues.

Speaker 2:

Yeah, I mean, we receive so much data that I think it's starting to spin off into more projects that are definitely going to surpass just my fellowship time.

Speaker 1:

Is this affecting how you're going to choose your job after fellowship in terms of because, realistically, speaking, don't ask them on air. What I'm thinking of is are you looking at opportunities for a job that would involve continuing relationship with the CHNC? If you go to a hospital that is not aligned when it comes to that mindset, it may stop this program. That's why I'm asking.

Speaker 3:

It's an interesting point.

Speaker 4:

So I was looking for jobs and, as I'm still looking for jobs, I did meet with Dr Piazza to ask him about what other sites in our area were using the CHNC Right. I didn't necessarily know that and he helped me understand the ones that were getting on boarded and kind of where other places were in our area. So that is something that's a factor.

Speaker 2:

I've definitely been asking about it and I've had a few places that there sounds like there's multiple that are coming joining in the next year or two, and I've had a few places talk about that and how they're excited about it.

Speaker 1:

Very well, you see, all right.

Speaker 3:

Don't want to put our trainees on the spot all the time.

Speaker 1:

Don't want to listen to this podcast anyway. All right, guys, thank you so much for coming on and good luck with the rest of your fellowship and on any future endeavor.

Speaker 2:

Thank you so much, thanks, thank you.

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