Physiologic stability in severe acute malnutrition

Partnering with the St. Louis Nutrition Project, clinician-researchers from Washington University in St. Louis are studying the relationship between heart rate variability and severe malnutrition in Malawi.  The use of this non-invasive means of determining physiologic stability may improve the ability to identify children who need more advanced medical treatment.



As a pediatric intensivist, Katie Nielsen's primary interest is in improving the health care systems involved in the delivery of care to critically ill children in resource-limited settings.  She started partnering with colleagues at Instituto Nacional de Salud del Niño (INSN) in Lima, Peru in 2013 as a Fogarty Global Health Research Fellow with the University of Washington.  With the help of pediatric colleagues in the emergency department, general pediatrics, and critical care, her group performed a case-control study of 1094 patients to develop an emergency department-specific risk score to identify children at high risk of having a serious adverse event during hospitalization.  Our score had an area under the ROC curve of 0.768.


After her return to the United States to join the University of Washington faculty, Dr. Nielsen's Peruvian colleagues identified a need for alternative non-invasive respiratory support due to challenges in maintaining adequate support with their CPAP device.  With approximately 80% of PICU patients at INSN receiving invasive mechanical ventilation for an average of 8 days, Dr. Nielsen and her Peruvian colleagues proposed using high flow nasal cannula (HFNC) after extubation to increase the number of ventilator-free days.  Alumni support from the Fogarty Global Health Research Fellowship (NIH 3R25TW009345-01) and internal support from Seattle Children’s Center for Clinical and Translational Research Clinical Research Scholars Program have made this project possible.

Ongoing opportunities for collaboration involving the implementation of standard protocols and/or building upon the emergency department risk score to improve monitoring of critically-ill children exist.  If you are interested in learning more about collaborations with INSN, please contact us.


Survey of Pediatric Critical Care Physician-Scientists in Resource-Limited Settings

Survey of Pediatric Critical Care Physician-Scientists in Resource-Limited Settings

Little research exists to support improving child outcomes in resource-limited settings (RLS), where most child deaths occur.  We surveyed pediatric critical care clinician-researchers in RLS to understand the challenges and potential solutions to improving research opportunities.

Presented at the 8th World Congress on Pediatric Intensive and Critical Care meeting, June 2016


Surviving Pediatric Sepsis in Tanzania: A Prospective Cohort Study to Identify Risk Factors and Barriers to Care

Over half of the annual 5.9 million under-five deaths occurred in Sub-Saharan Africa (SSA), the majority from sepsis, which is the final common inflammatory pathway for most infectious disease-related deaths. Pediatric sepsis is preventable and treatable, and prompt recognition and early therapy can impact survival. Yet, sepsis remains a serious, life-threatening condition and we lack a robust understanding of how to manage pediatric sepsis in SSA due to limited regional data. Relative to high-income countries (HICs), very little data is generated in low-income countries (LICs). Frequently, LICs must rely on guidelines produced in and based on data generated in HICs, despite the fact that LICs have a distinct patient population and unique resource constraints. These data are critical to identify high-risk patients, develop triage systems and reduce barriers to care.