Brynne Sullivan, MD, MSc

Brynne Sullivan, MD
CAMA Director
Associate Professor of Pediatrics, Neonatology
Brynne Sullivan is a neonatologist and physician-scientist. She received her BS in Biology from Washington and Lee University and her MD from the University of Virginia. She has lived in Charlottesville since medical school, completing her pediatric residency and neonatology fellowship at UVA.
Dr. Sullivan sees patients in the UVA Children’s NICU and has dedicated her research career to studying the use of bedside monitoring data to improve neonatal outcomes. Through her studies of the heart rate characteristics index, or HeRO score, and cardiorespiratory monitoring data, she found that mathematical analyses of continuous cardiorespiratory monitoring detect signatures of illness due to sepsis in premature infants. Her research has been funded by foundation grants, the integrated Translational Health Research Institute of Virginia (iTHRIV), and the NIH with NICHD K23 and NIBIB R18 awards. Randall Moorman, director of CAMA and cofounder of HeRO, served as her primary K23 mentor.
Among Sullivan’s primary research experiences was her work on cardiorespiratory signatures of illness due to sepsis in very low birth rate (VLBW) infants. She has also led and contributed to multiple analyses of cardiorespiratory data by helping develop algorithms that predict multiple adverse outcomes in preterm infants. She leads a 4-NICU collaboration that has built a robust multicenter database, which has fueled numerous studies combining physiologic and demographic data for outcome risk prediction in representative cohorts with external validation. In addition to her many publications on predictive monitoring and physiology in neonates, Sullivan has mentored and collaborated with numerous trainees and medical students on clinical research.
At CAMA, Sullivan analyzes, integrates, and displays clinical markers, biomarkers, and physiomarkers by applying predictive modeling for the early detection and treatment of neonatal sepsis. She works with others in the research group on time series analytics, machine learning models, and implementing the FAIR data pipeline for NICU data. She is a primary investigator on a team of neonatal researchers at UVA, University of Alabama-Birmingham, and Washington University in St. Louis, studying cardiorespiratory signatures in Neonatal Opioid Withdrawal Syndrome (NOWS).
Projects
Infants born months before their due date are extremely vulnerable to infection. Despite advances in technology and science that allow for the survival of the smallest premature infants, life-threatening infections occur in about 1 in 5 very low birth weight (VLBW, birthweight <1500g) infants. These illnesses, specifically sepsis, and NEC cause significant morbidity and mortality via systemic inflammation and cardiorespiratory collapse. Early diagnosis and treatment of these sub-acute, potentially catastrophic illnesses can start the course to recovery before serious injury occurs, but the earliest signs often go unrecognized using current technology. Dr. Sullivan’s research focuses on developing, implementing and testing early warning systems for sepsis and NEC using predictive analytics and the support of a multidisciplinary, multicenter research team.
In recent research, after analysis of data from a randomized trial of predictive monitoring in the NICU, a differential impact of randomization by race was found. Improving equity in patient care and in those trained to care for patients has become a focus of her research career and mentoring efforts. She led a 4-NICU team to study in utero exposure to area deprivation for infants born extremely premature and found associations between high maternal area deprivation and NICU mortality and morbidity, even after accounting for covariates such as gestational age, sex, and race. This work illustrates that predictive analytics could improve health equity if developed and implemented appropriately, but more work is needed to identify biases in the data and clinician’s actions and how these affect meaningful outcomes.
NOWS is a complex disorder with variable presentation and severity. Symptoms include extreme irritability, difficulty feeding, respiratory problems, and seizures. The current gold standard for NOWS evaluation and treatment uses subjective evaluation and symptom monitoring to guide the provision of non-pharmacologic and pharmacologic treatments. Inter-observer assessment variability and overlap with normal neonatal behavior lead to substantial ambiguity and variation in care. These challenges contribute to delays in treatment, hospital discharge, and care inequities. This research underscores the pressing need to better understand its pathophysiology and optimize the treatment of affected infants. The research team aims to develop a Pulse Oximetry Withdrawal Score (POWS), a novel technology for objective symptom assessment to guide treatment and hospital length of stay.
Parenteral Nutrition-Associated Cholestasis (PNAC), diagnosed by elevated serum conjugated bilirubin secondary to liver damage, correlates with very low birthweight (VLBW, <1500g) and prolonged parenteral nutrition. Cholestasis monitoring in very low birth weight (VLBW, <1500g) infants within the NICU lacks guidelines. Conjugated bilirubin measurements (CBM) are the primary screening tool. This research evaluates cholestasis monitoring in VLBW infants to identify areas needing standardization.
Premature infants are born with underdeveloped lung structures, surfactant deficiency, and weak accessory breathing muscles. For these reasons, the majority of premature infants delivered < 36 weeks require respiratory support immediately after birth. Interventions to increase respiratory support are largely guided by subjective physical exam assessments to evaluate for abnormal breathing patterns and effort. Once support is increased, signs of readiness or tolerance of weaning are also subjective and subtle. Using Analysis of Respiratory Kinematics (ARK) technology, this research will lay the scientific and logistical foundation for ARK monitoring in the NICU by (a) adapting the prototypes and signal processing algorithms for the NICU population (e.g. 2-3 sensors given small size of infants), and (b) collecting real-world ARK data to show technical feasibility and clinical utility.
- Sullivan BA, Howard P, Kendrick H, Zeller B, McPherson C, Vesoulis ZA. Cardiorespiratory Stability in Critically Ill Preterm Infants following Dexmedetomidine Initiation. Am J Perinatol. 2024 Nov 27. doi: 10.1055/a-2445-3010. Epub ahead of print. PMID: 39424361.
- Nagraj VP, Howard P, Fairchild KD, Sullivan BA. Tachycardia-Desaturation Episodes in Neonatal Intensive Care Unit Patients with and without Bronchopulmonary Dysplasia. Am J Perinatol. 2024 Nov 19. doi: 10.1055/a-2437-0461. Epub ahead of print. PMID: 39384297.
- Weigner MK, Kausch SL, Fairchild KD, Sullivan BA. Impact of Pharmacologic Patent Ductus Arteriosus Treatment on Acute Respiratory and Oxygenation Metrics in Very Low Birth Weight Infants. Am J Perinatol. 2024 Nov 12. doi: 10.1055/a-2441-6639. Epub ahead of print. PMID: 39406374.
- Kausch SL, Slevin CC, Duncan A, Fairchild KD, Lake DE, Keim-Malpass J, Vesoulis ZA, Sullivan BA. Clinical correlates of a high cardiorespiratory risk score for very low birth weight infants. Pediatr Res. 2024 Sep 19. doi: 10.1038/s41390-024-03580-y. Epub ahead of print. PMID: 39300276.
- Sullivan BA, Fairchild KD. Heart rate analysis in neonatal sepsis: a complex equation. Pediatr Res. 2024 Sep 6. doi: 10.1038/s41390-024-03548-y. Epub ahead of print. PMID: 39242935.
- Simek KA, Husain AN, Vesoulis ZA, Sullivan BA, Barry JS, McAdams RM, Moreira AG. Surveying current perceptions of artificial intelligence among pediatric healthcare professionals. J Perinatol. 2024 Aug 27. doi: 10.1038/s41372-024-02101-3. Epub ahead of print. PMID: 39191886.
- Vesoulis ZA, Diggs S, Brackett C, Sullivan B. Racial and geographic disparities in neonatal brain care. Semin Perinatol. 2024 Aug;48(5):151925. doi: 10.1016/j.semperi.2024.151925. Epub 2024 Jun 13. PMID: 38897830.
- Sullivan K, Sullivan B. Does nirsevimab prevent lower respiratory infections caused by respiratory syncytial virus? J Perinatol. 2024 May;44(5):767-769. doi: 10.1038/s41372-024-01970-y. Epub 2024 Apr 18. PMID: 38637681; PMCID: PMC11090781.
- Bultmann CR, Qiu J, Belmonte B, Fairchild KD, Sullivan BA. Heart rate and oxygen saturation patterns in very low birth weight infants with early onset sepsis and histologic chorioamnionitis. J Neonatal Perinatal Med. 2024;17(2):209-215. doi: 10.3233/NPM-230093. PMID: 38578905; PMCID: PMC11450634.
- Kausch SL, Lake DE, Di Fiore JM, Weese-Mayer DE, Claure N, Ambalavanan N, Vesoulis ZA, Fairchild KD, Dennery PA, Hibbs AM, Martin RJ, Indic P, Travers CP, Bancalari E, Hamvas A, Kemp JS, Carroll JL, Moorman JR, Sullivan BA; Prematurity-Related Ventilatory Control (Pre-Vent) Investigators. Apnea, Intermittent Hypoxemia, and Bradycardia Events Predict Late-Onset Sepsis in Infants Born Extremely Preterm. J Pediatr. 2024 Aug;271:114042. doi: 10.1016/j.jpeds.2024.114042. Epub 2024 Apr 2. PMID: 38570031; PMCID: PMC11239298.
- Moneme C, Kausch SL, Belmonte BM, Fleming Ii MA, Levin DE, Sullivan BA. Heart Rate Variability as a Prognostic Tool for Gastroschisis Infants in the Neonatal Intensive Critical Unit. Am J Perinatol. 2024 Sep;41(12):1660-1664. doi: 10.1055/a-2244-0148. Epub 2024 Jan 12. PMID: 38216140.
- Kumar R, Kausch SL, Gummadi AKS, Fairchild KD, Abhyankar MM, Petri WA Jr, Sullivan BA. Inflammatory biomarkers and physiomarkers of late-onset sepsis and necrotizing enterocolitis in premature infants. Front Pediatr. 2024 Jan 19;12:1337849. doi: 10.3389/fped.2024.1337849. PMID: 38312920; PMCID: PMC10834753.
- Sullivan BA, Beam K, Vesoulis ZA, Aziz KB, Husain AN, Knake LA, Moreira AG, Hooven TA, Weiss EM, Carr NR, El-Ferzli GT, Patel RM, Simek KA, Hernandez AJ, Barry JS, McAdams RM. Transforming neonatal care with artificial intelligence: challenges, ethical consideration, and opportunities. J Perinatol. 2024 Jan;44(1):1-11. doi: 10.1038/s41372-023-01848-5. Epub 2023 Dec 15. PMID: 38097685; PMCID: PMC10872325.
- Sullivan BA, Hochheimer CJ, Chernyavskiy P, King WE, Fairchild KD. Impact of race on heart rate characteristics monitoring in very low birth weight infants. Pediatr Res. 2023;94(2):575-580. doi:10.1038/s41390-023-02470-z
- Kausch SL, Brandberg JG, Qiu J, et al. Cardiorespiratory signature of neonatal sepsis: development and validation of prediction models in 3 NICUs. Pediatr Res. 2023;93(7):1913-1921. doi:10.1038/s41390-022-02444-7
- Sullivan BA, Doshi A, Chernyavskiy P, et al. Neighborhood deprivation and association with neonatal intensive care unit mortality and morbidity for extremely premature infants. JAMA Netw Open. 2023;6(5):e2311761. doi:10.1001/jamanetworkopen.2023.11761
- Monfredi OJ, Moore CC, Sullivan BA, et al. Continuous ECG monitoring should be the heart of bedside AI-based predictive analytics monitoring for early detection of clinical deterioration. J Electrocardiol. 2023;76:35-38. doi:10.1016/j.jelectrocard.2022.10.011
- Kumar R, Setiady I, Bultmann CR, Kaufman DA, Swanson JR, Sullivan BA. Implementation of a 24-hour empiric antibiotic duration for negative early-onset sepsis evaluations to reduce early antibiotic exposure in premature infants. Infect Control Hosp Epidemiol. October 24, 2022:1-6. doi:10.1017/ice.2022.246
- Sullivan BA, Doshi A, Chernyavskiy P, et al. Neighborhood deprivation is associated with NICU mortality for extremely premature infants: A 4-NICU study. medRxiv. September 29, 2022. doi:10.1101/2022.09.28.22280470
- Sullivan BA, Kausch SL, Fairchild KD. Artificial and human intelligence for early identification of neonatal sepsis. Pediatr Res. September 20, 2022. doi:10.1038/s41390-022-02274-7
- Kausch SL, Sullivan B, Spaeder MC, Keim-Malpass J. Individual illness dynamics: An analysis of children with sepsis admitted to the pediatric intensive care unit. PLOS Digit Health. 2022;1(3):e0000019. doi:10.1371/journal.pdig.0000019
- Sullivan BA, Ahmad SM, Slevin CC, Sinkin RA, Nagraj VP, Fairchild KD. Major cardiorespiratory events do not increase after immunizations, eye exams, and other stressors in most very low birth weight infants. J Neonatal Perinatal Med. 2022;15(2):275-282. doi:10.3233/NPM-210744
- Sullivan BA, Fairchild KD. Vital signs as physiomarkers of neonatal sepsis. Pediatr Res. 2022;91(2):273-282. doi:10.1038/s41390-021-01709-x
- Kumar RS, Otero NA, Abubakar MO, et al. Framework for considering abnormal heart rate characteristics and other signs of sepsis in very low birth weight infants. Am J Perinatol. December 7, 2021. doi:10.1055/a-1715-3727
- Sullivan BA, Panda A, Wallman-Stokes A, et al. Antibiotic spectrum index: A new tool comparing antibiotic use in three NICUs. Infect Control Hosp Epidemiol. November 23, 2021:1-5. doi:10.1017/ice.2021.467
- Kausch SL, Lobo JM, Spaeder MC, Sullivan B, Keim-Malpass J. Dynamic transitions of pediatric sepsis: A markov chain analysis. Front Pediatr. 2021;9:743544. doi:10.3389/fped.2021.743544
- Sullivan BA, Keim-Malpass J. BARRIERS to early detection of deterioration in hospitalized infants using predictive analytics. Hosp Pediatr. August 4, 2021. doi:10.1542/hpeds.2020-004382
- Zeigler AC, Ainsworth JE, Fairchild KD, Wynn JL, Sullivan BA. Sepsis and Mortality Prediction in Very Low Birth Weight Infants: Analysis of HeRO and nSOFA. Am J Perinatol. May 10, 2021. doi:10.1055/s-0041-1728829
- Sullivan BA, Slevin CC, Ahmad SM, Sinkin RA, Fairchild KD. Achievement of maturational milestones among very low birth weight infants. J Neonatal Perinatal Med. April 30, 2021. doi:10.3233/NPM-200698
- Zimmet AM, Sullivan BA, Fairchild KD, et al. Vital sign metrics of VLBW infants in three NICUs: implications for predictive algorithms. Pediatr Res. March 25, 2021. doi:10.1038/s41390-021-01428-3
- Fleiss N, Coggins SA, Lewis AN, et al. Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants With Late-Onset Infection. JAMA Netw Open. 2021;4(2):e2036518. doi:10.1001/jamanetworkopen.2020.36518
- Aviles-Otero N, Ransom M, Weitkamp J, et al. Urinary tract infections in very low birthweight infants: A two-center analysis of microbiology, imaging and heart rate characteristics. J Neonatal Perinatal Med. 2021;14(2):269-276. doi:10.3233/NPM-200513
- Sullivan BA, Nagraj VP, Berry KL, et al. Clinical and vital sign changes associated with late-onset sepsis in very low birth weight infants at 3 NICUs. J Neonatal Perinatal Med. 2021;14(4):553-561. doi:10.3233/NPM-200578
- Zimmet AM, Sullivan BA, Moorman JR, Lake DE, Ratcliffe SJ. Trajectories of the heart rate characteristics index, a physiomarker of sepsis in premature infants, predict Neonatal ICU mortality. JRSM Cardiovasc Dis. 2020;9:2048004020945142. doi:10.1177/2048004020945142
- Sullivan B, Nagraj VP, Berry KL, et al. Clinical and vital sign changes associated with late-onset sepsis in very low birth weight infants at 3 NICUs . Journal of Neonatal-Perinatal Medicine. 2020.
- Kumar N, Akangire G, Sullivan B, Fairchild K, Sampath V. Continuous vital sign analysis for predicting and preventing neonatal diseases in the twenty-first century: big data to the forefront. Pediatr Res. 2020;87(2):210-220. doi:10.1038/s41390-019-0527-0
- Fairchild KD, Nagraj VP, Sullivan BA, Moorman JR, Lake DE. Oxygen desaturations in the early neonatal period predict development of bronchopulmonary dysplasia. Pediatr Res. 2019;85(7):987-993. doi:10.1038/s41390-018-0223-5
- Kitzmiller RR, Vaughan A, Skeeles-Worley A, et al. Diffusing an innovation: clinician perceptions of continuous predictive analytics monitoring in intensive care. Appl Clin Inform. 2019;10(2):295-306. doi:10.1055/s-0039-1688478
- Sullivan BA, Wallman-Stokes A, Isler J, et al. Early pulse oximetry data improves prediction of death and adverse outcomes in a two-center cohort of very low birth weight infants. Am J Perinatol. 2018;35(13):1331-1338. doi:10.1055/s-0038-1654712
- Sullivan BA, McClure C, Hicks J, Lake DE, Moorman JR, Fairchild KD. Early heart rate characteristics predict death and morbidities in preterm infants. J Pediatr. 2016;174:57-62. doi:10.1016/j.jpeds.2016.03.042
- Sullivan BA, Fairchild KD. Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock. Semin Fetal Neonatal Med. 2015;20(4):255-261. doi:10.1016/j.siny.2015.03.006
- Sullivan BA, Grice SM, Lake DE, Moorman JR, Fairchild KD. Infection and other clinical correlates of abnormal heart rate characteristics in preterm infants. J Pediatr. 2014;164(4):775-780. doi:10.1016/j.jpeds.2013.11.038
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