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Developing models to predict patient outcomes in children with severe illness

28 December 2020 | Story André Damons | Photo Supplied

A lecturer from the University of the Free State’s (UFS) department of Paediatrics and Child Health is investigating the use of artificial neural networks to develop models for the prediction of patient outcomes in children with severe illness.

Dr Michael Pienaar, senior lecturer and specialist, is conducting this research as part of his doctoral research and the study deals primarily with the development of models that are designed and calibrated for use in South Africa. These artificial neural networks are computer programs designed to mimic some of the learning characteristics of biological neurons.

The potential applications of models

According to Dr Pienaar these models have traditionally been developed in high-income nations using conventional statistical methods.

“The potential applications of such models in the clinical setting include triage, medical research, guidance of resource allocation and quality control. Having initially begun this research investigating the prediction of mortality outcomes in the paediatric intensive care unit (PICU) I have broadened my scope to patients outside of PICU, seeking to identify children early during their illnesses who are at risk of serious illness requiring PICU,” says Dr Pienaar.

The research up until now has been directed towards the identification of characteristics that are both unique to children with serious illness in South Africa, but also accessible to clinicians in settings where expertise and technical resources are limited.

Research still in the early changes

The research is still in its early stages but next year a series of expert review panels will be held to investigate the selection of variables for the model, after which the collection of clinical data will begin. Once the data has been collected and prepared, a number of candidate models will be developed and evaluated. This should be concluded by the end of 2022.

Says Dr Pienaar: “The need to engage with the rapid proliferation of technology, particularly in the realms of machine learning, mobile technology, automation and the Internet of Things is as great in medical research now as it is in any academic discipline.

“It is critical that research, particularly in South Africa, engage with this in order to take advantage of the opportunities offered and avoid the dangers that go paired with them. Together with the technology as such, it has been essential to pursue this project as an interdisciplinary undertaking involving clinicians, biostatisticians and computer engineers.”

Hope for the research

Dr Pienaar says he was very fortunate and grateful to be the recipient of a generous interdisciplinary grant from the UFS which has allowed him to procure software and equipment that is critical to this project.

“The hope for this research is that the best performing of these models can be integrated with a mobile application that assists practitioners in a wide range of settings in the identification, treatment and early referral of children at high risk of severe illness. I would like to expand this research project to include other countries in Africa and South America and to use it as a bridge to collaboration with other clinical researchers in the Global South,” says Dr Pienaar.

As an early career researcher, Dr Pienaar hopes that this research can serve as a platform to build a body of research that uses the rapid technological advances of these times together with a wide range of collaborations with other disciplines in the pursuit of better child health.

He concludes by saying that he has had excellent support thus far from his supervisors, Prof Stephen Brown (Faculty of Health Sciences, UFS), Dr Nicolaas Luwes (Faculty of Computer Science and Engineering, Central University of Technology) and Dr Elizabeth George (Medical Research Council Clinical Trials Unit, University College London). I have also been supported by the Robert Frater Institute in the Faculty of Health Sciences.

News Archive

Research into surrogate milk important to wildlife conservation

2017-05-08

Prof Gary Osthoff from the UFS Department of
Microbial, Biochemical and Food Biotechnology,
will soon work on a milk formula for elephants.
Photo: Supplied

Research is being done at the University of the Free State (UFS) to analyse and synthetically imitate the unique milk of various wildlife species. This research is not only of scientific value, but also serves the conservation of South Africa’s wildlife species. At the forefront of this research is Prof Garry Osthoff from the Department of Microbial, Biochemical and Food Biotechnology.

Orphaned rhino calf pulled through with surrogate milk
“There is still a lot of research to be done. Naturally the research is of scientific importance, but with surrogate milk having the same composition as the mother’s milk of a specific species, orphaned calves or cubs of that species could be pulled through during a difficult time of weaning. Bearing in mind that exotic animals fetch thousands and even millions of rands at auctions, it goes without saying a game farmer will do everything possible to provide only the best nourishment to such an orphaned animal. In such a case, synthetically-manufactured milk would be the right choice,” says Prof Osthoff.

The fruits of his research were recently demonstrated in Germany when a rhino calf was left orphaned in the Leipzig Zoo. Prof Osthoff’s article: “Milk composition of a free-ranging white rhinoceros during late lactation” was used as a directive for applying surrogate milk for horse foals (which is already commercially available), since the composition of horse and rhino milk largely corresponds. The surrogate milk was used with great success and the rhino calf is flourishing. He mentions that such an orphan is often given the wrong nourishment with the best intentions, resulting in the starvation of the animal despite the amount of cow’s milk it devours.

With surrogate milk having the same
composition as the mother’s milk of a
specific species, orphaned calves or
cubs of that species could be pulled
through during the difficult time
of weaning.

Milk formula for baby elephants in the pipeline
With baby elephants left orphaned due to the increase in elephant poaching for their ivory, several attempts have been made to create a milk formula in order to feed these elephants. To date, many elephants have died in captivity from side effects such as diarrhoea as a result of the surrogate formula which they were fed.

Prof Osthoff recently received a consignment of frozen milk which he, together with researchers from Zimbabwe, will use to work on a milk formula for elephants. They are studying the milk in a full lactation period of two years. During lactation, the composition of the milk changes to such an extent that a single surrogate formula will not be sufficient. Four different formulas should probably be designed.

Prof Osthoff says that of the different species he has researched, elephants are the most interesting and deviate most from the known species.

Although his research to develop surrogate milk is adding much value to the wildlife industry, and although he finds this part of his work very exciting, his research focus is on food science and nutrition. “What is currently authentic in milk research is the study of the fat globules with content, the structure and composition of the casein micelle, and the prebiotic sugars. The knowledge which is gained helps to improve the processing, development of new food products, and development of food products for health purposes,” says Prof Osthoff.

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