S.K.

Yee Medical Foundation

Application Form for Funding of Project
Attention : Project No. _____________

1. Please read the Guidelines for Applicants carefully before completing this application form.
2. All sections of this form must be completed in English in standard size typescript using the space provided.
3. Completed forms should be sent to Unit 1708, Office Tower, Convention Plaza, 1 Harbour Road, Wan Chai, Hong Kong.

Section A Project Proposal (To be completed by the Project Leader)

1. Category
(Please select ONLY ONE category from the following categories of support)

Establishment of medical services for the poor and sick and the provision of equipment
and apparatus for such services
□ Provision of medical education
□ Acquisition and/or construction maintenance and/or alteration of any buildings or works
relevant to the provision of medical services or medical education
□ Assistance in support of charitable organizations providing medical services for the poor
and sick

If equipment is applied for, please state whether this is a new item, replacement item for existing
equipment and if so its approximate life span.
New item □ Replacement item
Previous funding source __________________________________________
Backup availability ______________________________________________

Useful life span: □ 0-5 years 5-10 years □ >10 years

Technology: Proven evidence □ Unproven □ No evidence
Mission critical for clinical service: □ High Medium □ Low
2. Project Title
Non-invasive, continuous haemodynamic monitoring in high-risk neonates

3. Project Participants (Please refer to Section 14a for supporting documents)

Project Leader

Title: (*Prof/Dr/Mr/Ms/Mrs) Surname: __Lam______ Forename: __Hugh Simon Hung San_______

Post: __Professor____________________ Department: _Paediatrics______________________
Organization: ____The Chinese University of Hong Kong_______________________________
Address: _6/F, Department of Paediatrics, Prince of Wales Hospital, Shatin, Hong Kong______
Tel. No.: _3505 2849__ Fax No.: _2636 0020_ E-mail Address: _hshslam@cuhk.edu.hk
Team Members
Name Post Department/Organization Tel. No.

Chan, Hiu Ying Peggy Postdoctoral fellow Dept Paediatrics, CUHK

Chan, Chi Ngong Associate consultant Dept Paediatrics, PWH 55699212
Lawrence
So, Chi Tak Enoch Resident Dept Paediatrics, PWH

4. Amount Of Donation Or Grant Applied For: $ 715300

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Section B Details Of The Project Proposal

(The information should be concise and comprehensible to a non-specialist, and should not exceed the given space.)

1. Ways in which the project is of direct benefit to the poor and sick:

Neonates in the neonatal intensive care unit (NICU) have high risk of developing
haemodynamic instability, reflected by fluctuations in blood pressure and heart rate. With the
relatively poorer capacity to compensate for haemodynamic stresses, organ perfusion may
become significantly reduced with increased in morbidity and mortality (Dilli et al., 2018).

Haemodynamic status can be affected by the following factors: 1) heart rate; 2) stroke volume;
3) vasoactivity; and 4) intravascular volume. Conventional physiological parameters, such as
blood pressure, heart rate, urine output, and blood gas analysis can only provide incomplete,
and/or indirect clues of a patient’s haemodynamic status. As a result, clinicians caring for
haemodynamically compromised newborn infants often have to start treatment under
considerable uncertainty. Even if haemodynamic assessment can be obtained by
echocardiographic assessment by the cardiology team, it is not possible for serial haemodynamic
assessments to determine whether response to treatment is adequate or not.

Electrical cardiometry (EC) is an advanced, non-invasive technology that allows continuous

monitoring of various haemodynamic parameters simultaneously, including heart rate, stroke
volume, cardiac output, heart contractility, and fluid status. The EC monitor is a portable and
easy to setup device that can assess patient’s haemodynamic status in less than 3 minutes. These
advantages allow health care professionals to evaluate high-risk infants’ haemodynamic status
easily and frequently, so that haemodynamic instability can be detected and managed at an early
stage.

Based on the data derived from the EC monitor, clinicians can make timely and accurate
diagnoses, optimize treatment strategies, and monitor the cardiac response to treatment. By
closely monitoring the haemodynamic parameters, short-term and long-term outcomes in
critically ill neonates can be improved (Fanaroff et al., 2006).

2. Aims, objectives and significance

To perform electrical cardiometry (EC) in high-risk neonates and evaluate its feasibility and
utility in a local NICU setting.

High-risk neonates include those who are suspected to have:

 patent ductus arteriosus (PDA),
 sepsis,
 necrotizing enterocolitis (NEC), and
 other conditions that may result to haemodynamic instability, e.g., dehydration, severe
blood loss, congenital cardiac abnormalities

Advantages of using EC:

1) Provide a more complete picture of a patient’s haemodynamic status for diagnosis
2) Allow continuous monitoring, which aids the optimization of fluid and drug administration
3) Non-invasive methodology
4) Not operator dependent (in contrast to echocardiography, which is highly operator-dependent)
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3. Background, implementation plans, feasibility and work schedule:

(For new projects : Please give a summary of related work already done in the specified project area by
project participants and by others in the space below.
For on-going projects : Please give a progress report in the space below.)

New Project □ Extension to On-going Project

Planned starting date Expected completion date Duration (in months)

1 Jul 2021 30 Jun 2024 36 months
Neonates in the NICU have high risk of developing haemodynamic instability, reflected
by fluctuations in blood pressure and heart rate. With the relatively poorer capacity to
compensate for haemodynamic stresses, organ perfusion may become significantly reduced with
increased in morbidity and mortality (Dilli et al., 2018). The complex transition process from
fetal to neonatal circulatory system, the presence of shunts, and the immaturity of the
cardiovascular system and other unique characteristics of neonatal physiology means that
keeping a sick infant haemodynamically stable can be very challenging.
Haemodynamic status can be affected by the following factors: 1) heart rate; 2) stroke
volume; 3) vasoactivity; and 4) intravascular volume. Conventional haemodynamic parameters
such as heart rate, blood pressure provide indirect clues of a patient’s haemodynamic status, but
cannot inform the clinician of systemic vascular resistance and cardiac output, which are
parameters which more closely reflect the patient’s status and which treatment strategy is
required. Tibby et al., (1997) demonstrated that it is difficult for clinicians to estimate the
cardiac index, an important haemodynamic parameter which reflects cardiac output, in
hospitalized infants based on physical examination and clinical and laboratory data only. The
routine methods for assessing the haemodynamic status among adult and paediatric populations
are either too invasive and not feasible in the neonatal population or requires highly specialized
experts. Therefore, there is a need for a non-invasive, timely and direct measurement of patient’s
haemodynamic status that can be managed by the frontline clinician.
Electrical cardiometry (EC) is an advanced, non-invasive technology that allows
monitoring of various haemodynamic parameters simultaneously, including heart rate, stroke
volume, cardiac output, heart contractility, and fluid status etc., which can fill the gaps of
traditional monitoring methods. EC has been validated against invasive thermodilution method
and Fick’s technique, which are regarded as “gold standard” in paediatric and adult populations
(Norozi et al., 2008; Tomaske et al., 2008; Zoremba et al., 2007), and has clinically acceptable
bias and precision in low and very low birth weight infants when compared to the
echocardiography, an non-invasive alternative but technically highly demanding method of
cardiac output measurement (Grollmuss et al., 2012).
The EC monitor (figure 1) is a portable and easy to setup device that can assess patient’s
haemodynamic status in less than 3 minutes. These advantages allow the health care
professionals to evaluate high-risk infants’ haemodynamic status easily and frequently, so that
haemodynamic instability can be detected at an early stage.
To perform EC monitoring, patient information (e.g. weight, height) will be entered into
the device, and then four small neonatal sensors will be placed on the head, left side of the neck,
thorax and thigh of the patient (figure 2). During the measurement, harmless electrical current is
sent through the thorax, and the conductivity is measured. Low conductivity is expected during
diastole while high conductivity is expected during systole. By analyzing the change in
conductivity in a few minutes, the EC monitor can derive useful parameters, including the heart
rate, velocity of blood flow, stroke volume, systolic time ratio, systemic vascular resistance, and
oxygen delivery.
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Before the implementation of EC monitoring, training sessions for health care

professionals will be conducted. Useful information, such as basic knowledge of EC monitoring,
mechanism of the device, how to setup and use the device will be covered in the training
sessions. A short survey will also be distributed in order to collect comments from our
colleagues. Questions may include: (On a scale from 1 to 5) “Do you think the EC monitor is
easy to use?”, “How likely will you use the EC monitor?”, “Do you think the parameters
provided by the EC monitor is reliable?”

Instructions and log sheet of the EC monitor will be prepared and placed in the trolley of
the EC monitor. Date and time, and purpose of each use of the device will be recorded. The data
logging feature of the device allows real-time data streaming to a computer, and the data will be
exported and saved regularly for future review, education, and research use.

At the end of the project, an evaluation form will be distributed to our colleagues to
collect feedback on the EC monitor. Questions may include: (On a scale from 1 to 5) “Do you
think the EC monitor is easy to use?”, “Do you think the parameters provided by the EC monitor
is reliable?”, “Do you think the parameters provided by the EC monitor help you make diagnosis
easier? ” The comments received at the beginning and the end of the project will be analyzed in
order to evaluate the feasibility and utility of the EC monitor.

The introduction of the device will be incorporated into a quality improvement project in
order to determine whether improvements in haemodynamic assessment of high-risk infants
have been achieved (outcome indicator), as well as whether compliance with use of device and
correct interpretation of the results were made (process indicators).

Fig. 1 The EC monitor with sample parameters Fig. 2 Placement sites for neonates
display Image source: ICON® NONINVASIVE
Image source: ICON® NONINVASIVE DEMODYNAMICS Electrical Cardiometry™ brochure
DEMODYNAMICS Electrical Cardiometry™ brochure

Please see appendix for references.

4. Justification of requirements and purpose:

EC monitor is an accurate, non-invasive, and easy to use tool that can provide valuable
information in neonates’ hemodynamic status and fill the blanks of traditional monitoring. Early
identification of hemodynamic instability is the key to successful care management. With the aid
of the EC monitor, frequent measurement and/ or continuous monitoring of patient’s
hemodynamic status can be achieved, and hopefully both the short-term and long-term outcomes
can be improved.
 The project requires a part-time research assistant (0.5FTE) to:
1) liaise with the manufacturer/ distributor for the purchase and transport logistic of the
EC monitor,
2) organize training session for health care professionals,
3) prepare evaluation forms, instructions of EC monitor, log sheet, and training
materials,
4) distribute and collect evaluation form,
5) data entry and analysis
6) basic maintenance of the device, include regular data exporting and backup
7) conduct the quality improvement initiative and assess the outcome and process
indicators
8) prepare progress reports
CUHK Payscale Point 11, with 5% MPF is budgeted. A 5%annual pay increase is assumed for
cost of living and merit adjustments.

5. Potential for implementation of results:

The evaluation results and comments collected from our colleagues will provide valuable
insight of the feasibility and utility in our NICU setting. Based on the result, we can prioritize
patients who benefit most from the EC monitoring, optimize and maximize the utilization of the
EC monitor and thus, further improvements can be made to benefit infants in our NICU.

6. Sustainability of the project after expiry of the S.K. Yee Medical Foundation
support:
Since we have dedicated neonatal team, our colleagues are ready to learn new technology
to improve the service and the outcomes of our patients.
At the end of the project, the feasibility and utility of the EC monitor will be evaluated
by our research team, and the results will be reviewed and discussed thoroughly within our
department. Improvements in implementing EC monitoring will be made if necessary. Once the
quality improvement initiative and training materials have been refined, even without the
research assistant the doctors and nurses on the NICU will be able to continue providing non-
invasive continuous haemodynamic monitoring to high-risk infants on the unit.

7. Location where the project will be conducted (Please give name of centre or unit and full address)
Ward 6HK
Department of Paediatrics
Prince of Wales Hospital, Sha Tin, New Territories

8. Number of beneficiaries:

Patients Paid Carers Family The General Others

Members Public
100 / Patient’s / /
parents

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9. Project cost and resource implications

(Please list all costs for the project in detail in the following tables. Vendors’ quotations and detail breakdown
must be provided. The application may be rejected if these details are not provided.)

a. Apparatus and equipment

1st Calendar Year 2nd Calendar Year 3rd Calendar Year
Items Unit Cost Qty Total Qty Total Qty Total
ICON EC-Portable 197000 1 197000 0 0 0 0
cardiovascular monitor
Extention Display 35000 1 35000 0 0 0 0
Monitoring kit

Neonatal sensors, box 4500 2 9000 2 9000 0 0

of 25 applications

Total $241000 $9000 $

Total cost for all years : $ 250000

b. Salary
Monthly 1st Calendar Year 2nd Calendar Year 3rd Calendar Year
Post Salary No. Total No. Total No. Total
Part time Research 12300 1 147600 1 154980 1 162720
Assistant (0.5 FTE) (for 1st
year)
12915
(for 2nd
year)
13560
(for 3rd
year)

Total $147600 $154980 $162720

Total cost for all years : $ 465300

c. General expenses
1st Calendar Year 2nd Calendar Year 3rd Calendar Year
Items Unit Cost Qty Total Qty Total Qty Total

Total $ $ $
Total cost for all years : $

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d. Capital costs

1st Calendar Year 2nd Calendar Year 3rd Calendar Year

Items Unit Cost Qty Total Qty Total Qty Total

Total $ $ $
Total cost for all years : $

e. Others

1st Calendar Year 2nd Calendar Year 3rd Calendar Year

Items Unit Cost Qty Total Qty Total Qty Total

Total $ $ $
Total cost for all years : $

Donation or grant applied for

1st Calendar 2nd Calendar 3rd Calendar Total Cost

Year Year Year for All Years
a) Apparatus and equipment $241000 $9000 $ 250000
b) Salary $147600 $154980 $162720 $ 465300
c) General expenses
d) Capital costs
e) Others
Less: Other sources of funding
already secured
Source:-

Amount Applied for $388600 $163980 $$162720 $ 715300

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10. Details of other sources of funding previously applied for or with intention to apply
(Please inform the Foundation if the same or similar application has been made to other funding bodies or
you intend to do so, and the results of such application when available.)

a. I confirm that this project or similar project(s) has been submitted to Research Grants
Council / Health and Medical Research Fund of the Research Fund Secretariat * in the
past two years immediately preceding this application. Details of such application and
outcome are as follows and comments from the Research Grants Council or Research
Fund Secretariat are attached. (* Please delete whichever is inapplicable.)

Funding Date of Amount Amount

Body Application Project Title Outcome Applied For Approved
Research
Grants
Council

Health and
Medical
Research
Fund

b. I confirm that this project or similar project(s) has been submitted to the following
funding bodies in the past two years immediately preceding this application. Details of
such application and outcome are as follows :

Funding Date of Amount Amount

Body Application Project Title Outcome Applied For Approved

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11. Facilities and resources already available

(Please describe the same or similar facilities and resources already available or secured from other sources,
including a list of public, subvented and private organizations, if any, in addition to those applied for above.)

Our NICU is staffed by nurses and doctors who are trained in the care of high-risk vulnerable
newborn infants who require neonatal intensive care. Our NICU is the largest in Hong Kong
with 22 beds and serves between 60-80 very low birth weight preterm infants per year. In
addition we are currently a tertiary referral centre, receiving newborn infants who require
emergency surgery from Tuen Mun Hospital and Princess Margaret Hospital. Our NICU is
equipped with ultrasound devices, cardiorespiratory monitors, mechanical ventilators and all the
devices required to support the sickest newborns.

12. Projects currently undertaken by project participants

(Please give details of on-going projects currently undertaken by project participants either individually or jointly with others.)
Name Starting Date Involvement
of Project Source(s) and Expected (Average no. of
Participant Project Title of Funds Completion Date hours per week)
Lam, Hugh Using Advanced RGC 01/06/2020 to 3
Simon Hung San Neuroimaging to Collaborative 31/05/2023
Predict Language Research Fund
and Cognitive
Outcomes in Pre-
Term Infants
Lam, Hugh Assessing the Food and Health 1 September 2020 1
Simon Hung San safety of statin Bureau - Health to 31 August
use among and Medical 2022
adolescents using Research Fund
genetic
variations of 3-
Hydroxy-3-
Methylglutaryl-
CoA Reductase
(HMGCR): a
mendelian
randomization
study
Lam, Hugh Hong Kong Food and Health 01/02/2019 to 2
Simon Hung San Growth Study Bureau - Health 31/01/2022
and Medical
Research Fund

13. Source of information about the invitation for applications

(Please indicate the source(s) from which you learnt about this round of applications.)

 Website of S.K. Yee Medical Foundation

 Newspaper Advertisement (please state which newspaper) _____________________________
 Advertisement in Hong Kong Medical Journal
 Circular issued by my organization
 Colleagues
 Others (please specify : ______________________________________________________)

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14. Supporting documents to be provided

(Apart from the following documents which are absolutely necessary and fundamental to the Foundation in the
consideration of the applications, additional sheets may not be attached to the application form and will be
returned.)

a. Curriculum vitae of project leader and all team members (i.e. relevant education,
employment history in recent 10 years and professional qualifications only. Do not
attach personal information and research and publication lists.)
b. Names of two independent referees (They should not be under the employment of the
registered institution or association concerned. Their opinion on the project may be
sought directly by the Foundation at a later stage if deemed necessary.)

Professional
Names of Contact Address Present Qualification
Referees Appointment
1. Professor Department of Newborn Care Professor MB BS, MD
Kei Lui Level 1, Royal Hospital for UNSW, FRACP
Women
Barker Street
Randwick NSW 2031
E-mail:
kei.lui@health.nsw.gov.au
2. Professor KK Women's and Children's Senior Consultant MBBS, MD
Victor Samuel Hospital (Paed), MRCP
Rajadurai E-mail: (UK) (Paed),
victor.samuel@singhealth.com.sg DCH, FAMS

c. Vendors’ quotations and detail breakdown for all items under Section B9.
d. Annual Report or other publication on the background and history of the registered
institution or association concerned (Not required for local tertiary institution, hospitals and centre
under the purview of Hospital Authority)
e. Copy of evidence of registration
f. Ethical approval of the overseeing organization, if relevant

15. Declaration (To be read and signed by Project Leader)

I have read and accept the provisions of the Guidelines for Applicants. I agree that the
Trustees may in its absolute discretion refuse this application whether wholly or in part and
without giving any reason. Nor should the giving of any reason in rejecting an application
detract from their absolute discretion. It is further agreed and accepted that the Trustees are
under no legal or enforceable obligation to consider this application.

Signature of Project Leader: _____________________________

Name of Project Leader: Lam, Hugh Simon Hung San

Date: 15 December 2020

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Section C Endorsement Of Organization / Overseeing Organization

(To be completed by the Head or authorized representative of the organization / overseeing
organization. A priority list and a summary of reasons on priority assignment should be
provided if more than one project proposal is submitted by the same organization, or by the
member institution or association under the same overseeing organization.)

1. I confirm that this application has been evaluated and

a. * Endorsed / Not endorsed for funding from the S.K. Yee Medical Foundation; and

b. Funding recommended : $_______________________

2. Comments on Proposal:

3. Comments on Funding Request:

4. If a grant is approved, the cheque should be made payable to:

_______________________________________________________________________

5. Details of the Chief Accounting Officer to be responsible for accounting and auditing
matters related to this project:

Name: _________________________________ Post: _________________________

Organization: ____________________________________ Tel. No.: ______________
Address: ______________________________________________________________

Signature: ________________________________________ Date: ______________________

(Head or authorized representative of
Organization / Overseeing Organization)

Name: ____________________________________ Post: _____________________________

Department: __________________________________________________________________
Organization: _________________________________________________________________
Address: _____________________________________________________________________

* Please delete as appropriate (December 2020)

 Appendix
References
Dilli, D., Soylu, H., & Tekin, N. (2018). Neonatal hemodynamics and management of
hypotension in newborns. Turkish Archives of Pediatrics/Türk Pediatri Arşivi, 53(Suppl
1), S65–S75. https://doi.org/10.5152/TurkPediatriArs.2018.01801
Fanaroff, J. M., Wilson-Costello, D. E., Newman, N. S., Montpetite, M. M., & Fanaroff, A. A.
(2006). Treated hypotension is associated with neonatal morbidity and hearing loss in
extremely low birth weight infants. Pediatrics, 117(4), 1131–1135.
https://doi.org/10.1542/peds.2005-1230
Grollmuss, O., Demontoux, S., Capderou, A., Serraf, A., & Belli, E. (2012). Electrical
velocimetry as a tool for measuring cardiac output in small infants after heart surgery.
Intensive Care Medicine, 38(6), 1032–1039. https://doi.org/10.1007/s00134-012-2530-3
Norozi, K., Beck, C., Osthaus, W. A., Wille, I., Wessel, A., & Bertram, H. (2008). Electrical
velocimetry for measuring cardiac output in children with congenital heart disease.
British Journal of Anaesthesia, 100(1), 88–94. https://doi.org/10.1093/bja/aem320
Tibby, S. M., Hatherill, M., Marsh, M. J., & Murdoch, I. A. (1997). Clinicians’ abilities to
estimate cardiac index in ventilated children and infants. Archives of Disease in
Childhood, 77(6), 516–518. https://doi.org/10.1136/adc.77.6.516
Tomaske, M., Knirsch, W., Kretschmar, O., Woitzek, K., Balmer, C., Schmitz, A., Bauersfeld,
U., & Weiss, M. (2008). Cardiac output measurement in children: Comparison of
Aesculon cardiac output monitor and thermodilution. British Journal of Anaesthesia,
100(4), 517–520. https://doi.org/10.1093/bja/aen024
Zoremba, N., Bickenbach, J., Krauss, B., Rossaint, R., Kuhlen, R., & Schälte, G. (2007).
Comparison of electrical velocimetry and thermodilution techniques for the measurement
of cardiac output. Acta Anaesthesiologica Scandinavica, 51(10), 1314–1319.
https://doi.org/10.1111/j.1399-6576.2007.01445.x