Neonatal Diagnostics: Toward Dynamic Growth Charts of Neuromotor Control

© 2016 Torres, Smith, Mistry, Brincker and Whyatt. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).The current rise of neurodevelopmental disorders poses a critical need to detect risk early in order to rapidly intervene. One of the tools pediatricians use to track development is the standard growth chart. The growth charts are somewhat limited in predicting possible neurodevelopmental issues. They rely on linear models and assumptions of normality for physical growth data – obscuring key statistical information about possible neurodevelopmental risk in growth data that actually has accelerated, non-linear rates-of-change and variability encompassing skewed distributions. Here, we use new analytics to profile growth data from 36 newborn babies that were tracked longitudinally for 5 months. By switching to incremental (velocity-based) growth charts and combining these dynamic changes with underlying fluctuations in motor performance – as the transition from spontaneous random noise to a systematic signal – we demonstrate a method to detect very early stunting in the development of voluntary neuromotor control and to flag risk of neurodevelopmental derail.Peer reviewedFinal Published versio

Neonatal non-contact respiratory monitoring based on real-time infrared thermography

<p>Abstract</p> <p>Background</p> <p>Monitoring of vital parameters is an important topic in neonatal daily care. Progress in computational intelligence and medical sensors has facilitated the development of smart bedside monitors that can integrate multiple parameters into a single monitoring system. This paper describes non-contact monitoring of neonatal vital signals based on infrared thermography as a new biomedical engineering application. One signal of clinical interest is the spontaneous respiration rate of the neonate. It will be shown that the respiration rate of neonates can be monitored based on analysis of the anterior naris (nostrils) temperature profile associated with the inspiration and expiration phases successively.</p> <p>Objective</p> <p>The aim of this study is to develop and investigate a new non-contact respiration monitoring modality for neonatal intensive care unit (NICU) using infrared thermography imaging. This development includes subsequent image processing (region of interest (ROI) detection) and optimization. Moreover, it includes further optimization of this non-contact respiration monitoring to be considered as physiological measurement inside NICU wards.</p> <p>Results</p> <p>Continuous wavelet transformation based on Debauches wavelet function was applied to detect the breathing signal within an image stream. Respiration was successfully monitored based on a 0.3°C to 0.5°C temperature difference between the inspiration and expiration phases.</p> <p>Conclusions</p> <p>Although this method has been applied to adults before, this is the first time it was used in a newborn infant population inside the neonatal intensive care unit (NICU). The promising results suggest to include this technology into advanced NICU monitors.</p

Continuous sensing and quantification of body motion in infants:A systematic review

Abnormal body motion in infants may be associated with neurodevelopmental delay or critical illness. In contrast to continuous patient monitoring of the basic vitals, the body motion of infants is only determined by discrete periodic clinical observations of caregivers, leaving the infants unattended for observation for a longer time. One step to fill this gap is to introduce and compare different sensing technologies that are suitable for continuous infant body motion quantification. Therefore, we conducted this systematic review for infant body motion quantification based on the PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). In this systematic review, we introduce and compare several sensing technologies with motion quantification in different clinical applications. We discuss the pros and cons of each sensing technology for motion quantification. Additionally, we highlight the clinical value and prospects of infant motion monitoring. Finally, we provide suggestions with specific needs in clinical practice, which can be referred by clinical users for their implementation. Our findings suggest that motion quantification can improve the performance of vital sign monitoring, and can provide clinical value to the diagnosis of complications in infants.</p

Medical Devices for Measuring Respiratory Rate in Children: a Review

Respiratory rate is an important vital sign used for diagnosing illnesses in children as well as prioritising patient care. All children presenting acutely to hospital should have a respiratory rate measured as part of their initial and ongoing assessment. However measuring the respiratory rate remains a subjective assessment and in children can be liable to measurement error especially if the child is uncooperative. Devices to measure respiratory rate exist but many provide only an estimate of respiratory rate due to the associated methodological complexities. Some devices are used within the intensive care, post-operative or more specialised investigatory settings none however have made their way into the everyday clinical setting. A non-contact device may be better tolerated in children and not cause undue stress distorting the measurement. Further validation and adaption to the acute clinical setting is needed before such devices can supersede current methods

Vastasyntyneen ja imeväisikäisen vauvan unenaikaisen hengitys- ja syketaajuuden tarkkailu puettavalla liikeanturilla

Vastasyntyneelle ja imeväisikäiselle nukkuminen on elintärkeä toiminto, ja se on välttämätöntä aivoverkkojen kehitykselle. Tiedetään, että huono unenlaatu aiheuttaa pitkällä tähtäimellä muun muassa kasvun hidastumista ja käyttäytymisongelmia. Imeväisikäisillä melko yleisesti esiintyvät unihäiriöt, kuten yöheräily ja nukahtamisvaikeudet aiheuttavat merkittävää rasitusta ja huolta vanhemmille. Objektiivisen mittausmenetelmän puutteen vuoksi ei ole kuitenkaan voitu selvittää imeväisikäisen unen kehittymistä kotiolosuhteissa. Tässä tutkimuksessa tarkasteltiin puettaviin pöksyihin kiinnitetyn liikeanturin ja EKG-kangaselektrodien soveltuvuutta vastasyntyneiden ja imeväisikäisten vauvojen unenaikaisen hengityksen ja sykkeen tarkkailuun. Tutkimuksen ensimmäisessä vaiheessa päiväaikaisten uni-EEG-tutkimuksien yhteydessä verrattiin liikeanturin mittauskanavien rekisteröimiä mittauskäyriä pietsoanturilla varustettuun hengitysvyöhön. Saatujen tutkimustuloksien perusteella liikeanturin gyroskooppi osoittautui tarkimmaksi hengitystaajuutta mittaavaksi parametriksi, kun taas anturin välittämä EKG-signaali oli tulkintakelpoisin osin luotettavaa. Tutkimuksen toisessa vaiheessa vauvaperheille annettiin unipöksyt ja älypuhelimet kotiin arvioidaksemme yön yli kestävää kotikäyttöä. Tutkimustulokset viittaavat siihen, että eri unitilojen tunnistaminen hengityksen vaihtelusta olisi todennäköisesti mahdollista gyroskooppisignaalista. Vanhemmilta saadun palautteen perusteella unipöksyjä pidettiin käytännöllisinä ja helppokäyttöisinä. Tulevissa tutkimuksissa tulisi keskittyä liikeanturin validointiin kliinisesti hyväksyttyjen mittausparametrien avulla, jotta algoritmeja voisi opettaa tunnistamaan eri uni-valve rytmejä automaattisesti. Näin puettava liikeanturi voisi tarjota tietoa vauvan luonnollisen unirakenteen kehittymisestä pitkällä aikavälillä. Lisäksi anturin kliininen validointi voisi mahdollistaa imeväisikäisten kardiorespiratoristen ongelmien ja liikehäiriöiden diagnostisen lisätyökalun kehittämisen.Sleep is one of the most vital functions of newborns and infants, and it is essential for neuronal network development. Therefore, long-term sleep disturbances have been associated with growth delays and behavioral disorders. Commonly reported infant sleep disturbances, such as night awakenings and difficulties falling asleep, cause distress to parents. Yet, the development of infant sleep in the home environment has not been fully elucidated due to lack of objective measurement parameters. In the current study, we assessed the feasibility of a motion sensor, attached to wearable pants, and ECG textile electrodes to monitor sleep-related respiration and heart rate of newborns and infants. First, we compared signals recorded by the motion sensor’s measurement channels to the standard respiratory piezo effort belt’s signal during daytime EEG recordings. According to our results, the motion sensor’s gyroscope proved to measure respiratory rate most accurately, while the ECG signal transmitted by the sensor was reliable in interpretable sections. We then provided wearable garments and smartphones to families with infants to assess overnight home-use. Our results indicate that different sleep states could likely be identified based on respiration fluctuation visible in the gyroscope’s signals. Moreover, the wearable system was considered practical and easy to use by the parents. Future studies should focus on validating the sensor with clinically approved measures, in order to train the algorithms to automatically identify different sleep-wake states. By doing so, the wearable sensor could provide information on natural infant sleep structure development over long time periods. Additionally, clinical validation of the sensor may result in the development of a companion diagnostic tool for infant cardiorespiratory and movement disorders

Exploring acceptability and feasibility of a wearable device to facilitate home phototherapy treatment for newborn jaundice in rural Scotland: an interpretive description study.

Jaundice is a common condition in newborn infants, turning skin colour yellow due to the build-up of bilirubin. Internationally, jaundice continues to result in newborn infants' hospital admission, forcing separation of family units at the pivotal point for breastfeeding initiation and bonding. The aim of this research was to explore - with healthcare professionals and parents - the acceptability and feasibility of a wearable device to facilitate home phototherapy treatment for newborn jaundice in rural Scotland. The research was undertaken through qualitative interviews, using Interpretive Description to accommodate various perspectives influencing acceptability and feasibility of a wearable device to facilitate home phototherapy treatment. Participants were recruited via purposive sampling from one NHS board in Scotland. Semi- structured interviews were used with parental dyads (n=4) and mothers (n=6). Healthcare professionals (n=9) were recruited onto two focus groups conducted in different geographical locations (an urban and regional hospital) in NHS Grampian. The Framework approach was used to thematically analyse the data. Miranda Fricker's concept of epistemic injustice, which proposes inequity due to unequal power dynamics between people or systems, provided a theoretical perspective to interpret key findings. The study found that, although parents expressed a desire for wearable phototherapy devices to facilitate breastfeeding and comfort for the newborn infant, they primarily wanted home-based phototherapy treatment. Study participants described a 'one-size-fits-all' focus for newborn jaundice, centred around quickly reducing serum bilirubin levels. Furthermore, healthcare professionals assumed that parents would agree that the use of overhead phototherapy devices was worthwhile despite the distress to mothers and newborn infants, because it was an effective means of lowering serum bilirubin levels and facilitating timely discharge from care. Parents perceived postnatal care of newborn infants with jaundice to be paternalistic, which was interpreted by parents as being evidence of healthcare professionals' lack of trust in their parental capabilities. Moreover, healthcare professionals did not trust their clinical judgement to assess and manage newborn jaundice, due to the fear that they would be held clinically accountable for serum bilirubin levels not improving. This affected healthcare professionals' ability to trust parental capabilities. As a result, the rural aspect of the study became inconsequential. The study concluded that parents were willing to compromise on size, functions, and usability of phototherapy devices to facilitate home-based phototherapy treatment in the short term. However, epistemic injustice towards parents and midwives impacted shared decision-making within care teams, which in turn obstructed the acceptability and feasibility of both home-based phototherapy in general, and more specifically a wearable device that could facilitate home-based phototherapy