Efficacy of feed forward and feedback signaling for inflations and chest compression pressure during cardiopulmonary resuscitation in a newborn mannequin

Background: The objective of the study was to evaluate a device that supports professionals during neonatal cardiopulmonary resuscitation (CPR). The device features a box that generates an audio-prompted rate guidance (feed forward) for inflations and compressions, and a transparent foil that is placed over the chest with marks for inter nipple line and sternum with LED’s incorporated in the foil indicating the exerted force (feedback). Methods: Ten pairs (nurse/doctor) performed CPR on a newborn resuscitation mannequin. All pairs initially performed two sessions. Thereafter two sessions were performed in similar way, after randomization in 5 pairs that used the device and 5 pairs that performed CPR without the device (controls). A rhythm score was calculated based on the number of CPR cycles that were performed correctly. Results: The rhythm score with the device improved from 85 ± 14 to 99 ± 2% (P <0.05). In the control group no differences were observed. The recorded pressures with the device increased from 3.1 ± 1.6 to 4.9 ± 0.8 arbitrary units (P <0.05). The second performance of the teams showed significant better results for the group with the CPR device compared to the controls. Conclusion: Feed forward and feedback signaling leads to a more constant rhythm and chest compression pressure during CPR

Behavioral state detection of newborns based on facial expression analysis

Prematurely born infants are observed at a Neonatal Intensive Care Unit (NICU) for medical treatment. Whereas vital body functions are continuously monitored, their incubator is covered by a blanket for medical reasons. This prevents visual observation of the newborns during most time of the day, while it is known that the facial expression can give valuable information about the presence of discomfort. This prompted the authors to develop a prototype of an automated video survey system for the detection of discomfort in newborn babies by analysis of their facial expression. Since only a reliable and situation-independent system is useful, we focus at robustness against non-ideal viewpoints and lighting conditions. Our proposed algorithm automatically segments the face from the background and localizes the eye, eyebrow and mouth regions. Based upon measurements in these regions, a hierarchical classifier is employed to discriminate between the behavioral states sleep, awake and cry. We have evaluated the described prototype system on recordings of three healthy newborns, and we show that our algorithm operates with approximately 95% accuracy. Small changes in viewpoint and lighting conditions are allowed, but when there is a major reduction in light, or when the viewpoint is far from frontal, the algorithm fails. © 2009 Springer Berlin Heidelberg

Mimo : a non-pharmacological comforting solution for preterm neonates

Preterm neonates often suffer from pain, distress and discomfort during the first weeks of their lives. While residing in special Neonatal Intensive Care Units (NICUs) that are designed for optimal care, they are subject to numerous interventions ranging from a simple diaper change to surgery. Although pharmacological pain treatment often is available, it cannot always be applied to relieve a neonate from pain or discomfort. Therefore, new non-pharmacological solutions are required to reduce the discomfort experienced by these babies during the first weeks of their lives. This paper describes a novel solution, called Mimo, that provides comfort through mediation of a parent’s physiological features to the distressed neonate. We discuss the design and the implementation and pilot-evaluation of a first prototype. Results show that the concept is promising enough to pursue a full-scale clinical trial

Mimo pillow : an intelligent cushion designed with maternal heart beat vibrations for comforting newborn infants

Premature infants are subject to numerous interventions ranging from a simple diaper change to surgery while residing in Neonatal Intensive Care Units (NICUs). These neonates often suffer from pain, distress and discomfort during the first weeks of their lives. Although pharmacological pain treatment often is available, it cannot always be applied to relieve a neonate from pain or discomfort. This paper describes a non-pharmacological solution, called Mimo, which provides comfort through mediation of a parent's physiological features to the distressed neonate via an intelligent pillow system embedded with sensing and actuating functions. We present the design, the implementation and the evaluation of the prototype. Clinical tests at Máxima Medical Centre in the Netherlands show that among the 9 of 10 infants who showed discomfort following diaper change, a shorter recovery time to baseline Skin Conductance Analgesimeter (SCA) values could be measured when the maternal heartbeat vibration in the Mimo was switched on and in 7 of these 10 a shorter crying time was measure

Tracing exogenous surfactant in vivo in rabbits by the natural variation of 13C

BACKGROUND: Respiratory Distress Syndrome (RDS) is a prematurity-related breathing disorder caused by a quantitative deficiency of pulmonary surfactant. Surfactant replacement therapy is effective for RDS newborns, although treatment failure has been reported. The aim of this study is to trace exogenous surfactant by 13C variation and estimate the amount reaching the lungs at different doses of the drug. METHODS: Forty-four surfactant-depleted rabbits were obtained by serial bronchoalveolar lavages (BALs), that were merged into a pool (BAL pool) for each animal. Rabbits were in nasal continuous positive airway pressure and treated with 0, 25, 50, 100 or 200 mg/kg of poractant alfa by InSurE. After 90 min, rabbits were depleted again and a new pool (BAL end experiment) was collected. Disaturated-phosphatidylcholine (DSPC) was measured by gas chromatography. DSPC-Palmitic acid (PA) 13C/12C was analyzed by isotope ratio mass spectrometry. One-way non-parametric ANOVA and post-hoc Dunn's multiple comparison were used to assess differences among experimental groups. RESULTS: Based on DSPC-PA 13C/12C in BAL pool and BAL end experiment, the estimated amount of exogenous surfactant ranged from 61 to 87% in dose-dependent way (p < 0.0001) in animals treated with 25 up to 200 mg/kg. Surfactant administration stimulated endogenous surfactant secretion. The percentage of drug recovered from lungs did not depend on the administered dose and accounted for 31% [24-40] of dose. CONCLUSIONS: We reported a risk-free method to trace exogenous surfactant in vivo. It could be a valuable tool for assessing, alongside the physiological response, the delivery efficiency of surfactant administration techniques

Antenatal allopurinol for reduction of birth asphyxia induced brain damage (ALLO-Trial); a randomized double blind placebo controlled multicenter study

<p>Abstract</p> <p>Background</p> <p>Hypoxic-ischaemic encephalopathy is associated with development of cerebral palsy and cognitive disability later in life and is therefore one of the fundamental problems in perinatal medicine. The xanthine-oxidase inhibitor allopurinol reduces the formation of free radicals, thereby limiting the amount of hypoxia-reperfusion damage. In case of suspected intra-uterine hypoxia, both animal and human studies suggest that maternal administration of allopurinol immediately prior to delivery reduces hypoxic-ischaemic encephalopathy.</p> <p>Methods/Design</p> <p>The proposed trial is a randomized double blind placebo controlled multicenter study in pregnant women at term in whom the foetus is suspected of intra-uterine hypoxia.</p> <p>Allopurinol 500 mg IV or placebo will be administered antenatally to the pregnant woman when foetal hypoxia is suspected. Foetal distress is being diagnosed by the clinician as an abnormal or non-reassuring foetal heart rate trace, preferably accompanied by either significant ST-wave abnormalities (as detected by the STAN-monitor) or an abnormal foetal blood scalp sampling (pH < 7.20).</p> <p>Primary outcome measures are the amount of S100B (a marker for brain tissue damage) and the severity of oxidative stress (measured by isoprostane, neuroprostane, non protein bound iron and hypoxanthine), both measured in umbilical cord blood. Secondary outcome measures are neonatal mortality, serious composite neonatal morbidity and long-term neurological outcome. Furthermore pharmacokinetics and pharmacodynamics will be investigated.</p> <p>We expect an inclusion of 220 patients (110 per group) to be feasible in an inclusion period of two years. Given a suspected mean value of S100B of 1.05 ug/L (SD 0.37 ug/L) in the placebo group this trial has a power of 90% (alpha 0.05) to detect a mean value of S100B of 0.89 ug/L (SD 0.37 ug/L) in the 'allopurinol-treated' group (z-test_2-sided). Analysis will be by intention to treat and it allows for one interim analysis.</p> <p>Discussion</p> <p>In this trial we aim to answer the question whether antenatal allopurinol administration reduces hypoxic-ischaemic encephalopathy in neonates exposed to foetal hypoxia.</p> <p>Trial registration number</p> <p>Clinical Trials, protocol registration system: NCT00189007</p