Contactless heart rate measurement in newborn infants using a multimodal 3D camera system

Newborns and preterm infants require accurate and continuous monitoring of their vital parameters. Contact-based methods of monitoring have several disadvantages, thus, contactless systems have increasingly attracted the neonatal communities' attention. Camera-based photoplethysmography is an emerging method of contactless heart rate monitoring. We conducted a pilot study in 42 healthy newborn and near-term preterm infants for assessing the feasibility and accuracy of a multimodal 3D camera system on heart rates (HR) in beats per min (bpm) compared to conventional pulse oximetry. Simultaneously, we compared the accuracy of 2D and 3D vision on HR measurements. The mean difference in HR between pulse oximetry and 2D-technique added up to + 3.0 bpm [CI−3.7 – 9.7; p = 0.359, limits of agreement (LOA) ± 36.6]. In contrast, 3D-technique represented a mean difference in HR of + 8.6 bpm (CI 2.0–14.9; p = 0.010, LOA ± 44.7) compared to pulse oximetry HR. Both, intra- and interindividual variance of patient characteristics could be eliminated as a source for the results and the measuring accuracy achieved. Additionally, we proved the feasibility of this emerging method. Camera-based photoplethysmography seems to be a promising approach for HR measurement of newborns with adequate precision; however, further research is warranted

The CSHQ-DE Questionnaire Uncovers Relevant Sleep Disorders in Children and Adolescents with Long COVID

Acute SARS-CoV-2 infections in children and adolescents are usually mild. However, they can suffer from ongoing symptoms, generally referred to as long COVID. Sleep disorders are one of the most frequent complaints in long COVID although precise data are missing. We assessed the sleep behavior of children and adolescents who presented at our outpatient clinic between January 2021 and May 2022 with the Children’s Sleep Habits Questionnaire (CSHQ-DE). We compared the sleep behavior at three different time points: pre-COVID-19; post-COVID-19 at the initial presentation; and post-COVID-19 at re-presentation. Data from 45 patients were analyzed. Of those, 64% were female and the median age was 10 years (range: 0–18 years). Asymptomatic or mild COVID-19 disease was experienced in 89% of patients; 11% experienced moderate disease. The initial presentation occurred at a median of 20.4 weeks (6 weeks–14 months) after the infection. The CSHQ-DE score increased significantly from pre-COVID-19 (45.82 ± 8.7 points) to post-COVID-19 (49.40 ± 8.3 points; p ≤ 0.01). The score then normalized at re-presentation (46.98 ± 7.8; p = 0.1). The greatest changes were seen in the CSHQ-DE subscale score “daytime sleepiness”. Our data showed that children and adolescents with long COVID often suffer from sleep disturbances. For most children and adolescents, these sleep disorders decreased over time without any further medical intervention aside from a basic sleep consultation

Early Lung Function Testing in Infants with Aortic Arch Anomalies Identifies Patients at Risk for Airway Obstruction

BACKGROUND: Aortic arch anomalies (AAA) are rare cardio-vascular anomalies. Right-sided and double-sided aortic arch anomalies (RAAA, DAAA) are distinguished, both may cause airway obstructions. We studied the degree of airway obstruction in infants with AAA by neonatal lung function testing (LFT). PATIENTS AND METHODS: 17 patients (10 RAAA and 7 DAAA) with prenatal diagnosis of AAA were investigated. The median (range) post conception age at LFT was 40.3 (36.6-44.1) weeks, median body weight 3400 (2320-4665) g. Measurements included tidal breathing flow-volume loops (TBFVL), airway resistance (R(aw)) by bodyplethysmography and the maximal expiratory flow at functional residual capacity (V'(max)FRC) by rapid thoracic-abdominal compression (RTC) technique. V'(max)FRC was also expressed in Z-scores, based on published gender-, age and height-specific reference values. RESULTS: Abnormal lung function tests were seen in both RAAA and DAAA infants. Compared to RAAA infants, infants with DAAA had significantly more expiratory flow limitations in the TBFVL, (86% vs. 30%, p<0.05) and a significantly increased R(aw) (p = 0.015). Despite a significant correlation between R(aw) and the Z-score of V'(max)FRC (r = 0.740, p<0.001), there were no statistically significant differences in V'(max)FRC and it's Z-scores between RAAA and DAAA infants. 4 (24%) infants (2 RAAA, 2 DAAA) were near or below the 10(th) percentile of V'(max)FRC, indicating a high risk for airway obstruction. CONCLUSION: Both, infants with RAAA and DAAA, are at risk for airway obstruction and early LFT helps to identify and to monitor these infants. This may support the decision for therapeutic interventions before clinical symptoms arise

Development of lung function in very low birth weight infants with or without bronchopulmonary dysplasia: Longitudinal assessment during the first 15 months of corrected age

<p>Abstract</p> <p>Background</p> <p>Very low birth weight (VLBW) infants (< 1,500 g) with bronchopulmonary dysplasia (BPD) develop lung damage caused by mechanical ventilation and maturational arrest. We compared functional lung development after discharge from hospital between VLBW infants with and without BPD.</p> <p>Methods</p> <p>Comprehensive lung function assessment was performed at about 50, 70, and 100 weeks of postmenstrual age in 55 sedated VLBW infants (29 with former BPD [O₂supplementation was given at 36 weeks of gestational age] and 26 VLBW infants without BPD [controls]). Mean gestational age (26 vs. 29 weeks), birth weight (815 g vs. 1,125 g), and the proportion of infants requiring mechanical ventilation for ≥7 d (55% vs. 8%), differed significantly between BPD infants and controls.</p> <p>Results</p> <p>Both body weight and length, determined over time, were persistently lower in former BPD infants compared to controls, but no significant between-group differences were noted in respiratory rate, respiratory or airway resistance, functional residual capacity as determined by body plethysmography (FRC_pleth), maximal expiratory flow at the FRC (V'max _FRC), or blood gas (pO₂, pCO₂) levels. Tidal volume, minute ventilation, respiratory compliance, and FRC determined by SF6 multiple breath washout (representing the lung volume in actual communication with the airways) were significantly lower in former BPD infants compared to controls. However, these differences became non-significant after normalization to body weight.</p> <p>Conclusions</p> <p>Although somatic growth and the development of some lung functional parameters lag in former BPD infants, the lung function of such infants appears to develop in line with that of non-BPD infants when a body weight correction is applied. Longitudinal lung function testing of preterm infants after discharge from hospital may help to identify former BPD infants at risk of incomplete recovery of respiratory function; such infants are at risk of later respiratory problems.</p

Monitoring des Lungenvolumens bei beatmeten Neugeborenen unter Verwendung des Tracergases Heptafluorpropan

This thesis contributes to the area of neonatal lung function research in ventilated newborn infans. Our studies have shown for the first time that heptafluoropropane (HFP) allows for safe, accurate, and reliable functional residual capacity (FRC) measurements and reproducible calculations of indices of ventilation homogeneity in ventilated healthy, sick and surfactant-depleted small lungs. HFP is an alternative tracer gas to the commonly used sulfur hexafluoride for the multiple breath washout (MBW) technique and its high volatility allows for repeated FRC measurements within short time periods without any influence on ventilator settings. Although a suitable reference method for FRC measurements in vivo was not available, the sensitivity of HFP MBW is sufficiently high to demonstrate even small treatment effects. By providing evidence that HFP MBW is a useful technique to assess the effect of thoraco-abdominal surgery on the lung, this new method was finally evaluated in the clinical setting. The effect of surgery on FRC and ventilatory inhomogeneity indices was procedure-specific, however, these changes were not reflected in mechanical or ventilatory variables. A prerequisite for clinical use of HFP MBW is that the measuring sensor be miniaturised so that measurements in premature infants are possible and that this technique is integrated into the standard monitoring of neonatal ventilators.Diese Habilitationsschrift liefert ihren Beitrag auf dem Gebiet der Lungenfunktion bei beatmeten Neugeborenen. Wir konnten erstmalig zeigen, dass der Einsatz von Heptafluorpropan (HFP) als Tracer-Gas im Rahmen einer Gasauswasch-Methode sicher ist und mit ausreichender Genauigkeit reproduzierbare Ergebnisse liefert. Wir konnten nachweisen, dass Messungen der funktionellen Residualkapazität (FRC) und reproduzierbare Berechnungen diverser Inhomogenitätsindizes bei beatmeten neonatalen Individuen mit gesunden und kranken, Surfactant-depletierten kleinen Lungen möglich war. HFP kann somit als alternatives Tracer-Gas statt des in Deutschland nicht zugelassenen Sulfurhexafluorid (SF6) im Rahmen einer sogenannten "Multiple breath washout (MBW) Technik" angewandt werden. Aufgrund seiner hohen Flüchtigkeit können auch wiederholt FRC Messungen bei beatmeten Neugeborenen innerhalb kurzer Zeitspannen durchgeführt werden ohne die Beatmungsparameter und Einstellunegn zu beeinflussen. Obwohl eine geeignete in vivo Referenzmethode für FRC-Messungen nicht verfügbar ist, stellte sich die Sensitiviät der HFP-MBW als ausreichend hoch dar, um auch kleinste Behandlungseffekte bei neugeborenen Individuen nachzuweisen. Indem der Nachweis erbracht werden konnte, dass HFP-MBW eine nutzbare Technik darstellt, gelang es die die Methode im klinischen Setting einzusetzen und den Effekt einer thorako-abdominellen OP auf die Lunge nachzuweisen. Der Effekt der OP auf die FRC und die Inhomogenitätsindizes war abhängig vom OP-Verfahren, aber diese Änderungen waren nicht aus den Beatmungsvariablen und -parameter ableitbar. Als Voraussetzung für eine breite Anwendung sollte die HFP-MBW Sensor-Technologie weiter miniaturisiert werden, damit Messungen auch bei Frühgeborenen möglich wären und dieses Monitoring in das Standard-Monitoring neonataler Ventilatoren integriert werden könnte

Three-dimensional multi-slice view: new prospects for evaluation of congenital anomalies in the fetus

OBJECTIVES: The purpose of this study was to describe the use and potential of Multi-Slice View 3-dimensional (3D) ultrasonographic software (Medison Co, Ltd, Seoul, Korea) in showing fetal congenital anomalies. METHODS: Fetuses with congenital anomalies diagnosed by means of 2-dimensional ultrasonography were prospectively included in the study. Good-quality 3D volumes of the region of interest were obtained in each case. Subsequently, these volumes were reviewed with use of 3D eXtended Imaging with Multi-Slice View and SonoMR (Medison Co, Ltd). Image processing was performed through the use of off-line software (Medison XI Viewer, version 1.0.0.218). RESULTS: A total of 6 fetuses (median gestational age, 27 weeks; range, 16-35 weeks) with the following anomalies were examined: dacryocystocele, esophageal atresia, right-sided aortic arch, hydrometrocolpos, horseshoe kidney, and hemivertebra. Images of diagnostic quality were obtained from all patients. According to the respective underlying anomalies and the positions of the fetuses, images were obtained from the initial axial plane in 2 cases (esophageal atresia and right-sided aortic arch) and from reconstructed planes in the remaining 4 cases (dacryocystocele, hydrometrocolpos, horseshoe kidney, and hemivertebra). CONCLUSIONS: Three-dimensional Multi-Slice View can deliver informative images of the region of interest regardless of fetal position. It may be particularly helpful for evaluation of difficult anomalies in the fetus

Persurf, a new method to improve surfactant delivery: a study in surfactant depleted rats.

PURPOSE: Exogenous surfactant is not very effective in adults with ARDS, since surfactant does not reach atelectatic alveoli. Perfluorocarbons (PFC) can recruit atelectatic areas but do not replace impaired endogenous surfactant. A surfactant-PFC-mixture could combine benefits of both therapies. The aim of the proof-of-principal-study was to produce a PFC-in-surfactant emulsion (Persurf) and to test in surfactant depleted Wistar rats whether Persurf achieves I.) a more homogenous pulmonary distribution and II.) a more homogenous recruitment of alveoli when compared with surfactant or PFC alone. METHODS: Three different PFC were mixed with surfactant and phospholipid concentration in the emulsion was measured. After surfactant depletion, animals either received 30 ml/kg of PF5080, 100 mg/kg of stained (green dye) Curosurf™ or 30 ml/kg of Persurf. Lungs were fixated after 1 hour of ventilation and alveolar aeration and surfactant distribution was estimated by a stereological approach. RESULTS: Persurf contained 3 mg/ml phospholipids and was stable for more than 48 hours. Persurf-administration improved oxygenation. Histological evaluation revealed a more homogenous surfactant distribution and alveolar inflation when compared with surfactant treated animals. CONCLUSIONS: In surfactant depleted rats administration of PFC-in-surfactant emulsion leads to a more homogenous distribution and aeration of the lung than surfactant alone

Influence of the Incubator as Direct Patient Environment on Bacterial Colonization of Neonates

Background: Preventing healthcare-associated infections (HAI) in neonatal intensive care units is a challenge of highest priority. For further insight into the incubator as direct patient environment and potential source for contamination, we present data correlating microbiological samples of very low birthweight infants in the form of colonization results of surveillance screenings with samples of their associated incubator in this study. Methods: Samples were taken via rectal and throat swabs of neonates as well as Polywipe&reg; sponges for the incubator. If the same bacterial species was found in corresponding neonate and incubator samples, whole genome sequencing via Illumina technology was performed. Results: 52 microbiological species matches were found, and 30 matches were sequenced where we found 26 clonal pairs (12 E. faecalis, 10 S. aureus, 2 E. coli, 1 E. cloacae, and 1 E. faecium). Conclusion: The combinations of measurements of weekly screenings swabs, probing of surfaces with Polywipes&reg;, and whole genome sequencing showed transmissions of microorganism and risk for potential non-physiological colonization of neonatal infants