The Classification of Movement in Infants for the Autonomous Monitoring of Neurological Development

Neurodevelopmental delay following extremely preterm birth or birth asphyxia is common but diagnosis is often delayed as early milder signs are not recognised by parents or clinicians. Early interventions have been shown to improve outcomes. Automation of diagnosis and monitoring of neurological disorders using non-invasive, cost effective methods within a patient’s home could improve accessibility to testing. Furthermore, said testing could be conducted over a longer period, enabling greater confidence in diagnoses, due to increased data availability. This work proposes a new method to assess the movements in children. Twelve parent and infant participants were recruited (children aged between 3 and 12 months). Approximately 25 min 2D video recordings of the infants organically playing with toys were captured. A combination of deep learning and 2D pose estimation algorithms were used to classify the movements in relation to the children’s dexterity and position when interacting with a toy. The results demonstrate the possibility of capturing and classifying children’s complexity of movements when interacting with toys as well as their posture. Such classifications and the movement features could assist practitioners to accurately diagnose impaired or delayed movement development in a timely fashion as well as facilitating treatment monitoring

The Global Competitive Challenge For EMBA Students

This article describes the birth and development of an innovative international business course called the Global Competitive Challenge. The paper highlights the process of developing the course and how the course is being updated to meet the requirements of current participants in an EMBA program

Restricted visiting reduces nosocomial viral respiratory tract infections in high-risk neonates

Restricting visitors on the neonatal intensive care unit to parents only during a worldwide pandemic resulted in a 39% reduction in nosocomial viral respiratory tract infections in neonatal patients. These findings need validating in a prospective trial

Small sample deep learning for newborn gestational age estimation

A baby’s gestational age determines whether or not they are preterm, which helps clinicians decide on suitable post-natal treatment. The most accurate dating methods use Ultrasound Scan (USS) machines, but these machines are expensive, require trained personnel and cannot always be deployed to remote areas. In the absence of USS, the Ballard Score can be used, which is a manual postnatal dating method. However, this method is highly subjective and results can vary widely depending on the experience of the rater. In this paper, we present an automatic system for postnatal gestational age estimation aimed to be deployed on mobile phones, using small sets of images of a newborn’s face, foot and ear. We present a novel two-stage approach that makes the most out of Convolutional Neural Networks trained on small sets of images to predict broad classes of gestational age, and then fuse the outputs of these discrete classes with a baby’s weight to make fine-grained predictions of gestational age. On a purpose- collected dataset of 88 babies, experiments show that our approach attains an expected error of 6 days and is three times more accurate than the manual postnatal method (Ballard). Making use of images improves predictions by 30% compared to using weight only. This indicates that even with a very small set of data, our method is a viable candidate for postnatal gestational age estimation in areas were USS is not available

Temporal trends of in utero and early postnatal transfer of extremely preterm infants between 2011 and 2016: a UK population study

Objective Early postnatal transfer (PNT) of extremely preterm infants is associated with adverse outcomes compared with in utero transfer (IUT). We aimed to explore recent national trends of IUT and early PNT.Design Observational cohort study using the National Neonatal Research Database.Setting Neonatal units in England, Scotland and Wales.Patients Extremely preterm infants 23+0–27+6 weeks’ gestation admitted for neonatal care from 2011 to 2016.Main outcome The incidence of IUT or PNT within 72 hours of life. Secondary outcomes included mortality, hospital transfer level between centres and temporal changes across two equal epochs, 2011–2013 (epoch 1 (Ep1)) and 2014–2016 (epoch 2 (Ep2)).Results 14 719 infants were included (Ep1=7363 and Ep2=7256); 4005 (27%) underwent IUT; and 3042 (20.7%) had PNT. IUTs decreased significantly between epochs from 28.3% (Ep1=2089) to 26.0% (Ep2=1916) (OR 0.90, 95% CI 0.84 to 0.97,

Variation in visiting and isolation policies in neonatal units: a UK nationwide survey

Global pandemics, such as H1N1, are a major risk for neonatal patients. We surveyed UK tertiary and district neonatal units about visiting and infection control policies relating to viral respiratory infections. There was marked variation with visiting policies, tertiary units being more restrictive. Isolation, screening and outbreak management of infected babies was highly variable posing a risk in future pandemics

The Critical Role Of Technologies In Neonatal Care

Neonatal care has made significant advances in the last few decades. As a result, mortality and morbidity in high-risk infants, such as extremely preterm infants or those infants with birth-related brain injury, has reduced significantly. Many of these advances have been facilitated or delivered through development of medical technologies allowing clinical teams to be better supported with the care they deliver or provide new therapies and diagnostics to improve management.The delivery of neonatal intensive care requires the provision of medical technologies that are easy to use, reliable, accurate and ideally developed for the unique needs of the newborn population. Many technologies have been developed and commercialised following adult trials without ever being studied in neonatal patients despite the unique characteristics of this population. Increasingly, funders and industry are recognising this major challenge which has resulted in initiatives to develop new ideas from concept through to clinical care.This review explores some of the key medical technologies used in neonatal care and the evidence to support their adoption to improve outcomes. A number of devices have yet to realise their full potential and will require further development to optimise and find their ideal target population and clinical benefit. Examples of emerging technologies, which may soon become more widely used, are also discussed.As neonatal care relies more on medical technologies, we need to be aware of the impact on care pathways, especially from a human factors approach, the associated costs and subsequent benefits to patients alongside the supporting evidence

Airflow dispersion during common neonatal resuscitation procedures: A simulation study

BackgroundAerosol generating medical procedures (AGMPs) are common during newborn resuscitation. Neonates with respiratory viruses such as severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection may pose a risk to healthcare workers. International guidelines differ on methods to minimize the risk due to limited data.ObjectiveWe examined the expiratory airflow dispersion during common neonatal resuscitation AGMPs using infant simulators.MethodsExpiratory airflow dispersion in term and preterm manikins was simulated (n = 288) using fine particle smoke at tidal volumes of 5 ml/kg. Using ImageJ, we quantified dispersion during common airway procedures including endotracheal tube (ETT) and T‐piece ventilation.ResultsMaximal expiratory dispersion distances for the unsupported airway and disconnected uncuffed ETT scenarios were 30.2 and 22.7 cm (term); 22.1 and 17.2 cm (preterm), respectively. Applying T‐piece positive end expiratory pressure (PEEP) via an ETT (ETTPEEP) generated no expiratory dispersion but increased tube leak during term simulation, while ventilation breaths (ETTVENT) caused significant expiratory dispersion and leak. There was no measurable dispersion during face mask ventilation. For term uncuffed ETT ventilation, the particle filter eliminated expiratory dispersion but increased leak. No expiratory dispersion and negligible leak were observed when combining a cuffed ETT and filter. Angulated T‐piecesgenerated the greatest median dispersion distances of 35.8 cm (ETTPEEP) and 23.3 cm (ETTVENT).ConclusionsAirflow dispersion during neonatal AGMPs is greater than previouslypostulated and potentially could contaminate healthcare providers during resuscitation of infants infected with contagious viruses such as SARS‐CoV‐2. It is possible to mitigate this risk using particle filters and cuffed ETTs. Applicability in the clinical setting requires further evaluation

Risk of severe intraventricular haemorrhage in the first week of life in preterm infants transported before 72 hours of age

Objectives: Evaluate the risk of severe intraventricular hemorrhage, in the first week of life, in preterm infants undergoing early interhospital transport.Design: Retrospective cohort study.Setting: Tertiary neonatal centers of the Trent Perinatal Network in the United Kingdom.Patients: Preterm infants less than 32 weeks gestation, who were either born within and remained at the tertiary neonatal center (inborn), or were transferred (transported) between centers in the first 72 hours of life.Interventions: None.Measurements and Main Results: Multivariable logistic regression models adjusting for key confounders were used to calculate odds ratios for intraventricular hemorrhage with 95% CIs for comparison of inborn and transported infants. Cranial ultrasound findings on day 7 of life. Secondary analyses were performed for antenatal steroid course and gestational age subgroups. A total of 1,047 preterm infants were included in the main analysis. Transported infants (n = 391) had a significantly higher risk of severe (grade III/IV) intraventricular hemorrhage compared with inborns (n = 656) (9.7% vs 5.8%; adjusted odds ratio, 1.69; 95% CI, 1.04–2.76), especially for infants born at less than 28 weeks gestation (adjusted odds ratio, 1.83; 95% CI, 1.03–3.21). Transported infants were less likely to receive a full antenatal steroid course (47.8% vs 64.3%; p < 0.001). A full antenatal steroid course significantly decreased the risk of severe intraventricular hemorrhage irrespective of transport status (odds ratio, 0.33; 95% CI, 0.2–0.55). However, transported infants less than 28 weeks gestation remained significantly more likely to develop a severe intraventricular hemorrhage despite a full antenatal steroid course (adjusted odds ratio, 2.84; 95% CI, 1.08–7.47).Conclusions: Preterm infants transported in the first 72 hours of life have an increased risk of early-life severe intraventricular hemorrhage even when maternal antenatal steroids are given. The additional burden of postnatal transport could be an important component in the pathway to severe intraventricular hemorrhage. As timely in-utero transfer is not always possible, we need to focus research on improving the transport pathway to reduce this additional risk