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Duffy SS, Lee S, Gottlieb Sen D. Pediatric Monitoring Technologies and Congenital Heart Disease: A Systematic Review. World J Pediatr Congenit Heart Surg 2024:21501351241247500. [PMID: 38807505 DOI: 10.1177/21501351241247500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Outpatient monitoring of infants with congenital heart disease has been shown to significantly reduce rates of mortality in the single ventricle population. Despite the accelerating development of miniaturized biosensors and electronics, and a growing market demand for at-home monitoring devices, the application of these technologies to infants and children is significantly delayed compared with the development of devices for adults. This article aims to review the current landscape of available monitoring technologies and devices for pediatric patients to describe the gap between technologies and clinical needs with the goal of progressing development of clinically and scientifically validated pediatric monitoring devices.
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Affiliation(s)
- Summer S Duffy
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sharon Lee
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
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Morimoto A, Nakamura S, Koyano K, Nishisho S, Nakao Y, Arioka M, Inoue K, Inoue E, Nishioka K, Morita H, Konishi Y, Hirao K, Kusaka T. Continuous monitoring using thermography can capture the heat oscillations maintaining body temperature in neonates. Sci Rep 2024; 14:10449. [PMID: 38714775 PMCID: PMC11076520 DOI: 10.1038/s41598-024-60718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/26/2024] [Indexed: 05/10/2024] Open
Abstract
The body temperature of infants at equilibrium with their surroundings is balanced between heat production from metabolism and the transfer of heat to the environment. Total heat production is related to body size, which is closely related to metabolic rate and oxygen consumption. Body temperature control is a crucial aspect of neonatal medicine but we have often struggled with temperature measures. Contactless infrared thermography (IRT) is useful for vulnerable neonates and may be able to assess their spontaneous thermal metabolism. The present study focused on heat oscillations and their cause. IRT was used to measure the skin temperature every 15 s of neonates in an incubator. We analyzed the thermal data of 27 neonates (32 measurements), calculated the average temperature within specified regions, and extracted two frequency components-Components A and B-using the Savitzky-Golay method. Furthermore, we derived an equation describing the cycle-named cycle T-for maintaining body temperature according to body weight. A positive correlation was observed between cycle T and Component B (median [IQR]: 368 [300-506] s). This study sheds light on the physiological thermoregulatory function of newborns and will lead to improved temperature management methods for newborns, particularly premature, low-birth-weight infants.
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Affiliation(s)
- Aya Morimoto
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Shinji Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Kosuke Koyano
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Sae Nishisho
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Yasuhiro Nakao
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Makoto Arioka
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Kota Inoue
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Eri Inoue
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Katsufumi Nishioka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Hirosuke Morita
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | - Yukihiko Konishi
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan
| | | | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kitagun, Japan.
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Zhao Y, Bergmann JHM. Non-Contact Infrared Thermometers and Thermal Scanners for Human Body Temperature Monitoring: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:7439. [PMID: 37687902 PMCID: PMC10490756 DOI: 10.3390/s23177439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
In recent years, non-contact infrared thermometers (NCITs) and infrared thermography (IRT) have gained prominence as convenient, non-invasive tools for human body temperature measurement. Despite their widespread adoption in a range of settings, there remain questions about their accuracy under varying conditions. This systematic review sought to critically evaluate the performance of NCITs and IRT in body temperature monitoring, synthesizing evidence from a total of 72 unique settings from 32 studies. The studies incorporated in our review ranged from climate-controlled room investigations to clinical applications. Our primary findings showed that NCITs and IRT can provide accurate and reliable body temperature measurements in specific settings and conditions. We revealed that while both NCITs and IRT displayed a consistent positive correlation with conventional, contact-based temperature measurement tools, NCITs demonstrated slightly superior accuracy over IRT. A total of 29 of 50 settings from NCIT studies and 4 of 22 settings from IRT studies achieved accuracy levels within a range of ±0.3 °C. Furthermore, we found that several factors influenced the performance of these devices. These included the measurement location, the type of sensor, the reference and tool, individual physiological attributes, and the surrounding environmental conditions. Our research underscores the critical need for further studies in this area to refine our understanding of these influential factors and to develop standardized guidelines for the use of NCITs and IRT.
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Affiliation(s)
| | - Jeroen H. M. Bergmann
- Department of Engineering Science, University of Oxford, Parks Road, Oxford OX1 3PJ, UK;
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Çetin K, Ekici B. The Effect of Incubator Cover on Newborn Vital Signs: The Design of Repeated Measurements in Two Separate Groups with No Control Group. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1224. [PMID: 37508721 PMCID: PMC10378478 DOI: 10.3390/children10071224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
(1) Background: During their stays in neonatal intensive care units (NICU), newborns are exposed to many stimuli that disrupt their physiological indicators. The aim of this study was to investigate the impact of the light-dark cycle created with and without an incubator cover on the vital signs of term and preterm newborns. (2) Methods: A repeated measures design was used in the study utilizing two separate groups, without a control group. The study included 91 neonates hospitalized in a NICU (44 term and 47 preterm). With and without an incubator cover, the newborns' vital signs (heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and body temperature (BT)) were measured. Three separate measurements were taken. (3) Results: The mean age of the newborns was 37.0 weeks. There was no significant difference between the HR and RR medians of the term and preterms in the incubator undraped and clad measurements (p > 0.05). At the first measurement, the SpO2 medians of the incubator-covered term and preterms were significantly higher than those of the incubator-covered term and preterms (p = 0.001). (4) Conclusions: The vital signs of the neonates demonstrated variable responses in the measurements when their incubators were covered vs. when they were not covered. However, more research on the effect of the light-dark cycle on their vital signs is required.
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Affiliation(s)
- Kenan Çetin
- Neonatal Intensive Care Unit, Siverek State Hospital, Şanlıurfa 63600, Türkiye
| | - Behice Ekici
- School of Nursing, Maltepe University, Istanbul 34857, Türkiye
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Everhart KC, Donevant SB, Iskersky VN, Wirth MD, Dail RB. Case Comparison of Preterm Infant Stability During Packed Red Blood Cell Transfusions. Nurs Res 2023; 72:301-309. [PMID: 37350698 DOI: 10.1097/nnr.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Very preterm infants (less than 32 weeks gestational age) experience acute morbidity during their stay in a neonatal intensive care unit. Because of their prematurity and frequent laboratory testing, they experience anemia, requiring correction with packed red blood cell (PRBC) transfusion(s). PRBC transfusions have been linked to neonatal morbidity, such as necrotizing enterocolitis, but never signs and symptoms of physiological stability. OBJECTIVE The secondary data analysis aimed to examine very preterm infants' physiological stability before, during, and after PRBC transfusions. METHODS A within-case, mixed-methods design was used in a secondary data analysis for 16 transfusion cases from 13 very preterm infants. RESULTS The findings showed very preterm infants with physiological variables falling within defined limits based on gestational age during the transfusion. Two contrasting case exemplars will be presented. DISCUSSION PRBC transfusions are necessary and prevent morbidity in very preterm infants. Observing instability during transfusions and prospectively studying hypothermia, cardiac instability, and thermal gradients is essential to design interventions to decrease morbidity associated with PRBC transfusions.
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Reis HHT, Brito CJ, Sillero-Quintana M, Silva AG, Fernández-Cuevas I, Cerqueira MS, Werneck FZ, Marins JCB. Can Adipose Tissue Influence the Evaluation of Thermographic Images in Adolescents? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4405. [PMID: 36901414 PMCID: PMC10001993 DOI: 10.3390/ijerph20054405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Infrared thermography (IRT) is a technology easy to use for clinical purposes as a pre-diagnostic tool for many health conditions. However, the analysis process of a thermographic image needs to be meticulous to make an appropriate decision. The adipose tissue is considered a potential influence factor in the skin temperature (Tsk) values obtained by IRT. This study aimed to verify the influence of body fat percentage (%BF) on Tsk measured by IRT in male adolescents. A total of 100 adolescents (16.79 ± 0.97 years old and body mass index of 18.41 ± 2.32 kg/m²) was divided into two groups through the results of a dual-energy X-ray absorptiometry analysis: obese (n = 50, %BF 30.21 ± 3.79) and non-obese (n = 50, %BF 11.33 ± 3.08). Thermograms were obtained by a FLIR T420 infrared camera and analyzed by ThermoHuman® software version 2.12, subdividing the body into seven regions of interest (ROI). The results showed that obese adolescents presented lower mean Tsk values than the non-obese for all ROIs (p < 0.05), with emphasis on the global Tsk (0.91 °C) and anterior (1.28 °C) and posterior trunk (1.18 °C), with "very large" effect size values. A negative correlation was observed in all the ROI (p < 0.01), mainly in the anterior (r = -0.71, p < 0.001) and posterior trunk (r = -0.65, p < 0.001). Tables of thermal normality were proposed for different ROIs according to the classification of obesity. In conclusion, the %BF affects the registered Tsk values in male Brazilian adolescents assessed by IRT.
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Affiliation(s)
- Hamilton H. T. Reis
- Departamento de Educação Física, Universidade Federal de Viçosa, Viçosa 36570-900, Brazil
| | - Ciro J. Brito
- Departamento de Educação Física, Universidade Federal de Juiz de Fora, Governador Valadares 35010-180, Brazil
| | - Manuel Sillero-Quintana
- Faculty of Physical Activity and Sports Sciences (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Alisson G. Silva
- Departamento de Educação Física, Universidade Federal de Viçosa, Viçosa 36570-900, Brazil
- Departamento de Educação Física, Escola Preparatória de Cadetes do Ar, Barbacena 36205-058, Brazil
| | - Ismael Fernández-Cuevas
- Faculty of Physical Activity and Sports Sciences (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Matheus S. Cerqueira
- Instituto Federal de Educação, Ciência e Tecnologia do Sudeste de Minas Gerais, Rio Pomba 36180-000, Brazil
| | - Francisco Z. Werneck
- Departamento de Educação Física, Universidade Federal de Ouro Preto, Ouro Preto 35400-000, Brazil
| | - João C. B. Marins
- Departamento de Educação Física, Universidade Federal de Viçosa, Viçosa 36570-900, Brazil
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Reis HHT, Brito CJ, Sillero-Quintana M, Silva AGD, Fernández-Cuevas I, Cerqueira MS, Werneck FZ, Marins JCB. Can the body mass index influence the skin temperature of adolescents assessed by infrared thermography? J Therm Biol 2023; 111:103424. [PMID: 36585088 DOI: 10.1016/j.jtherbio.2022.103424] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
Infrared thermography (IRT) is a technology that has been used as an auxiliary tool in the diagnostic process of several diseases and in sports monitoring to prevent injuries. However, the evaluation of a thermogram can be influenced by several factors that need to be understood and controlled to avoid a misinterpretation of the thermogram and, consequently, an inappropriate clinical action. Among the possible factors that can affect IRT are anthropometric factors, especially those related to body composition. Based on these, our objective was to verify the influence of Body Mass Index (BMI) on skin temperature (Tsk) in male adolescents. One hundred male adolescents (age: 16.83 ± 1.08 years; body mass: 66.51 ± 13.35 kg; height: 1.75 ± 7.04 m and BMI: 21.57 ± 4.06 kg/m2) were evaluated and divided into three groups, based on the World Health Organization (WHO) proposed classification ranges: underweight (n = 33), normal weight (n = 34) and overweight/obesity (n = 34). Thermograms were obtained using the FLIR T420 thermal imager after a period of acclimatization of the subjects in a controlled environment (temperature: 21.3 ± 0.7 °C and humidity: 55.3 ± 2.2%); they were evaluated using the ThermoHuman® software, integrating the original regions of interest (ROI) into seven larger ROIs. The results showed that underweight individuals had higher Tsk values than normal weight and overweight/obese individuals for all evaluated ROIs, and overweight/obese individuals had lower Tsk values than normal weight individuals for most evaluated ROIs, except for arms region. BMI showed a correlation of -0.68 and -0.64 for the anterior and posterior regions of the trunk, respectively. Thermal normality tables were proposed for various ROIs according to BMI classification. Our study demonstrated that BMI can affect the Tsk values assessed by IRT and needs to be considered to interpret the thermograms.
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Affiliation(s)
| | - Ciro José Brito
- Departament of Physical Education, Federal University of Juiz de Fora, Campus Governador Valadares, Brazil
| | - Manuel Sillero-Quintana
- Sports Department Faculty of Physical Activity and Sports Sciences, Technical University of Madrid, Madrid, Spain
| | - Alisson Gomes da Silva
- Department of Physical Education, Federal University of Viçosa, Viçosa, Brazil; Department of Physical Education, Escola Preparatória de Cadetes do Ar, Brazil
| | - Ismael Fernández-Cuevas
- Sports Department Faculty of Physical Activity and Sports Sciences, Technical University of Madrid, Madrid, Spain
| | - Matheus Santos Cerqueira
- Academic Department of Education, Federal Institute for Education, Sciences, and Technology Southeast of Minas Gerais, Rio Pomba, Minas Gerais, Brazil
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Devi RS, Pugazhendi S, Juyal R, Gaur A, Singh SB. Evaluation of existing Home Based Newborn Care (HBNC) services and training for improving performance of Accredited Social Health Activists (ASHA) in rural India: A multiple observation study. Midwifery 2023; 116:103514. [PMID: 36351329 DOI: 10.1016/j.midw.2022.103514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 09/18/2022] [Accepted: 10/16/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND One-fourth of global neonatal deaths occur in India alone. Accredited Social Health Activists (ASHA) was launched with the purpose of improving healthcare services, including neonatal survival primarily in rural areas. The aim of this study is to determine the status of ASHA's knowledge, practices, and attitude regarding Home Based Newborn Care (HBNC) services, as well as to provide necessary trainings for improvement of their performance. METHODS For this study, 102 ASHA working in Doiwala were recruited at random, and Quasi Experimental Design - Multiple Observation Method (single group time series design) was adopted. The data were collected using pretested tools consisting of knowledge questionnaires, attitude scale, and practices and skill-based questionnaires on various domains of HBNC. The data from the ASHA were collected 4 times at a regular interval of 30 days. Each time, the assessment of ASHA was accompanied by re-education and training on HBNC. RESULTS Even though, about 90% of ASHA had been working for more than 5 years, they possessed average knowledge regarding HBNC before the training. Less than 50% of them were aware of mandatory vaccines and infection care services for newborns. About 70% of them were uninformed about the potential risk of hypothermia in neonates and also lacked knowledge regarding its preventive measures. Their knowledge, practices and attitude regarding HBNC was significantly improved after the training (p ˂ 0.05). About 54% of ASHA became aware of the avoidance of pre-lacteal feeding in newborns. Their practices score regarding prevention of hypothermia was increased from 80% to 95%. The number of ASHA who understood the importance of Kangaroo Mother Care (KMC) was also increased from 56% to 87%. About 95% of the ASHA understood the significance of feeding breast milk to newborns. Moreover, the attitude of ASHA towards the traditional way of newborn care such as early bathing, giving pre-lacteal feed, application of turmeric and ghee to the umbilicus of baby etc. was significant improved. CONCLUSION ASHA must be assessed regularly in order to identify their basic needs, knowledge gaps, challenges and difficulties to quality HBNC services. Proper training on HBNC at regular interval significantly improved their knowledge, practices, and attitude toward their responsibilities, which is crucial for improving newborn health status.
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Affiliation(s)
- Rajkumari Sylvia Devi
- Himalayan College of Nursing (HCN), Swami Rama Himalayan University, Dehradun, India.
| | - Sanchita Pugazhendi
- Himalayan College of Nursing (HCN), Swami Rama Himalayan University, Dehradun, India
| | - Ruchi Juyal
- Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University, Dehradun, India
| | - Ashish Gaur
- Department of Community Medicine, Sri Aurobindo Medical College and PG Institute, Indore, India
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Mota-Rojas D, Wang D, Titto CG, Martínez-Burnes J, Villanueva-García D, Lezama K, Domínguez A, Hernández-Avalos I, Mora-Medina P, Verduzco A, Olmos-Hernández A, Casas A, Rodríguez D, José N, Rios J, Pelagalli A. Neonatal infrared thermography images in the hypothermic ruminant model: Anatomical-morphological-physiological aspects and mechanisms for thermoregulation. Front Vet Sci 2022; 9:963205. [PMID: 35990264 PMCID: PMC9386124 DOI: 10.3389/fvets.2022.963205] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
Hypothermia is one factor associated with mortality in newborn ruminants due to the drastic temperature change upon exposure to the extrauterine environment in the first hours after birth. Ruminants are precocial whose mechanisms for generating heat or preventing heat loss involve genetic characteristics, the degree of neurodevelopment at birth and environmental aspects. These elements combine to form a more efficient mechanism than those found in altricial species. Although the degree of neurodevelopment is an important advantage for these species, their greater mobility helps them to search for the udder and consume colostrum after birth. However, anatomical differences such as the distribution of adipose tissue or the presence of type II muscle fibers could lead to the understanding that these species use their energy resources more efficiently for heat production. The introduction of unconventional ruminant species, such as the water buffalo, has led to rethinking other characteristics like the skin thickness or the coat type that could intervene in the thermoregulation capacity of the newborn. Implementing tools to analyze species-specific characteristics that help prevent a critical decline in temperature is deemed a fundamental strategy for avoiding the adverse effects of a compromised thermoregulatory function. Although thermography is a non-invasive method to assess superficial temperature in several non-human animal species, in newborn ruminants there is limited information about its application, making it necessary to discuss the usefulness of this tool. This review aims to analyze the effects of hypothermia in newborn ruminants, their thermoregulation mechanisms that compensate for this condition, and the application of infrared thermography (IRT) to identify cases with hypothermia.
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Affiliation(s)
- Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City, Mexico
- *Correspondence: Daniel Mota-Rojas
| | - Dehua Wang
- School of Life Sciences, Shandong University, Qingdao, China
| | - Cristiane Gonçalves Titto
- Laboratório de Biometeorologia e Etologia, FZEA-USP, Faculdade de Zootecnia e Engenharia de Alimentos, Universidade de São Paulo, Pirassununga, Brazil
| | - Julio Martínez-Burnes
- Animal Health Group, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City, Mexico
| | - Dina Villanueva-García
- Division of Neonatology, National Institute of Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Karina Lezama
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City, Mexico
| | - Adriana Domínguez
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City, Mexico
| | - Ismael Hernández-Avalos
- Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de Mexico (UNAM), Mexico City, Mexico
| | - Patricia Mora-Medina
- Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de Mexico (UNAM), Mexico City, Mexico
| | - Antonio Verduzco
- Division of Biotechnology—Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
| | - Adriana Olmos-Hernández
- Division of Biotechnology—Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City, Mexico
| | - Alejandro Casas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City, Mexico
| | - Daniela Rodríguez
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City, Mexico
| | - Nancy José
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City, Mexico
| | - Jennifer Rios
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City, Mexico
| | - Alessandra Pelagalli
- Department of Advanced Biomedical Sciences, University of Napoli Federico II, Naples, Italy
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Hamada K, Hirakawa E, Asano H, Hayashi H, Mine T, Ichikawa T, Nagata Y. Infrared Thermography with High Accuracy in a Neonatal Incubator. Ann Biomed Eng 2022; 50:529-539. [PMID: 35237903 PMCID: PMC8890465 DOI: 10.1007/s10439-022-02937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
As the accuracy of body temperature measurement is especially critical in premature infants on admission to the neonatal intensive care unit (NICU), noninvasive measurement using infrared thermography (IRT) has not been widely adopted in the NICU due to a lack of evidence regarding its accuracy. We have established a new calibration method for IRT in an incubator, and evaluated its accuracy and reliability at different incubator settings using a variable-temperature blackbody furnace. This method improved the accuracy and reliability of IRT with an increase in percentage of data with mean absolute error (MAE) < 0.3 °C to 93.1% compared to 4.2% using the standard method. Two of three IRTs had MAE < 0.1 °C under all conditions examined. This method provided high accuracy not only for measurements at specific times but also for continuous monitoring. It will also contribute to avoiding the risk of neonates' skin trouble caused by attaching a thermistor. This study will facilitate the development of novel means of administering neonatal body temperature.
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Affiliation(s)
- Keisuke Hamada
- Department of Clinical Engineering, Nagasaki Harbor Medical Center, Nagasaki, Nagasaki, Japan.
- Department of Comprehensive Community Care Systems, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan.
| | - Eiji Hirakawa
- Department of Neonatology, Kagoshima City Hospital, Kagoshima, Kagoshima, Japan
| | - Hidetsugu Asano
- Research & Development Group, Technical Department, Atom Medical Corporation, Saitama, Saitama, Japan
| | - Hayato Hayashi
- Research & Development Group, Technical Department, Atom Medical Corporation, Saitama, Saitama, Japan
| | - Takashi Mine
- Department of Comprehensive Community Care Systems, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
- Department of Clinical Oncology, Nagasaki Harbor Medical Center, Nagasaki, Nagasaki, Japan
| | - Tatsuki Ichikawa
- Department of Comprehensive Community Care Systems, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki, Nagasaki, Japan
| | - Yasuhiro Nagata
- Department of Comprehensive Community Care Systems, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
- Department of Community Medicine, Nagasaki University School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
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Asano H, Hirakawa E, Hayashi H, Hamada K, Asayama Y, Oohashi M, Uchiyama A, Higashino T. A method for improving semantic segmentation using thermographic images in infants. BMC Med Imaging 2022; 22:1. [PMID: 34979965 PMCID: PMC8721998 DOI: 10.1186/s12880-021-00730-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022] Open
Abstract
Background Regulation of temperature is clinically important in the care of neonates because it has a significant impact on prognosis. Although probes that make contact with the skin are widely used to monitor temperature and provide spot central and peripheral temperature information, they do not provide details of the temperature distribution around the body. Although it is possible to obtain detailed temperature distributions using multiple probes, this is not clinically practical. Thermographic techniques have been reported for measurement of temperature distribution in infants. However, as these methods require manual selection of the regions of interest (ROIs), they are not suitable for introduction into clinical settings in hospitals. Here, we describe a method for segmentation of thermal images that enables continuous quantitative contactless monitoring of the temperature distribution over the whole body of neonates. Methods The semantic segmentation method, U-Net, was applied to thermal images of infants. The optimal combination of Weight Normalization, Group Normalization, and Flexible Rectified Linear Unit (FReLU) was evaluated. U-Net Generative Adversarial Network (U-Net GAN) was applied to thermal images, and a Self-Attention (SA) module was finally applied to U-Net GAN (U-Net GAN + SA) to improve precision. The semantic segmentation performance of these methods was evaluated. Results The optimal semantic segmentation performance was obtained with application of FReLU and Group Normalization to U-Net, showing accuracy of 92.9% and Mean Intersection over Union (mIoU) of 64.5%. U-Net GAN improved the performance, yielding accuracy of 93.3% and mIoU of 66.9%, and U-Net GAN + SA showed further improvement with accuracy of 93.5% and mIoU of 70.4%. Conclusions FReLU and Group Normalization are appropriate semantic segmentation methods for application to neonatal thermal images. U-Net GAN and U-Net GAN + SA significantly improved the mIoU of segmentation.
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Affiliation(s)
- Hidetsugu Asano
- Technical Department, Atom Medical Corporation, 2-2-1, Dojo, Sakura-ku, Saitama city, Saitama, 338-0835, Japan.
| | - Eiji Hirakawa
- Department of Neonatology, Nagasaki Harbor Medical Center, 6-39, Shinchi-machi, Nagasaki City, Nagasaki, 850-8555, Japan.,Department of Neonatology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima City, Kagoshima, 890-8760, Japan
| | - Hayato Hayashi
- Technical Department, Atom Medical Corporation, 2-2-1, Dojo, Sakura-ku, Saitama city, Saitama, 338-0835, Japan
| | - Keisuke Hamada
- Department of Clinical Engineering, Nagasaki Harbor Medical Center, 6-39, Shinchi-machi, Nagasaki City, Nagasaki, 850-8555, Japan.,Department of Comprehensive Community Care Education, Nagasaki University Graduate School of Biomedical Sciences, 1-14, Bunkyo-machi, Nagasaki City, Nagasaki, 852-8521, Japan
| | - Yuto Asayama
- Technical Department, Atom Medical Corporation, 2-2-1, Dojo, Sakura-ku, Saitama city, Saitama, 338-0835, Japan
| | - Masaaki Oohashi
- Technical Department, Atom Medical Corporation, 2-2-1, Dojo, Sakura-ku, Saitama city, Saitama, 338-0835, Japan
| | - Akira Uchiyama
- Mobile Computing Laboratory, Graduate School of Information Science and Technology, Osaka University, 1-5, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Teruo Higashino
- Mobile Computing Laboratory, Graduate School of Information Science and Technology, Osaka University, 1-5, Yamadaoka, Suita, Osaka, 565-0871, Japan
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12
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Abstract
The classical dogma states that brown adipose tissue (BAT) plays a major role in the regulation of temperature in neonates. However, although BAT has been studied in infants for more than a century, the knowledge about its physiological features at this stage of life is rather limited. This has been mainly due to the lack of appropriate investigation methods, ethically suitable for neonates. Here, we have applied non-invasive infrared thermography (IRT) to investigate neonatal BAT activity. Our data show that BAT temperature correlates with body temperature and that mild cold stimulus promotes BAT activation in newborns. Notably, a single short-term cold stimulus during the first day of life improves the body temperature adaption to a subsequent cold event. Finally, we identify that bone morphogenic protein 8B (BMP8B) is associated with the BAT thermogenic response in neonates. Overall, our data uncover key features of the setup of BAT thermogenesis in newborns.
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13
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Alisi M, Al-Ajlouni J, Ibsais MK, Obeid Z, Hammad Y, Alelaumi A, Al-Saber M, Abuasbeh O, Abuhajleh F. Thermographic Assessment of Reperfusion Profile Following Using a Tourniquet in Total Knee Arthroplasty: A Prospective Observational Study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:133-139. [PMID: 34007224 PMCID: PMC8122004 DOI: 10.2147/mder.s300726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Infrared thermal imaging is a non-invasive technique capable of detecting changes in temperature that could ultimately signify changes in blood supply. Flir One is a smartphone-based thermal camera, working by a downloadable application, capable of detecting the limb temperature through a non-contact method using infrared thermography technology. Using the Flir One camera, we will assess the lower limb reperfusion profile following the tourniquet release post total knee arthroplasty (TKA). Methods A prospective study included 46 patients who underwent primary TKA. We used the (Flir One Gen 3) thermographic camera to capture images at ankle joint preoperatively, and at 1, 10, and 20 minutes post tourniquet release on operation side. The contralateral ankle stands as control. Results The mean preoperative temperature (in Celsius) of ankle control side and operated side were 33.03 (SD=1.65) and 33.26 (SD=1.42), respectively. The mean ankle temperature on operation side was 19.73 (SD=2.85), 30.49 (SD=2), and 32.43 (SD=1.31) at 1, 10, and 20 minutes post tourniquet release, respectively, while the control side showed a mean temperature of 32.85 (SD=1.42), 32.84 (SD=0.91), and 33.15 (SD=0.95) at the same time intervals. There was a significant statistical difference between both ankle temperatures at 1 and 10 minutes (P=0.00 for each time). At 20 minutes, 37 ankles (80.4%) at operation side reached a temperature level similar but below the level of control side; however, the difference was not significant (P=0.692). Conclusion Infrared thermography using the smartphone-connected camera is a simple, non-invasive, feasible, and reliable technology. It provides an objective measure to assess the perfusion status of the limbs. In TKA, the distal limb will reach full reperfusion status after approximately 20 minutes of tourniquet release.
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Affiliation(s)
- Mohammed Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Jihad Al-Ajlouni
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Zeinab Obeid
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Yazan Hammad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad Alelaumi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Munther Al-Saber
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Odai Abuasbeh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Feras Abuhajleh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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14
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Lubkowska A, Szymański S, Chudecka M. Neonatal thermal response to childbirth: Vaginal delivery vs. caesarean section. PLoS One 2020; 15:e0243453. [PMID: 33296407 PMCID: PMC7725314 DOI: 10.1371/journal.pone.0243453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/22/2020] [Indexed: 11/24/2022] Open
Abstract
Newborns, regardless of the method of termination of pregnancy, are exposed to the first exogenous stress factors during delivery. The purpose of the study was to evaluate the differences in newborns' thermal response to vaginal (VD) vs caesarean section (CS) delivery. The temperature was measured during the first minutes of life within 122 healthy full-term newborns, on the forehead, chest and upper-back by infrared camera (FLIR T1030sc HD). The lowest temperatures were recorded in the forehead of VD newborns (significantly difference with CS; p < 0.001), the warmest was the chest. A significant correlation was found between the duration of the second stage of natural childbirth and surface temperature and pO2 in the newborn blood. The temperatures of selected body surface areas correlate highly positively, regardless of the mode of delivery. In the case of healthy neonates, with normal birth weight and full-term, VD creates more favourable conditions stimulating the mechanisms of adaptation for a newborn than CS.
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Affiliation(s)
- Anna Lubkowska
- Chair and Department of Functional Diagnostics and Physical Medicine, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Sławomir Szymański
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Monika Chudecka
- Institute of Physical Culture Sciences, Faculty of Physical Education and Health, University of Szczecin, Szczecin, Poland
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15
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Burunkaya M, Yucel M. Measurement and Control of an Incubator Temperature by Using Conventional Methods and Fiber Bragg Grating (FBG) Based Temperature Sensors. J Med Syst 2020; 44:178. [PMID: 32856101 DOI: 10.1007/s10916-020-01650-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
Incubator is a medical device that provide a climatic environment for a newborn and a preterm infant. In the incubator environment, especially, the temperature significantly increases the survival rate of infants. In this study, the incubator air temperature, temperature uniformity and infant skin temperature were measured and controlled with conventional methods and FBG based temperature sensors, and their results and related literature results were compared among them. To this end, in addition to classical sensors, six FBG sensors were used during the measurements, and very close results were obtained between them (R2 = 0.9989). In addition, since real time monitoring of the FBG bands were ensured with a user-friendly interface, measurement processes have been made more ergonomic. In this way, the insulation required for the measurements is also provided perfectly. Measurement errors caused by conventional sensors' properties, which are different for each of them, change over/with time, and also change with different values, have been minimized by using this method. Moreover, in case of increasing the number of sensors for multi-point, continuous and real time temperature measurement in conventional methods, some of the problems such as monitoring of these sensors, obstructing or changing the air flow due to the confusions of these sensors and their cables in the incubator cabinet, and following these, control errors caused by these reasons, and difficulties that may be happened during the infant care and resuscitation procedures have been eliminated. Thus, thermoneutrality in closed incubators were also able to validated and assessed fast and more accurately for preterm and neonates.
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Affiliation(s)
- Mustafa Burunkaya
- Faculty of Technology, Department of Electrical and Electronics Engineering, Gazi University, 06500, Ankara, Turkey.
| | - Murat Yucel
- Faculty of Technology, Department of Electrical and Electronics Engineering, Gazi University, 06500, Ankara, Turkey
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Picón-Jaimes YA, Orozco-Chinome JE, Molina-Franky J, Franky-Rojas MP. Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia. MEDUNAB 2020. [DOI: 10.29375/01237047.3714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introducción. En mamíferos, el control de la temperatura corporal es vital. El estado de consciencia y control motor en humanos, ocurren a una temperatura de 37°C y las desviaciones pueden alterar las propiedades celulares, generando disfunciones fisiológicas. En especies como los roedores (su relación área de superficie/volumen facilita la pérdida de calor) mantienen temperaturas basales cercanas a los 30°C. Distinto es con animales como los paquidermos, cuya temperatura es menor comparada con los humanos. El objetivo es identificar los aspectos fisiológicos de la termorregulación. Descripción de temas tratados. Revisión descriptiva de la literatura de artículos publicados en diferentes bases de datos. La termorregulación es la capacidad del cuerpo para establecer y mantener su temperatura, regulando producción y pérdida de calor para optimizar la eficiencia de procesos metabólicos. El protagonismo lo tiene el sistema nervioso central y su control neuro-hormonal en múltiples niveles. El centro regulador térmico está en el hipotálamo anterior. Este recibe información de los receptores de grandes vasos, vísceras abdominales, médula espinal y de la sangre que perfunde el hipotálamo. Cuando aumenta la temperatura central, el termorregulador activa fibras eferentes del sistema nervioso autónomo, provocando pérdida de calor por convección y evaporación. Ante el descenso de temperatura, la respuesta es disminuir la pérdida de calor (vasoconstricción y menor sudoración); además, incrementar la producción de calor, intensificando la actividad muscular. Conclusión. La termorregulación es liderada por el hipotálamo, quien regula aumento y disminución de la temperatura respondiendo a las necesidades del organismo para llegar a la homeostasis y compensación, enfrentando las alteraciones de la temperatura ambiental
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17
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Topalidou A, Ali N, Sekulic S, Downe S. Thermal imaging applications in neonatal care: a scoping review. BMC Pregnancy Childbirth 2019; 19:381. [PMID: 31651266 PMCID: PMC6814124 DOI: 10.1186/s12884-019-2533-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/24/2019] [Indexed: 12/16/2022] Open
Abstract
Background In neonatal care, assessment of the temperature of the neonate is essential to confirm on-going health, and as an early signal of potential pathology. However, some methods of temperature assessment involve disturbing the baby, disrupting essential sleep patterns, and interrupting maternal/infant interaction. Thermal imaging is a completely non-invasive and non-contact method of assessing emitted temperature, but it is not a standard method for neonatal thermal monitoring. To examine the potential utility of using thermal imaging in neonatal care, we conducted a comprehensive systematic scoping review of thermal imaging applications in this context. Methods We searched EMBASE, MEDLINE and MIDIRS. Results From 442 hits, 21 met the inclusion criteria and were included in the review. A significant number (n = 9) were published in the last 8 years. All the studies were observational studies, with 20 out of 21 undertaken in North America or Europe. Most of them had small cohorts (range 4–29 participants). The findings were analysed narratively, to establish the issues identified in the included studies. Five broad themes emerged for future examination. These were: general thermal physiology; heat loss and respiratory monitoring; identification of internal pathologies, including necrotising enterocolitis; other uses of thermal imaging; and technical concerns. The findings suggest that thermal imaging is a reliable and non-invasive method for continuous monitoring of the emitted temperature of the neonates, with potential for contributing to the assurance of wellbeing, and to the diagnosis of pathologies, including internal abnormalities. However, the introduction of thermal imaging into everyday neonatology practice has several methodological challenges, including environmental parameters, especially when infants are placed in incubators or open radiant warmers. Conclusion In conclusion, although the first attempt at using thermal imaging in neonatal care started in the early-1970s, with promising results, and subsequent small cohort studies have recently reinforced this potential, there have not been any large prospective studies in this area that examine both the benefits and the barriers to its use in practice.
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Affiliation(s)
- Anastasia Topalidou
- Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK.
| | - Nazmin Ali
- Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Slobodan Sekulic
- Department of Neurology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Soo Downe
- Research in Childbirth and Health Unit, School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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18
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Lubkowska A, Szymański S, Chudecka M. Surface Body Temperature of Full-Term Healthy Newborns Immediately after Birth-Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081312. [PMID: 31013692 PMCID: PMC6518189 DOI: 10.3390/ijerph16081312] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
Abstract
The aim of the study was to perform an evaluation of chosen body surface temperatures in neonates immediately after birth, and to seek a relationship between those temperatures and the factors related both to the mother and newborn. The study included 74 healthy newborns. Maternal age, body weight, body mass index before pregnancy and on delivery day, birth and pregnancy order, newborn sex, birth weight, body length, pregnancy week on delivery, as well as newborn gasometric test results were collected. The highest temperature values were observed in the chest of the newborn. Significant relationships between the temperature of the evaluated areas were found. The parameters that correlated positively with the temperature of the back region were maternal body weight (both before pregnancy and on delivery day) as well as weight gain during pregnancy. The core and surface temperatures of the body are one of the most important elements of neonatal homeostasis and any changes constitute a risk to the newborn's health. It seemed that according to the surface temperature, the most important area that must be evaluated is the neonate's back, as it is most affected by appropriate weight gain during pregnancy.
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Affiliation(s)
- Anna Lubkowska
- Department of Functional Diagnostics and Physical Medicine, Faculty of Health Sciences Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 71-210 Szczecin, Poland.
| | - Sławomir Szymański
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Monika Chudecka
- Department of Functional Anatomy and Biometry, Faculty of Physical Education and Health Promotion, University of Szczecin, al. Piastów 40b/6, 71-065 Szczecin, Poland.
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Negative Temperature Differential in Preterm Infants Less Than 29 Weeks Gestational Age: Associations With Infection and Maternal Smoking. Nurs Res 2017; 66:442-453. [PMID: 29095375 DOI: 10.1097/nnr.0000000000000250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypothermia is related to increased morbidity and mortality in very preterm infants; continuous temperature monitoring is necessary. Thermoregulation is limited in preterm infants. OBJECTIVES The purpose of the research was to assess and describe negative temperature differential (NTD) and assess the associations of NTD with infant demographic characteristics, medical history, and clinical events. METHODS An exploratory, case study design was used. Abdominal and foot temperature was measured every minute over the first 2 weeks of life in 22 preterm infants at less than 29 weeks gestational age. RESULTS All infants experienced NTD. Daily NTD in all infants across all study days ranged from 0 to 70.7%; 2-week mean NTD over all infants ranged from 7.3% to 38.5%. Four infants treated for late onset of infection had a higher NTD than 18 infants without infection (M = 27.8%, SD = 9.52 vs. M = 16.4%, SD = 5.34, p < .05). Although not statistically significant, higher mean percentage of NTD was noted in infants having early onset infection (24.1% vs. 16.4%), African American race (20.0% vs. 15.3%), and/or being born to a mother who smoked during pregnancy (26.6% vs. 16.7%). DISCUSSION A larger study is needed to examine associations between NTD and race, maternal smoking history, and infection. NTD might be used as a biomarker to guide acute clinical care and identify infants at risk for acute and chronic morbidity.
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