A new ecological method for the estimation of Nutritive Sucking Efficiency in newborns: measurement principle and experimental assessment

An automatized system for the assessment of nutritive sucking behavior in infants: a preliminary analysis on term neonates

Nutritive Sucking (NS) is a highly organized process that can reflect infants' maturation during the early post-natal period. The assessment of NS may provide a sensitive means of evaluating early motor skills and their development. Thus, a reliable tool for assessing sucking behavior may benefit diagnostics and treatment of newborns since the first days of life. The aim of this work is to propose an automatized system to measure sucking ability and calculate a set of objective and quantitative indices for its assessment. We focused on the analysis of the Intraoral Pressure (IP) generated by infants while feeding: an ad-hoc designed software application was developed to analyze the signal obtained by a pressure transducer connected with a catheter placed through a standard bottle teat into the oral cavity during feeding. Automatic algorithms for suck and burst identification and for their characterization are described. We carried out a preliminary test of the system, analyzing data from two healthy term newborns, tested twice over time (1-2 days old and 6-10 weeks later). We calculated a set of different sucking parameters (e.g. sucking amplitude, frequency and area), and proposed some indices, that are typically used for the assessment of motor control, in order to assess the smoothness of IP. Results encourage further investigation of the proposed system for monitoring the development of early sucking skills.

Design and characterization of a measurement system for monitoring pressure exerted by bronchial blockers: In vitro trials

Bronchial blockers (BBs) allow occluding the bronchial duct and collapsing the "dependent" lung in a number of thoracic surgery. The occlusion is obtained through a cuff that, inflated with a proper air volume, exerts a pressure, Pe, on the inner wall of the mainstem bronchus. In this work a measurement chain, based on two piezorestistive force sensors, was developed and calibrated to measure Pe exerted by six BBs, as a function of inflated volume on in vitro models (two latex ducts with diameters similar to the ones of the adult mainstem bronchi: 12 mm and 15 mm). Pe showed wide changes considering different BBs, and significantly increases with the decrease of the model's diameter, at the same inflated volume. Lastly, the minimum occlusive volume (MOV) to sail the two models was estimated for each BB. These experiments were performed by applying a pressure difference across the cuff of 25 cmH2O, in order to simulate the worst condition in a clinical scenario. Results show that MOV depends on both the type of BB and the duct diameter. The knowledge of this volume allows estimating the minimum value of Pe exerted by BBs to avoid air leakage.

Technological solutions and main indices for the assessment of newborns' nutritive sucking: a review

Nutritive Sucking (NS) is a highly organized process that is essential for infants' feeding during the first six months of their life. It requires the complex coordination of sucking, swallowing and breathing. The infant's inability to perform a safe and successful oral feeding can be an early detector of immaturity of the Central Nervous System (CNS). Even though the importance of early sucking measures has been confirmed over the years, the need for standardized instrumental assessment tools still exists. Clinicians would benefit from specifically designed devices to assess oral feeding ability in their routine clinical monitoring and decision-making process. This work is a review of the main instrumental solutions developed to assess an infant's NS behavior, with a detailed survey of the main quantities and indices measured and/or estimated to characterize sucking behavior skills and their development. The adopted sensing measuring systems will be described, and their main advantages and weaknesses will be discussed, taking into account their application to clinical practice, or to at-home monitoring as post-discharge assessment tools. Finally, the study will highlight the most suitable sensing solutions and give some prompts for further research.

A transistors-based, bidirectional flowmeter for neonatal ventilation: design and experimental characterization

A bidirectional, low cost flowmeter for neonatal artificial ventilation, suitable for application in mono-patient breathing circuits, is described here. The sensing element consists of two nominally identical bipolar junction transistors employed as hot bodies. The sensor working principle is based on the convective heat transfer between the transistors, heated by Joule phenomenon, and the colder hitting fluid which represents the measurand. The proposed design allows the sensor to discriminate flow direction. Static calibration has been carried out in a range of flowrate values (from -8 L·min(-1) up to +8 L L·min(-1)) covering the ones employed in neonatal ventilation, at different pipe diameters (ie., 10 mm and 30 mm) and collector currents (i.e., 500 mA, 300 mA, and 100 mA) in order to assess the influence of these two parameters on sensor's response. Results show that the configuration with a pipe diameter of 10 mm at the highest collector current guarantees the highest sensitivity (i.e., 763 mV/Lmin1 at low flowrate ± 1 L-min(-1)) and ensures the minimum dead space (2 mL vs 18 mL for 30 mm of diameter). On the other hand, the 30 mm pipe diameter allows extending the range of measurement (up to ±6 L-min 1 vs ±3.5 L· min(-1) at 10 mm), and improving both the discrimination threshold (<;0.1 L·min-(1)) and the symmetry of response. These characteristics together with the low dead space and low cost foster its application to neonatal ventilation.

Design, development and experimental validation of a non-invasive device for recording respiratory events during bottle feeding

In newborns, a poor coordination between sucking, swallowing and breathing may undermine the effectiveness of oral feeding and signal immaturity of Central Nervous System. The aim of this work is to develop and validate a non-invasive device for recording respiratory events of newborns during bottle feeding. The proposed device working principle is based on the convective heat exchanged between two hot bodies and the infants' breathing. The sensing elements are inserted into a duct and the gas exchanged by infants is conveyed into this duct thanks to an ad hoc designed system to be mounted on a commercial feeding bottle. Two sets of experiments have been carried out in order to investigate the discrimination threshold of the device and characterize the sensor response at oscillating flows. The effect of distance and tilt between nostrils and device, and the breathing frequency, have been investigated simulating nostrils and neonatal respiratory pattern. The device has a discrimination threshold lower than 0.5 L/min at both 10° and 20° of tilt. Distance for these two settings does not affect the threshold in the investigated range (10-20 mm). Moreover, the device is able to detect breathing events, and to discriminate the onset of expiratory phase, during a neonatal respiratory task delivered by a lung simulator. The results foster the successful application of this device to the assessment of the temporal breathing pattern of newborns during bottle feeding with a non-invasive approach.