Sound spectrographic cry analysis of infants with hydrocephalus

Comparative Spectrographic Analysis of the Newborns' Cry in the Presence of Tight Intrapartum Nuchal Cord vs. Normal using the Neonat App. Preliminary Results

Background and objectives: The objective of this study was to contribute to the evaluation of the newborn (NB) cry as a means of communication and diagnosis. Materials and Methods: The study implied the recording of the spontaneous cry of 101 NBs with no intrapartum events (control sample), and of 72 NBs with nuchal cord (study sample) from the "Bega" University Clinic of Obstetrics-Gynecology and Neonatology of Timisoara, Romania. The sound analysis was based upon: Imagistic highlighting methods, descriptive statistics, and data mining techniques. Results: The differences between the cry of NBs with no intrapartum events and that of NBs affected by nuchal cord are statistically significant regarding the volume unit meter (VUM) (p = 0.0021) and the peak point meter (PPM) (p = 0.041). Conclusions: While clinically there are no differences between the two groups, the cry recorded from the study group (nuchal cord group) shows distinctive characteristics compared to the cry recorded from the control group (eventless intrapartum NBs group).

A classification model for infant cries with hearing impairment and unilateral cleft lip and palate

OBJECTIVE

The aim of the study was to examine the acoustic features of infant cries in order to find differences between infants with normal development, hearing impairment (HI) and unilateral cleft lip and palate (UCLP). The study focused on two issues: (1) are differences in acoustic cry parameters specific of a certain pathological development, and (2) do these differences allow for a reliable classification of infant cries?

PATIENTS AND METHODS

In total, 128 spontaneous cries of infants up to 12 months of age were recorded. The mean values of acoustic cry parameters were statistically analyzed by one-way analysis of variance and Sheffé post hoc tests. A C5.0 decision tree was trained to classify infant cries by their acoustic parameters.

RESULTS

Significant differences in cry duration, fundamental frequency, formants 2 and 4, intensity, jitter, shimmer and harmonics-to-noise ratio were found between the groups. The C5.0 decision tree was able to predict an infant's membership to the healthy, UCLP or HI groups with a probability of 89.2%.

CONCLUSION

We conclude that C5.0 decision trees are suited to reliably classify healthy infants as well as infants with HI and UCLP by acoustic parameters.

Segmentation of expiratory and inspiratory sounds in baby cry audio recordings using hidden Markov models

The paper describes an application of machine learning techniques to identify expiratory and inspiration phases from the audio recording of human baby cries. Crying episodes were recorded from 14 infants, spanning four vocalization contexts in their first 12 months of age; recordings from three individuals were annotated manually to identify expiratory and inspiratory sounds and used as training examples to segment automatically the recordings of the other 11 individuals. The proposed algorithm uses a hidden Markov model architecture, in which state likelihoods are estimated either with Gaussian mixture models or by converting the classification decisions of a support vector machine. The algorithm yields up to 95% classification precision (86% average), and its ability generalizes over different babies, different ages, and vocalization contexts. The technique offers an opportunity to quantify expiration duration, count the crying rate, and other time-related characteristics of baby crying for screening, diagnosis, and research purposes over large populations of infants.

Assessment of infant cry: acoustic cry analysis and parental perception

Infant crying signals distress to potential caretakers who can alleviate the aversive conditions that gave rise to the cry. The cry signal results from coordination among several brain regions that control respiration and vocal cord vibration from which the cry sounds are produced. Previous work has shown a relationship between acoustic characteristics of the cry and diagnoses related to neurological damage, SIDS, prematurity, medical conditions, and substance exposure during pregnancy. Thus, assessment of infant cry provides a window into the neurological and medical status of the infant. Assessment of infant cry is brief and noninvasive and requires recording equipment and a standardized stimulus to elicit a pain cry. The typical protocol involves 30 seconds of crying from a single application of the stimulus. The recorded cry is submitted to an automated computer analysis system that digitizes the cry and either presents a digital spectrogram of the cry or calculates measures of cry characteristics. The most common interpretation of cry measures is based on deviations from typical cry characteristics. Another approach evaluates the pattern across cry characteristics suggesting arousal or under-arousal or difficult temperament. Infants with abnormal cries should be referred for a full neurological evaluation. The second function of crying--to elicit caretaking--involves parent perception of the infant's needs. Typically, parents are sensitive to deviations in cry characteristics, but their perception can be altered by factors in themselves (e.g., depression) or in the context (e.g., culture). The potential for cry assessment is largely untapped. Infant crying and parental response is the first language of the new dyadic relationship. Deviations in the signal and/or misunderstanding the message can compromise infant care, parental effectiveness, and undermine the budding relationship. (c) 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:83-93.

Spectral analysis of prespeech sounds (spontaneous cries) in infants with unilateral cleft lip and palate (UCLP): a pilot study

OBJECTIVE

The objectives of the present study were: (1) to analyze the cry features of infants with cleft lip and palate (UCLP) by means of spectral analysis, (2) to describe changes of the acoustic parameters from birth until 9 months of age, and (3) to compare these data with existing cry data of infants without cleft (control group).

DESIGN

The study was designed on a interdisciplinary, prospective, and longitudinal basis.

SETTING

Interdisciplinary study: (1) Institute of Anthropology at the Humboldt-University, Berlin; (2) Heidelberg University Hospital: Interdisciplinary Cleft Palate and Craniofacial Center.

PATIENTS AND METHOD

The cry parameters of five patients with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were analyzed from birth to 9 months of age. The patients were treated with the same protocol. At the age of 24 months, sensomotor development was assessed using the KIPHARD test. Perceptual judgment of speech, performed after 36 months of life, included nasal resonance, nasal emission of air, articulation disorders, and speech intelligibility.

MAIN OUTCOME MEASURE

The cry parameters of fundamental frequency (F(0)), pitch period perturbation quotient (PPQ), and cry duration (Tsam) were analyzed.

RESULTS

Contrary to the expectation that laryngeal parameters are not affected by vocal tract malformations, differences of cry parameters were found between the patients with UCLP and the non-cleft group. Particularly, the F(0) and its short-time variability (PPQ) were affected.

CONCLUSIONS

The preliminary results of this study showed that F(0) and PPQ of spontaneous cries are influenced in patients with UCLP, and a cry analysis might become a noninvasive tool for early detection of an at-risk status for neuromuscular development and prediction of an at-risk status for later speech and language acquisition in infants with cleft lip and palate. Future research strategies are outlined.

Factors that influence the behavioral pain responses of premature infants

The responses of preterm neonates to acute tissue-damaging stimuli have been described. However, factors which influence these responses have received little attention. In this study, we observed 124 premature infants before, during and after a routine heel lance and determined how two contextual variables (severity of illness and behavioral state) influenced their behavioral responses. Significant changes in facial actions occurred between baseline and the most invasive phase of the heel lance procedure, stick. The fundamental frequency, harmonic structure and peak spectral energy of the infant's cry were also significantly increased during the stick phase. Behavioral state was found to influence the facial action variables and severity of illness modified the acoustic cry variables. Accurate identification of pain in premature infants requires consideration of factors that influence their response.

Computerized cry analysis in infants affected by severe protein energy malnutrition

A new method of computerized cry analysis has been utilized to evaluate the cries of infants affected by severe protein energy malnutrition. We studied 17 Kenian babies affected by severe malnutrition for more than four months (9 cases of marasmus and 8 of kwashiorkor) and a control group of 17 well-nourished babies. The cries of the malnourished children showed lower inter-utterance variability, formants' frequencies and cry score, assigned by the Infant Cry Modulation Assessment Scale. The melodic pattern was more often flat, rising or falling-rising, when compared to the cries of the well-nourished babies. We hypothesize that these differences reflect the state of brain damage associated with protein energy malnutrition. No differences were found between the cries of infants affected by marasmus and those affected by kwashiorkor, between the cries recorded before and after nutritional therapy and between the first cries of malnourished children who subsequently died during hospitalization and those of infants who survived.

Multidimensional pain assessment in premature neonates: a pilot study

OBJECTIVE

To describe the physiologic and behavioral responses of premature neonates to a painful stimulus.

DESIGN

Descriptive.

SETTING

Secondary-level neonatal unit in a large metropolitan university teaching hospital.

PARTICIPANTS

Forty neonates between 32 and 34 weeks' postconceptual age and less than 5 days' postnatal age.

MAIN OUTCOME MEASURES

Physiologic (heart rate, oxygen saturation, and intracranial pressure) and behavioral (facial expression and cry) outcomes observed during a routine heel stick.

RESULTS

Physiologic responses were significant, but were not specific to pain. Behavioral responses were more promising and indicated that premature neonates were capable of responding in a manner similar to full-term neonates.

CONCLUSIONS

Premature neonates are capable of expressing their pain in a manner similar to healthy, full-term neonates. Factors that alter this response were not clearly delineated. Further research is needed to determine more precise patterns of response in this age group.

Developmental changes in pain expression in premature, full-term, two- and four-month-old infants

The purpose of this study was to examine the behavioural responses of infants to pain stimuli across different developmental ages. Eighty infants were included in this cross-sectional design. Four subsamples of 20 infants each included: (1) premature infants between 32 and 34 weeks gestational age undergoing heel-stick procedure; (2) full-term infants receiving intramuscular vitamin K injection; (3) 2-month-old infants receiving subcutaneous injection for immunisation against DPT; and (4) 4-month-old infants receiving subcutaneous injection for immunisation against DPT. Audio and video recordings were made for 15 sec from stimulus. Cry analysis was conducted on the first full expiratory cry by FFT with time and frequency measures. Facial action was coded using the Neonatal Facial Action Coding System (NFCS). Results from multivariate analysis showed that premature infants were different from older infants, that full-term newborns were different from others, but that 2- and 4-month-olds were similar. The specific variables contributing to the significance were higher pitched cries and more horizontal mouth stretch in the premature group and more taut tongue in the full-term newborns. The results imply that the premature infant has the basis for communicating pain via facial actions but that these are not well developed. The full-term newborn is better equipped to interact with his caretakers and express his distress through specific facial actions. The cries of the premature infant, however, have more of the characteristics that are arousing to the listener which serve to alert the caregiver of the state of distress from pain.