1
|
Kar S, Jarain VZL, Karmakar S, Devi U, Som TK, Mohanty PK, Sahoo T, Sahoo JP, Jeyaraman S, Acharya S. Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit. BMJ Open Qual 2024; 13:e002697. [PMID: 38816009 PMCID: PMC11138311 DOI: 10.1136/bmjoq-2023-002697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/02/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Sick preterm neonates are most vulnerable to developing skin injuries. Despite sound knowledge and application of evidence-based practices for preventing medical adhesive-related skin injury (MARSI), the incidence of MARSI was 30 events per 1000 adhesive application days in our unit. AIMS AND OBJECTIVES We aimed to reduce the median MARSI rate from the existing 30 per 1000 MARSI days to <5 per 1000 MARSI over 5 months from June 2023 to October 2023. MATERIAL & METHODS With the point-of-care quality improvement (QI) approach, a prospective study was planned to reduce the incidence of MARSI among sick very preterm newborns (<32 weeks gestational age) and eventually improve overall skin condition during hospital stay. Sequential Plan-Do-Study-Act cycles were implemented based on the identified risk factors recognised during recurring team discussions. RESULTS We demonstrated a reduction in the MARSI rate from 30 events per 1000 adhesive applications (during baseline assessment) to zero events per 1000 adhesive applications at the end of the study period. It was temporally related to the assessment of skin risk stratification at admission using a validated tool, regular assessment of neonatal skin condition score based on the skin risk stratification, and reinforcement of MARSI prevention bundle by application of barrier spray. Awareness regarding 'skin injury prevention' bundles was continually generated among healthcare professionals. The MARSI rate remained <5 events per adhesive application in the sustenance phase over 6 months. CONCLUSION Implementing evidence-based skin care practices resulted in a significant reduction in iatrogenic cutaneous injury events in very preterm neonates.
Collapse
Affiliation(s)
- Shrutiprajna Kar
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | | | - Soumi Karmakar
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Usha Devi
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Tapas Kumar Som
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Pankaj Kumar Mohanty
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Tanushree Sahoo
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Jagdish Prasad Sahoo
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Saranya Jeyaraman
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Sangeeta Acharya
- Department of Neonatology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| |
Collapse
|
2
|
Peterson J, Jennings C, Mahaveer A. A clinical evaluation and acceptability study of the innovative SurePulse VS wireless heart rate monitor across the neonatal journey. Front Pediatr 2024; 12:1355777. [PMID: 38827218 PMCID: PMC11140120 DOI: 10.3389/fped.2024.1355777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/19/2024] [Indexed: 06/04/2024] Open
Abstract
Background The SurePulse vital signs (VS) device is an innovative wireless heart rate monitor designed for neonatal patients. This study evaluates the application of SurePulse VS technology in clinical practice. Methods Data were collected about the quantitative metrics of the device itself when deployed on real infants and qualitative feedback from perinatal professionals and parents regarding their experiences using this novel technology. Results This study recruited 101 infants and achieved target completion rates of 101 healthcare professional (HCP) and 51 parent questionnaires over the seven-month study period. The SurePulse device was deployed across a range of gestational ages (34-39 weeks) and birth weights (1.8-3.5 kg). Device deployment was performed across a range of clinical environments, with 51% of deployments at delivery and 47% within the neonatal unit. The data show clinically acceptable timings from device deployment to heart rate signal acquisition [median 20 s (IQR 15-76 s)]. HCP feedback rated SurePulse monitoring as "Always" or "Mostly" reliable in 80% of cases. Parental feedback reported that having the SurePulse device was reassuring, convenient and beneficial to them. These positive comments were reflected across device deployment in the delivery room and within the neonatal unit. Conclusions The study findings show that the SurePulse device has potential to be a significant advancement in the way neonatal patients are monitored in a variety of post-delivery circumstances. This study has demonstrated that the SurePulse device has utility throughout the neonatal journey, enabling accurate heart rate monitoring in a manner that promotes parent-infant contact and bonding.
Collapse
Affiliation(s)
- Jennifer Peterson
- Faculty of Biology, Medicine and Health Sciences, The University of Manchester, Manchester, United Kingdom
- Neonatal Intensive Care Unit, St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Clare Jennings
- Neonatal Intensive Care Unit, St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Ajit Mahaveer
- Neonatal Intensive Care Unit, St Mary’s Maternity Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
3
|
Letzkus L, Pulido JV, Adeyemo A, Baek S, Zanelli S. Machine learning approaches to evaluate infants' general movements in the writhing stage-a pilot study. Sci Rep 2024; 14:4522. [PMID: 38402234 PMCID: PMC10894291 DOI: 10.1038/s41598-024-54297-1] [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: 04/26/2023] [Accepted: 02/11/2024] [Indexed: 02/26/2024] Open
Abstract
The goals of this study are to describe machine learning techniques employing computer-vision movement algorithms to automatically evaluate infants' general movements (GMs) in the writhing stage. This is a retrospective study of infants admitted 07/2019 to 11/2021 to a level IV neonatal intensive care unit (NICU). Infant GMs, classified by certified expert, were analyzed in two-steps (1) determination of anatomic key point location using a NICU-trained pose estimation model [accuracy determined using object key point similarity (OKS)]; (2) development of a preliminary movement model to distinguish normal versus cramped-synchronized (CS) GMs using cosine similarity and autocorrelation of major joints. GMs were analyzed using 85 videos from 74 infants; gestational age at birth 28.9 ± 4.1 weeks and postmenstrual age (PMA) at time of video 35.9 ± 4.6 weeks The NICU-trained pose estimation model was more accurate (0.91 ± 0.008 OKS) than a generic model (0.83 ± 0.032 OKS, p < 0.001). Autocorrelation values in the lower limbs were significantly different between normal (5 videos) and CS GMs (5 videos, p < 0.05). These data indicate that automated pose estimation of anatomical key points is feasible in NICU patients and that a NICU-trained model can distinguish between normal and CS GMs. These preliminary data indicate that machine learning techniques may represent a promising tool for earlier CP risk assessment in the writhing stage and prior to hospital discharge.
Collapse
Affiliation(s)
- Lisa Letzkus
- Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800828, Charlottesville, VA, 22908, USA.
| | - J Vince Pulido
- Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Abiodun Adeyemo
- Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800828, Charlottesville, VA, 22908, USA
| | - Stephen Baek
- School of Data Science, University of Virginia, Charlottesville, VA, USA
| | - Santina Zanelli
- Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800828, Charlottesville, VA, 22908, USA
| |
Collapse
|
4
|
August D, Hall S, Marsh N, Coyer F. A scoping review and narrative synthesis of neonatal skin injury severity scales. Nurs Crit Care 2024. [PMID: 38355874 DOI: 10.1111/nicc.13018] [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: 08/29/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Mechanical force skin injuries are common for critical care patients, especially neonates. Currently, identification and severity assessments of injuries are dependent on clinical experience and/or utilization of severity tools. Compared with adults, neonates sustain skin injuries in different anatomical locations and have decreased layers of healthy tissue (from 0.9 to 1.2 mm) creating questions around direct application of adult injury severity scales reliant on visual assessment. AIMS The aim of this scoping review (ScR) was to investigate severity scales used to report hospital acquired skin injuries for neonates. METHODS This study utilized the 2015 Joanna Briggs Institute methodology for scoping reviews and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews extension. PubMed, CINAHL, COCHRANE Central, Scopus, and the reference lists of included studies were searched for studies published between 2001 and 2023, that included severity scales use within neonatal population. Two authors independently identified studies for full review, data extraction, and quality assessment. RESULTS A systematic database search returned 1163 records. After full test review of 109 studies, 35 studies were included. A majority of studies included were cohort or action research and conducted in the United States of America. Most studies (57%, n = 20) reported skin injuries acquired throughout the body, 14 (40%) of the studies reported the nasal area alone and one study reported no anatomical location. A total of nine severity scales or combination of scales were utilized within studies (n = 31) and four studies did not report a scale. Various versions of scales from the National Pressure Ulcer Advisory Panel (n = 16), European Pressure Ulcer Advisory Panel (n = 8) or Neonatal Skin Condition Score (n = 4) were reported, compared with locally developed classifications/scales (n = 4). Scales were predominantly of ordinal grouping (74%, n = 26) or categorical assessment (14%, n = 5). Only one scale from 2004 was validated for neonates. CONCLUSION Neonatal skin injuries will continue to be reported subjectively until severity scales are consistently applied or other measurements are identified to support assessment. Additionally, without skin injury assessment uniformity, critical examination of effectiveness of skin care treatment practices will have subjective comparison. This review suggests there is a need for consistent skin assessment and severity scales that are valid for the neonatal population and their unique skin considerations.
Collapse
Affiliation(s)
- Deanne August
- Department Neonatology, Royal Brisbane and Women's Hospital (Neonatal Unit), Herston, Queensland, Australia
- Royal Brisbane and Women's Hospital (Nursing and Midwifery Research Centre), Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Stephanie Hall
- Department Neonatology, Royal Brisbane and Women's Hospital (Neonatal Unit), Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital (Nursing and Midwifery Research Centre), Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Royal Brisbane and Women's Hospital (Intensive Care Services), Herston, Queensland, Australia
| |
Collapse
|
5
|
Shi Z, Li X. Predictive validity and reliability of two pressure injury risk assessment scales at a neonatal intensive care unit. Int Wound J 2023; 21:e14430. [PMID: 37798925 PMCID: PMC10828721 DOI: 10.1111/iwj.14430] [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: 08/27/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
To compare the predictive ability and reliability of two pressure injury (PI) assessment tools, the Neonatal/Infant(N/I) Braden Q and Braden QD scale, in neonates. A prospective and cross-sectional study. This study was conducted in the neonatal intensive care unit (NICU) of a tertiary-level university hospital in China between April and June 2023. A total of 410 patients were included in this study. Risk assessment was performed with the N/I Braden Q scale, followed immediately with the Braden QD scale once daily. Risk assessment was terminated when the PI developed or the patient was discharged from the NICU or died. Each patient's final risk assessment was considered in the data analysis. The area under the curve (AUC) of the two scales was 0.879 and 0.857, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and Cronbach's α coefficient of the N/I Braden Q Scale scores were 0.844, 0.833, 0.30, 0.984 and 0.806, respectively. The Braden QD scale scores were 0.938, 0.733, 0.229, 0.993 and 0.727, respectively. Both scales are valid and reliable in predicting the risk of PI in the NICU. The N/I Braden Q Scale was better to distinguish patients at PI risk and not at PI risk than the Braden QD scale. The literature is limited on this topic. This study provides insight into the comparison of different pressure injury risk assessment scales. The findings of this study may guide nurses to choose a suitable tool to assess the risk of pressure injury in neonates.
Collapse
Affiliation(s)
- Zeyao Shi
- Department of Neonatology NursingWest China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University)Ministry of EducationChengduChina
| | - Xiaowen Li
- Department of Neonatology NursingWest China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduChina
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University)Ministry of EducationChengduChina
| |
Collapse
|
6
|
Jani P, Mishra U, Buchmayer J, Maheshwari R, D'Çruz D, Walker K, Gözen D, Lowe K, Wright A, Marceau J, Culcer M, Priyadarshi A, Kirby A, Moore JE, Oei JL, Shah V, Vaidya U, Khashana A, Godambe S, Cheah FC, Zhou WH, Hu XJ, Satardien M. Global variation in skin injures and skincare practices in extremely preterm infants. World J Pediatr 2023; 19:139-157. [PMID: 36372868 PMCID: PMC9660114 DOI: 10.1007/s12519-022-00625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/19/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Globally, are skincare practices and skin injuries in extremely preterm infants comparable? This study describes skin injuries, variation in skincare practices and investigates any association between them. METHODS A web-based survey was conducted between February 2019 and August 2021. Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes. The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions. RESULTS Responses from 848 neonatal intensive care units, representing all geographic regions and income status groups were received. Diaper dermatitis (331/840, 39%) and medical adhesive-related skin injuries (319/838, 38%) were the most common injuries. Following a local skincare guideline reduced skin injuries [medical adhesive-related injuries: adjusted odds ratios (aOR) = 0.63, 95% confidence interval (CI) = 0.45-0.88; perineal injuries: aOR = 0.66, 95% CI = 0.45-0.96; local skin infections: OR = 0.41, 95% CI = 0.26-0.65; chemical burns: OR = 0.46, 95% CI = 0.26-0.83; thermal burns: OR = 0.51, 95% CI = 0.27-0.96]. Performing skin assessments at least every four hours reduced skin injuries (abrasion: aOR = 0.48, 95% CI = 0.33-0.67; pressure: aOR = 0.51, 95% CI = 0.34-0.78; diaper dermatitis: aOR = 0.71, 95% CI = 0.51-0.99; perineal: aOR = 0.52, 95% CI = 0.36-0.75). Regional and resource settings-based variations in skin injuries and skincare practices were observed. CONCLUSIONS Skin injuries were common in extremely preterm infants. Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries. Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations.
Collapse
Affiliation(s)
- Pranav Jani
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia.
| | - Umesh Mishra
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Julia Buchmayer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Rajesh Maheshwari
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Daphne D'Çruz
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Karen Walker
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Council of International Neonatal Nurses, Boston, MA, USA
- The George Institute for Global Health, Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, Sydney, NSW, Australia
| | - Duygu Gözen
- Pediatric Nursing Department, Florence Nightingale Faculty of Nursing, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Krista Lowe
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Audrey Wright
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - James Marceau
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Mihaela Culcer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Archana Priyadarshi
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Adrienne Kirby
- The National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - James E Moore
- Connecticut Children's Division of Neonatal-Perinatal Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
- UCONN School of Medicine, Farmington, CT, USA
| | - Ju Lee Oei
- The Royal Hospital for Women, Randwick, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - Vibhuti Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Mount Sinai Hospital, Toronto, Canada
| | - Umesh Vaidya
- Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | | | - Sunit Godambe
- Divisional Director for Clinical Governance, Women's, Children's and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
| | - Fook Choe Cheah
- Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan, Bangi, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Wen-Hao Zhou
- Department of Neonatology and Vice President, Children's Hospital of Fudan University, Shanghai, China
| | - Xiao-Jing Hu
- Vice Director of Nursing Department, Children's Hospital of Fudan University, Shanghai, China
| | - Muneerah Satardien
- Department of Paediatrics and Child Health, Tygerberg Hospital, Cape Town, South Africa
- University of Stellenbosch, Cape Town, South Africa
| |
Collapse
|
7
|
Stuart T, Hanna J, Gutruf P. Wearable devices for continuous monitoring of biosignals: Challenges and opportunities. APL Bioeng 2022; 6:021502. [PMID: 35464617 PMCID: PMC9010050 DOI: 10.1063/5.0086935] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022] Open
Abstract
The ability for wearable devices to collect high-fidelity biosignals continuously over weeks and months at a time has become an increasingly sought-after characteristic to provide advanced diagnostic and therapeutic capabilities. Wearable devices for this purpose face a multitude of challenges such as formfactors with long-term user acceptance and power supplies that enable continuous operation without requiring extensive user interaction. This review summarizes design considerations associated with these attributes and summarizes recent advances toward continuous operation with high-fidelity biosignal recording abilities. The review also provides insight into systematic barriers for these device archetypes and outlines most promising technological approaches to expand capabilities. We conclude with a summary of current developments of hardware and approaches for embedded artificial intelligence in this wearable device class, which is pivotal for next generation autonomous diagnostic, therapeutic, and assistive health tools.
Collapse
Affiliation(s)
- Tucker Stuart
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona 85721, USA
| | - Jessica Hanna
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona 85721, USA
| | - Philipp Gutruf
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona 85721, USA
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, Arizona 85721, USA
- Bio5 Institute, University of Arizona, Tucson, Arizona 85721, USA
- Neuroscience GIDP, University of Arizona, Tucson, Arizona 85721, USA
| |
Collapse
|
8
|
Cay G, Ravichandran V, Saikia MJ, Hoffman L, Laptook A, Padbury J, Salisbury AL, Gitelson-Kahn A, Venkatasubramanian K, Shahriari Y, Mankodiya K. An E-Textile Respiration Sensing System for NICU Monitoring: Design and Validation. JOURNAL OF SIGNAL PROCESSING SYSTEMS 2021; 94:543-557. [PMID: 34306304 PMCID: PMC8286045 DOI: 10.1007/s11265-021-01669-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 06/13/2023]
Abstract
The world is witnessing a rising number of preterm infants who are at significant risk of medical conditions. These infants require continuous care in Neonatal Intensive Care Units (NICU). Medical parameters are continuously monitored in premature infants in the NICU using a set of wired, sticky electrodes attached to the body. Medical adhesives used on the electrodes can be harmful to the baby, causing skin injuries, discomfort, and irritation. In addition, respiration rate (RR) monitoring in the NICU faces challenges of accuracy and clinical quality because RR is extracted from electrocardiogram (ECG). This research paper presents a design and validation of a smart textile pressure sensor system that addresses the existing challenges of medical monitoring in NICU. We designed two e-textile, piezoresistive pressure sensors made of Velostat for noninvasive RR monitoring; one was hand-stitched on a mattress topper material, and the other was embroidered on a denim fabric using an industrial embroidery machine. We developed a data acquisition system for validation experiments conducted on a high-fidelity, programmable NICU baby mannequin. We designed a signal processing pipeline to convert raw time-series signals into parameters including RR, rise and fall time, and comparison metrics. The results of the experiments showed that the relative accuracies of hand-stitched sensors were 98.68 (top sensor) and 98.07 (bottom sensor), while the accuracies of embroidered sensors were 99.37 (left sensor) and 99.39 (right sensor) for the 60 BrPM test case. The presented prototype system shows promising results and demands more research on textile design, human factors, and human experimentation.
Collapse
Affiliation(s)
- Gozde Cay
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
| | - Vignesh Ravichandran
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
| | - Manob Jyoti Saikia
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
- Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA USA
| | - Laurie Hoffman
- Pediatrics, Women and Infants Hospital, Providence, RI USA
| | - Abbot Laptook
- Pediatrics, Women and Infants Hospital, Providence, RI USA
| | - James Padbury
- Pediatrics, Women and Infants Hospital, Providence, RI USA
| | - Amy L. Salisbury
- Pediatrics, Women and Infants Hospital, Providence, RI USA
- School of Nursing, Virginia Commonwealth University, Richmond, VA USA
| | - Anna Gitelson-Kahn
- Department of Textiles, Rhode Island School of Design, Providence, RI USA
| | | | - Yalda Shahriari
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
| | - Kunal Mankodiya
- Department of Electrical, Computer, and Biomedical Engineering, University of Rhode Island, Kingston, RI USA
| |
Collapse
|
9
|
A wireless, skin-interfaced biosensor for cerebral hemodynamic monitoring in pediatric care. Proc Natl Acad Sci U S A 2020; 117:31674-31684. [PMID: 33257558 PMCID: PMC7749320 DOI: 10.1073/pnas.2019786117] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The standard of clinical care in many pediatric and neonatal neurocritical care units involves continuous monitoring of cerebral hemodynamics using hard-wired devices that physically adhere to the skin and connect to base stations that commonly mount on an adjacent wall or stand. Risks of iatrogenic skin injuries associated with adhesives that bond such systems to the skin and entanglements of the patients and/or the healthcare professionals with the wires can impede clinical procedures and natural movements that are critical to the care, development, and recovery of pediatric patients. This paper presents a wireless, miniaturized, and mechanically soft, flexible device that supports measurements quantitatively comparable to existing clinical standards. The system features a multiphotodiode array and pair of light-emitting diodes for simultaneous monitoring of systemic and cerebral hemodynamics, with ability to measure cerebral oxygenation, heart rate, peripheral oxygenation, and potentially cerebral pulse pressure and vascular tone, through the utilization of multiwavelength reflectance-mode photoplethysmography and functional near-infrared spectroscopy. Monte Carlo optical simulations define the tissue-probing depths for source-detector distances and operating wavelengths of these systems using magnetic resonance images of the head of a representative pediatric patient to define the relevant geometries. Clinical studies on pediatric subjects with and without congenital central hypoventilation syndrome validate the feasibility for using this system in operating hospitals and define its advantages relative to established technologies. This platform has the potential to substantially enhance the quality of pediatric care across a wide range of conditions and use scenarios, not only in advanced hospital settings but also in clinics of lower- and middle-income countries.
Collapse
|