Camera-Based, Non-Contact, Vital-Signs Monitoring Technology May Provide a Way for the Early Prevention of SIDS in Infants

Newborn auditory brainstem response and sudden infant death syndrome

Sudden infant death syndrome (SIDS)-the sudden and unexplained death of a seemingly healthy infant, <1 year old-may be associated with abnormalities in the brain regions that underlie breathing and arousal during sleep. While post-mortem studies suggest abnormalities in SIDS infants' brainstems, there are no studies of these infants' brainstem function before death. One way to assess the function of the brainstem is with auditory brainstem response (ABR), a routine hearing-screening method that noninvasively measures the brainstem's response to sound. We hypothesize that anomalies in newborns' ABR measures may predict SIDS. Indeed, previous studies identified abnormalities in ABR characteristics in small samples of near-miss SIDS infants hospitalized for infant apnea syndrome. However, there is a need to examine the ABRs of infants who died of SIDS. Therefore, in the current study, we propose integrating two secondary datasets to examine newborns' ABRs (N = 156,972), including those who later died of SIDS (n = ~42; .27 out of every 1000 infants), using existing archived records of neonatal ABR results from a sample of newborns born in Florida. We hypothesize that infants who die from SIDS are more likely than non-SIDS infants to have abnormal ABRs as newborns. Understanding the association between SIDS and ABR may facilitate more accurate identification of an infant's risk for SIDS at birth, enabling increased monitoring, which may facilitate interventions and improve survivorship.

Contactless heart rate measurement in newborn infants using a multimodal 3D camera system

Newborns and preterm infants require accurate and continuous monitoring of their vital parameters. Contact-based methods of monitoring have several disadvantages, thus, contactless systems have increasingly attracted the neonatal communities' attention. Camera-based photoplethysmography is an emerging method of contactless heart rate monitoring. We conducted a pilot study in 42 healthy newborn and near-term preterm infants for assessing the feasibility and accuracy of a multimodal 3D camera system on heart rates (HR) in beats per min (bpm) compared to conventional pulse oximetry. Simultaneously, we compared the accuracy of 2D and 3D vision on HR measurements. The mean difference in HR between pulse oximetry and 2D-technique added up to + 3.0 bpm [CI-3.7 - 9.7; p = 0.359, limits of agreement (LOA) ± 36.6]. In contrast, 3D-technique represented a mean difference in HR of + 8.6 bpm (CI 2.0-14.9; p = 0.010, LOA ± 44.7) compared to pulse oximetry HR. Both, intra- and interindividual variance of patient characteristics could be eliminated as a source for the results and the measuring accuracy achieved. Additionally, we proved the feasibility of this emerging method. Camera-based photoplethysmography seems to be a promising approach for HR measurement of newborns with adequate precision; however, further research is warranted.

Feasibility of non-contact cardiorespiratory monitoring using impulse-radio ultra-wideband radar in the neonatal intensive care unit

Background

Current cardiorespiratory monitoring equipment can cause injuries and infections in neonates with fragile skin. Impulse-radio ultra-wideband (IR-UWB) radar was recently demonstrated to be an effective contactless vital sign monitor in adults. The purpose of this study was to assess heart rates (HRs) and respiratory rates (RRs) in the neonatal intensive care unit (NICU) using IR-UWB radar and to evaluate its accuracy and reliability compared to conventional electrocardiography (ECG)/impedance pneumography (IPG).

Methods

The HR and RR were recorded in 34 neonates between 3 and 72 days of age during minimal movement (51 measurements in total) using IR-UWB radar (HR_Rd, RR_Rd) and ECG/IPG (HR_ECG, RR_IPG) simultaneously. The radar signals were processed in real time using algorithms for neonates. Radar and ECG/IPG measurements were compared using concordance correlation coefficients (CCCs) and Bland-Altman plots.

Results

From the 34 neonates, 12,530 HR samples and 3,504 RR samples were measured. Both the HR and RR measured using the two methods were highly concordant when the neonates had minimal movements (CCC = 0.95 between the RR_Rd and RR_IPG, CCC = 0.97 between the HR_Rd and HR_ECG). In the Bland-Altman plot, the mean biases were 0.17 breaths/min (95% limit of agreement [LOA] -7.0–7.3) between the RR_Rd and RR_IPG and -0.23 bpm (95% LOA -5.3–4.8) between the HR_Rd and HR_ECG. Moreover, the agreement for the HR and RR measurements between the two modalities was consistently high regardless of neonate weight.

Conclusions

A cardiorespiratory monitor using IR-UWB radar may provide accurate non-contact HR and RR estimates without wires and electrodes for neonates in the NICU.

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review

Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby’s overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby’s stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant’s HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant’s clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients’ health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.

The effect of sleeping position on heart rate variability in newborns

Background

Lower heart rate variability (HRV) in a newborn might represent a risk factor for unfavourable outcome, a longer recovery after illness, and a sudden infant death. Our aim was to determine whether the newborn’s sleeping position is associated with HRV.

Methods

We performed a prospective clinical study in 46 hospitalized cardiorespiratory stable term newborns. During sleeping, we measured the parameters of HRV in four body positions (supine, supine with tilt, prone, prone with tilt).

Results

The TP (total power spectral density) was significantly higher when lying supine in comparison to prone (p = 0,048) and to prone with tilt (p = 0,046). The HF (high frequency of power spectral density) in the supine position without tilt tended to be higher compared to prone without tilt (p > 0,05). The LF (low frequency power) was significantly higher when lying supine compared to prone, both without tilt (p = 0,018). TP and HF showed a positive correlation with gestational but not postmenstrual age (p = 0.044 and p = 0.036, respectively).

Conclusions

In term newborns, sleeping position is associated with HRV. Higher TP and HF were found in the supine position, which might reflect better ANS stability. Gestational age positively correlated with TP and HF power, but only in supine position.

Trial registration

ISRCTN11702082, date of registration: March, 13th, 2020; retrospectively registered.

Ultra-Low Power Wearable Infant Sleep Position Sensor

Numerous wearable sensors have been developed for a variety of needs in medical/healthcare/wellness/sports applications, but there are still doubts about their usefulness due to uncomfortable fit or frequent battery charging. Because the size or capacity of battery is the major factor affecting the convenience of wearable sensors, power consumption must be reduced. We developed a method that can significantly reduce the power consumption by introducing a signal repeater and a special switch that provides power only when needed. Antenna radiation characteristics are an important factor in wireless wearable sensors, but soft material encapsulation for comfortable fit results in poor wireless performance. We improved the antenna radiation characteristics by a local encapsulation patterning. In particular, ultra-low power operation enables the use of paper battery to achieve a very thin and flexible form factor. Also, we verified the human body safety through specific absorption rate simulations. With these methods, we demonstrated a wearable infant sleep position sensor. Infants are unable to call for help in unsafe situations, and it is not easy for caregivers to observe them all the time. Our wearable sensor detects infants’ sleep positions in real time and automatically alerts the caregivers when needed.

Non-contact respiration monitoring using impulse radio ultrawideband radar in neonates

Vital sign monitoring in neonates requires adhesive electrodes, which often damage fragile newborn skin. Because impulse radio ultrawideband (IR-UWB) radar has been reported to recognize chest movement without contact in adult humans, IR-UWB may be used to measure respiratory rates (RRs) in a non-contact fashion. We investigated the feasibility of radar sensors for respiration monitoring in neonates without any respiratory support to compare the accuracy and reliability of radar measurements with those of conventional impedance pneumography measurements. In the neonatal intensive care unit, RRs were measured using radar (RRRd) and impedance pneumography (RRIP) simultaneously. The neonatal voluntary movements were measured using the radar sensor and categorized into three levels (low [M0], intermediate [M1] and high [M2]). RRRd highly agreed with RRIP (r = 0.90; intraclass correlation coefficient [ICC] = 0.846 [0.835-0.856]). For the M0 movement, there was good agreement between RRRd and RRIP (ICC = 0.893; mean bias -0.15 [limits of agreement (LOA) -9.6 to 10.0]). However, the agreement was slightly lower for the M1 (ICC = 0.833; mean bias = 0.95 [LOA -11.4 to 13.3]) and M2 (ICC = 0.749; mean bias = 3.04 [LOA -9.30 to 15.4]) movements than for the M0 movement. In conclusion, IR-UWB radar can provide accurate and reliable estimates of RR in neonates in a non-contact fashion. The performance of radar measurements could be affected by neonate movement.

Moving From Clinic to Home: What the Future Holds for Ophthalmic Telemedicine

PURPOSE

To describe the expanding role of telemedicine in healthcare, the key criteria required for a successful device and program implementation, and the current and future role of home monitoring in ophthalmology.

DESIGN

Expert perspective.

METHODS

Analysis with real-world interpretation of home monitoring technologies, including current adoption barriers and expanded future demands based on demographic and market forces.

RESULTS

Remote patient monitoring represents a paradigm shift in the way physicians care for patients. Success depends on meeting several criteria, among which are a recognized value proposition to the physician, robust device performance validation, ease of use for the patient, reliability of connectivity, safe and secure data transmission, and economic feasibility. Ophthalmic diseases, such as age-related macular degeneration, glaucoma, and diabetic retinopathy, are ideal candidates for home monitoring practice integration. Established home monitoring technology is already facilitating early detection and improved visual outcomes for patients with age-related macular degeneration. Future innovation currently underway or on the horizon will continue to evolve and expand the footprint of telemedicine within ophthalmology.

CONCLUSION

Home monitoring has the potential to enhance the patient-physician relationship and to positively impact visual acuity outcomes in ophthalmic diseases. Advances in technology, demographic shifts, market changes, and patient demand for personalized medicine will require physicians to embrace technology in new and diverse ways, perhaps facilitating widespread adoption of home monitoring technology platforms.