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Hussain NM, Amin B, McDermott BJ, Dunne E, O’Halloran M, Elahi A. Feasibility Analysis of ECG-Based pH Estimation for Asphyxia Detection in Neonates. SENSORS (BASEL, SWITZERLAND) 2024; 24:3357. [PMID: 38894148 PMCID: PMC11174966 DOI: 10.3390/s24113357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024]
Abstract
Birth asphyxia is a potential cause of death that is also associated with acute and chronic morbidities. The traditional and immediate approach for monitoring birth asphyxia (i.e., arterial blood gas analysis) is highly invasive and intermittent. Additionally, alternative noninvasive approaches such as pulse oximeters can be problematic, due to the possibility of false and erroneous measurements. Therefore, further research is needed to explore alternative noninvasive and accurate monitoring methods for asphyxiated neonates. This study aims to investigate the prominent ECG features based on pH estimation that could potentially be used to explore the noninvasive, accurate, and continuous monitoring of asphyxiated neonates. The dataset used contained 274 segments of ECG and pH values recorded simultaneously. After preprocessing the data, principal component analysis and the Pan-Tompkins algorithm were used for each segment to determine the most significant ECG cycle and to compute the ECG features. Descriptive statistics were performed to describe the main properties of the processed dataset. A Kruskal-Wallis nonparametric test was then used to analyze differences between the asphyxiated and non-asphyxiated groups. Finally, a Dunn-Šidák post hoc test was used for individual comparison among the mean ranks of all groups. The findings of this study showed that ECG features (T/QRS, T Amplitude, Tslope, Tslope/T, Tslope/|T|, HR, QT, and QTc) based on pH estimation differed significantly (p < 0.05) in asphyxiated neonates. All these key ECG features were also found to be significantly different between the two groups.
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Affiliation(s)
- Nadia Muhammad Hussain
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
| | - Bilal Amin
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Barry James McDermott
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Eoghan Dunne
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Martin O’Halloran
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Adnan Elahi
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
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Sheikholeslami D, Dyson AE, Villarreal EG, Farias JS, Rausa J, Flores S, Loomba RS. Venous blood gases in pediatric patients: a lost art? Minerva Pediatr (Torino) 2022; 74:789-794. [PMID: 34530585 DOI: 10.23736/s2724-5276.21.06464-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Blood oximetry provides a fundamental approach to blood gases for inpatients. Arterial blood gases (ABG) have been considered the gold standard for blood oximetry assessment. Venous blood gas (VBG) evaluation is frequently available and provides a source of a more comfortable method for the assessment of blood oximetry in pediatric patients. Some data provided by the venous blood gas can be additive and offer insights apart from the arterial blood gas. The purpose of this review was to provide an assessment of the performance of VBG in pediatric patients. The study concludes that VBG are helpful tools in assessing oxygenation and ventilation in critically ill children and can be used as a marker of adequacy of systemic oxygen delivery. In the setting of systemic oxygen delivery decrease or oxygen extraction increase, the partial pressure of oxygen on the VBG will decrease. Thus, the partial pressure of oxygen and the corresponding venous saturation can be a marker of systemic oxygen delivery in a variety of illnesses. Simultaneous ABG and VBG comparison can actually lend great insight to not only the respiratory status of a patient but provide an assessment of the adequacy of cardiac output and systemic oxygen delivery.
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Affiliation(s)
- Danielle Sheikholeslami
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Aaron E Dyson
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Enrique G Villarreal
- School of Medicine and Health Sciences, Monterrey Institute of Technology and Higher Education, Monterrey, Mexico -
| | - Juan S Farias
- School of Medicine and Health Sciences, Monterrey Institute of Technology and Higher Education, Monterrey, Mexico
| | - Jacqueline Rausa
- Unit of Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Saul Flores
- Baylor School of Medicine, Unit of Critical Care and Cardiology, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Rohit S Loomba
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.,Unit of Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA
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Costanzo I, Sen D, Rhein L, Guler U. Respiratory Monitoring: Current State of the Art and Future Roads. IEEE Rev Biomed Eng 2020; 15:103-121. [PMID: 33156794 DOI: 10.1109/rbme.2020.3036330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this article, we present current methodologies, available technologies, and demands for monitoring various respiratory parameters. We discuss the importance of noninvasive techniques for remote and continuous monitoring and challenges involved in the current "smart and connected health" era. We conducted an extensive literature review on the medical significance of monitoring respiratory vital parameters, along with the current methods and solutions with their respective advantages and disadvantages. We discuss the challenges of developing a noninvasive, wearable, wireless system that continuously monitors respiration parameters and opportunities in the field and then determines the requirements of a state-of-the-art system. Noninvasive techniques provide a significant amount of medical information for a continuous patient monitoring system. Contact methods offer more advantages than non-contact methods; however, reducing the size and power of contact methods is critical for enabling a wearable, wireless medical monitoring system. Continuous and accurate remote monitoring, along with other physiological data, can help caregivers improve the quality of care and allow patients greater freedom outside the hospital. Such monitoring systems could lead to highly tailored treatment plans, shorten patient stays at medical facilities, and reduce the cost of treatment.
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Ochiai M, Kurata H, Inoue H, Ichiyama M, Fujiyoshi J, Watabe S, Hiroma T, Nakamura T, Ohga S. Transcutaneous blood gas monitoring among neonatal intensive care units in Japan. Pediatr Int 2020; 62:169-174. [PMID: 31845473 DOI: 10.1111/ped.14107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 05/29/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to investigate the utility of transcutaneous (tc) measurements of partial pressure of oxygen (tcPO2 ) and carbon dioxide (tcPCO2 ) monitoring in neonatal intensive care units (NICUs) in Japan. METHODS At the end of 2016,we sent a survey questionnaire on tc monitoring to all 106 NICUs registered with the Japanese Neonatologist Association. The questions included usage, subjects, methods, management, and the practical usefulness of tc monitoring. RESULTS The questionnaire was returned by 69 NICUs (65.1% of response rate). Seventeen institutions (24.6%) measured both tcPCO2 and tcPO2 , and 42 (60.9%) measured tcPCO2 alone. Transcutaneous PCO2 or tcPO2 monitoring was applied for "pre-viable" infants born at 22-23 weeks' gestational age (18.6% vs 23.5%), and infants of <500 g birthweight (30.5% vs 17.6%). The tcPCO2 and tcPO2 monitoring was started at birth in 49.2% and 70.6% of the newborn infants, respectively. The temperature of the sensor was set at <38°C for tcPCO2 in 54.3% and >42°C for tcPO2 in 58.9% of NICUs. The accuracy for tcPO2 was rated as good in 35.3% or moderate in 64.7%, of institutions but or for tcPCO2 as 1.7% or 93.2%of institutions , respectively. CONCLUSION Transcutaneous monitoring was widely, but limitedly, used for preterm infants. The lower temperature of the tcPCO2 sensor compared to that reported in other developed countries might compromise the accuracy but increase the feasibility of tc monitoring in Japan.
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Affiliation(s)
- Masayuki Ochiai
- Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan.,Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroaki Kurata
- Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirosuke Inoue
- Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masako Ichiyama
- Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junko Fujiyoshi
- Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichi Watabe
- Department of Neonatal Intensive Care, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takehiko Hiroma
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
| | | | - Shouichi Ohga
- Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Incremental value of noncerebral somatic tissue oxygenation monitoring for patients undergoing surgery. Curr Opin Anaesthesiol 2019; 32:50-56. [DOI: 10.1097/aco.0000000000000672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tan RNGB, Pauws SC, van Loon E, Smits VEHJ, Lopriore E, Te Pas AB. Correlation and Interchangeability of Venous and Capillary Blood Gases in Non-Critically Ill Neonates. Front Pediatr 2018; 6:89. [PMID: 29755961 PMCID: PMC5932392 DOI: 10.3389/fped.2018.00089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Venous blood gas (VBG) is frequently used in the neonatal unit as alternative for capillary blood gas (CBG). However, studies reporting correlation are conflicting and data on interchangeability in neonates are lacking. OBJECTIVE We investigated the correlation and interchangeability of the components between VBG and CBG in infants admitted to the neonatal intensive care unit. METHODS In a prospective study in the neonatal unit in Leiden University Medical Center (Netherlands), simultaneously VBG and CBG were withdrawn in neonates when both venous puncture and intravenous access as blood gas monitoring was indicated. From each blood gas analysis, a Pearson correlation, intraclass correlation, and Bland-Altman analysis was performed. Clinically acceptable difference for each blood gas value was defined up-front by means of an absolute difference: pH ± 0.05; partial pressure of carbon dioxide (pCO2) (±0.67 kPa = 5 mmHg); partial pressure of oxygen (pO2) (±0.67 kPa = 5 mmHg); base excess ± 3 mmol/l; and bicarbonate (HCO3-) ± 3 mmol/l. RESULTS In 93 patients [median gestational age 31 (IQR 29-34) weeks], 193 paired samples of VBG and CBG were collected. The Pearson correlation between VBG and CBG was very strong for pH (r = 0.79; P < 0.001), BE (r = 0.90; P < 0.001) and bicarbonate (r = 0.87; P < 0.001); strong for pCO2 (r = 0.68; P < 0.001); and moderate for pO2 (r = 0.31; P < 0.001). The percentage of the interchangeability within our acceptable absolute difference for pH was 88%, pCO2 72%, pO2 55%, BE 90%, and bicarbonate 94%. CONCLUSION VBG and CBG in neonates are well correlated and mostly interchangeable, except for pO2.
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Affiliation(s)
- Ratna N G B Tan
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Steffen C Pauws
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, Netherlands.,Tilburg Center for Cognition and Communication, Tilburg University, Tilburg, Netherlands
| | - Evelyne van Loon
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Vivanne E H J Smits
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, Netherlands
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McArdle AJ, Webbe J, Sim K, Parrish G, Hoggart C, Wang Y, Kroll JS, Godambe S, Cunnington AJ. Determinants of Carboxyhemoglobin Levels and Relationship with Sepsis in a Retrospective Cohort of Preterm Neonates. PLoS One 2016; 11:e0161784. [PMID: 27552216 PMCID: PMC4995038 DOI: 10.1371/journal.pone.0161784] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/11/2016] [Indexed: 12/27/2022] Open
Abstract
Carboxyhemoglobin levels in blood reflect endogenous carbon monoxide production and are often measured during routine blood gas analysis. Endogenous carbon monoxide production has been reported to be increased during sepsis, but carboxyhemoglobin levels have not been thoroughly evaluated as a biomarker of sepsis. We sought to determine whether carboxyhemoglobin levels were elevated during sepsis in a high risk population of premature neonates. We conducted a retrospective cohort study of 30 infants in two neonatal intensive care units using electronic medical and laboratory records. The majority of infants were extremely premature and extremely low birth weight, and 25 had at least one episode of sepsis. We collected all carboxyhemoglobin measurements during their in-patient stay and examined the relationship between carboxyhemoglobin and a variety of clinical and laboratory parameters, in addition to the presence or absence of sepsis, using linear mixed-effect models. We found that postnatal age had the most significant effect on carboxyhemoglobin levels, and other significant associations were identified with gestational age, hemoglobin concentration, oxyhemoglobin saturation, and blood pH. Accounting for these covariates, there was no significant relationship between the onset of sepsis and carboxyhemoglobin levels. Our results show that carboxyhemoglobin is unlikely to be a clinically useful biomarker of sepsis in premature infants, and raise a note of caution about factors which may confound the use of carbon monoxide as a clinical biomarker for other disease processes such as hemolysis.
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Affiliation(s)
- Andrew J. McArdle
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James Webbe
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
- Neonatal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kathleen Sim
- Section of Paediatrics, Department of Medicine, Imperial College, London, United Kingdom
| | - Graham Parrish
- Neonatal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Clive Hoggart
- Section of Paediatrics, Department of Medicine, Imperial College, London, United Kingdom
| | - Yifei Wang
- Imperial College School of Medicine, South Kensington Campus, Imperial College, London, United Kingdom
| | - J. Simon Kroll
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Paediatrics, Department of Medicine, Imperial College, London, United Kingdom
| | - Sunit Godambe
- Neonatal Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Paediatrics, Department of Medicine, Imperial College, London, United Kingdom
| | - Aubrey J. Cunnington
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Paediatrics, Department of Medicine, Imperial College, London, United Kingdom
- * E-mail:
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