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Zhao H, Cai H, Liu M. Transformer based multi-modal MRI fusion for prediction of post-menstrual age and neonatal brain development analysis. Med Image Anal 2024; 94:103140. [PMID: 38461655 DOI: 10.1016/j.media.2024.103140] [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: 08/01/2023] [Revised: 11/23/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
The brain development during the perinatal period is characterized by rapid changes in both structure and function, which have significant impact on the cognitive and behavioral abilities later in life. Accurate assessment of brain age is a crucial indicator for brain development maturity and can help predict the risk of neonatal pathology. However, evaluating neonatal brains using magnetic resonance imaging (MRI) is challenging due to its complexity, multi-dimension, and noise with subtle alterations. In this paper, we propose a multi-modal deep learning framework based on transformers for precise post-menstrual age (PMA) estimation and brain development analysis using T2-weighted structural MRI (T2-sMRI) and diffusion MRI (dMRI) data. First, we build a two-stream dense network to learn modality-specific features from T2-sMRI and dMRI of brain individually. Then, a transformer module based on self-attention mechanism integrates these features for PMA prediction and preterm/term classification. Finally, saliency maps on brain templates are used to enhance the interpretability of results. Our method is evaluated on the multi-modal MRI dataset of the developing Human Connectome Project (dHCP), which contains 592 neonates, including 478 term-born and 114 preterm-born subjects. The results demonstrate that our method achieves a 0.5-week mean absolute error (MAE) in PMA estimation for term-born subjects. Notably, preterm-born subjects exhibit delayed brain development, worsening with increasing prematurity. Our method also achieves 95% accuracy in classification of term-born and preterm-born subjects, revealing significant group differences.
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Affiliation(s)
- Haiyan Zhao
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Hongjie Cai
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Manhua Liu
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China; MoE Key Lab of Artificial Intelligence, AI Institute, Shanghai, China.
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Carneiro MMC, Ribeiro SNS, Menegol NA, Okubo R, Montemezzo D, Sanada LS. Nest positioning on motor development, sleep patterns, weight gain in preterm infants: systematic review. Pediatr Res 2024:10.1038/s41390-023-02972-w. [PMID: 38409428 DOI: 10.1038/s41390-023-02972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 02/28/2024]
Abstract
The aim was to evaluate the effects of Nest Positioning (NP) on motor development, sleep patterns, and weight gain in preterm newborns (PTNB) hospitalized in a neonatal intensive care unit (NICU). This study was constructed based on PRISMA guideline criteria. Systematic research was carried out in electronic databases: MEDLINE via PubMed, Web of Science, Scopus, and VHL-BIREME following the PICOS strategy. Studies with PTNB populations who were hospitalized in the NICU and received therapeutic NP as an intervention strategy in this population were included in this study. We sought outcomes related to sleep patterns, weight gain, and motor development. After selection, 12 studies were included in this systematic review, of which 5 (41.7%) evaluated motor development as their primary outcome, 6 (50%) sleep-wake cycle patterns, and 1 (8.3%), weight gain and, subsequently, hospital discharge. Qualitative results indicate that prolonged exposure to decubitus variations may favor PTNB hospitalized in NICUs acquiring flexor postures, stimulate their midline, and increase their total sleep time. Studies reported no adverse effects regarding the use of NP. Evidence suggests that NP benefits motor development and sleep pattern in PTNB hospitalized in NICUs. IMPACT: Nest positioning improves sleep quality in preterm newborns hospitalized in neonatal intensive care unit. Nest positioning improves motor development in preterm newborns hospitalized in neonatal intensive care unit. No evidence of nest positioning on weight gain was observed. Half of the included clinical studies showed good methodological quality. Nesting positioning is a secure and cost-effective method.
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Affiliation(s)
- Mayara M C Carneiro
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Simone N S Ribeiro
- Faculdade Ciências Médicas de Minas Gerais, Instituto de Previdência dos Servidores do Estado de Minas Gerais, Belo Horizonte, Brazil
| | - Natália A Menegol
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Rodrigo Okubo
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Dayane Montemezzo
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Luciana Sayuri Sanada
- Programa de Pós-graduação em Fisioterapia, Department of Physical Therapy, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil.
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Ruiz-Zafra A, Precioso D, Salvador B, Lubian-Lopez SP, Jimenez J, Benavente-Fernandez I, Pigueiras J, Gomez-Ullate D, Gontard LC. NeoCam: An Edge-Cloud Platform for Non-Invasive Real-Time Monitoring in Neonatal Intensive Care Units. IEEE J Biomed Health Inform 2023; 27:2614-2624. [PMID: 37819832 DOI: 10.1109/jbhi.2023.3240245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
In this work we introduce NeoCam, an open source hardware-software platform for video-based monitoring of preterms infants in Neonatal Intensive Care Units (NICUs). NeoCam includes an edge computing device that performs video acquisition and processing in real-time. Compared to other proposed solutions, it has the advantage of handling data more efficiently by performing most of the processing on the device, including proper anonymisation for better compliance with privacy regulations. In addition, it allows to perform various video analysis tasks of clinical interest in parallel at speeds of between 20 and 30 frames-per-second. We introduce algorithms to measure without contact the breathing rate, motor activity, body pose and emotional status of the infants. For breathing rate, our system shows good agreement with existing methods provided there is sufficient light and proper imaging conditions. Models for motor activity and stress detection are new to the best of our knowledge. NeoCam has been tested on preterms in the NICU of the University Hospital Puerta del Mar (Cádiz, Spain), and we report the lessons learned from this trial.
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Dai HR, Guo HL, Hu YH, Xu J, Ding XS, Cheng R, Chen F. Precision caffeine therapy for apnea of prematurity and circadian rhythms: New possibilities open up. Front Pharmacol 2022; 13:1053210. [DOI: 10.3389/fphar.2022.1053210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Caffeine is the globally consumed psychoactive substance and the drug of choice for the treatment of apnea of prematurity (AOP), but its therapeutic effects are highly variable among preterm infants. Many of the molecular underpinnings of the marked individual response have remained elusive yet. Interestingly, the significant association between Clock gene polymorphisms and the response to caffeine therapy offers an opportunity to advance our understanding of potential mechanistic pathways. In this review, we delineate the functions and mechanisms of human circadian rhythms. An up-to-date advance of the formation and ontogeny of human circadian rhythms during the perinatal period are concisely discussed. Specially, we summarize and discuss the characteristics of circadian rhythms in preterm infants. Second, we discuss the role of caffeine consumption on the circadian rhythms in animal models and human, especially in neonates and preterm infants. Finally, we postulate how circadian-based therapeutic initiatives could open new possibilities to promote precision caffeine therapy for the AOP management in preterm infants.
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Firmino C, Rodrigues M, Franco S, Ferreira J, Simões AR, Castro C, Fernandes JB. Nursing Interventions That Promote Sleep in Preterm Newborns in the Neonatal Intensive Care Units: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10953. [PMID: 36078666 PMCID: PMC9518210 DOI: 10.3390/ijerph191710953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Sleep is a crucial factor for the psychological and physiological well-being of any human being. In Neonatal Intensive Care Units, preterm newborns' sleep may be at risk due to medical and nursing care, environmental stimuli and manipulation. This review aims to identify the nurses' interventions that promote sleep in preterm newborns in the Neonatal Intensive Care Units. An integrative review was conducted following Whittemore and Knafl's methodology and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The research was carried out on the electronic databases PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ScienceDirect, with a timeframe from 2010 to 2021. A total of 359 articles were initially identified. After selection and analysis, five studies were included in the sample. Interventions by nursing staff that promote sleep in preterm newborns in the Neonatal Intensive Care Units fall within three categories: environmental management, relaxation techniques and therapeutic positioning. Nurses play a vital role in implementing interventions that promote preterm newborns' sleep. They can positively affect preterm newborns' sleep by controlling environmental stimuli and applying relaxation techniques and therapeutic positioning to their care practices.
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Affiliation(s)
- Catarina Firmino
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Marlene Rodrigues
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Sofia Franco
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Judicília Ferreira
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Ana Rita Simões
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
| | - Cidália Castro
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal
| | - Júlio Belo Fernandes
- Escola Superior de Saúde Egas Moniz, Caparica, 2829-511 Almada, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), 2829-511 Almada, Portugal
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC), 2829-511 Almada, Portugal
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Trickett J, Hill C, Austin T, Johnson S. The Impact of Preterm Birth on Sleep through Infancy, Childhood and Adolescence and Its Implications. CHILDREN 2022; 9:children9050626. [PMID: 35626803 PMCID: PMC9139673 DOI: 10.3390/children9050626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
Abstract
There is emergent literature on the relationship between the development of sleep-wake cycles, sleep architecture, and sleep duration during the neonatal period on neurodevelopmental outcomes among children born preterm. There is also a growing literature on techniques to assess sleep staging in preterm neonates using either EEG methods or heart and respiration rate. Upon discharge from hospital, sleep in children born preterm has been assessed using parent report, actigraphy, and polysomnography. This review describes the ontogeny and measurement of sleep in the neonatal period, the current evidence on the impact of preterm birth on sleep both in the NICU and in childhood and adolescence, and the interaction between sleep, cognition, and social-emotional outcomes in this population.
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Affiliation(s)
- Jayne Trickett
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7RH, UK
- Correspondence:
| | - Catherine Hill
- School of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
- Department of Sleep Medicine, Southampton Children’s Hospital, Southampton SO17 1BJ, UK
| | - Topun Austin
- Neonatal Intensive Care Unit, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK;
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
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Arvinti B, Iacob ER, Isar A, Iacob D, Costache M. Automated Medical Care: Bradycardia Detection and Cardiac Monitoring of Preterm Infants. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1199. [PMID: 34833417 PMCID: PMC8625917 DOI: 10.3390/medicina57111199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Prematurity of birth occurs before the 37th week of gestation and affects up to 10% of births worldwide. It is correlated with critical outcomes; therefore, constant monitoring in neonatal intensive care units or home environments is required. The aim of this work was to develop solutions for remote neonatal intensive supervision systems, which should assist medical diagnosis of premature infants and raise alarm at cardiac abnormalities, such as bradycardia. Additionally, the COVID-19 pandemic has put a worldwide stress upon the medical staff and the management of healthcare units. Materials and Methods: A traditional medical diagnosing scheme was set up, implemented with the aid of powerful mathematical operators. The algorithm was tailored to the infants' personal ECG characteristics and was tested on real ECG data from the publicly available PhysioNet database "Preterm Infant Cardio-Respiratory Signals Database". Different processing problems were solved: noise filtering, baseline drift removal, event detection and compression of medical data using the à trous wavelet transform. Results: In all 10 available clinical cases, the bradycardia events annotated by the physicians were correctly detected using the RR intervals. Compressing the ECG signals for remote transmission, we obtained compression ratios (CR) varying from 1.72 to 7.42, with the median CR value around 3. Conclusions: We noticed that a significant amount of noise can be added to a signal while monitoring using standard clinical sensors. We tried to offer solutions for these technical problems. Recent studies have shown that persons infected with the COVID-19 disease are frequently reported to develop cardiovascular symptoms and cardiac arrhythmias. An automatic surveillance system (both for neonates and adults) has a practical medical application. The proposed algorithm is personalized, no fixed reference value being applied, and the algorithm follows the neonate's cardiac rhythm changes. The performance depends on the characteristics of the input ECG. The signal-to-noise ratio of the processed ECG was improved, with a value of up to 10 dB.
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Affiliation(s)
- Beatrice Arvinti
- Fundamentals of Physics for Engineers Department, “Politehnica” University Timisoara, Bd. Vasile Pârvan 2, 300223 Timisoara, Romania;
| | - Emil Radu Iacob
- Department of Pediatric Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Alexandru Isar
- Faculty of Electronics, Telecommunications and Information Technologies, “Politehnica” University Timisoara, Bd. Vasile Pârvan 2, 300223 Timisoara, Romania;
| | - Daniela Iacob
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Marius Costache
- Fundamentals of Physics for Engineers Department, “Politehnica” University Timisoara, Bd. Vasile Pârvan 2, 300223 Timisoara, Romania;
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Culture and the organization of infant sleep: A study in the Netherlands and the U.S.A. Infant Behav Dev 2021; 64:101620. [PMID: 34392065 DOI: 10.1016/j.infbeh.2021.101620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/17/2021] [Accepted: 07/24/2021] [Indexed: 11/22/2022]
Abstract
This study investigates differences in the amount and structure of infant sleep in two cultural places with previously documented, divergent parental beliefs and practices. Eight-month-old infants (n = 24 per site) were recruited from towns in the Netherlands and the eastern U.S.A. To evaluate sleep, infants' physical activity was recorded at home for 24 h using a miniature actigraph, while parents kept a diary of infant activities. Measures derived from actigraphy include total sleep, longest sleep episode, longest wake episode, number of sleep episodes, and percent of sleep during nighttime, as well as time in the stages of Quiet and Active Sleep. Measures based on the parental diaries include most of these aspects as well, except those related to sleep stages. Results based on the more precise actigraphy method indicate that (1) the Dutch infants averaged 13.65 h of sleep per 24 h, 1.67 h more than the U.S. infants; this difference was mostly due to daytime sleep; (2) The Dutch infants' longest wake episode averaged less than that of the U.S. infants, while their longest sleep episode appeared slightly longer. (3) The Dutch infants, compared to the U.S. sample, spent more time in the Quiet, rather than the Active phase of sleep; (4) They began their Quiet sleep earlier in the evening than did their U.S. counterparts. Measures derived from parental diaries are largely in agreement with the actigraph findings. These results are consistent with reported and observed practices and beliefs in the two communities. The pattern of differences - less apparent maturity among the Dutch in the amount of sleep, but greater apparent maturity in the structure of sleep -- illustrates that behavioral and neurological maturity can be assessed only in the context of the developing child's adaptation to the specific demands and affordances of the culturally structured developmental niche.
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Immature control of breathing and apnea of prematurity: the known and unknown. J Perinatol 2021; 41:2111-2123. [PMID: 33712716 PMCID: PMC7952819 DOI: 10.1038/s41372-021-01010-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 02/05/2023]
Abstract
This narrative review provides a broad perspective on immature control of breathing, which is universal in infants born premature. The degree of immaturity and severity of clinical symptoms are inversely correlated with gestational age. This immaturity presents as prolonged apneas with associated bradycardia or desaturation, or brief respiratory pauses, periodic breathing, and intermittent hypoxia. These manifestations are encompassed within the clinical diagnosis of apnea of prematurity, but there is no consensus on minimum criteria required for diagnosis. Common treatment strategies include caffeine and noninvasive respiratory support, but other therapies have also been advocated with varying effectiveness. There is considerable variability in when and how to initiate and discontinue treatment. There are significant knowledge gaps regarding effective strategies to quantify the severity of clinical manifestations of immature breathing, which prevent us from better understanding the long-term potential adverse outcomes, including neurodevelopment and sudden unexpected infant death.
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