Depth-Based Intervention Detection in the Neonatal Intensive Care Unit Using Vision Transformers.

Depth cameras can provide an effective, noncontact, and privacy-preserving means to monitor patients in the Neonatal Intensive Care Unit (NICU). Clinical interventions and routine care events can disrupt video-based patient monitoring. Automatically detecting these periods can decrease the time required for hand-annotating recordings, which is needed for system development.

Increasing the Use of Newborn Pain Treatment Following the Implementation of a Parent-Targeted Video: An Outcome Evaluation.

Background/objectives: Despite strong evidence that breastfeeding, skin-to-skin care, and sucrose reduce pain in newborns during minor painful procedures, these interventions remain underutilized in practice. To address this knowledge-to-practice gap, we produced a five-minute parent-targeted video demonstrating the analgesic effects of these strategies and examined whether the use of newborn pain treatment increased in maternal-newborn care settings following the introduction of the video by nurses.

Methods: The design was a pre-post outcome evaluation.

Infant Infections Following Cesarean Delivery on Maternal Request: A Population-Based Cohort Study.

Objectives: Investigations about cesarean delivery (CD) on maternal request (CDMR) and infant infection risk frequently rely on administrative data with poorly defined indications for CD. We sought to determine the association between CDMR and infant infection using an intent-to-treat approach.

Methods: This was a population-based cohort study of low-risk singleton pregnancies with a term live birth in Ontario, Canada between April 2012 and March 2018.

Exploring implementation processes of a parent-targeted educational video for improving newborn pain treatment: A sequential exploratory mixed-methods study.

Despite known analgesic effects of breastfeeding (BF), skin-to-skin care (SSC), and sweet solutions (sucrose) for newborns, these interventions remain underutilized. Our team produced a five-minute parent-targeted video (BSweet2Babies) demonstrating BF, SSC, and sucrose during newborn blood sampling. We conducted a sequential exploratory mixed-methods study with eight maternal-newborn units across Ontario, Canada to identify barriers and facilitators to implementing the video and the three pain management strategies.

Bottle-Feeding Intervention Detection in the NICU.

Video-based monitoring of patients in the neonatal intensive care unit (NICU) has great potential for improving patient care. Video-based detection of clinical events, such as bottle feeding, would represent a step towards semi-automated charting of clinical events. Recording such events contemporaneously would address the limitations associated with retrospective charting.

RGB-D scene analysis in the NICU.

Continuity of care is achieved in the neonatal intensive care unit (NICU) through careful documentation of all events of clinical significance, including clinical interventions and routine care events (e.g., feeding, diaper change, weighing, etc.

The validity of skin conductance for assessing acute pain in mechanically ventilated infants: A cross-sectional observational study.

Background: Assessing pain in mechanically ventilated infants is challenging. The assessment of skin conductance (SC) is based on the sympathetic nervous system response to stress. This study purpose was to evaluate the validity of SC for assessing pain in mechanically ventilated infants.

Video-Based Neonatal Motion Detection.

Newborns admitted to the neonatal intensive care unit (NICU) require a high level of care due to their precarious condition. Nurses typically monitor their vital signs continuously using wearable sensors such as electrocardiogram (ECG) electrodes placed on their chest and a pulse oximeter on a limb. When the patient moves, this can cause motion artifacts on one or more physiologic signals, potentially resulting in a false alarm on the patient monitor.

Economic Analysis of Exclusive Human Milk Diets for High-Risk Neonates, a Canadian Hospital Perspective.

There is increasing evidence that premature newborns and infants with low birth weight can benefit substantially from an exclusive human milk-based diet (EHMD), consisting of human milk supplemented with a pasteurized donor human milk-derived fortifier. However, compared with the standard infant diet, EHMD also represents a significant added cost to the hospital and/or health system, thereby raising important questions about the economic feasibility of incorporating EHMD into newborn care. We conducted a cost analysis and estimated the potential cost savings to a Canadian tertiary hospital based on the attributable complications averted from EHMD among low-weight neonates.

Data accuracy in the Ontario birth Registry: a chart re-abstraction study.

Background: Ontario's birth Registry (BORN) was established in 2009 to collect, interpret, and share critical data about pregnancy, birth and the early childhood period to facilitate and improve the provision of healthcare. Since the use of routinely-collected health data has been prioritized internationally by governments and funding agencies to improve patient care, support health system planning, and facilitate epidemiological surveillance and research, high quality data is essential. The purpose of this study was to verify the accuracy of a selection of data elements that are entered in the Registry.

The Validity of Skin Conductance For Assessing Acute Pain in Infants: A Scoping Review.

Objectives: Measuring pain in infants is important but challenging, as there is no "gold standard." The measurement of skin conductance (SC) is considered to be a measure of stress and as a surrogate indicator of pain. The objectives of this study were to identify the extent of research conducted and to synthesize the validity evidence of SC for assessing acute pain in infants.

Use of a maternal newborn audit and feedback system in Ontario: a collective case study.

Background: As part of a larger study examining the effectiveness of the Maternal Newborn Dashboard, an electronic audit and feedback system to improve maternal-newborn care practices and outcomes, the purpose of this study was to increase our understanding of factors explaining variability in performance after implementation of the Dashboard in Ontario, Canada.

Methods: A collective case study. A maximum variation sampling approach was used to invite hospitals reflecting different criteria to participate in a 1-day to 2-day site visit by the research team.

A Parent-Targeted and Mediated Video Intervention to Improve Uptake of Pain Treatment for Infants During Newborn Screening: A Pilot Randomized Controlled Trial.

Most newborns undergo newborn screening blood tests. Breastfeeding, skin-to-skin care, and sweet solutions effectively reduce pain; however, these strategies are inconsistently used. We conducted a 2-armed pilot randomized controlled trial in a mother-baby unit to examine the feasibility and acceptability of a parent-targeted and -mediated video demonstrating use of these pain-reducing strategies and to obtain preliminary effectiveness data on uptake of pain management.

Elective Repeat Caesarean Section in Low-Risk Women-Economic Evaluation Comparing Births Before vs. After 39 Weeks Gestation in Ontario, Canada.

Purpose: To undertake an economic analysis of repeat Caesarean births in low-risk women (LRW) not in labour in Ontario who delivered at 37-38 weeks (<39 weeks) vs. 39-40 weeks (≥39 weeks) gestation.

Methods: Data from the Better Outcomes Registry & Network (BORN) Information System for fiscal years 2012-2013 and 2013-2014 meeting the definition for elective repeat CS (ERCS) for LRW between 37 and 40 weeks gestation.

Parental characteristics and perspectives pertaining to neonatal visits to the emergency department: a multicentre survey.

Background: Parents take neonates to the emergency department for many reasons, often nonurgent, pressuring an already burdened system. We aimed to characterize these visits and families to identify potential strategies to decrease neonatal emergency department visits.

Methods: We developed and implemented a survey that explored characteristics of neonates and parents/guardians evaluated in the emergency department, perspectives of parents and use of health care services.

Effect of a population-level performance dashboard intervention on maternal-newborn outcomes: an interrupted time series study.

Objectives: To assess the effect of the Maternal Newborn Dashboard on six key clinical performance indicators in the province of Ontario, Canada.

Design: Interrupted time series using population-based data from the provincial birth registry covering a 3-year period before implementation of the Dashboard and 2.5 years after implementation (November 2009 through March 2015).

Be Sweet to Babies During Painful Procedures: A Pilot Evaluation of a Parent-Targeted Video.

Background: Breastfeeding (BF), skin-to-skin care (SSC), and sucrose effectively reduce babies' pain during newborn blood work, but these strategies are infrequently used. Our team developed a parent-targeted video intervention showing the effectiveness of the 3 pain management strategies.

Purpose: To evaluate neonatal intensive care unit (NICU) parents' (1) baseline knowledge and previous use of BF, SSC, and sucrose for procedural pain management; (2) intention to advocate/use BF, SSC, or sucrose for their infants' future blood work after viewing the video; (3) intention to recommend the video to other parents; and (4) perceptions of the video and identify areas for improvement.

Pain Management During Newborn Screening: Using YouTube to Disseminate Effective Pain Management Strategies.

To assess the reach, acceptability, and effect of the BSweet2Babies video showing breast-feeding, skin-to-skin care, and sucrose during blood sampling on intention to recommend the video or advocate for use of the interventions. In July 2014, the video and an electronic survey were produced and posted. After 1 year, the online viewer survey responses and YouTube analytics were analyzed.

Effects of Targeting Higher or Lower Oxygen Saturations in Centers with More Versus Less Separation between Median Saturations.

Subgroup analysis of the Canadian Oxygen Trial to compare outcomes of extremely preterm infants in centers with more versus less separation between median arterial oxygen saturations in the two target ranges Centers with more separation observed lower rates of death or disability in the 85%-89% range than in the 91%-95% target range.

A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol.

Background: There are wide variations in maternal-newborn care practices and outcomes across Ontario. To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal-newborn care. The dashboard provides (1) near real-time feedback, with site-specific and peer comparison data about six key performance indicators; (2) a visual display of evidence-practice gaps related to the indicators; and (3) benchmarks to provide direction for practice change.

Performance Evaluation of New-Generation Pulse Oximeters in the NICU: Observational Study.

This crossover observational study compares the data characteristics and performance of new-generation Nellcor OXIMAX and Masimo SET SmartPod pulse oximeter technologies. The study was conducted independent of either original equipment manufacturer (OEM) across eleven preterm infants in a Neonatal Intensive Care Unit (NICU). The SmartPods were integrated with Dräger Infinity Delta monitors.

β-trace protein may be a more suitable marker of neonatal renal function.

Background: To determine the relationship between maternal and neonatal cystatin C (CysC) and β-trace protein (BTP), markers of glomerular filtration rate (GFR) on day 1 of life.

Methods: Blood levels of CysC, BTP, and creatinine (Cr) were analyzed from 128 healthy term and preterm neonates admitted to the neonatal intensive care unit (NICU) (36% female) to determine the relationship between gestational age and maternal levels on day 1 of life.

Results: Maternal Cr correlated positively and significantly with neonatal Cr (r = 0.

Ingested soluble CD14 from milk is transferred intact into the blood of newborn rats.

Background: Milk acts as an edible immune system that is transferred from mother to newborn. Soluble Cluster of Differentiation 14 (sCD14) is a protein found in significant quantities in human milk (~8-29 µg/ml). At a 10-fold lower concentration in the blood (~3 µg/ml), the most notable role of sCD14 is to sequester lipopolysaccharides of Gram-negative bacteria from immune cells.

Free thyroxine and thyroid-stimulating hormone reference intervals in very low birth weight infants at 3-6 weeks of life with the Beckman Coulter Unicel DxI 800.

Objectives: To establish reference intervals for thyroid stimulating hormone (TSH) and free thyroxine (FT4) at 3-6 weeks of age in very low birth weight (VLBW) infants with the Beckman Coulter Unicel DxI 800 by gender, birth weight (BW) and gestational age (GA) subgroups.

Design And Methods: A 4 year retrospective cohort of 308 VLBW infants (GA=27.9 weeks, BW=992.

The use of a quality indicator to reduce elective repeat Caesarean section for low-risk women before 39 weeks' gestation: the Eastern Ontario experience.

Objective: Elective repeat Caesarean section (ERCS) for low-risk women at < 39 weeks' gestation has consistently been associated with increased risks to the neonate, including respiratory morbidity, NICU admission, and lengthier hospital stays than ERCS at 39 to 40 weeks' gestation. The objective of this quality improvement project was to reduce high rates of ERCS < 39 weeks across the Eastern Ontario region.

Methods: All hospitals within the region providing care during labour and birth (n = 10) were asked to participate.