Construction of a comprehensive fetal monitoring database for the study of perinatal hypoxic ischemic encephalopathy.

This article describes the methods used to build a large-scale database of more than 250,000 electronic fetal monitoring (EFM) records linked to a comprehensive set of clinical information about the infant, the mother, the pregnancy, labor, and outcome. The database can be used to investigate how birth outcome is related to clinical and EFM features. The main steps involved in building the database were: (1) Acquiring the raw EFM recording and clinical records for each birth.

Comparison of Wired and Wireless Heart Rate Monitoring in the Neonatal Intensive Care Unit.

In the Neonatal Intensive Care Unit (NICU), infants' vital signs are monitored on a continuous basis via wired devices. These often interfere with patient care and pose increased risks of skin damage, infection, and tangling around the body. Recently, a wireless system for neonatal monitoring called ANNEⓇ One (Sibel Health, Chicago, USA) was developed.

Accounting for Nulliparity in the Prediction of Hypoxic-Ischemic Encephalopathy Using Cardiotocography.

Nulliparous pregnancies, those where the mother has not previously given birth, are associated with longer labors and hence expose the fetus to more contractions and other adverse intrapartum conditions such as chorioamnionitis. The objective of the present study was to test if accounting for nulliparity could improve the detection of fetuses at increased risk of developing hypoxic-ischemic encephalopathy (HIE). During labor, clinicians assess the fetal heart rate and uterine pressure signals to identify fetuses at risk of developing HIE.

The use of wireless sensors in the neonatal intensive care unit: a study protocol.

Background: Continuous monitoring of vital signs and other biological signals in the Neonatal Intensive Care Unit (NICU) requires sensors connected to the bedside monitors by wires and cables. This monitoring system presents challenges such as risks for skin damage or infection, possibility of tangling around the patient body, or damage of the wires, which may complicate routine care. Furthermore, the presence of cables and wires can act as a barrier for parent-infant interactions and skin to skin contact.

Clinical usefulness of reintubation criteria in extremely preterm infants: a cohort study.

Objective: To describe the thresholds of instability used by clinicians at reintubation and evaluate the accuracy of different combinations of criteria in predicting reintubation decisions.

Design: Secondary analysis using data obtained from the prospective observational Automated Prediction of Extubation Readiness study (NCT01909947) between 2013 and 2018.

Setting: Multicentre (three neonatal intensive care units).

Wireless monitoring devices in hospitalized children: a scoping review.

The purpose of this study is to provide a structured overview of existing wireless monitoring technologies for hospitalized children. A systematic search of the literature published after 2010 was conducted in Medline, Embase, Scielo, Cochrane, and Web of Science. Two investigators independently reviewed articles to determine eligibility for inclusion.

Non-Parametric Nonlinear Parameter-Varying Parallel-Cascade Identification of Dynamic Joint Stiffness.

Objective: The paper presents a method to identify ankle joint dynamic stiffness during functional tasks where intrinsic and reflex stiffness change with a time-varying scheduling variable (SV), such as joint position or torque.

Methods: The method models joint stiffness with two pathways: (1) A parameter-varying (PV) impulse response function (IRF) describing intrinsic stiffness; and (2) a reflex stiffness model comprising a PV static nonlinearity followed by a PV linear element.

Results: Monte-Carlo simulations demonstrated that the method accurately estimated all elements of the intrinsic and reflex pathways as they changed with a SV.

Multi-Chain Semi-Markov Analysis of Intrapartum Cardiotocography.

Visual assessment of the evolution of fetal heart rate (FHR) and uterine pressure (UP) patterns is the standard of care in the intrapartum period. Unfortunately, this assessment has high levels of intra- and inter-observer variability. This study processed and analyzed FHR and UP patterns using computerized pattern recognition tools.

The Nonlinear Dynamic Response of Intrapartum Fetal Heart Rate to Uterine Pressure.

The research objective of our group is to improve the intrapartum detection of cardiotocography tracings associated with an increased risk of developing fetal acidosis and subsequent hypoxic-ischemic encephalopathy (HIE). The detection methods that we aim to develop must be sensitive to abnormal tracings without causing excessive unnecessary interventions. Past studies showed that the dynamic response of fetal heart rate (FHR) to uterine pressure (UP) during the intrapartum could be modelled using linear systems.

Age at First Extubation Attempt and Death or Respiratory Morbidities in Extremely Preterm Infants.

Objective: To describe the timing of first extubation in extremely preterm infants and explore the relationship between age at first extubation, extubation outcome, and death or respiratory morbidities.

Study Design: In this subanalysis of a multicenter observational study, infants with birth weights of 1250 g or less and intubated within 24 hours of birth were included. After describing the timing of first extubation, age at extubation was divided into early (within 7 days from birth) vs late (days of life 8-35), and extubation outcome was divided into success vs failure (reintubation within 7 days after extubation), to create 4 extubation groups: early success, early failure, late success, and late failure.

Automated prediction of extubation success in extremely preterm infants: the APEX multicenter study.

Background: Extremely preterm infants are frequently subjected to mechanical ventilation. Current prediction tools of extubation success lacks accuracy.

Methods: Multicenter study including infants with birth weight ≤1250 g undergoing their first extubation attempt.

Identification of human balance control responses to visual inputs using virtual reality.

Human upright balance is maintained through feedback mechanisms that use a variety of sensory modalities. Vision senses information about the position and velocity of the visual surround motion to improve balance by reducing the sway evoked by external disturbances. This study characterized the effects of visual information on human anterior-posterior body sway in upright stance by presenting perturbations through a virtual reality system.

Identification of Central and Stretch Reflex Contributions to Human Postural Control.

Human postural control requires continuous modulation of ankle torque to stabilize the upright stance. The torque is generated by two components: active contributions, due to central control and stretch reflex, and passive mechanisms, due to joint intrinsic stiffness. Identifying the contribution of each component is difficult, since their effects appear together, and standing is controlled in closed-loop.

Contributions of Vision in Human Postural Control: A Virtual Reality-based Study.

During human standing, it has been previously observed that information about the position and frequency of visual surround motion improves balance by reducing sway responses to external disturbances. However, experimental limitations only allowed for independent investigation of such parameters while being incapable of providing a fully immersive experience of a real environment. The aim of this study is to investigate the effect of visual information on dynamic body sway in the human upright stance by presenting perturbations through a virtual reality (VR) system.

Automatic unsupervised respiratory analysis of infant respiratory inductance plethysmography signals.

Infants are at risk for potentially life-threatening postoperative apnea (POA). We developed an Automated Unsupervised Respiratory Event Analysis (AUREA) to classify breathing patterns obtained with dual belt respiratory inductance plethysmography and a reference using Expectation Maximization (EM). This work describes AUREA and evaluates its performance.

A Model-Based Insulin Dose Optimization Algorithm for People With Type 1 Diabetes on Multiple Daily Injections Therapy.

Objective: Multiple daily injections (MDI) therapy is the most common treatment for type 1 diabetes (T1D) including basal insulin doses to keep glucose levels constant during fasting conditions and bolus insulin doses with meals. Optimal insulin dosing is critical to achieving satisfactory glycemia but is challenging due to inter- and intra-individual variability. Here, we present a novel model-based iterative algorithm that optimizes insulin doses using previous-day glucose, insulin, and meal data.

Postprandial hyperglycaemia following insulin suspensions by the artificial pancreas: Implications for bolus calculators.

Conventional bolus calculators apply negative prandial corrections when premeal glucose levels are low. However, no study has evaluated the need for this negative correction with closed-loop systems. We analysed data retrospectively from a cohort study evaluating a closed-loop artificial pancreas system conducted in a diabetes camp over a period of 11 days.

A pilot non-inferiority randomized controlled trial to assess automatic adjustments of insulin doses in adolescents with type 1 diabetes on multiple daily injections therapy.

Background: Multiple daily injections (MDI) therapy for type 1 diabetes involves basal and bolus insulin doses. Non-optimal insulin doses contribute to the lack of satisfactory glycemic control. We aimed to evaluate the feasibility of an algorithm that optimizes daily basal and bolus doses using glucose monitoring systems for MDI therapy users.

A Closed-Loop Method to Identify EMG-Torque Dynamics in Human Balance Control.

Human balance control requires continuous modulation of ankle torque by central and spinal activation of the ankle muscles combined with the intrinsic mechanical stiffness of the joint. These components appear together and cannot be measured separately. This work presents a novel multiple-input, single-output, closed-loop identification method that decomposes the ankle torque in human balance control into its central, stretch reflex, and intrinsic components.

Patterns of muscle activation and modulation of ankle intrinsic stiffness in different postural operating conditions.

Intrinsic stiffness describes the dynamic relationship between imposed angular perturbations to a joint and the resulting torque response, due to intrinsic mechanical properties of muscles and joint, and inertia of the limbs. Recently, we showed that ankle intrinsic stiffness changes substantially with sway in normal standing. In the present study, we documented how ankle intrinsic stiffness changes with postural operating conditions.

Assessment of Extubation Readiness Using Spontaneous Breathing Trials in Extremely Preterm Neonates.

Importance: Spontaneous breathing trials (SBTs) are used to determine extubation readiness in extremely preterm neonates (gestational age ≤28 weeks), but these trials rely on empirical combinations of clinical events during endotracheal continuous positive airway pressure (ET-CPAP).

Objectives: To describe clinical events during ET-CPAP and to assess accuracy of comprehensive clinical event combinations in predicting successful extubation compared with clinical judgment alone.

Design, Setting, And Participants: This multicenter diagnostic study used data from 259 neonates seen at 5 neonatal intensive care units from the prospective Automated Prediction of Extubation Readiness (APEX) study from September 1, 2013, through August 31, 2018.