Neonatal Monitoring: Current Practice and Future Trends

Neonatal Monitoring: Current Practice and Future Trends

Wei Chen (Eindhoven University of Technology, The Netherlands), Sidarto Bambang Oetomo (Máxima Medical Center, The Netherlands) and Loe Feijs (Eindhoven University of Technology, The Netherlands)
DOI: 10.4018/978-1-61520-670-4.ch045

Abstract

This chapter focuses on monitoring vital health parameters for a particular group of patients - critically ill newborn infants in neonatal intensive care units (NICU) at hospitals. These neonates are extremely tiny and vulnerable. Thus, health monitoring for the neonates provides crucial parameters for urgent diagnoses and corresponding medical procedures, subsequently increasing the survival rates. Neonatal monitoring is a multidisciplinary area which involves a unique integration of knowledge from medical science, design, technology and social study. In this chapter, the authors introduce current status and new developments in neonatal monitoring. They present some ongoing research examples of non-invasive neonatal monitoring designed and developed at the department of Industrial Design and the department of Electrical Engineering, Eindhoven University of Technology (TU/e) in collaboration with the department of neonatology, Máxima Medical Center (MMC), Veldhoven, in the Netherlands, including the first prototype smart jacket, a wireless power supply and video signal processing for neonatal monitoring. Challenges and social impacts of non-invasive neonatal monitoring will be discussed.
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Introduction

The word “neonate” refers to the infant's first four weeks after birth (Thomas, 1980). Neonatology is a subspecialty of Pediatrics that cares for newborn infants, especially the ill or premature newborn infants. Neonatal monitoring refers to monitor vital physiological parameters of neonates. Monitoring of the newborn is an old biological phenomenon. All species of the animal kingdom monitor their offspring from birth, using the sense organs for smelling, tasting, feeling, seeing and hearing (Smith, 1980). Critically ill neonates are a special group of patients that consists of premature infants and full term infants that became severely ill during or immediately after birth. Premature infants are babies that are born after a pregnancy lasting 37 weeks or less. Critically ill preterm neonates can weigh as little as 500 g with a size of our palm and are highly vulnerable to external disturbances. Premature neonates are normally admitted to neonatal incubators in Neonatal Intensive Care Units (NICU). Neonatal medicine has progressed strongly in the past decades. Continuous health monitoring for the neonates provides crucial parameters for urgent diagnoses so that adequate medical treatment can be instituted. Recent advances over the last decades in medical treatments resulted in a significant increase of survival. As a result, neonates born after 25 weeks of pregnancy can survive with appropriate medical care in NICU (Costeloe, 2000). Therefore, incubators are populated by steadily younger neonates, whose survival and long-term health prospects depend strongly on reliable and comfortable health-status monitoring systems.

The Eindhoven University of Technology (TU/e) in the Netherlands has started a 10-year project on non-invasive perinatal monitoring in cooperation with the Máxima Medical Centre (MMC) in Veldhoven, the Netherlands. The goal of this project is to improve the healthcare of the pregnant woman, and her child before, during and after delivery.

In this chapter, we focus on the current practice and future trends of neonatal monitoring. The NICU environment, the technologies for physiological measurements, and the different users all contribute to the current practice of neonatal monitoring. Understanding the current practice is important for the future development of this multi-disciplinary area. As the existing neonatal monitoring systems meet the pressing needs of users and society at best partly, innovations will be needed to achieve the required degrees of functionality, reliability, robustness, comfort, and ease of use. These innovations aim to strongly improve comfort and reliability of neonatal monitoring systems, so as to improve the neonates’ comfort and quality of life later on, to enhance the parent-child interaction, and to alleviate workload of clinical staff.

In order to understand the nature of the innovations which arise now and which can be expected and created in the future, we propose the following innovation model (see Figure 1). The model contains ten types of professional activities, all of which are happening in parallel. These are shown as rounded boxes. Moreover the model contains several interactions between the activities. The interactions include information flow as well as transfer of working prototypes and products. The interactions can be understood as feed forward and feedback. The innovation model thus becomes a closed system. The four leftmost activities represent four major areas of research and development (R&D). It is essential to appreciate the fact that these are conducted not just for the sake of neonatal monitoring only. They are driven by technological roadmaps, some of which are self-propelling, and all of which assume huge emerging consumer markets for embedded systems, wearable electronics and ambient intelligence. Neonatal monitoring is just one of these markets, at best. More realistically is to assume that it represents an interesting niche and a forerunner for larger markets, eventually targeting older and less critically ill children. In other words, there is a technology push of which the development of neonatal monitoring can take great advantage. The latter development is represented by the middle area with three activities which speak for themselves. Next to the abovementioned feed forwards there is also an input from clinical neonatal practice, viz. the explicitly formulated needs which arise in clinical practice. The major output of the integration and prototyping activity inside the development for neonatal monitoring consists of working prototypes which, when approved by the ethical committee, can be put to the test (clinical validation). The neonatal development informs the technological R&D of its needs and experiences, as shown by the dotted curved arrows.

Figure 1.

Innovation model

Key Terms in this Chapter

Apnoea: A pause during respiration. When the period lasts 20 seconds or more then it is considered as a pathologic apnoea.

Pulse Oximeter: Pulse oximetry is a well-known non-invasive method for monitoring the percentage of hemoglobine that is saturated with oxygen. A pulse oximeter consists of light sources that emit light at wavelengths of red and infra-red and a photo detector that measures the absorption of light by the blood in the underlying tissues. Transmission and reflectance are two methods to perform pulse oximetry

Smart Textiles: Textile fabrics which have special physical properties such as electric conductivity, temperature-dependent colors etc. Also more generally, assemblies of traditional textiles, conductive yarns and other yarns with special physical properties together with embedded electronic systems.

Thermistor: A type of resistor with resistance varying according to its temperature. In neonatology, thermistors are used for monitoring core body temperature and skin temperature.

Cerebral Function Monitoring (CFM): A device for monitoring background brain activity using a filtered, rectified and compressed EEG signal.

Pre-Term: An infant born before the 37th week of pregnancy.

Contactless Energy Transfer (CET): A process in which electrical energy is transferred between two or more electrical devices through inductive coupling as opposed to energy supply through conventional “plug and socket” connectors. The main method through which energy is transferred in the system is by magnetic fields and the mutual inductance between their primary and secondary coils.

Kangaroo Mother Care: A way of holding a baby on the chest so that there is skin-to-skin contact between the infant and the person holding it.

Hypothermia: In neonatology, this is a condition in which an infant’s temperature drops below 36.5° that is required for normal metabolism and bodily functions.

Neonate: A newborn infant, especially an infant less than a month old.

Phototherapy: A method used to treat jaundice. It consists of fluorescent lights placed over the incubator.

Bradycardia: A slow heart rate. In neonatology, it is a decrease in the baby’s heart rate to below 100. Below 60 is considered severe bradycardia.

Neonatology: A subspecialty of pediatrics that cares for newborn infants, especially the ill or premature newborn infants.

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