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Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units.

ABSTRACT: Standard clinical care in neonatal and pediatric intensive-care units (NICUs and PICUs, respectively) involves continuous monitoring of vital signs with hard-wired devices that adhere to the skin and, in certain instances, can involve catheter-based pressure sensors inserted into the arteries. These systems entail risks of causing iatrogenic skin injuries, complicating clinical care and impeding skin-to-skin contact between parent and child. Here we present a wireless, non-invasive technology that not only offers measurement equivalency to existing clinical standards for heart rate, respiration rate, temperature and blood oxygenation, but also provides a range of important additional features, as supported by data from pilot clinical studies in both the NICU and PICU. These new modalities include tracking movements and body orientation, quantifying the physiological benefits of skin-to-skin care, capturing acoustic signatures of cardiac activity, recording vocal biomarkers associated with tonality and temporal characteristics of crying and monitoring a reliable surrogate for systolic blood pressure. These platforms have the potential to substantially enhance the quality of neonatal and pediatric critical care.

SUBMITTER: Chung HU

PROVIDER: S-EPMC7315772 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units.

Chung Ha Uk HU Rwei Alina Y AY Hourlier-Fargette Aurélie A Xu Shuai S Lee KunHyuck K Dunne Emma C EC Xie Zhaoqian Z Liu Claire C Carlini Andrea A Kim Dong Hyun DH Ryu Dennis D Kulikova Elena E Cao Jingyue J Odland Ian C IC Fields Kelsey B KB Hopkins Brad B Banks Anthony A Ogle Christopher C Grande Dominic D Park Jun Bin JB Kim Jongwon J Irie Masahiro M Jang Hokyung H Lee JooHee J Park Yerim Y Kim Jungwoo J Jo Han Heul HH Hahm Hyoungjo H Avila Raudel R Xu Yeshou Y Namkoong Myeong M Kwak Jean Won JW Suen Emily E Paulus Max A MA Kim Robin J RJ Parsons Blake V BV Human Kelia A KA Kim Seung Sik SS Patel Manish M Reuther William W Kim Hyun Soo HS Lee Sung Hoon SH Leedle John D JD Yun Yeojeong Y Rigali Sarah S Son Taeyoung T Jung Inhwa I Arafa Hany H Soundararajan Vinaya R VR Ollech Ayelet A Shukla Avani A Bradley Allison A Schau Molly M Rand Casey M CM Marsillio Lauren E LE Harris Zena L ZL Huang Yonggang Y Hamvas Aaron A Paller Amy S AS Weese-Mayer Debra E DE Lee Jong Yoon JY Rogers John A JA

Nature medicine 20200311 3

Standard clinical care in neonatal and pediatric intensive-care units (NICUs and PICUs, respectively) involves continuous monitoring of vital signs with hard-wired devices that adhere to the skin and, in certain instances, can involve catheter-based pressure sensors inserted into the arteries. These systems entail risks of causing iatrogenic skin injuries, complicating clinical care and impeding skin-to-skin contact between parent and child. Here we present a wireless, non-invasive technology th ...[more]

PMID: 32161411

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Project description:Decolonization with topical antibiotics is necessary to control outbreaks of multidrug-resistant bacterial infection in the Neonatal Intensive Care Unit (NICU), but can trigger bacterial resistance. The objective of this study was to determine whether skin-to-skin contact of newborns colonized with Methicillin-Oxacillin Resistant Staphylococcus aureus or Methicillin-Oxacillin-Resistant Coagulase-Negative Staphylococcus aureus (MRSA/MRSE) with their mothers could be an effective alternative to promote bacterial decolonization of newborns' nostrils.We performed a randomized clinical trial with 102 newborns admitted to the NICU in three hospitals in São Luís, Brazil. Inclusion criteria were birth weight of 1300 to 1800 g, more than 4 days of hospitalization, newborns with positive nostril cultures for MRSA and/or multidrug-resistant coagulase-negative Staphylococcus and mothers not colonized by these bacteria. We used a random number algorithm for randomization. Allocation was performed using sealed opaque envelopes. Skin-to-skin contact was given twice a day for 60 minutes for seven consecutive days. The control group received routine care without skin-to-skin contact. There was no masking of newborn's mothers or researchers but the individuals who carried out bacterial cultures and assessed results were kept blind to group allocation. The primary outcome was colonization status of newborns' nostrils after 7 days of intervention. The directional hypothesis was that more newborns who receive skin-to-skin holding 2 hours/day for 7 days than newborns who receive normal care will be decolonized.Decolonization of MRSA/MRSE was greater in the intervention group (Risk Ratio?=?2.27; 95% CI 1.27-4.07, p-value?=?0.003). Number Needed to Treat (NNT) was 4.0 (95% CI 2.2 - 9.4). After adjustment for the possible confounding effects of small for gestational age birth, antibiotic use, need for resuscitation, sex and cesarean delivery, skin-to-skin contact remained strongly associated with decolonization of newborns' nostrils from MRSA/MRSE bacteria (p?=?0.007). There was no need to interrupt the trial for safety reasons.Skin-to-skin contact might be an effective and safe method for promoting decolonization of newborns' nostrils colonized by MRSA/MRSE.The study was registered with ClinicalTrials.gov ( NCT01498133 , November 21, 2011).

Dataset Information

Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units.

Publications

Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units.

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