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Infants are exceptionally fragile and physically vulnerable. Continuous monitoring of their vital characteristics and physiological parameters is vital for assessing their exact health status. The progressive achievements of bioelectrical, biophysical, biochemical and hybrid soft monitoring technologies in infant are discussed. We offer insights into the remaining challenges and translational hurdles of soft electronics for clinical-grade infant monitoring from the benchtop to the bedside. [Display omitted] Infants are exceptionally fragile and physically vulnerable who need special healthcare. Continuous monitoring of vital information of infants is essential for understanding their health status. Whereas modern infant health monitoring is carried out with dedicated facilities in controlled hospital settings, they are associated with several issues such as potential iatrogenic injuries, barriers for skin-to-skin parental bonding, and even complications during basic clinical tasks. Recently, soft electronics have become an accessory and mobile infant monitoring platform with remarkable advantages over existing technologies. This review comprehensively summarizes the research advances on soft electronics for advanced infant monitoring. We first introduce the physiological characteristics from anatomy, diseases, and treatments of infants. In accordance with these characteristics, we discuss the progressive achievements of soft bioelectrical, biophysical, biochemical, and hybrid monitoring technologies for infants. In addition, we offer insights into the remaining challenges and future directions of a soft electronics based intelligent system for clinical-grade infant monitoring from sensor design, data processing, power supply, and digital interactions in the era of Internet of Things. Finally, we highlight the translational challenges to be considered in bringing soft electronics for infant monitoring from the benchtop to the bedside. [ABSTRACT FROM AUTHOR]

The evaluation of a parent-completed screening system, the Infant Monitoring Questionnaires, found: 86 percent to 91 percent agreement between classifications of infants made using standardized tests and the questionnaires, low under-screening and over-screening rates (0 percent to 11 percent), high inter-observer and test-retest agreement, and low cost. (Author/DB)

Infant monitoring is very important in daily life, since infants lack the ability to verbalize and communicate with their caregivers. However, a full-time monitoring provided by caregivers or practitioners is very expensive and labor intensive. To solve the practical difficulties for particular nighttime monitoring and further reduce the labor cost, in this article, we propose a novel 24-hour infant monitoring system, enabling continuous monitoring for infant discomfort detection using both Red-Green-Blue (RGB) and Near Infrared-light (NIR) videos. The proposed algorithm is robust to arbitrary head rotations, occlusions and face profiles. For this purpose, a Faster R-CNN architecture is first pre-trained with the ImageNet dataset, and then fine-tuned with a specific training dataset of different infant expressions. Our proposed method obtains an Average Precision of more than 87% for classifying discomfort expression. Infant monitoring during the nighttime using NIR videos is proposed for the first time, and the presented system enables reflux disease analysis and continuous remote home monitoring in a more relaxed environment, which is largely preferred by pediatricians and parents. [ABSTRACT FROM AUTHOR]

This article presents an indoor infant monitoring system based on Android system which employs a low-cost Bluetooth Low Energy (BLE) pseudolite to accurately locate the infants in the activity indoors and timely remind the parents. It can achieve a positioning accuracy better than 2 m and effectively reduce the risk of injury to infants and young children. The performance of the proposed system, using false negative rate, false alarm rate, and alarm response time as indicators, is compared with that of the system using Quuppa as a positioning source. The experiment results show that both BLE pseudolite and Quuppa as a positioning source can basically meet the positioning accuracy for the infant monitoring system, but the BLE-pseudolite-based system provides a more cost-efficient solution. [ABSTRACT FROM AUTHOR]

Background As part of the Collaborative Home Infant Monitoring Evaluation, a home monitor was developed to record breathing, heart rate, other physiologic variables, and the time the monitor was used. Objective To determine the frequency of monitor use, factors that influence use, and validity of a model developed to predict use. Design We developed a model to predict monitor use using multiple linear regression analysis; we then tested the validity of this model to predict adherence for the first week of monitoring and for the subsequent 4-week period (weeks 2-5). Setting Clinical research centers in Chicago, Ill; Cleveland, Ohio; Honolulu, Hawaii; Los Angeles, Calif; and Toledo, Ohio. Patients Preterm infants, infants younger than 1 month with a history of autopsy-confirmed sudden infant death syndrome in a sibling, and infants with an idiopathic apparent life-threatening event were divided into 2 cohorts based on enrollment date. Main Outcome Measure Mean hours of monitor use per week. Results In cohort 1, the variables available before monitoring were only weakly associated with total hours of monitor use in weeks 2 to 5 (total model r2 = 0.08). However, when hours of monitor use in week 1 were included as a variable to predict monitor use in weeks 2 to 5, the r2 increased to 0.64 for hours of monitor use per week. Conclusions Our data show that monitor use in the first week was the most important variable for predicting subsequent monitor use. The study suggests that a major focus of home monitoring should be adherence in the first week, although it remains to be tested whether this adherence can be altered. [ABSTRACT FROM AUTHOR]

Background: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers' group is instrumental for policy makers, health care providers, and researchers. Objective: This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed. Methods: Data were extracted from a Facebook mothers' group in May 2019. After trialing various search terms, searching for the term "SIDS" on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers. Results: Of the shared photos relating to the infant sleep environment, 86% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified. Conclusions: This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers. [ABSTRACT FROM AUTHOR]

The manual monitoring of young infants suffering from diseases like reflux is significant, since infants can hardly articulate their feelings. In this work, we propose a video-based infant monitoring system for the analysis of infant expressions and states, approaching real-time performance. The expressions of interest consist of discomfort, unhappy, joy and neutral, whereas states include sleep, pacifier and open mouth. Benefiting from the expression analysis, the discomfort moments can also be used and correlated with a symptom-related disease, such as a reflux measurement for the diagnosis of gastroesophageal reflux. The system consists of three components: infant expressions and states detection, object tracking and detection compensation. The proposed system is based on combining expression detection using Fast R-CNN with a compensated detection using analyzing information from the previous frame and utilizing a Hidden Markov Model. The experimental results show a mean average precision of 81.9% and 84.8% for 4 infant expressions and 3 states evaluated with both clinical and daily datasets. Meanwhile, the average precision for discomfort detection achieves up to 90%. [ABSTRACT FROM AUTHOR]

The Infant Monitoring Project is designed to identify infants in need of further evaluation, by having parents complete a set of questionnaires about their infant's development at four-six month intervals. Evaluation of the questionnaires has shown that they are low-cost and have substantial agreement with standardized assessments. (Author/JDD)

Remote in-home infant monitoring technologies hold great promise for increasing the scalability and safety of infant research (including in regard to the current Covid-19 pandemic), but remain rarely employed. These technologies hold a number of fundamental challenges and ethical concerns that need addressing to aid the success of this fast-growing field. In particular, the responsible development of such technologies requires caregiver input. We conducted a survey of the opinions of 410 caregivers on the viability, privacy and data access of remote in-home monitoring technologies and study designs. Infant-friendly wearable devices (such as sensing body suits) were viewed favourably. Caregivers were marginally more likely to accept video and audio recording in the home if data was anonymised (through automated processing) at point of collection, particularly when observations were lengthy. Caregivers were more open to international data sharing for anonymous data. Caregivers were interested in viewing all types of data, but were particularly keen to access video and audio recordings for censoring purposes (i.e., to delete data segments). Taken together, our results indicate generally positive attitudes to remote in-home monitoring technologies and studies for infant research but highlight specific considerations such as safety, privacy and family practicalities (e.g. multiple caregivers, visitors and varying schedules) that must be taken into account when developing future studies. [ABSTRACT FROM AUTHOR]

In this revolutionary world, we are noticing an exponential increase in women's workforce. This has become one of the main reasons that affect baby care in many families from the birth of the baby to a certain age. The most vital factors that are to be followed in infants are body temperature and sleep patterns. In this IOT and ML Project, which is based on baby monitoring system, which is a smart cradle structure, tracks the overall temperature of the room and its humidity with sound of the baby, and all these data received from the IOT sensor network will be processed using Raspberry Pi and transferred to a web platform and checked in real-time. If the baby is crying, the cradle will start swinging automatically. If we observe any increase in the room temperature, the fan will be turned on. This project is included with an emotion recognition unit. Furthermore, it stores data in private cloud servers and includes a GUI. The end result of our proposed experiment indicates that this assistant could ease some workload of parents and enable them to take utmost care of their infants. [ABSTRACT FROM AUTHOR]

The decline in birth rates has raised concerns about the safety of infants and young children (0–18 months), particularly those who suffer suffocation or even death during sleep from their own or external causes. How to ensure that infants and young children can safely pass through this dangerous period after birth is the focus of this project. This article focuses on sleeping infants and young children as the subject of research. Blood oxygen sensors and heart rate sensors attached to socks are used to monitor changes in blood oxygen and heart rate when infants and young children experience asphyxia. The changes are then transmitted via Bluetooth to a mobile app and an alarm sound is generated to act as a good warning. At the same time, the researchers received good feedback from testing the garments on two babies and toddlers, indicating they provide an effective warning. [ABSTRACT FROM AUTHOR]

Introduction: Tenofovir disoproxil fumarate (TDF) is a common drug of choice for pre‐exposure prophylaxis (PrEP) or as a combination HIV treatment for pregnant women. In‐utero exposure to TDF was found to be associated with lower bone mineral content (BMC) in HIV‐exposed uninfected neonates. Data for infants born to women taking TDF‐PrEP are lacking. The CAP016 randomized control trial was conducted in South Africa between September 2017 and August 2021 and pregnant women either initiated TDF/FTC PrEP in pregnancy (Immediate PrEP arm‐IP) or at cessation of breastfeeding (Deferred PrEP arm‐DP). In a secondary data analysis, we evaluated BMC in HIV‐unexposed infants in the CAP016 trial in the first 18 months of life in association with maternal TDF‐PrEP use during pregnancy. Methods: Infants born to women randomized to the IP arm or DP arm in the CAP016 clinical trial had BMC measurements of the whole body with head (WBH) and lumbar spine (LS) by dual energy X‐ray absorptiometry (DXA) at 6, 26, 50 and 74 weeks. Results: Of 481 infants born to women enrolled in the CAP016 clinical trial, 335 (69.6%) infants had a minimum of one DXA scan of the WBH and LS between 6 and 74 weeks of age (168 IP and 167 DP). Women in the IP arm received TDF‐FTC PreP for a median of 19 weeks between initiation in pregnancy and delivery. Using a mixed linear regression model and adjusted for gestational age, sex and ever‐breastfed, the mean difference (95% CI) for BMC of the WBH between IP and DP arms were −0.74 (−8.69 to 7.20), −1.26 (−10.75 to 8.23), −9.17 (−20.02 to 1.69) and 5.02 (−6.74 to 16.78) g at 6, 26, 50 and 74 weeks (p = 0.283). Mean differences in BMC of the LS were 0.07 (−0.10 to 0.23), 0.02 (−0.18 to 0.22), −0.14 (−0.36 to 0.09) and 0.14 (−0.11 to 0.38) g at 6, 26, 50 and 74 weeks, respectively (p = 0.329). Conclusions: In a randomized controlled trial, there were no differences in BMC of the WBH and LS between infants exposed to in‐utero TDF‐FTC PrEP and unexposed infants in the first 18 months of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rolling is an important developmental milestone for infants where identifying the coordinated movement patterns could facilitate the early identification of motor development delays. Current methods for identifying coordinated movements of rolling are limited to a laboratory setting and not feasible for clinicians. OBJECTIVE: To develop video-based methods in which six coordinated movements, previously defined through motion capture, can be identified through video alone. METHODS: Forty-five videos of sixteen healthy infants achieving a roll were used to develop the video-based methodology and twenty-four videos had corresponding motion capture data used for validation. Four raters comprised of researchers and a clinician identified rolling coordination using the new video-based methods. A Fleiss' Kappa statistical test determined the inter- and intra-rater reliability of agreement for the new methodology and compared it to motion capture. RESULTS: The comparison of the motion capture and video-based methods resulted in substantial agreement. The video-based methods inter- and intra-rater reliability were substantial and almost perfect, respectively. CONCLUSIONS: We developed reliable methodology to accurately identify the coordinated movements of infant rolling using only 2D video. This methodology will allow researchers to reliably define coordinated movements of infants through video alone and may assist clinicians in identifying possible motor development delays and disorders. [ABSTRACT FROM AUTHOR]

Introduction: Models of attachment and information processing suggest that the attention infants allocate to social information might occur in a schemadriven processing manner according to their attachment pattern. A major source of social information for infants consists of facial expressions of emotion. We tested for differences in attention to facial expressions and emotional discrimination between infants classified as securely attached (B), insecureavoidant (A), and insecure-resistant (C). Methods: Sixty-one 14-month-old infants participated in the Strange Situation Procedure and an experimental task of Visual Habituation and Visual Paired- Comparison Task (VPC). In the Habituation phase, a Low-Arousal Happy face (habituation face) was presented followed by a VPC task of 6 trials composed of two contrasting emotional faces always involving the same actress: the one used in habituation (trial old face) and a new one (trial new face) portraying changes in valence (Low-Arousal Angry face), arousal (High-Arousal Happy face), or valence + arousal (High-Arousal Angry face). Measures of fixation time (FT) and number of fixations (FC) were obtained for the habituation face, the trial old face, the trial new face, and the difference between the trial old face and the trial new face using an eye-tracking system. Results: We found a higher FT and FC for the trial new face when compared with the trial old face, regardless of the emotional condition (valence, arousal, valence + arousal contrasts), suggesting that 14-month-old infants were able to discriminate different emotional faces. However, this effect differed according to attachment pattern: resistant-attached infants (C) had significantly higher FT and FC for the new face than patterns B and A, indicating they may remain hypervigilant toward emotional change. On the contrary, avoidant infants (A) revealed significantly longer looking times to the trial old face, suggesting overall avoidance of novel expressions and thus less sensitivity to emotional change. Discussion: Overall, these findings corroborate that attachment is associated with infants' social information processing. [ABSTRACT FROM AUTHOR]

Reliability of classification performance is important for many biomedical applications. A classification model which considers reliability in the development of the model such that unreliable segments are rejected would be useful, particularly, in large biomedical data sets. This approach is demonstrated in the development of a technique to reliably determine sleep and wake using only the electrocardiogram (ECG) of infants. Typically, sleep state scoring is a time consuming task in which sleep states are manually derived from many physiological signals. The method was tested with simultaneous 8-h ECG and polysomnogram (PSG) determined sleep scores from 190 infants enrolled in the collaborative home infant monitoring evaluation (CHIME) study. Learning vector quantization (LVQ) neural network, multilayer perceptron (MLP) neural network, and support vector machines (SVMs) are tested as the classifiers. After systematic rejection of difficult to classify segments, the models can achieve 85%-87% correct classification while rejecting only 30% of the data. This corresponds to a Kappa statistic of 0.65-0.68. With rejection, accuracy improves by about 8% over a model without rejection. Additionally, the impact of the PSG scored indeterminate state epochs is analyzed. The advantages of a reliable sleep/wake classifier based only on ECG include high accuracy, simplicity of use, and low intrusiveness. Reliability of the classification can be built directly in the model, such that unreliable segments are rejected. [ABSTRACT FROM AUTHOR]

The objective evaluation of an infant's activity and sleep pattern is critical in improving the comfort of the babies and ensuring the proper amount of quality sleep. The predefined behavioral states of an infant describe their consciousness and arousal level. The different states are characterized by different movements, body tone, eye movements and breath patterns. To recognize and adapt to these states is an essential part of development-friendly caring. It affects the neonate's sleep, influencing their brain development, while improving the bonding between mother and baby, and feeding is more successful during the state of quiet awakened. It can be a more difficult task to determine the level of arousal in premature neonates. In preterm clinics, the general practice is continuous observation, requiring the attention of the hospital staff. To create an automated, more objective system, helping the hospital staff and the parents, we developed a multi-RNN (multi-recurrent neural network) network-based solution to solve this classification problem, which works on a time-series-like feature set, extracted from cameras' video feeds. The set is composed of video actigraphy features, video-based respiration signal and additional descriptors. We separate infant caring from undisturbed presence based on our previous ensemble network solution. The network was trained and evaluated using our database of 402 h of footage, collected at the Neonatal Intensive Care Unit, Dept. of Neonatology of Pediatrics, Dept. of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary, with all-day recordings of 10 babies. [ABSTRACT FROM AUTHOR]

Biological market theory (BMT) predicts that the balance between supply and demand determines the economic value of a "commodity," which consequently determines the amount of "services" that an individual needs to provide to obtain the commodity. In infant handling among primates, the existing literature suggests that handlers need to groom a mother to obtain access to its infant, particularly when the value of the infant is high (e.g., when the number of infants is low). However, grooming by handlers may not be a prerequisite for the occurrence of infant handling, because handlers can handle an infant that is separated from its mother. Based on 3 years of behavioral observations of wild Japanese macaques (Macaca fuscata), we examined the process by which infant handling occurs and the role of grooming in infant handling. We found that infant handling occurred more frequently when the mother and infant were separated than when they were in contact. Grooming rarely occurred before infant handling. The subsequent occurrence of infant handling was not predicted by either the occurrence or duration of grooming toward mothers by non‐mother individuals. Grooming by handlers was also more likely to occur when an infant was in contact with its mother and when an infant's mother was dominant to the handlers. Contrary to BMT, the number of infants in a group did not affect grooming by handlers. These results indicate that the handlers' decision to groom depended on the opportunistic availability of an infant and the social relationship between the infant's mother and themselves. We conclude that grooming was not always necessary for infant handling. Research Highlights: Grooming was not a prerequisite for infant handling. The handlers' decision to groom depended on the opportunistic availability of an infant and the social relationship between the infant's mother and themselves. Grooming before infant handling did not affect the handling duration, and the likelihood of grooming increased when an infant was in contact with its mother and when an infant's mother was dominant to the handlers. Infant number and the rank distance between the mother and handler did not affect the grooming duration. Grooming duration before infant handling was longer the lower the relatedness between mother and handler. [ABSTRACT FROM AUTHOR]

Background: Managing Abstinence in Newborns (MAiN) is an evidence-based, cost-saving approach to caring for infants at risk of developing neonatal opioid withdrawal syndrome (NOWS). MAiN provides medication management in combination with education and is being implemented in hospitals across South Carolina (SC). This expansion of MAiN throughout the state includes educational training for providers on managing NOWS symptomology and evaluation support for data collection and analysis. This evaluation assessed the readiness of hospitals to implement MAiN by identifying potential barriers and facilitators to early program adoption. Methods: We used the Consolidated Framework for Implementation Framework (CFIR) to guide the evaluation. As part of the ongoing evaluation of MAiN implementation, brief, structured interviews were conducted with healthcare providers (n = 82) at seven hospitals between 2019 and 2022 to learn more about perceived barriers and facilitators to implementation readiness. Two coders independently reviewed all transcripts and used deductive thematic analysis to code qualitative data using Atlas.ti Web using the established CFIR codebook. Results: We identified barriers and facilitators to implementing MAiN in all five CFIR domains. Providers identified MAiN as an evidence-based, patient-centered model with the flexibility to adapt to patients' complex needs. Specific champions, external support, alignment with providers' personal motivation, and an adaptable implementation climate were identified as facilitators for implementation readiness. Barriers included a lack of consistent communication among hospital providers, minimal community resources to support patients and families after discharge, and a lack of provider buy-in early in implementation. Conclusions: Key barriers and facilitators of MAiN implementation readiness were identified at seven participating hospitals throughout SC. Communication, staff and hospital culture and climate, and internal and external resource were all reported as essential to implementation. These findings could inform the MAiN program expansion in hospitals across SC. [ABSTRACT FROM AUTHOR]

Aim: To investigate developmental trajectories in early childhood and predictors of class assignment. Methods: Data were available for Gen2 infants at 12 (n = 2275), 24 (n = 1845) and 36 (n = 2110) months of age in the Raine Study. Latent growth class analysis was used to identify developmental trajectories based on the Ages and Stages Questionnaire. Multivariate logistic regression analyses were used to estimate associations between foetal growth restriction, gestational age, child biological sex, breast feeding, parental age, socioeconomic factors and developmental trajectories. Results: Two groups of infants were identified, one typically performing and one poorer performing. Being born early-term, pre-term and male were associated with poorer development. Not exposed to breastfeeding was associated with the lower trajectories in the adaptive and personal-social domains. Conclusions: Developmental surveillance and advice for early-term infants should be considered. Findings highlight the continued need to support and promote breastfeeding as a protective mechanism for child development. [ABSTRACT FROM AUTHOR]

Introduction: Information on the impact of medicines on breastfeeding and the breastfed infant remains scarce. The aims of this review were to identify databases and cohorts holding this information, and pinpoint current information and research deficits. Method: We searched 12 electronic databases, including PubMed/ Medline and Scopus, using a combination of controlled vocabulary (MeSH terms) and free text terms. We included studies reporting data from databases with information on breastfeeding, medicines exposure, and infant outcomes. We excluded studies not reporting all three parameters. Two reviewers independently selected papers and extracted data using a standardised spreadsheet. Risk of bias was assessed. Recruited cohorts with relevant information were tabulated separately. Discrepancies were resolved by discussion. Results: From 752 unique records, 69 studies were identified for full review. Eleven papers reported analyses from ten established databases with information on maternal prescription or non-prescription drugs, breastfeeding and infant outcomes. Twenty-four cohort studies were also identified. No studies reported educational or long-term developmental outcomes. The data are too sparse to warrant any firm conclusions, beyond the need for more data. The overall picture hints at 1) unquantifiable, but probably rare, serious harms to infants exposed to medicines via breastmilk, 2) unknown long-term harms, and 3) a more insidious but more pervasive harm in terms of reduced breastfeeding rates following medicines exposure in late pregnancy and peri-partum. Implications: Analyses of databases reporting on the full population are needed to quantify any adverse effects of medicines and identify dyads at risk of harm from prescribed medicines while breastfeeding. This information is essential to ensure 1) infants are monitored appropriately for any adverse drug reactions 2) inform breastfeeding patients using long-term medicines as to whether the benefits of breastfeeding outweigh exposure to medicines via breastmilk and 3) target additional support to breastfeeding patients whose medicines may affect breastfeeding. The protocol is registered with the Registry of Systematic Reviews, no.994. [ABSTRACT FROM AUTHOR]

Premature birth is considered to be a substantial problem in perinatal medicine, which in the vast majority of cases (>60%), concerns African and South Asian countries. Nevertheless, prematurity is a global problem and is faced by both less-developed (where 12% of babies are prematurely born) and well-developed countries (with 9% prematurity rate) [1, 2]. The percentage of children born prematurely, i.e., before the 37th week of pregnancy, was 8.7% in Europe, while, in Poland, it was 7.34% [3]. Care of prematurely born babies is a huge challenge for parents and medical staff in the neonatal intensive care unit. Preterm infants, because of their low weight and gestational age, are prone to health problems and even death. For this reason, continuous monitoring of health parameters plays an important role. It is achieved by the use of various sensors that are inserted in infants' garments. Sensor systems monitor an infant's health condition, and then the data are transmitted to doctors or parents. This article is for illustrative purposes, aimed at presenting solutions such as the use of sensors for monitoring infants' physiological parameters. [ABSTRACT FROM AUTHOR]

Aim: To examine the outcome for apparent life‐threatening event infants and the determining factors for that outcome. Methods: A retrospective review of 903 infants (0–12 months of age) presenting to the pediatric wards at Christchurch Hospital between 1985 and 1996 with events characterized by some combination of apnoea, change in color, and muscle tone. Events, resulting in 1088 admissions, were classified from medical record review according to the severity and underlying conditions, with risk factors and long‐term outcomes examined. Results: The severity of events was reduced with implementing sudden infant death syndrome recommendations regarding the risk of prone sleeping. There were no sudden infant death syndrome deaths on home apnoea monitoring. Five apparent life‐threatening event infants, not referred for home apnoea monitoring, subsequently died of sudden infant death syndrome. Two infants died and one suffered significant hypoxic insult when apnoea monitoring was interrupted under the age of 4 months. Asthma and neurodevelopmental conditions appeared to be over‐represented subsequently in the apparent life‐threatening event group. Conclusion: Identifying apparent life‐threatening event infants at risk of sudden infant death syndrome lacked specificity. The use of apnoea home monitoring appeared protective in this cohort, but safe sleeping practices remained central for reducing sudden infant death syndrome risk. [ABSTRACT FROM AUTHOR]

Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. About 90% of SIDS occur before six months of age, the peak incidence is between two and four months, and the median age for death is elven weeks. The clinical, social, and economic relevance of SIDS, together with the evidence that prevention of this syndrome was possible, has significantly stimulated research into risk factors for the development of SIDS in the hope of being able to introduce new effective preventive measures. This narrative review discusses the potential relationships between apparent life-threatening events (ALTE) or brief resolved unexplained events (BRUE) and SIDS development, and when a home cardiorespiratory monitor is useful for prevention of these conditions. A literature analysis showed that home cardiorespiratory monitoring has been considered a potential method to identify not only ALTE and BRUE but SIDS also. ALTE and BRUE are generally due to underlying conditions that are not detectable in SIDS infants. A true relationship between these conditions has never been demonstrated. Use of home cardiorespiratory monitor is not recommended for SIDS, whereas it could be suggested for children with previous ALTE or severe BRUE or who are at risk of the development of these conditions. However, use of home cardiorespiratory monitors assumes that family members know the advantages and limitations of these devices after adequate education and instruction in their use. [ABSTRACT FROM AUTHOR]

Progress in the diagnosis and management of seizure disorders and the availability of effective anticonvulsive medications has enabled increasing numbers of epileptic women of child-bearing age to raise families. Breast feeding, which these women may wish to choose, provides health, nutritional, immunological, developmental, social, economic and environmental benefits. The traditional anticonvulsants, such as phenytoin, carbamazepine and valproic acid (valproate sodium), are generally considered safe for use during breast feeding; however, observation for adverse effects is recommended. The use of phenobarbital while breast feeding is controversial because of its slow elimination by the nursing infant. The newer anticonvulsants, such as clobazam, felbamate, gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, and vigabatrin, are used mainly as adjunctive therapy. Data on the use of these drugs in pregnancy and lactation, and regarding long term effects on cognition and behaviour, are sparse. Weighing the benefits of breast feeding against the potential risk to the nursing infant, breast feeding is considered to be safe when the mother is taking carbamazepine, valproic acid or phenytoin. Infant monitoring for potential adverse effects is advisable when the mother is taking phenobarbital, clobazam, gabapentin, lamotrigine, oxcarbazepine or vigabatrin. Monitoring of infant serum drug concentrations is advisable but not compulsory. The use of felbamate, tiagabine and topiramate during breast feeding should await further study. [ABSTRACT FROM AUTHOR]

Aim: To describe and test the accuracy of respiratory rate assessment in long‐term surveillance using an open‐source infant wearable, NAPping PAnts (NAPPA). Methods: We recorded 24 infants aged 1–9 months using our newly developed infant wearable that is a diaper cover with an integrated programmable electronics with accelerometer and gyroscope sensors. The sensor collects child's respiration rate (RR), activity and body posture in 30‐s epochs, to be downloaded afterwards into a mobile phone application. An automated RR quality measure was also implemented using autocorrelation function, and the accuracy of RR estimate was compared with a reference obtained from the simultaneously recorded capnography signal that was part of polysomnography recordings. Results: Altogether 88 h 27 min of data were recorded, and 4147 epochs (39% of all data) were accepted after quality detection. The median of patient wise mean absolute errors in RR estimates was 1.5 breaths per minute (interquartile range 1.1–2.6 bpm), and the Blandt‐Altman analysis indicated an RR bias of 0.0 bpm with the 95% limits of agreement of −5.7–5.7 bpm. Conclusion: Long‐term monitoring of RR and posture can be done with reasonable accuracy in out‐of‐hospital settings using NAPPA, an openly available infant wearable. [ABSTRACT FROM AUTHOR]

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. AUREA computes six metrics and inputs them into a series of four binary k-means classifiers. Breathing patterns were characterized by normalized variance, nonperiodic power, instantaneous frequency and phase. Signals were classified sample by sample into one of 5 patterns: pause (PAU), movement (MVT), synchronous (SYB) and asynchronous (ASB) breathing, and unknown (UNK). MVT and UNK were combined as UNKNOWN. Twenty-one preprocessed records obtained from infants at risk for POA were analyzed. Performance was evaluated with a confusion matrix, overall accuracy, and pattern specific precision, recall, and F-score. Segments of identical patterns were evaluated for fragmentation and pattern matching with the EM reference. PAU exhibited very low normalized variance. MVT had high normalized nonperiodic power and low frequency. SYB and ASB had a median frequency of respectively, 0.76Hz and 0.71Hz, and a mode for phase of 4o and 100o. Overall accuracy was 0.80. AUREA confused patterns most often with UNKNOWN (25.5%). The pattern specific F-score was highest for SYB (0.88) and lowest for PAU (0.60). PAU had high precision (0.78) and low recall (0.49). Fragmentation was evident in pattern events <2s. In 75% of the EM pattern events >2s, 50% of the samples classified by AUREA had identical patterns. Frequency and phase for SYB and ASB were consistent with published values for synchronous and asynchronous breathing in infants. The low normalized variance in PAU, was consistent with published scoring rules for pediatric apnea. These findings support the use of AUREA to classify breathing patterns and warrant a future evaluation of clinically relevant respiratory events. [ABSTRACT FROM AUTHOR]

Purpose: The importance of the neurodevelopmental outcomes of very-low-birth-weight (VLBW) infants has been emphasized as their mortality rate has markedly improved. This study aimed to assess the validity of the Korean Developmental Screening Test (K-DST), a developmental screening tool approved by the Korean Society of Pediatrics, for the timely diagnosis of neurodevelopmental delay in VLBW infants. Methods: Subjects included VLBW infants enrolled in the Korean Neonatal Network database between January 2012 and December 2014. The collected data were analyzed for sensitivity, specificity, positive predictive value, and negative predictive value (NPV) in the K-DST compared to those in the Bayley Scales of Infant Development-II for VLBW infants. Results: A total of 173 patients were enrolled. Their mean gestational age and mean birth weight were 27.5±2.8 weeks and 980.5±272.1 g, respectively. The frequency of failed psychomotor developmental index (PDI) <85 was similar to that in at least one domain of K-DST <1 standard deviation. Failure in more than one K-DST domain compared with a mental developmental index (MDI) <85 showed a sensitivity and NPV of 73.2% and 75.0%, respectively. Failure in more than one K-DST domain compared with PDI <85 showed a sensitivity and NPV of 60.3% and 71.6%, respectively. Each K-DST domain had a stronger correlation with predicting a failing MDI <85 than a failing PDI <85 (P<0.05). Conclusion: K-DST could be a useful screening tool for predicting mental developmental delay in VLBW infants and referring them for neurodevelopmental assessments. [ABSTRACT FROM AUTHOR]

Background Infant spinal anesthesia with levobupivacaine has been promoted as a technique to reduce both the risk of postoperative apnea and exposure to volatile anesthesia. There is, however, no pharmacokinetic data to support the currently recommended doses. Aims Our aim was to determine whether infant levobupivacaine spinal anesthesia is associated with plasma concentrations consistent with a low risk of local anesthetic systemic toxicity. Methods This was an open-label pharmacokinetic safety and tolerability study of levobupivacaine spinal anesthesia in infants <55 weeks Post Menstrual Age undergoing lower abdominal surgery. Infants received a spinal anesthetic with levobupivacaine 1 mg·kg−1 in the left lateral position. Results Spinal anesthesia was successful in 25 (86.2%) of 29 infants (postmenstrual age 36-52 weeks; weight 2.2-4.7 kg). The median ( IQR) total venous levobupivacaine plasma concentrations was 0.33 (0.25-0.42) μg·ml−1 and unbound venous levobupivacaine was 19.5 (14.5-38) ng·ml−1. Median protein binding was 93.5 (91.4-96%). Alpha-1 acid glycoprotein concentrations were 0.25 (0.17-0.37) g·l−1 and albumin concentrations were 29 (24-32) g·l−1. Conclusion Total plasma concentrations and unbound (free) concentration of levobupivacaine were consistently lower than concentrations reported in cases of pediatric local anesthetic toxicity. In a small number of infants requiring a repeat spinal of 1 mg·kg−1 was also associated with acceptable total and free concentrations. We conclude that levobupivacaine at 1 mg·kg−1 is associated with no systemic side effects in infants receiving awake spinal anesthesia. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia (SA) is widely used for awake regional anesthesia in ex-preterm infants scheduled for herniotomy. Awake caudal anesthesia (CA) is suggested as an alternative approach for these patients and type of surgery. The aim of this study was to compare efficacy and complications of the two different techniques. Methods: Two historical populations of 575 ex-preterm infants undergoing herniotomy under awake SA ( n = 339; 1998–2001) and under awake CA ( n = 236; 2001–2009) were investigated. Data are compared using t-test and chi-square tests ( P < 0.05). Results: The SA group consisted of 339 patients, they were born after 32.0 (3.3) weeks of gestation on average with a mean birth weight of 1691 g (725). The CA group consisted of 236 patients born after 32.1 weeks (3.7) with a mean birth weight of 1617 g (726). At the time of operation, the total age was 41.37 (3.6) and 41.28 (4.0), respectively, for SA and CA patients, and the corresponding weights were 3326 (1083) g and 3267 (931) g for SA and CA patients, respectively. For SA, significantly more puncture attempts were needed (1.83 vs 1.44, P < 0.001). Surgery was performed under pure regional anesthesia in 85% (SA) and 90.1% (CA) (ns). A change to general anesthesia was necessary in 7.7% (SA) and 3.9% (CA) (ns). Overall, intra- and postoperative complications were not statistically different. Conclusions: Caudal anesthesia was shown to be technically less difficult than SA and to have a higher success rate. Its application as awake regional anesthesia technique in these patients seems more appropriate than SA. [ABSTRACT FROM AUTHOR]

A shift from language-general to language-specific sound discrimination abilities has been largely attested in different populations of infants during the second half of the first year of life; however, data are still scarce regarding bilingual populations. Previous research with 4-, 8- and 12-month-old Catalan-Spanish bilingual infants had offered evidence of a U-shaped pattern in their ability to discriminate a language-specific vowel contrast. This research explores monolingual and bilingual 4- and 8-month-olds’ capacities to discriminate two common vowel contrasts: /o–u/ and /e–u/. All groups succeeded except 8-month-old bilinguals tested on the phonetically close /o–u/ contrast. Discrimination was not facilitated when talker and token variability were reduced. A U-shaped pattern was again found when data from an additional group of 12-month-olds were included. These results confirm bilinguals’ specific developmental pattern of perceptual reorganization for acoustically close vowels and challenge an interpretation merely based on a distributional account. [ABSTRACT FROM AUTHOR]

Background. Human immunodeficiency virus (HIV) infection in infancy features a persistently high viral load and elevated antiretroviral drug clearance rates, which pose significant therapeutic challenges to the clinician. Viral and cellular kinetic analyses performed in HIV-infected adults have yielded significant insights into the dynamic setting of this viral infection. Similar studies are needed in pediatric populations, in whom differing dynamics might translate into age-specific treatment approaches. Methods. Viral and cellular kinetic analyses were performed using a nonlinear mixed-effects model in a cohort of 48 infants 1–24 months of age enrolled in a trial of ritonavir-based highly active antiretroviral therapy (HAART). Results. Infected cell compartment kinetics were comparable with reported adult values, with no age-specific differences demonstrated—suggesting the ability to suppress viral replication in infants receiving HAART. Comparisons between 2 ritonavir dosing schedules revealed significant improvement in phase 1/2 decay constants in favor of the higher dose. A negative correlation was established between plasma RNA levels and phase 1 decay rates, which has worrisome implications for infant therapeutics given high infant pretreatment plasma virus levels. Conclusions. Ritonavir-based HAART regimens in infancy result in HIV decay constants comparable to those reported in adults, without age-specific variability. Despite higher plasma HIV levels and CD4 lymphocyte counts in infancy, HAART can result in timely, effective control of viral replication. [ABSTRACT FROM AUTHOR]

Objective: Current practice guidelines discourage use of lithium during breast-feeding, despite limited data. This study aimed to quantify lithium exposure in nursing infants. Method: In 10 mother-infant pairs, the authors obtained assays of lithium in maternal serum, breast milk, and infant serum and indices of infant renal and thyroid function. Results: Maternal serum, breast milk, and infant serum daily trough concentrations of lithium averaged 0.76, 0.35, and 0.16 meq/liter, respectively, each lithium level lower than the pre- ceding level by approximately one-half. No serious adverse events were observed, and elevations of thyroid-stimulating hormone, blood urea nitrogen, and creatinine were few, minor, and transient. Conclusions: Serum lithium levels in nursing infants were low and well tolerated. No significant adverse clinical or behavioral effects in the infants were noted. These findings encourage reassessment of recommendations against lithium during breast-feeding and underscore the importance of close clinical monitoring of nursing infants. [ABSTRACT FROM AUTHOR]

The social networks that rhesus monkeys develop in nature are centered around multiple generations of matrilineal kin embedded in a larger social grouping that have some degree of distinctiveness and permanence. Within each family, infants initially grow up in the care of their mothers and the close presence of relatives, and they subsequently expand their social network to include peers and others in the larger community and beyond while continuing to retain strong family ties throughout adolescence (for males) and for the rest of their lives (for females). Rhesus monkey families differ in relative status within their community-like troops, and these differences can have long-term consequences for individuals within each family. Yet there is also evidence that changes in within-family relationships, particularly those between mothers and offspring , can eventually lead to changes in the basic nature of the troop itself. It seems appropriate to characterize the social relationships that emerge between rhesus monkey mothers and their offspring in attachment-like terms, especially given Bowlby's reliance on observations of rhesus monkey mother-infant interactions to provide the biological basis of the attachment theory he was formulating in the late 1950s and 1960s. Contrastingly, it may be overly simplistic to describe the various other social relationships that rhesus monkeys routinely develop within their expanding social networks exclusively from an attachment perspective. Instead, these other social relationships clearly differ from their relationship with their mother with respect to the specific behaviors that characterize each type of relationship, the physical and social contexts in which the relationships are expressed, and the manner in which each relationship changes throughout development. Moreover, the different relationships each monkey develops as it matures appear to complement one another as it becomes integrated into its overall social network. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine whether in infants, the evaluation of thoracoabdominal movements alone, with no measurement of airflow, could be used to identify obstructive sleep apnea events (OA). Two different methods were used: first, we initially quantified thoracoabdominal asynchrony. Although 79.3% of OAs showed a significant increase of thoracoabdominal asynchrony, only 10.9% of the events scored by the identification of phase opposition were true OAs. Next, we developed two artificial neural networks (ANNs) as classifiers for the study of the thoracoabdominal signals. The first network was trained to locate obstructive and central apnea events. It correctly detected 75% of the OAs; however, only 6.2% of the detected events were true OAs. When a second network was used, OAs could not be discriminated from other portions of the signals showing similar phase characteristics. It was concluded that the information available in uncalibrated signals of thoracic and abdominal respiratory movements was insufficient to unambiguously detect OA events in sleeping infants. [ABSTRACT FROM AUTHOR]

Relatively little has been written about one group of infants identified with Ainsworth's "Strange Situation" assessment of infant-parent attachment, those classified insecure/ambivalent. Although virtually all samples contain some insecure/ambivalent infants, these infants are uncommon, comprising 7%-15% of most American samples. Recently developed assessments of attachment in children and adults have identified attachment groups of older individuals thought to parallel the insecure/ambivalent infant group. Empirical work in which insecure/ambivalent individuals are examined as a separate group is reviewed within the context of attachment theory, and a coherent picture emerges of the antecedents (relatively low or inconsistent maternal availability; biological vulnerability) and sequelae (limited exploratory competence) of this group. This picture is used as the basis for additional theoretical proposals, and suggestions for future research are presented. [ABSTRACT FROM AUTHOR]

Human activity recognition (HAR) works have mostly focused on the activities of adults. However, HAR is typically beneficial to the safety and wellness of newborn or infants because they have difficulties in verbal communication. The activities of infants are different from those of adults in terms of its types and intensity. Hence, it is necessary to study the behavior of infants separately. We study newborn and infant activity recognition by analyzing accelerometer data from the sensors attached to body. We aim to classify four types of activities: sleeping, moving in agony, moving in normal condition, and movement by external force. For this work, we collected 11 h videos and corresponding sensor data from 10 infant subjects. For recognition, we propose an end-to-end deep model using autoencoder and k-means clustering, which is trained in an unsupervised way. From a set of performance tests, our model can achieve 0.96 in balanced accuracy and F-1 score of 0.95. [ABSTRACT FROM AUTHOR]

Numerous wearable sensors have been developed for a variety of needs in medical/healthcare/wellness/sports applications, but there are still doubts about their usefulness due to uncomfortable fit or frequent battery charging. Because the size or capacity of battery is the major factor affecting the convenience of wearable sensors, power consumption must be reduced. We developed a method that can significantly reduce the power consumption by introducing a signal repeater and a special switch that provides power only when needed. Antenna radiation characteristics are an important factor in wireless wearable sensors, but soft material encapsulation for comfortable fit results in poor wireless performance. We improved the antenna radiation characteristics by a local encapsulation patterning. In particular, ultra-low power operation enables the use of paper battery to achieve a very thin and flexible form factor. Also, we verified the human body safety through specific absorption rate simulations. With these methods, we demonstrated a wearable infant sleep position sensor. Infants are unable to call for help in unsafe situations, and it is not easy for caregivers to observe them all the time. Our wearable sensor detects infants' sleep positions in real time and automatically alerts the caregivers when needed. [ABSTRACT FROM AUTHOR]