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International audience; In very preterm infants, cardio-respiratory events and associated hypoxemia occurring during early postnatal life have been associated with risks of retinopathy, growth alteration and neurodevelopment impairment. These events are commonly detected by continuous cardio-respiratory monitoring in neonatal intensive care units (NICU), through the associated bradycardia. NICU nurse interventions are mainly triggered by these alarms. In this work, we acquired data from 52 preterm infants during NICU monitoring, in order to propose an early bradycardia detector which is based on a decentralized fusion of three detectors. The main objective is to improve automatic detection under real-life conditions without altering performance with respect to that of a monitor commonly used in NICU. We used heart rate lower than 80 bpm during at least 10 sec to define bradycardia. With this definition we observed a high rate of false alarms (64%) in real-life and that 29% of the relevant alarms were not followed by manual interventions. Concerning the proposed detection method, when compared to current monitors, it provided a significant decrease of the detection delay of 2.9 seconds, without alteration of the sensitivity (97.6% vs 95.2%) and false alarm rate (63.7% vs 64.1%). We expect that such an early detection will improve the response of the newborn to the intervention and allow for the development of new automatic therapeutic strategies which could complement manual intervention and decrease the sepsis risk.

The paper presents development of a smart infant monitoring system using multiple non-invasive sensors to detect various physiological functions. The system can evaluate different physiological activities such as respiration, movement, noise, position, as well as ambient temperature, and humidity. By processing the acquired data from different sensor modules, the system can generate alarm signals for adverse situations such as the occurrence of apnea, seizure, or noisy and uncomfortable environmental conditions. The system will also be able to detect critical respiratory conditions by analyzing breathing data and saturated blood oxygen level (SpO2) using machine learning (ML) models such as neural networks. The proposed system allows the caregiver to monitor the condition of the patient from a remote location by implementing wireless communication with a remote computer or a cell phone.

The amount of employability among men and women had raised a lot in comparison with olden days. With this increase in employability, the amount of care taken by the parents toward their infants had also decreased. But, in childhood stage, children need proper rest and sleep for proper health and body growth. Thus, most of parents send their infants to their grandparent’s house, and some may taught of living their babies at baby care houses. But all the people cannot keep nanny, and also, it is always difficult for the parents to keep trust on some strangers to look after their baby. But, in any of the cases, parents may not continuously monitor the situations and conditions of their babies. Therefore, an IoT-based baby monitoring system has been introduced which can be made available at affordable cost and works efficient in real time. The system is developed using Node MCU microcontroller, a speaker and a sound sensor module. The sound sensor module detects the babies cry and executed according to the action provided. The BLYNK application server is used to send the notifications to the registered parent’s mobile number as alert message regarding their kids status.

This paper investigates the monitoring of infants using wearable sensor networks technologies based on blood oxygen saturation. Wearable sensors are suitable for the diagnostic and monitoring of “applications”. Their miniaturization as well as that of electronic circuits play a vital role in the development of wearable systems. On the other hand, bBood oxygen content is now considered as one of the vital signs for infant monitoring based on temperature, respiratory rate, heart rate, and blood pressure. One of the main advantages of pulse oximetry is that measurements are taken non-invasively through optical measurements. The system consists of a sensor module, a monitor, and an alarm. The sensor is to be placed on a peripheral tissue bed such as the child’s ankle. The monitor should be able to receive telemetric data through a signal from a sensor. The monitor and an alarm could be placed in a different room, for instance, the parents room. The alarm must sound if an abnormal level of oxygen or pulse rate is detected. This paper reports on the usability of such monitoring system. This paper discusses on a general architecture for infant monitoring system using wireless body area network based on oxygen saturation.

Acoustic analysis of cry signals helps understanding the physiological and emotional state of an infant, and the likely cause of cry. In our earlier studies, acoustic analysis was carried out to characterize the infant cry signal due to different cause of crying. In this paper, we propose an Intelligent Cry Monitoring and Cry Detection System (ICMCDS) that can help working parents who are constrained to leave their children with the care-takers, and remain worried about their well-being. They need to be notified when their child cries. Functional prototype of a smart ICMCDS is developed at low-cost, which can monitor a child in real-time. Signal processing methods auto-correlation and a recently proposed modified zero-frequency filtering are used for cry-detection. Features F 0 , Strength of Excitation and Signal Energy are extracted from the cry signal. Parameters mean, standard deviation and normalized standard deviation in F 0 are derived. Acoustic analysis of the cry signal helps detecting a cry as well as the cry-cause. The system detects a cry and informs the parent automatically through sms. If the child-cry continues for some time, then the intelligent system sends a second message, raising urgency concern. Further the system also identifies the likely cause of crying by examining the features, and informs to the parents by a third sms. The concerned parent may talk to a human controller, who in-turn can give control commands to a robot, using a webpage or mobile phone. The robot, equipped with audio-visual sensors, can be sent near to the child to get the actual state, by sending back live video streaming of the child and surroundings. It also validates the alert message about child crying. Wi-Fi medium is used for communication between humans and the robot. Performance evaluation is carried out using an Infant Cry Signals Database (IIITS ICSD 2). The proposed ICMCDS has a range of applications in homes, hospitals, child-care centers and schools.

Sudden Infant Death Syndrome is one of the major causes of death among infants. We propose to develop an analytical model for reducing the Sudden Infant Death Syndrome (SIDS) using infant heart rate, Panic vibration and prone body position of an infant and to develop a prototype model. The proposed system for infants can be used at home or hospital nursery room. It consists of SpO2 sensor, vibration sensor, heart beat sensor, and Global System for Mobile Communication (GSM) application. Heartbeat sensor is used to measure the heart rate of an infant. Heart rate during awake 100–160 BPM and sleep condition 90–160 BPM (Infant 1 month to 1 year). SpO2 sensor is used to detect the abnormal sleeping position of the infant due to which breathing problem may occur which can lead to SIDS. Similarly vibration sensor is used to sense the abnormal vibration which infant may experience during panic condition during their sleep. Using these three sensor measurements and an analytical model is developed to detect the cause of SIDS. For the analytical modelling, we have considered linear regression between heart beat and SpO2 as well as heart rate and vibration. Based on the predictive value β, the alarm signal regarding the cause of SIDS will be given to the concerned person like a parent, medical advisors or Ambulatory service. The prototype will be developed for an analytical model using a heart beat sensor, SpO2 sensor, vibration sensor, ARM processor and GSM for wireless communication.

In this paper, we propose an infant monitoring system that automatically detects epileptic seizures in domestic and hospital environments. The proposed system measures the movements and electroencephalogram (EEG) signals of an infant using a video camera and an electroencephalograph. Seizure features are then extracted from the video images and EEG signals, and the evaluation indices based on medical knowledge are calculated from the features. The system employs a probabilistic neural network for the automatic detection of seizures, thereby allowing the choice/combination of evaluation indices appropriate for the environment via network training. We tested the system in simulated domestic and hospital environments. The validity of the proposed system was reinforced by the results of comparisons with clinical diagnoses.

A wireless Infant Monitoring Device has been developed as a preventive measure against sudden infant death syndrome. It measures the sleep position, respiratory rate and body temperature of an infant as well as its surrounding carbon monoxide concentration. Those data are considered as the risk factors of the sudden infant death syndrome. They are analyzed on board and results are transmitted to a remote server via Wi-Fi. Alarms will be triggered if any of the monitored parameters is beyond the preset limits. The system was tested on an infant manikin driven by an infant ventilator. Test outcomes demonstrated that it can reliably measure respiratory rate down to the low respiratory pressure of 3 mmHg peak to peak in addition to the infant position, temperature and carbon monoxide concentration. The device can be easily integrated into cloud service to enhance its features with its wireless communication capabilities.

In the last few decades, role of females in the employment field in the industrialized nations has prominently grown. Consequently, infant carehas turned out to be a great challenge to most of the families in their current life style. Mothersare constantly worried regarding the well-beingand safety oftheir baby. When a system is developed which constantly sends update regarding their infants during the time of severeillness or normal routine, then it will be of significant assistance to such parents as they can work in stress less environment without worrying much about their children. Moreover, in case of urgent situation, it can be noticed quickly and handled within less time. Hence, aneffective infant monitoring system is developed with the assistance of Micro-Electro-Mechanical systems (MEMS) for the purpose of adequately reducing the potential risks for Sudden Infant Death Syndrome (SIDS). This system assists in effectively reducing the infant'sdeath at home and hospitals. This system includes heart beat sensor and active zigbeetechnology. This system monitors temperature, heart beat andblood pressure. All the necessary information isdisplayed in LCD screen. This proposed system give a peace of mind to loved ones as they can get an update status of their wellbeing.

This paper proposes a low-cost, mobile-based monitoring and advisory system that continuously monitors the baby and remotely updates the mother on child status. This technology involves continuous measuring of the temperature, heart rate and motion and send it to a server where the data is processed. The server analyzes the received data and sends the processed biological information of the baby to the mother and generates an alert system if the conditions of the baby are found abnormal. These alert messages are transmitted to support systems and nearby health clinics in emergency situations. Also, advisory first-aid information is sent to the mother in order to take immediate action. Thus, this ubiquitous system would enhance mother's awareness of their baby health status.

The development of a prototype Internet-based infant monitoring system is currently ongoing. Real time analog, digital and video signals are transferred over the Internet. This project will investigate the advantages, disadvantages and limitations of using Internet for telemedicine monitoring.

An integrated care pathway (ICP) is a structured chart that prompts for key observations and interventions in patients to be recorded at set times by medical and nursing staff. ICPs were introduced into the neonatal department of the Queen Elizabeth Central Hospital in Blantyre, Malawi. The number of observations of babies recorded in the year before and 2 years after the introduction of ICPs were compared. When ICPs were in use, 9-96% of the 18 possible daily observations were recorded as having been carried out, compared with 0-33% before their introduction. In the 2nd of the 3 years, there was a fall-off in some observations made, probably because of staff shortages. The ICPs proved effective and easy to use. When adapted to local needs they play an important role in delivering neonatal care.

Infants at low and increased risk for sudden infant death syndrome (SIDS) from five clinical centers in the United States are being studied at home using a cardiorespiratory monitor that stores physiologic data surrounding detected events and normative data unrelated to events. The monitor records breathing waveforms by inductance plethysmography (IP), and transthoracic impedance (TTT), ECG, beat-beat heart rate, hemoglobin oxygen saturation, and times of monitor use. Comparisons with simultaneously recorded overnight polysomnograms (PSG) in hospital validated the ability of this device to detect cardiorespiratory events including upper airway obstruction. Parental compliance in using this complicated instrument is slightly lower than that reported for conventional home cardiorespiratory monitors.

Noninvasive infant monitoring occasionally results in burns and tissue damage. The medical literature now contains 14 isolated reports that were summarized for this review. All 14 victims were less than 24 months of age, and of these 14, two died by electrocution. Burns and tissue damage resulted from infant respiratory monitors (six), pulse oximeters (four), electrocardiographic monitors (two), an anal myoneural junction monitor (one), and a fetal scalp monitor (one). Infant extremities were injured most often (40%), and the trunk was burned somewhat less frequently (23%). Infants were burned in the hospital (57%) only slightly more often than at home (43%). Household burns involved only infant cardiorespiratory monitors. The most common mechanism of injury was the misapplication or improper connection of electrode lead wires (57%). A full one third of infants with burns required a reconstructive surgical procedure, usually a skin graft. Risk factors related to monitor-induced burns and tissue damage have been identified and presented. Injury prevention principles are also outlined.

Accuracy of the Respiratory Inductance Plethysmography (RIP) Collaborative Home Infant Monitoring Evaluation (CHIME) Monitor in Identifying Obstructed Breaths ♦ 1972

This paper presents the first multimodal neonatal pain dataset that contains visual, vocal, and physiological responses following clinically required procedural and postoperative painful procedures. It was collected from 58 neonates (27-41 gestational age) during their hospitalization in the neonatal intensive care unit. The visual and vocal data were recorded using an inexpensive RGB camera while the physiological responses (vital signs and cortical activity) were recorded using portable bedside monitors. The recorded behavioral and physiological responses were scored by expert nurses using two validated pain scales to obtain the ground truth labels. In addition to behavioral and physiological responses, our dataset contains clinical information such as the neonate’s age, gender, weight, pharmacological and non-pharmacological interventions, and previous painful procedures. The presented multimodal dataset can be used to develop artificial intelligence systems that monitor, assess, and predict neonatal pain based on the analysis of behavioral and physiological responses. It can also be used to advance the understanding of neonatal pain, which can lead to the development of effective pain prevention and treatment.

Camera-based infant monitoring has received substantial attention because of its unobtrusiveness, allowing long-term and continuous monitoring. To assess infant sleep, it is required to know whether the infant is in bed or out of bed. This can automate monitoring for analyzing data solely when the infant is in bed, providing accurate assessment of sleep quality. In this work, we propose a method aimed at detecting infant in/out of bed status for a 24 h period using motion estimates derived from an infrared video camera. The method is based on several heuristic decision-making rules to examine the motions between peaky motions that are expected to express activities or events of putting the infant in bed or taking the infant out of bed. For example, when these events are identified, intuitively, if a period between two events has consistently motions (caused by infant's body movements), this period should be detected as infant 'in bed', otherwise as 'out of bed'. Our proposed method would largely increase the efficiency (i.e. reduce the computational load) compared to some advanced computer vision algorithms that try to recognize infant's face or torso. To separate the motions caused by infant body movements and other activities from, for example, parents, a region of interest (ROI) is configured. This ROI can be fixed and customized. 77 datasets of 24 h recordings from five infant participants were analyzed in this study. Experiments were conducted in a free-living environment in the participants' own home. Results show that an average accuracy of 95.8% using a fixed ROI configuration, and that of 96.9% using a customized configuration were achieved. This indicates that our proposed method is reliable for infant in/out of bed detection.

Prolonged monitoring of infant sleep is paramount for parents and healthcare professionals for interpreting and evaluating infants&rsquo, sleep quality. Wake-sleep patterns are often studied to assess this. Video cameras have received a lot of attention in infant sleep monitoring because they are unobtrusive and easy to use at home. In this paper, we propose a method using motion data detected from infrared video frames (video-based actigraphy) to identify wake and sleep states. The motion, mostly caused by infant body movement, is known to be substantially associated with infant wake and sleep states. Two features were calculated from the video-based actigraphy, and a Bayesian-based linear discriminant classification model was employed to classify the two states. Leave-one-subject-out cross validation was performed to validate our proposed wake and sleep classification model. From a total of 11.6 h of infrared video recordings of 10 healthy term infants in a laboratory pilot study, we achieved a reliable classification performance with a Cohen&rsquo, s kappa coefficient of 0.733 &plusmn, 0.204 (mean &plusmn, standard deviation) and an overall accuracy of 92.0% &plusmn, 4.6%.

Current technologies to allow continuous monitoring of vital signs in pre-term infants in the hospital require adhesive electrodes or sensors to be in direct contact with the patient. These can cause stress, pain, and also damage the fragile skin of the infants. It has been established previously that the colour and volume changes in superficial blood vessels during the cardiac cycle can be measured using a digital video camera and ambient light, making it possible to obtain estimates of heart rate or breathing rate. Most of the papers in the literature on non-contact vital sign monitoring report results on adult healthy human volunteers in controlled environments for short periods of time. The authors' current clinical study involves the continuous monitoring of pre-term infants, for at least four consecutive days each, in the high-dependency care area of the Neonatal Intensive Care Unit (NICU) at the John Radcliffe Hospital in Oxford. The authors have further developed their video-based, non-contact monitoring methods to obtain continuous estimates of heart rate, respiratory rate and oxygen saturation for infants nursed in incubators. In this Letter, it is shown that continuous estimates of these three parameters can be computed with an accuracy which is clinically useful. During stable sections with minimal infant motion, the mean absolute error between the camera-derived estimates of heart rate and the reference value derived from the ECG is similar to the mean absolute error between the ECG-derived value and the heart rate value from a pulse oximeter. Continuous non-contact vital sign monitoring in the NICU using ambient light is feasible, and the authors have shown that clinically important events such as a bradycardia accompanied by a major desaturation can be identified with their algorithms for processing the video signal.

Generally, in Hospital Nurseries, nurses are taking care of abnormalities and the health of the newborn babies but they may not be available for taking care of the Infants 24x7. So, sometimes in the absence of care taker it may happens that health of the Infant becomes critical. Wireless technologies used by different Infant Monitoring Systems contain radiations that are highly harmful for the Infants. So, under these critical conditions, we have proposed an Automatic Wireless Li-Fi based Advanced Infant Monitoring System which continuously measures the intensive parameter of the child’s health using wearable sensors, if any abnormal condition occurs, it will indicate a notification.

Infant arousal scoring based on the Atlas Task Force definition of transient EEG arousal was evaluated to determine (1). whether transient arousals can be identified and assessed reliably in infants and (2). whether arousal and no-arousal epochs scored previously by trained raters can be validated reliably by independent sleep experts. Phase I for inter- and intrarater reliability scoring was based on two datasets of sleep epochs selected randomly from nocturnal polysomnograms of healthy full-term, preterm, idiopathic apparent life-threatening event cases, and siblings of Sudden Infant Death Syndrome infants of 35 to 64 weeks postconceptional age. After training, test set 1 reliability was assessed and discrepancies identified. After retraining, test set 2 was scored by the same raters to determine interrater reliability. Later, three raters from the trained group rescored test set 2 to assess inter- and intrarater reliabilities. Interrater and intrarater reliability kappa's, with 95% confidence intervals, ranged from substantial to almost perfect levels of agreement. Interrater reliabilities for spontaneous arousals were initially moderate and then substantial. During the validation phase, 315 previously scored epochs were presented to four sleep experts to rate as containing arousal or no-arousal events. Interrater expert agreements were diverse and considered as noninterpretable. Concordance in sleep experts' agreements, based on identification of the previously sampled arousal and no-arousal epochs, was used as a secondary evaluative technique. Results showed agreement by two or more experts on 86% of the Collaborative Home Infant Monitoring Evaluation Study arousal scored events. Conversely, only 1% of the Collaborative Home Infant Monitoring Evaluation Study-scored no-arousal epochs were rated as an arousal. In summary, this study presents an empirically tested model with procedures and criteria for attaining improved reliability in transient EEG arousal assessments in infants using the modified Atlas Task Force standards. With training based on specific criteria, substantial inter- and intrarater agreement in identifying infant arousals was demonstrated. Corroborative validation results were too disparate for meaningful interpretation. Alternate evaluation based on concordance agreements supports reliance on infant EEG criteria for assessment. Results mandate additional confirmatory validation studies with specific training on infant EEG arousal assessment criteria.

Context: The Collaborative Home Infant Monitoring Evaluation (CHIME) study enrolled healthy term infants and 3 groups of infants considered to be at increased risk for sudden infant death syndrome to evaluate apnea and bradycardia events in the home. Mother-infant pairs without a telephone were ineligible for enrollment. Objective: To determine whether mother-infant pairs who were offered a telephone subsidy would agree to enroll in CHIME and achieve protocol compliance rates comparable with those of matched subjects able to afford telephones. Design: Thirty-one telephone subsidy subjects were retrospectively compared with 55 control subjects matched for study group, site, birth weight, and maternal race, age, and education. Setting: Collaborative Home Infant Monitoring Evaluation clinical research centers in Honolulu, Hawaii, and Toledo, Ohio. Intervention: Provision of telephone subsidy to otherwise eligible enrollees for CHIME. Main Outcome Measures: Frequency of compliance with protocol requirements for follow-up evaluations and for extent of home monitoring. Results: Subsidy subjects achieved protocol completion rates that were comparable with those of control subjects, for developmental assessments at 56 and 92 weeks postconceptional age (PCA), and for the polysomnogram. Unexpectedly, however, subsidy subjects were more likely to have a developmental assessment at 44 weeks PCA (P=.02), as well as a cry analysis (P=.04). They were also more likely to use the CHIME home monitor for more hours during weeks 2 through 5 (P=.004), have a higher percentage using the monitor for 10 or more hours per week during weeks 2 through 5 (P=.009), and have a higher total number of days of monitor use throughout 6 months (P

BACKGROUND: The immediate transition from foetus to neonate includes substantial changes especially concerning the cardiovascular system. As sex related differences have been shown in cardiovascular medicine, this topic warrants further investigation in neonatology. Aim: The aim of this present study was to measure cardiac output (CO) and cerebral oxygenation (cTOI) non-invasively in term neonates and to investigate potential sex related differences between female and male neonates after birth. METHODS: This is a mono-centric prospective observational study. For CO-measurements, the electrical velocimetry method was used. The pulse oximetry for arterial oxygen saturation and heart-rate measurements was placed on the right hand or wrist. cTOI was measured using a NIRO 200NX monitor. The near-infrared spectroscopy probe was positioned on the right side of forehead in each infant. Monitoring started at minute 1 and was continued until minute 15 after birth. At minutes 5, 10, and 15 after birth, CO was calculated as an average out of six 10-second periods. RESULTS: 99 term neonates were enrolled. In our study population, we could identify 54 female and 45 male neonates. Males had higher cardiac output compared to females throughout the observational period, with a significant difference in minute 15 after birth (217, 95% CI: 203–231 mL/kg/min versus 178, 95% CI: 163–192 mL/kg/min; P

Heart rate (HR) measurement is crucial for newborn infant monitoring in the neonatal intensive care unit (NICU). The widely used contact HR measurement methods based on electrocardiography (ECG) and photoplethysmography (PPG) signals can lead to discomfort and possible skin irritation on neonates, which limit its application in NICU scenarios. In this work, we propose a non-contact HR monitoring method simply using a RGB camera. Eulerian video magnification (EVM) is employed to detect the subtle changes of neonatal faces results from blood circulation. The magnified signal is then transformed to the spectral domain to extract HR information. Compared with the widely investigated independent component analysis (ICA)-based HR measurement method using video recordings, the proposed method can achieve the real time HR measurement, which is a significant superiority in NICU neonatal monitoring. To the best of our knowledge, this is the first study to employ EVM algorithm in real time neonatal HR monitoring.

The sick preterm infant monitoring is an intriguing job that medical staff in Neonatal Intensive Care Units (NICU) must deal with on a daily basis. As a standards monitoring procedure, preterm infants are monitored via sensors and electrodes that are firmly attached to their fragile and delicate skin and connected to processing monitors. However, an alternative exists in contactless imaging to record such physiological signals (we call it as Physio-Markers), detecting superficial changes and internal structures activities which can be used independently of, or aligned with, conventional monitors. Countless advantages can be gained from unobtrusive monitoring not limited to: (1) quick data generation; (2) decreasing physical and direct contact with skin, which reduces skin breakdown and minimizes risk of infection; and (3) reduction of electrodes and probes connected to clinical monitors and attached to the skin, which allows greater body surface-area for better care. This review is an attempt to build a solid ground for and to provide a clear perspective of the potential clinical applications of technologies inside NICUs that use contactless imaging modalities such as Visible Light Imaging (VLI), Near Infrared Spectroscopy (NIRS), and Infrared Thermography (IRT).

Sudden Infant Death Syndrome (SIDS) usually happened for new born. It typically occurs associated with a period of sleep. The cause (or causes) of SIDS is still unknown. Deprived of oxygen, parental alcohol consumption and over-heating are environmental risk factors of SIDS. In this paper, an intelligent method for preventing sudden infant death based on Arduino system is proposed. The proposed method will mainly consist of intelligent software incorporated with hardware components such as sensors to sense and detect important physical signals i.e. infant breath, infant temperature and heart rate and accordingly pass these recording data to Arduino device. In addition, parents will wirelessly receive Multimedia Messaging Service (MMS) via Global System for Mobile communication (GSM) in real time. Such message will carry the recorded data as well as a warning when problems occurred. A prototype is designed and developed which gives a reliable and efficient real time infant monitoring system that can play a vital role in reducing the SIDS occurred and save an infant's life.

Developmental language delays are common and are associated with increased risk of adverse educational and psychosocial outcomes later in life. Early intervention services supporting language development may prevent these later problems from occurring. However, with the variability that exists in language development, it is less clear which children with developmental language delays actually require intervention. As such, increased understanding of the trajectory of language impairment and the long-term outcomes in adulthood is needed. The purpose of this thesis was to: (i) determine the early life characteristics that placed children at risk for poor language outcomes, and (ii) profile the long-term psychosocial outcomes in adulthood for language impaired populations. To address these aims prospective longitudinal data from two Australian pregnancy cohort studies; the Mater-University of Queensland Study of Pregnancy (MUSP) and the Western Australian Pregnancy Cohort (Raine) Study, were utilised. The first three studies of this thesis investigated the early life characteristics that predicted later language outcomes in childhood and adulthood. Firstly, Chapter 2 investigated the parental and early childhood factors present at, or prior to 5 years, which were associated with different vocabulary developmental profiles in the MUSP cohort. Receptive vocabulary skills were measured at 5- and 21- years, using the Peabody Picture Vocabulary Test-Revised (PPVT-R). A one standard deviation cut-off was applied to determine average and below average performances at the two assessment points. Four vocabulary developmental profiles were then identified, including: ‘consistently typical’ (average performance at both time points), ‘consistently low’ (below average scores at both time points), ‘improved’ (below average performance at 5 years but average performance at 21 years), and ‘deteriorated’ (average skills at 5 years but below average performance at 21 years). The results revealed that adults with deteriorating vocabulary profiles were more likely to have had internalising behaviours at 5 years, mothers who smoked during pregnancy, and fathers with lower educational attainment, compared to adults with consistently typical vocabulary histories. No significant risk factors were identified for adults showing consistently low vocabulary in comparison to those adults whose early vocabulary delays had improved. Applying the same methodological approach as Chapter 2, Chapter 3 investigated possible predictors of change in language performance from 2 to 10 years in the Raine cohort. At 2 years, expressive vocabulary was measured using the Language Development Survey (LDS) and at 10 years, language ability was measured using the Clinical Evaluation of Language Fundamentals (CELF-3). Children with deteriorating language profiles were more likely to be male and have mothers who smoked during pregnancy, have fathers with lower educational attainment, come from families with lower income, and not be read to at 2 years by their parents. Children with consistently low language skills were also more likely to have mothers who smoked during pregnancy compared to those late talkers whose language skills resolved to within normal limits at 10 years. Chapter 4 investigated the predictive accuracy of a general developmental screening instrument (the Infant Monitoring Questionnaire, IMQ) at 3 years of age for explaining language outcomes at 10 years. The predictive ability of traditional logistic regression models was compared to the predictive statistics obtained when using machine learning algorithms. Furthermore, model accuracies were calculated using only communication subscale data as well as broader IMQ data encompassing fine and gross motor, adaptive and personal-social skills. The findings obtained from the machine learning algorithms were equivalent to logistic regression, and the inclusion of other behaviours of neurodevelopment (motor, social and adaptive skills) did not improve predictive accuracy over and above communication skills alone. Chapters 5 and 6 then investigated the long-term psychosocial outcomes into adulthood. Chapter 5 examined the long-term prognosis for late talkers in adulthood in terms of their levels of autistic-like traits as measured by the Autism-Spectrum Quotient (AQ) at the 20-year follow-up in the Raine Study. The results of this chapter revealed that a smaller vocabulary size at 2 years was associated with higher levels of autistic-like traits in adulthood, particularly in the area of social communication. Finally, Chapter 6 examined the educational, vocational and mental health outcomes at 21 years in the MUSP for the four different vocabulary developmental profiles identified in Chapter 2. Results indicated that those adults with deteriorating vocabulary skills had poorer outcomes across the educational, vocational and mental health domains. Adults with consistently low vocabularies had lower educational and vocational prospects, and adults with improved vocabulary skills remained at increased risk of poorer vocational outcomes compared to adults with consistently typical profiles. The findings of this thesis have implications for the identification of those children who require early intervention language services, by increasing awareness of children at risk of persisting language difficulties. It also emphasises the increased risk of future educational and psychosocial problems in children with early and later-emerging language difficulties, highlighting the need for universal preventative strategies to enhance early language development.

Background: Rohingya refugees are one of the most vulnerable group due to lack of health care system, personal hygiene, shelter, sanitation and violence. Aim: The present study aims to find out the health problems and health care seeking behavior of rohingya refugee peoples, to identify the socio-demographic information for such exposure group in relation to age, sex, occupation, living areas, to explore the patient's physical, emotional, perceptions, attitudes and environmental health problems and to bring out health care seeking behavior of refugees. Methodology: A cross-sectional study was conducted. A total of 149 samples were selected conveniently for this study from the refugee camps. Data was collected by using mixed type of questionnaire. Descriptive statistic was used for data analysis which has depicted through tables, pie chart and bar chart. Results: The finding of the study showed that 45.6% participants had multiple problems, followed by 16.8% participants who had other specific problems like musculoskeletal pain, visual problems and peptic ulcer. Urinary tract infection was the leading individual health problem with 11.4% of the sample group having it. 10.7% participants had hypertension, 6% had respiratory tract infection, 3.4% had nutrition deficiency, 4.75% had diabetes mellitus and 1.3% had sanitation & hygiene problems. Among the participants, 68.4% age ranged between 15-59 years. The study showed that, only 16.1% participants were satisfied with the quality of service they received while 37.6% participants said that they needed better services such as more laboratory test, radiological imaging, more medicine and more doctors. Conclusion: It is clear that refugees suffered from a variety of health problems, because their living condition and environmental situation were not similar like an independent nation. Further, basic amenities like medicines and other services were not available. Keywords: Health problems, Rohingya refugee, Health seeking behaviour, Bangladesh. Introduction Rohingyas are an ethnic, linguistic and religious minority group of Northern Rakhine State (NRS) of Myanmar. Myanmar government categorized them as illegal immigrants from Bangladesh and have been excluded from citizenship and basic human rights [1]. From 1991-1992 a mass exodus of more than 250,000 Rohingya refugees fled persecution in the Union of Myanmar and arrived in Bangladesh, living in temporary camps and completely dependent on outside support from the United Nations (UN), the Government of Bangladesh (GOB) and numerous non-governmental organizations (NGOs) [2,3,4]. Globally, the total population of refugees is about 9.9 million. The general health status of refugees in various countries is reported to be poor with malnutrition being the major health problem due to lack of access to sufficient food and nutrient intakes. Other health problems among refugees include mental illnesses, intestinal parasites, hepatitis B, tuberculosis, sexually transmitted diseases, HIV/ AIDS, malaria and anemia [2,5]. Infants and young children are often the earliest and most frequent victims of violence, disease, and malnutrition which accompany population displacement and refugee outflows. One of them said "My life is over. All I want is, for my children to have a chance at a better life." Two generations of the Rohingya have said this. The vast majority of their community suffers the same neglect and lack of opportunity that their parents faced at present, there are no specific services available to refugee children with special needs or disabilities. With regards to cases of sexual exploitation of children, there have been reports and cases of refugee minors (females) being harassed, abused or raped by local villagers. A survey found that out of 508 children of under 5 years of age, 65% were anemic and therefore, chronically malnourished (4, 6, 7). Rohingya is an ethic group of people referring from the Sunni Muslim dwelling from Arakan, the historic name of border region of Myanmar which has a long history of apartness from the rest of the country. In general, Rohingya are of mixed tribe, who have traxces from their generation from ancestry (Arabs, Moors, Turks, Persians, Moguls and Pathans) and also from local Bengali and Rakhine. They speak Chittagonian (a local language style), a regional idiom of Bengali which is also used extensively throughout south-eastern Bangladesh [8]. Basic services like shelter, nutrition, education, medication and health care are needed for Syrian refugees. Near about 1.4 million Syrian refugees are children, United Nations Children's Fund has showed that these children are at risk of being a "lost generation". Syrian refugees tolerate daily physical and mental survival-challenge. In the case of extreme needs for physical and nutritional interventions, mental health professionals find out the emergency needs for counseling services based on comprehensive documented reports of refugees [9,10]. Three meals a day were served in camps, but refugees were not satisfied with the quality of what was being served. There were occasional cases of food intoxication. Refugees were not allowed to cook their food in tents because of the risk of fire. Out of camps, the nutritional status of refugees is mostly bad and only limited number of them could have 3 meals a day. In general, they fed on bread and vegetables. A survey conducted at a provincial centre found, among women in the age group 15-49, iron (by 50%) and B12 vitamin deficiency (by 46%) [11]. Some of the countries in the region (notably Pakistan, Bangladesh, and Nepal) hosted the refugees and displaced populations from neighbouring states, a circumstance that in itself merits attention since it has the potential to cause major political unrest [12]. Myanmar is a High HIV prevalence neighboring country of Bangladesh. A small town Teknaf is in the Chittagong Division situated at the southern tip of Bangladesh. It separates Bangladesh and Myanmar from the eastern side. Tens of thousands of refugees are currently living in poverty-stricken conditions at the Bangladeshi side [13]. A 19 years old refugee at Nayapara camp sayed that "I was born in Burma, but the Burmese government says I don't belong there. I grew up in Bangladesh, but the Bangladesh government says I cannot stay here. As a Rohingya, I feel I am caught between a crocodile and a snake" [14]. The population of Bangladesh is growing at an approximately rate of l.59 percent per annum which includes 27% in the urban areas while that of rural is 73%. Bangladesh's population growth rate was among the highest in the world in the 1960s and 1970s, when the country swelled from 65 to 110 million [15]. The problem of Rohingya refugee has been a chronic issue that involves the question of an ethnic minority's identity. In Myanmar, the Rohingyas are an ethnic minority group in the northern Arakan (currently known as Rakhine). From the eleventh century to 1962, the Rohingyas trace their historical roots in the Arakan region commonly known as Muslim Arakanese [16]. More than Hundreds of Rohingya have been the victims of torture, despotically binding, rape, sexual harassment and other forms of serious physical and mental harm, Rohingya have been fully devoid of freedom of movement and access to food, clean drinking water, sanitation, medical care, work opportunities, and education [17]. There is no domestic law in Bangladesh to regulate the administration of refugee affairs or to guarantee refugee rights. New refugees have difficulties accessing health care, their health problems may worsen with time.5 Social isolation and disconnection have been shown to contribute to premature death among members of isolated communities [18]. In refugee camps, medical services are mostly crippled as there is no examination and with the exception of some community health centers (RHU) there is no pregnant women and infant monitoring either, since family planning services for refugees are not available, there are unwanted births and increase in infant mortality, women additionally face risks of gender discrimination, sexual violence, early marriage and miscarriage and birth complications [19]. The government of Bangladesh showed their warm welcome to the Rohingyas from beginning and made corporeal efforts to accommodate them but the GOB had clearly maintained from the beginning that shelter for the refugees was temporary and encouraged them about their immediate return, In 1992 in south–western area, 20 refugee camps were constructed in Bangladesh for refugees. Among them, only few have been persisted till now which are as named Nayapara and Ukhia. Nayapara refugee camp is situated at Teknaf and Kutupalong refugee camp near Ukhia, giving shelter to 21,621 refugees, and also Kutupalong camp officially houses 8,216 refugees and Nayapara 13,405 (as of recorded till December 2001) [20)]. Methods Study Place The study was conducted at the refugee camp in Cox's Bazar in Bangladesh. Data Collection, Management & Analysis The data was collect from the refugee camp in Cox's Bazar in Bangladesh through a standard mixed type questionnaire. The study was conducted at the Nayapara refugee camp at teknaf in Cox's Bazar. About 149 samples were collected from July 2016 to October 2016 in Nayapara refugee camp by convenient sampling. After collecting the data analysis is done by SPSS (Statistical Package of Social Science) software version 16.0. Ethical consideration A research proposal was submitted to the public health department of ASA University for approval and the proposal was approved by the faculty members and gave permission initially from the supervisor of the research project and from the academic coordinator before conducting the study. The necessary information has been approved by the ethical committee of public health department and was permitted to do this research. Also the necessary permission was taken from the Camp In charge (CIC), health coordinator & medical team leader of the refugee health unit (RHU). The participants were explained about the purpose and goal of the study before collecting data from the participants. Pseudonyms were used in the notes, transcripts and throughout the study. It was ensured to the participants that the entire field notes, transcripts and all the necessary information was kept in a locker to maintain confidentiality and all information was destroyed after completion of the study. The participants were also assured that their comments will not affect them in any way possible. Result Among 149 participants, 82 (55%) were female and 67 (45%) were male. Female were predominantly higher than male. Mean age of the participants was 45.52 (±19.28) years, mode was 35. The range is 100 with minimum age 02 years and maximum 102 years. Among the participants the higher numbers of the participants were at the age of 35 years and the numbers were 13 (8.7%). The number of ≤ 18 years were 15 (10.1%), ≤60 years were 102 (68.4%) and ≥60 were 32 (21.5%). Majority of the participants were illiterate the numbers were 112 (75.2%) and 37 (24.8%) participants were literate those who complete their primary education. Majority of the participants were married the numbers were 105 (70.5%) followed by those who are widow the numbers were 24 (16.1%) and 20 (13.4%) participants were married. Nuclear family were 76 (51%) whereas 72 (49.0%) participants were in extended family. Among total particepants housewife were 61(40.9%), Unemployed were 42 (28.2%), others 16 (10.7%), student 13(8.7%), Day labour 11(7.4%), Agriculture 3(2%) Driver2 (1.3%) and Fisher man1 (0.7%) (Table 1). The mean of the number of problems faced was 7.39 with standard deviation (± 3.28), median being 9.0 and the mode was 10. Out of the 149 participants, 68 participants (45.6%) had multiple problems followed by 25 participants (16.8%), who had other specific problems like musculoskeletal pain, visual problems and peptic ulcer. Urinary tract infection was the leading individual health problem {17 participants (11.4%)}, 16 (10.7%) participants had hypertension, 9 (6%) had respiratory tract infection, 5 (3.4%) had nutrition deficiency, 7 (4.75%) had diabetes mellitus and 2 (1.3%) had sanitation & hygiene problems (Figure 1). 82 (55%) participants took medicine from RHU, 49 (32.9%) received multiple services like medicine, referral, laboratory test & others { 5 (3.4%)} received both laboratory test and referral to other organizations & 6 (4%) participants said that they didn't received any treatment from health center. Majority {75 (50.3%)} of the participants said that they received health services from RHU, followed by those who received health services from multiple organizations like RHU, HI, ACF & RTMI and 6 (4%) said that they received services from others like MSF, health complexes. Among the 149 participants, only 11.4% (n=17) participants said they have enough health services to meet their needs, 58.4% (n=87) said that sometimes they have enough health services to meet their needs and 30.2% (n=45) said that they did not not enough health services. Majority ( n=50, 33.6%) of the participants said they didn't meet needs because there was a lack of medicine supply and doctors in the camps. 47 (31.4%) of the patients said that they didn't meet needs because there is a lack of medicine supply in camps (Table 3). Among the 149 participants, 56 (37.6%) participants said that they need better services. Majority of the participants said that they need multiple services includes more laboratory test, radiological imaging, more medicine & more doctors, 17 (11.4%) participants said that they need more medicine and 3 (2%) said that they require more referral, laboratory test and radiological imaging. Table 1: Distribution of demographic variables (Kindly look at the PDF for the Tables and Figures) Table 2: Type of health care and health care receive organization (n=149) Among the 149 participants, only 16.1% (n=24) participants were satisfied with the quality of service received, 56.4% (n=84) said that they were sometimes satisfied after receiving the services and 27.5% (n=41) denied of being satusfied even after receiving it. Table 3: Health care services that meet the demands and the reason for not fulfill the demands (n=149) Figure 2: Expectation among the participants (n=149) Figure 3. Satisfaction level among the participants (n=149) Discussion: The result of this study showed that 45.6% participants were having multiple problems followed by 16.8% participants who had other specific problems like musculoskeletal pain, visual problems and peptic ulcer. Urinary tract infection was the leading individual health problems (11.4% had it), while 10.7% participants had hypertension, 6% had respiratory tract infection, 3.4% had nutrition deficiency, 4.75% had diabetes mellitus and 1.3% had sanitation & hygiene problems during the course of the study. It was also observed that among the participants the mean age of the participants was 45.52 (±19.28) years. The range is 100 with minimum age pf 2 years and maximum 102 years. Among the participants, the higher numbers of the participants were at the age of 35 years (8.7%). The numbers of ≤ 18 years were 10.1%, ≤60 years were 68.4% and ≥60 were 21.5%, the middle age people were the ones which had maority of the health problems. Önen C et al stated that health problems among refugees were frequently seen mostly at the early childhood & in adult aged problems, a community based study was carried out by Turkish medical association stated that 25.0% children had sleeping disorder at the of below 18 years & 24.0% have adult persons with the same problems [22]. The study showed that, majority of the participants received health services from RHU {75 (50.3%)}, followed by other multiple organizations like RHU, HI, ACF & RTMI and 6 (4%) said that they received services from others like MSF and health complexes. The study showed that, only 16.1% participants were satisfied with the quality of service they received, 56.4% said that they were sometimes satisfied after receiving services while 27.5% were not satisfied. Among the 149 participants, 32.9% participants said that they were not satisfied because there is a lack of medicine supply in RHU, 13.4% participants were not satisfied because there is a lack of qualified doctor in RHU & 38.9% participants stated that in RHU there wass a lack of budget, lack of doctor, lack of medicine supply, lack of referral to other organization in timely, not gave proper medicine & treatment & lack of serial maintain during medicine collection. Conclusion Rohingya refugees are far away to achieve their basic human rights and they have become stateless without a legal nationality from 1962. Considering the importance of nationality crisis of the Rohingya and problems associated with these following steps can be taken: Supplies of adequate Medicine, Increase Doctors' and Nurse, Modernized treatment, Increase Childcare hospital, Decrease pollution, Mass awareness of life threatening disease. Acknowledgement: Authors acknowledge the Kauvery Research Group for necessary support. References: Azad A, Jasmin F. Durable solutions to the protracted refugee situation: The case of Rohingyas in Bangladesh. J Indian Res. 2013;1(4):25–35. Teng TS, Zalilah MS. Nutritional status of rohingya children in kuala lumpur. Malaysian J Med Heal Sci. 2011;7(1):41–9. Coutts E. The Rohingya Refugee Situation in Bangladesh. American International School; 2005 [cited 27 February 2017]. Available from: http://www.rna-press.com/data/itemfiles/9bcc51b07210277172cfaca50dd60ff6.pdf Report of the WFP-UNHCR Joint Assessment Mission. Bangladesh: WFP and UNHCR; 2010 [cited 27 February 2017]. Available from: http://www.refworld.org/pdfid/4cdd31062.pdf Kemmer TM, Bovill ME, Kongsomboon W, Hansch SJ, Geisler KL, Cheney C, et al. Iron deficiency is unacceptably high in refugee children from Burma. J Nutr. 2003;133(12):4143–9 Nationality crisis and Rights of Rohingya Refugee Children: A Sociological Analysis of Children's Rights in Bangladesh.Dhaka: Department of Sociology University of Dhaka; 2014[cited 27 February 2017]. Available from : http://repository.libracry.du.ac.bd/xmlui/bitstream/handle/123456789/386/Israt%20Jahan.pdf?sequence=1: Analysis of Gaps in the Protection of Rohingya Refugees.Bangladesh:UNHCR; 2007 [cited 27 February 2017]. Available from: http://www.unhcr.org/protect/PROTECTION/46fa1af32.pdf Kiragu E, Rosi AL, Morris T. A review of UNHCR's response to the protracted situation of stateless Rohingya refugees in Bangladesh. United Nations High Commissioner for Refugees; 2011 [cited 27 February 2017]. Available from: http://www.unhcr.org/4ee754c19.pdf Karaman MA, Ricard RJ. Meeting the Mental Health Needs of Syrian Refugees in Turkey. 2016;6(4):318–27. SURİYELİ SIĞINMACILARIN TÜRKİYE'YE ETKİLERİ.ORSAM;2015 [cited 27 February 2017] Available from: http://tesev.org.tr/wp-content/uploads/2015/11/Suriyeli_Siginmacila

Presently, cardiovascular issues have become an emerging challenge for physiologists and researchers. Due to the fact, that the population is growing at a rapid pace and of course there is a shortage of doctors and hospitals, the demand and cost of healthcare is rising and is a topic of major concern. Also, it is not always possible for the affected person to visit the hospital or the doctor. In addition to this, specifically talking about people suffering from cardiac diseases, they require a system which continuously monitors their heart activities so that instantaneous detection of cardiac abnormalities at an early stage can be performed, consequently followed by an immediate remedy/treatment by the doctor. As a result, a huge amount of attention has been diverted to make the health-care systems intelligent i.e., real-time, continuous, long-term sensing and monitoring of bio-signals which can be carried out even at remote locations whether the person is in motion or at rest. There are several methods to measure the bio-signals but Electrocardiogram (ECG) is the premium method for measuring the heart signals. In this paper, we review the domains where continuous and long-term supervision of heart-rate is essential; the areas include elderly and differently-abled people, fetal ECG monitoring, infant monitoring, monitoring for automobile drivers, etc.

Aims and objectives To determine the effects of pacifier use on transition to full breastfeeding and sucking skills in preterm infants. Background Feeding problems in preterm infants cause delays in hospital discharge, extend mother-infant reunification, and increase medical cost. Nutritive sucking skills of preterm infants may develop by improving non-nutritive sucking skills and increasing sucking experiences. Design A prospective, randomised controlled trial conducted in the Eastern Turkey. Methods Seventy infants were randomised into two groups: a pacifier group (n=34) and a control group (n=36). Pacifier use was applied in the preterm infants in the pacifier group, up to switching to full breastfeeding. The infants in the control group did not use pacifiers. Data were collected by a researcher using the Preterm Infant Introductory Information Form, the Preterm Infant Monitoring Form, and the LATCH Breastfeeding Assessment Tool. For the study, ethics committee approval, official permission, and written informed consents of the families were obtained. Results The time to transition to full breastfeeding (123.06±66.56 hours) and the time to discharge (434.50±133.29 hours) in the pacifier group was significantly shorter compared to the control group (167.78±91.77 and 593.63±385.32 hours, respectively) (p

The aim of this study was to investigate two new scoring algorithms employing artificial neural networks and decision trees for distinguishing sleep and wake states in infants using actigraphy and to validate and compare the performance of the proposed algorithms with known actigraphy scoring algorithms. The study employed previously recorded longitudinal physiological infant data set from the Collaborative Home Infant Monitoring Evaluation (CHIME) study conducted between 1994 and 1998 [http://dccwww.bumc.bu.edu/ChimeNisp/Main_Chime.asp; Sleep26 (1997) 553] at five clinical sites around the USA. The original CHIME data set contains recordings of 1079 infants

Public health professionals assert that parents could prevent a substantial portion of infant mortality due to unintentional injury (IMUI) by creating a safe environment for the infant. Examples of safe parenting behaviors include attending to a bathing infant, properly securing a child safety seat in a motor vehicle, and removing soft pillows from a crib. The contraction of regional economies, an ambient phenomenon previously reported to affect salutary behaviors, may distract parents from these routine infant monitoring tasks. I test this distraction hypothesis that the monthly incidence of IMUI will vary inversely with the performance of the economy. I retrieve economic data from the Bureau of Labor Statistics and use data from the Birth Cohort File on 2 618 752 infants in all 26 metropolitan areas of California. Results support the hypothesis in that a one percent decline in employed persons coincides with an eight percent increase of IMUI in that month. Findings remain robust to control for individual covariates that could confound observed associations. I discuss my findings in relation to the literature concerned with parental distraction, describe other mechanisms through which the economy may affect IMUI, and recommend further investigation.

To determine if infants with cardiorespiratory events detected by home memory monitoring during early infancy have decreased neurodevelopmental performance.Infants (n = 256) enrolled in the Collaborative Home Infant Monitoring Evaluation also completed the Bayley Scales of Infant Development II at 92 weeks' postconceptional age. Infants were classified as having 0, 1 to 4, or 5+ cardiorespiratory events. Events were defined as apneaor=20 seconds or heart rate60 to 80 bpm or50 to 60 bpm, foror=5 to 15 seconds, depending on age.For term infants, having 0, 1 to 4, and 5+ cardiorespiratory events was associated with unadjusted mean Mental Developmental Index (MDI) values (+/-SD) of 103.6 (10.6), 104.2 (10.7), and 97.7 (10.9), respectively, and mean Psychomotor Developmental Index (PDI) values of 109.5 (16.6), 105.8 (16.5), and 100.2 (17.4). For preterm infants, having 0, 1 to 4, and 5+ cardiorespiratory events was associated with unadjusted mean MDI values of 100.4 (10.3), 96.8 (11.5), and 95.8 (10.6), respectively, and mean PDI values of 91.7 (19.2), 93.8 (15.5), and 94.4 (17.7). The adjusted difference in mean MDI scores with 5+ events compared with 0 events was 5.6 points lower in term infants ( P = .03) and 4.9 points lower in preterm infants ( P = .04).Having 5+ conventional events is associated with lower adjusted mean differences in MDI in term and preterm infants.

Late preterm infants have been called “great imposters” [1] because they often appear to be and are therefore treated as term infants, however their brainstem development and neural control of respiration are less mature than in full-term infants. During late gestation there are dramatic developmental changes in the brainstem and forebrain: at 34 gestational weeks the total brain weight is 65% of that at term [2]. The control of lung volume, laryngeal reflexes, upper airways, chemoreceptor activity, coordination of sucking, swallowing, breathing, the incidence of apnea and periodic breathing and the control of heart rate are still developing during late gestation and the degree of maturity of these mechanisms appears to lie on a continuum that extends from more immature infants to after term. Also, these reflexes are influenced by sleep-wake states whose neurobiological development is still evolving. The brainstem is not completely mature even at term, as confirmed by the fact that its myelination, the marker of completed neuronal/axonal maturation, is still incomplete at that time. This protracted maturation is not surprising, considering that the neurodevelopment of the respiratory control and sleep-wake cycle continues into infancy. The few data on control of breathing in late preterm infants indicate that ventilatory responses to CO2 and hypoxia as well as autonomic control of heart rate are not yet mature at 36 weeks PMA. Clinically, late preterm infants have more apnea and periodic breathing than term infants and immature coordination of sucking, swallowing and breathing often delay their ability to feed without episodes of bradycardia, desaturation and even apnea [3]. The incidence of apparent life-threatening events is more common in preterm infants (8-10%) than full-term infants (1% or less). In the Collaborative Home Infant Monitoring Evaluation studies the frequency of conventional and extreme (clinically relevant) events in near term infants is intermediate between preterm infants

Sudden infant death syndrome (SIDS) is the common cause of death in infants. Apnea is known to be associated with increased incidence of the SIDS. A cessation of breathing, longer than 15 seconds, or accompanied by hypoxia or bradycardia, is called apnea of prematurity and has been found in more than 50% of premature infants. We have designed and constructed an apnea detector for infant monitoring in a clinical environment. The device uses a breath processor module with a surface ECG for detecting apnea. When the infant's breathing counts and heart rates are abnormal, an alarm will sound. This device has shown good performance and feasibility.

An electronic simulator of physiologic signals used in infant monitoring has been designed, constructed and applied in the Collaborative Home Infant Monitor Evaluation (CHIME). A unique feature of the simulator is that it contains actual physiologic waveforms recorded from infants rather than artificial, idealized signals. The simulator stores breathing waveforms that can be used to test transthoracic-impedance- and inductance-plethysmography-based monitors, and heart rate channels are tested by playing a neonatal QRS complex at preset fixed rates or a variable rate as determined from infant recordings. The transfer characteristics of the simulator are constant over frequencies ranging from 0.5 to 8 Hz for the respiration channels. Data stored in memory are divided into 60 second epochs that can be presented to the monitor being tested in a programmable sequence. A group of 66 CHIME monitors was tested using a simulator programmed with 17 apnoea and bradycardia waveforms. The agreement between monitors as to the duration of detected apnoea decreases as the amount of artefact in the signal increases. Discrepancies between monitors in detecting apnoea duration were found to be similar to inconsistencies between CHIME investigators manually scoring similar waveforms.

Study Objectives: Epoch lengths from 20 seconds to 1 minute, and smoothing strategies from zero to three minutes are encountered in the infant sleep and waking literature. The present study systematically examined the impact of various epoch lengths and smoothing strategies on infant sleep state architecture. Design: Overnight polysomnographic recordings were visually assessed by epoch as wake or as each of four sleep state parameters: electroencephalographic patterns, respiration, body movement, and eye movement. From these findings, sleep and waking states were assigned for each of six combinations of epoch length (30-second or 1-minute) and smoothing window length (none, 3-epoch, or 5-epoch). Setting: N/A Participants: Subjects were 91 term infants, 42-46 weeks postconceptional age, from the Collaborative Home Infant Monitoring Evaluation (CHIME) study. Interventions: N/A Measurements and Results: A greater epoch length resulted in more active and less quiet sleep as a percentage of total study; however, the size of the smoothing window did not affect the percentage of sleep/waking states. In general, the greater the epoch length and the greater the smoothing window length, the fewer the number of, the greater the mean duration of, and the greater the longest continuous episode of sleep/waking states. Analysis of significant interactions indicated that a 1-minute epoch length relative to a 30-second epoch length resulted in increasingly longer episodes of quiet and especially active sleep with a greater smoothing window length. Conclusions: Smoothing strategy significantly altered sleep state architecture in infants and may explain part of the variability in infant sleep state findings between laboratories.

As part of the Collaborative Home Infant Monitoring Evaluation (CHIME) we compared apnea identified by a customized home monitor using respiratory inductance plethysmography (RIP) with simultaneously recorded polysomnography-acquired nasal end-tidal CO2 (Pet CO2 ) and nasal/oral thermistor in 422 infants during overnight laboratory recordings to determine concordance between techniques, sources of disagreement, and capacity of RIP to detect obstructed breaths within an apnea. Among 233 episodes of apnea identified by at least one method as ⩾ 16 s, 120 were observed by the CHIME monitor, 219 by Pet CO2 , and 163 by thermistor. The positive predictive value of the CHIME-identified apnea was 89.2% (95% CI 83, 95) and 73% (95% CI 65, 81) for Pet CO2 and thermistor, respectively. However, the sensitivity of the CHIME monitor in identifying events detected by the other methods was only ∼ 50%. Among 87 apnea events identified by all three techniques, no two methods showed high agreement in measurement of apnea d...

Studies on the long-term developmental effects of in utero cocaine exposure are few and the small number of studies published do not consider the postnatal environment. The present investigation was con- ducted to quantify the role that postnatal environment played compared to prenatal exposure. Four groups of 25 infants, each assessed at 12 months of age, were included in the study design: 1) noncocaine-exposed children re- siding with their biological parents in low socioeconomic environments, 2) cocaine-exposed children living with their biological parents in low socioeco- nomic environments, 3) noncocaine-exposed children adopted at birth in middle to upper-middle socioeconomic environments, and 4) cocaine-exposed children adopted at birth. Infants were assessed by the Uzgiris-Hunt Ordinal Scales of Infant Psychological Development, the Fagan Test of Infant Intel- ligence, and the Infant Monitoring Questionnaire. Height and head circum- ference were measured. Gender and ethnicity were controlled statistically. Significant differences were found in cognitive functioning, in fine motor development, and in physical growth between control and prenatally cocaine- exposed children. Adoption enhanced cognitive functioning and fine motor skills among infants not exposed to cocaine prenatally, but had no apparent effect on infants prenatally exposed to cocaine. Am. J. Hum. Biol. 12:417-428, 2000. © 2000 Wiley-Liss, Inc.

The use of reference standards, such as those of the National Center for Health Statistics (NCHS), for determining the health and nutritional status of breast-fed infants and children has been questioned. A recent study found that the mean weight of formula-fed infants remained at about the 50th percentile throughout their first year, whereas that of breast-fed infants fell below the 50th percentile well before age one year. Although these children probably are not at nutritional risk, deviation from the national reference data could lead to unnecessary infant monitoring and testing as well as undue parental concern.

Limitations in home monitoring technology have precluded longitudinal studies of hemoglobin oxygen saturation during unperturbed sleep. The memory monitor used in the Collaborative Home Infant Monitoring Evaluation addresses these limitations. We studied 64 healthy term infants at 2 to 25 weeks of age. We analyzed hemoglobin oxygen saturation by pulse oximetry (SpO(2)), respiratory inductance plethysmography, heart rate, and sleep position during 35, 127 epochs automatically recorded during the first 3 minutes of each hour. For each epoch baseline SpO(2) was determined during >/=10 s of quiet breathing. Acute decreases of at least 10 saturation points and /=5 s were identified, and the lowest SpO(2) was noted. The median baseline SpO(2) was 97.9% and did not change with age or sleep position. The baseline SpO(2) was /=16% were associated with isolated apnea. With the use of multivariate analyses, the odds of having an acute decrease increased as the number of epochs with periodic breathing increased, and they lessened significantly with age. We conclude that healthy infants generally have baseline SpO(2) levels >95%. The transient acute decreases are correlated with younger age, periodic breathing, and apnea and appear to be part of normal breathing and oxygenation behavior.

Objectives. To examine the degree of agreement between parental reporting of the development of high-risk infants and professional assessment by a multidisciplinary team. Methods. The developmental status of 196 infants discharged from neonatal intensive care units (NICUs) was assessed by their parents using the Infant Monitoring Questionnaire (IMQ) at 4, 8, or 12 months' corrected age. On the same day, a clinical assessment was done by a multidisciplinary team consisting of a developmental pediatrician, physical therapist, and psychologist. The κ statistic was used to measure agreement between the assessments. Logistic regression was used to investigate factors that might influence agreement. Results. Both the IMQ and the multidisciplinary team classified infants as developing normally ("normal"), being at risk for abnormal development ("suspect"), or developing abnormally ("abnormal"). Although the same proportion of children fell into the three categories by both assessments, parents and the multidisciplinary team showed poor agreement with respect to the classification of individual infants (k = 0.276). No infant or family characteristic was found to have an influence on agreement. Conclusions. For a group of high-risk infants discharged from NICUs, the agreement between parental assessment of developmental status using the IMQ and the professional assessment by a multidisciplinary team is poor in the first year of life. We do not recommend the use of this questionnaire as a substitute for clinical assessment of biologically at-risk infants discharged from NICUs. However, it may be useful for those groups of infants for whom no other information is available or as an adjunct to clinical assessment when infants are not behaving typically because of an unfamiliar setting or concurrent illness.

Background Patient safety is of great importance in the pediatric emergency department (PED). The combination of acutely and critically ill patients and high patient volumes creates a need for systems to support physicians in making accurate and timely diagnoses. Electronic patient tracking systems can potentially improve PED safety by reducing overcrowding and enhancing security. Objectives To enhance our understanding of current electronic tracking technologies, how they are implemented in a clinical setting, and resulting effect on patient care outcomes including patient safety. Methods Nine databases were searched. Two independent reviewers identified articles that contained reference to patient tracking technologies in pediatrics or emergency medicine. Quantitative studies were assessed independently for methodological strength by two reviewers using an external assessment tool. Results Of 2292 initial articles, 22 were deemed relevant. Seventeen were qualitative, and the remaining five quantitative articles were assessed as being methodologically weak. Existing patient tracking systems in the ED included: infant monitoring/abduction prevention; barcode identification; radiofrequency identification (RFID)- or infrared (IR)-based patient tracking. Twenty articles supported the use of tracking technology to enhance patient safety or improve efficiency. One article failed to support the use of IR patient sensors due to study design flaws. Conclusions Support exists for the use of barcode-, IR-, and RFID-based patient tracking systems to improve ED patient safety and efficiency. A lack of methodologically strong studies indicates a need for further evidence-based support for the implementation of patient tracking technology in a clinical or research setting.

To test the hypothesis that term-born Asian infants, at reduced risk to die of Sudden Infant Death Syndrome (SIDS) exhibit a circadian heart rate rhythm (CHR) at a later age than non-Asian term infants.Repeated overnight heart rate (HR) traces obtained with a battery-operated Polar S810i heart-rate monitor at home in 17 Asian Torajan infants in Indonesia, were compared with those of 52 non-Asian infants monitored as part of the Collaborative Home Infant Monitoring Evaluation (CHIME). HR was determined using a moving window averaging technique. A comparison of median HR during quiet sleep (QS) episodes (identified by minimum HR variability), established the presence of CHR.Seventy three percent of non-Asian CHIME infants ≤7 weeks exhibited CHR compared to 45% of Asian Torajan infants. Between 8 and 12 weeks, 94% of non-Asian CHIME infants exhibited CHR, compared to 33% of Asian Torajan infants (p0.001). Forty seven and 56% of Asian Torajan infants exhibited the CHR at the age intervals of 16-20 weeks and 21-25 weeks respectively. Active wakefulness percentages as a function of the entire recording and median QS HR were not significantly different in the two groups.Despite the fact that Asian Torajan infants were on average a week older than non-Asian CHIME babies, between two and three months of age only one in three exhibited the CHR, compared to virtually all non-Asian CHIME infants. We speculate that the cause of this difference rests in the infants' environment rather than their genetic origin.

A successful case for UWB technology application to Vital Signs Monitoring Systems created by authors is presented in this paper. Baby Monitor for remote contactless monitoring of respiratory and heart rate is designed both for consumer and medical infant monitoring applications. Unlike conventional sound- and video-based baby monitors, which do not provide any useful information at infant sleep time (no sounds or static picture) the devices allow permanent parental control and effectively prevent Sudden Infant Death Syndrome (SIDS) from occurring. SIDS is reported to be leading death cause of healthy infants after one month age.

Respiratory diseases are among the most important and serious conditions that can affect the newborn baby. A cessation of breathing, longer than 15 seconds, or accompanied by hypoxia or bradycardia, is called apnea of prematurity (AOP) and has been found in more than 50% of premature infants. An apnea detector used in infant monitoring has been designed and constructed and is intended to be applied in a clinical environment. Diaphragmatic surface EMG has been used as the technique for detecting apnea episodes due to a direct relation with the respiratory drive. Both obstructive and central apnea can be determined as well as heart rate. Good performance and feasibility have been shown by the prototype.