Standard of care management in neonatal and pediatric intensive care units (NICUs and PICUs) involve continuous monitoring of vital signs with hard-wired devices that adhere to the skin and, in certain instances, include catheter-loaded pressure sensors that insert into the arteries. These protocols involve risks for complications and impediments to clinical care and skin-to-skin contact between parent and child. Here we present a wireless, non-invasive technology that not only offers measurement equivalency to these management standards but also supports a range of important additional features (without limitations or shortcomings of existing approaches), supported by data from pilot clinical studies in the neonatal intensive care unit (NICU) and pediatric ICU (PICU). The combined capabilities of these platforms extend beyond clinical quality measurements of vital signs (heart rate, respiration rate, temperature and blood oxygenation) to include novel modalities for (1) tracking movements and changes in body orientation, (2) quantifying the physiological benefits of skin-to-skin care (e.g. Kangaroo care) for neonates, (3) capturing acoustic signatures of cardiac activity by directly measuring mechanical vibrations generated through the skin on the chest, (4) recording vocal biomarkers associated with tonality and temporal characteristics of crying impervious to confounding ambient noise, and (5) monitoring a reliable surrogate for systolic blood pressure. The results have potential to significantly enhance the quality of neonatal and pediatric critical care.In the United States, over 480,000 critically-ill infants and children enter intensive care units (ICUs) each year. Those less than one year of age suffer from the highest morbidity and mortality rates and therefore require the most intensive care 1,2 . These fragile patients include
Skin-mounted soft electronics incorporating high-bandwidth triaxial accelerometers can provide broad classes of physiologically relevant information, such as mechanoacoustic signatures of underlying body processes (such as those captured by a stethoscope) and precision kinematics of core body motions. Here, we describe a wireless device designed to be conformally placed on the suprasternal notch for the continuous measurement of mechanoacoustic signals, from subtle vibrations of the skin at accelerations of ~10 −3 m•s −2 to large motions of the entire body at ~10 m•s −2 , and at frequencies up to ~800 Hz. Because th measurements are a complex superposition of signals that arise from locomotion, body orientation, swallowing, respiration, cardiac activity, vocal-fold vibrations and other sources, we used frequency-domain analysis and machine learning to obtain, from human subjects during natural daily activities and exercise, real-time recordings of heart rate, respiration rate, energy intensity and other essential vital signs, as well as talking time and cadence, swallow counts and patterns, and other unconventional biomarkers. We also used the device in sleep laboratories, and validated the measurements via polysomnography. Natural processes of the human body yield a multitude of mechano-acoustic (MA) signals, many of which strongly attenuate at the skin-air interface 1-5. Motions with amplitudes and Lee et al.
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