Apnea of Newborn, Birth Asphyxia, Birth Outcome, Adverse, Delivery Complication, Delivery Problem for Fetus, ECG Electrode Site Reaction, Infant ALL, Infant Apnea, Infant Conditions, Infant Death, Infant, Newborn, Diseases, Newborn Asphyxia, Newborn Morbidity, Newborn; Vitality, Parents, Pregnancy Related, Sudden Unexplained Infant Death
Conditions
Keywords
Delivery Room, Newborn, Neonatal Resuscitation, Wireless Technology, Vital Sign Monitoring, Sudden Unexplained Post-Natal Collapse, SUPC, Obstetrical Center, Obstetrics, Neonate, Birth, Birthing Center, C-Section, Vaginal Delivery, Sensors, Heart Rate (HR), Respiratory Rate (RR), Blood Oxygen Saturation (SpO2), Skin Temperature (Tskin), Pulse Rate (PR), International, Low-Income, Middle-Income, High-Income, Golden Hour, Post-Birth
Brief summary
The goals of this observational study is to assess whether a new advanced wireless skin sensor vital sign monitoring system can effectively monitor the vital signs of healthy newborn infants (≥ 35 weeks gestational age). The main aims of this Study are to: 1. Assess feasibility 2. Evaluate safety 3. Determine accuracy of the wireless monitoring system, compared to the standard of care wired vital sign monitoring system, immediately after delivery and for the first 2h of age in the obstetrical center under unsupervised parents' care. The newborn infants participating in the Study will have both vital sign monitoring systems placed on their chest and limb. Their vital signs will be monitored for 2h consecutively.
Detailed description
When the transition from intrauterine to extrauterine life necessitates Neonatal Resuscitation, specialized monitoring of vital signs is required. Sudden Unexpected Postnatal Collapse (SUPC) is an apnea or cardiorespiratory failure occurring in otherwise healthy near-term or term neonates, usually in the first 48 hours of age, during the initial Kangaroo Mother Care (KMC) in the obstetrical center. SUPC carries a high morbidity and mortality rate. Approximately 10 million babies do not breathe immediately after birth, and 60% require basic resuscitation interventions. Sudden Unexpected Postnatal Collapse has been estimated to occur in 2.6-133 cases per 100.000 newborns and over 50% of the cases occur following accidental suffocation, which frequently goes unrecognised by parents in the obstetrical center during unsupervised KMC. Current guidelines recommend monitoring of heart rate (HR), oxygen saturation (SpO2), and skin temperature (Tskin) during neonatal resuscitation. This is usually achieved by using wired electrodes and sensors that require expensive and large base units attached to a power supply. SUPC is a rare but largely preventable cause of neonatal mortality that deserves particular attention. Better resuscitation and prevention of SUPC might be achieved by continuous non-intrusive monitoring of vital signs immediately after delivery and while in the obstetrical center. This research will address a very important gap in care; the need for safe and accurate advanced, non-invasive, and non-intrusive wireless technologies for monitoring of vital signs immediately after birth and during the immediate postnatal care, potentially preventing cases of SUPC while in the obstetrical center. Reliable and low-cost wireless monitoring that could be used immediately after delivery would promote widespread adoption of neonatal resuscitation recommendations in low and middle income countries, improve detection of vital signs quickly after delivery and during early unsupervised KMC, and optimize neonatal care in the obstetrical centers or during hospital stay, to prevent cases of SUPC and its associated high mortality.
Interventions
The wireless monitoring system will be applied to the newborn and consist of a chest sensor (Anne Arc by Sibel Inc.) and a RAD-7 (Masimo)pulse oximeter limb sensor.
A standard ECG and SpO2 monitoring device will be applied suing the Infinity M540 monitor (Draeger, Germany). The chest sensor will be placed as per standard of care on the newborn's chest and abdomen, and the SpO2 sensor on their hands or feet.
Sponsors
Study design
Eligibility
Inclusion criteria
1. Newborns ≥35 weeks (gestational age) 2. Newborns determined to be clinically stable at delivery 3. Newborns with no skin abnormalities
Exclusion criteria
1. Newborns ≤ 35 weeks (gestational age) 2. Newborns determined to not be clinically stable at delivery 3. Newborns with Skin abnormalities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of using a wireless monitoring system immediately after delivery for HR. | 6 months | Percentage of time for which heart rate (HR) is displayed. |
| Feasibility of using a wireless monitoring system immediately after delivery for RR. | 6 months | Percentage of time for which respiratory rate (RR) is displayed. |
| Feasibility of using a wireless monitoring system immediately after delivery for SpO2. | 6 months | Percentage of time for which blood oxygen saturation (SpO2) is displayed. |
| Feasibility of using a wireless monitoring system immediately after delivery for Tskin | 6 months | Percentage of time for which skin temperature (Tskin) is displayed. |
| Feasibility of using a wireless monitoring system immediately after delivery - Gap occurence | 6 months | Occurrence of gaps in signal detection/recordings (% and length in seconds). |
| Feasibility of using a wireless monitoring system immediately after delivery - Gap causes | 6 months | Causes of the gaps in signal detection/recordings. |
| Feasibility of using a wireless monitoring system immediately after delivery - User satisfaction | 6 months | Descriptive analysis of user surveys and their satisfaction with the wireless system. |
| Safety of using a wireless system immediately after delivery - skin score | 6 months | Skin score (Neonatal Skin Condition Score) to be determined by a blinded dermatologist using de-identified pictures of the skin after removal of the sensors of each system. A "perfect" score using the NSCS is 3; the worst score is 9. |
| Safety of using a wireless system immediately after delivery - pain scale | 6 months | Pain scale (Neonatal Infant Pain Scale) to assess any discomfort or pain during the removal of the sensors, with higher scores indicating greater pain. |
| Safety of using a wireless system immediately after delivery - clinical event discrepancies | 6 months | Clinically significant events detected by the wired system (HR \< 100 bpm or SpO2 \< 80%) but missed by the wireless system. |
| Assess the accuracy of this wireless system - correlation coefficient. | 6 months | Measuring HR, RR, SpO2 and Tskin signals compared with the "standard of care" wired system - Correlation coefficient |
| Assess the accuracy of this wireless system - slope | 6 months | Measuring HR, RR, SpO2 and Tskin signals compared with the "standard of care" wired system - Slop |
| Assess the accuracy of this wireless system - variance accounted for | 6 months | Measuring HR, RR, SpO2 and Tskin signals compared with the "standard of care" wired system - Variance accounted for |
| Assess the accuracy of this wireless system - bias. | 6 months | Measuring HR, RR, SpO2 and Tskin signals compared with the "standard of care" wired system - Bias |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time between sensors placement and data display (seconds) | 6 months | To determine the time (seconds)between sensors placement and data display for each system (seconds) |
Countries
Brazil, Canada, Italy, Switzerland
Contacts
The Research institute of the McGill University Health Centre