Maintaining adequate and stable blood oxygen level is important for preterm babies to avoid the risk of brain, lung and retinal injury such as retinopathy of prematurity (ROP). However, wide disparities in policies and practices of oxygenation in preterm babies exist among neonatal care providers as it is still unclear which best method of monitoring and what features of oxygen measurements are important to clinician’s interpretations for assessing preterm babies at risk of developing severe ROP or unstable health condition. This thesis consists of two projects: NZ-ROP that examines multiple factors of severe ROP including summary statistics (mean, standard deviation (SD), coefficient of variation (CV) and desaturation) for oxygen saturation (OS) features in very extreme preterm babies, and NZ-LP that investigates the efficacy of some of these statistics for health monitoring of late preterm babies. The OS data in NZ-ROP were recorded using modified oximeters that have offsets and inherent software artefact, both of which mask the actual saturation for certain OS ranges and may complicate the choice of methods in the analyses. Therefore, novel algorithms involving linear and quadratic interpolations are developed, implemented on the New Zealand data, and validated using the data of a UK preterm baby, as recorded from offsets and non-offsets oximeters. For all data sets, the algorithms produced saturation distributions that were very close to those obtained from the non-offset oximeter. The algorithms perform within the recommended standards of commercial oximeters currently used in the clinical practice. ROP is a multifactorial disease, with oxygenation fluctuations as one of the key contributors. The all-subsets logistic regression, robust and generalised additive statistical modelling, along with a model averaging approach, are applied in NZ-ROP to determine the relationship of variability and level of OS with severe ROP, and the extent of contribution of various clinical predictors to the severity of this eye disease. Desaturation, as a measure of OS variability, has the strongest association with severe ROP among all OS statistics, in particular, the risk of severe ROP is almost three times higher in babies that exhibit greater occurrences of desaturation episodes. Additionally, this study identifies longer periods of ventilation support, frequent desaturation events, extreme prematurity and low birth weight as the most important factors that substantially exacerbate the severity of ROP, and therefore signify babies’ underlying condition of being severely ill. Persistent cardiorespiratory instabilities prior to hospital discharge may expose preterm babies to a greater risk of neuro-developmental impairments. In NZ-LP, the statistical summaries of mean, SD and CV are computed from the OS measurements of healthy stable and unstable babies, and the performance of these statistics in detecting the unstable babies is evaluated using an extremeness index for outlying data and a hierarchical clustering technique. With SD and CV, the clinically unstable babies were very well separated from the group of stable babies, wherein, the separation was even more apparent with the use of CV. These suggest that measures of variability could be better than saturation level for highlighting babies’ underlying instability due to immature physiological systems, but the combination of variability and level through the CV are believed to be even better. Identification and summarisation of useful OS features quantitatively hold great promise for improved monitoring of oxygenation instability and diagnosis of severe ROP for preterm babies.

The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

No description available.

SAS has became an increasingly important public-health problem since 1970. It can adversely affect neurocognitive, cardiovascular, respiratory diseases and can also cause behavior disorder. Moreover, up to 90% of these cases are obstructive sleep apnea (OSA). Presently, Polysomnography is considered as the gold standard for diagnosing sleep apnea syndrome (SAS). However, Polysomnography-based sleep studies are expensive and time-consuming because they require overnight evaluation in sleep laboratories with dedicated systems and attending personnel. In this study, based on the nocturnal oxygen saturation (SpO2) signals, this work develops a method to classify patients with different levels of respiratory disturbance index (RDI) values. To achieve this goal, this study uses neural network in conjunction with different sets of feature variables to perform classification.

The objectives for the first part of this thesis were to describe changes in oxygen saturation (SpO2) and heart rate (HR) in newly born infants in the delivery room (DR) and to illustrate the changes using centile reference charts. The objective of the second part of the thesis was to investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV), immediately after birth with a T-piece have higher SpO2 measurements at five minutes than infants ventilated with a self inflating bag (SIB). / Study Design. A prospective observational study was used to achieve the first objectives. For the second part of the thesis I coordinated a randomised, controlled trial of two devices used for resuscitation of extremely preterm infants in the DR where the primary outcome measure was SpO2. / Patients and methods. In all studies a Masimo Radical pulse oximeter (PO) was placed on the infant’s right hand/wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light). / Results. Observational studies: The dataset to develop the reference range charts included 61,650 data points from 468 infants. Infants had a mean (range) gestational age of 38 (25-42) weeks and birthweight 2970 (625-5135) g. For all 468 infants at one minute the 3rd, 10th, 50th, 90th and 97th centiles were 29%, 39%, 66%, 87% and 92%; at two minutes 34%, 46%, 73%, 91% and 95% and at five minutes 59%, 73%, 89%, 97% and 98%. It took a median of 7.9 (IQR 5.0 to 10) minutes to reach a SpO2 > 90%. SpO2 of preterm infants rose more slowly than that of term infants. At one min the median (IQR) HR was 82 (66 to 138) bpm rising at two min and five min to 151 (112 to 169) bpm and 166 (148 to 176) bpm respectively. In preterm infants, the SpO2 and HR rose more slowly than term infants. / Randomised trial: Forty nine infants were randomly allocated to the T-piece and 50 to the SIB. Ten infants did not receive PPV, 4 (8%) in the T-piece group and 6 (12%) in the SIB group and were not included in the analysis. Forty-one infants received PPV with a T-piece and 39 with a SIB. At 5 minutes after birth there was no significant difference between the mean (SD) SpO2 in the T-piece and SIB groups [50 (31)% vs. 53 (25)%, (p=0.73)]. More T-piece infants received oxygen during DR resuscitation (100% vs. 90%, p=0.04). There was no significant difference between the groups in the use of continuous positive airway pressure (CPAP); endotracheal intubation or administration of surfactant in the DR. Fewer of the T-piece group who left the DR on CPAP were intubated in the first 24 hrs after birth. (7% vs. 23%, p=0.05). / Conclusion. The centile charts developed in this thesis provide a reference range for SpO2 and HR in the first 10 minutes after birth for preterm and term infants. In the randomised trial there was no significant difference in SpO2 at five minutes after birth in extremely preterm infants given PPV with a T-piece or a SIB.

Master of Science / Department of Electrical and Computer Engineering / Steven Warren / A reference design for a wearable, wireless biomedical sensor set has been a long-term need for researchers at Kansas State University, driven by the idea that a basic set of sensor components could address the demands of multiple types of human and animal health monitoring scenarios if these components offered even basic reconfigurability. Such a reference design would also be a starting point to assess sensor performance and signal quality in the context of various biomedical research applications. This thesis describes the development of a set of wireless health monitoring sensors that can be used collectively as a data acquisition platform to provide biomedical research data and to serve as a baseline reference design for new sensor and system development. The host computer, an Intel Edison unit, offers plug-and-play usability and supports both Wi-Fi and Bluetooth wireless connectivity. The reference sensor set that accompanies the Intel Edison single-board computer includes an electrocardiograph, a pulse oximeter, and an accelerometer/gyrometer. All sensors are based on the same physical footprint and connector placement so that the sensors can be stacked to create a collection with a minimal volume and footprint. The latest hardware version is 3.1. Version 1.0 supported only a pulse oximeter, whereas version 2.0 included an electrocardiograph, pulse oximeter, and respiration belt. In version 3.0, the respiration belt was removed, and accelerometers and gyroscopes were added to the sensor set. Version 3.1 is a refined version of the latter design, where known hardware bugs were remedied. Future work includes the development of new sensors and casing designs that can hold these sensor stacks.

This dissertation focuses on the use of near-infrared spectroscopy (NIRS) to identify trends in regional cerebral oxygen saturation (rSO2) in both conscious and anaesthetised healthy horses. A cerebral/somatic oximeter sensor recorded rSO2 from the dorsal sagittal sinus of 6 healthy horses. Values for rSO2, arterial and venous oxygen and carbon dioxide tensions (PaO2, PvO2, PaCO2 and PvCO2 respectively), along with arteriovenous oxygen saturations (SavO2) were recorded in unsedated (recording period [RP] 1), sedated (RP2), and anaesthetised horses (RP3-5); and during recovery (RP6-8). During anaesthesia, horses were ventilated to achieve states of normo- (RP3), hyper- (RP4) and hypocapnoea (RP5). Overall mean ± s.d. values for rSO2, PaO2, PvO2, PaCO2, SavO2 and mean arterial pressure (MAP) varied significantly by RP. Significant decreases in rSO2 were identified between RP1 and the post-anaesthetic periods however no significant differences in rSO2 values were identified between RP1 and the intra-anaesthesia periods. Regional cerebral oxygen saturation was significantly correlated with PaO2, PvO2 and SavO2. No correlation was identified between rSO2 and lactate concentration. This is the first study to identify trends in rSO2 in horses using NIRS. A significant positive correlation was identified between rSO2 and PvO2, suggesting that alterations in cerebral oxygenation may be reflected in jugular PvO2. Results of this study demonstrate that NIRS can be used during general anaesthesia to monitor trends in rSO2 in healthy horses, and has the potential to alert clinicians to cerebral desaturation events when used in a clinical setting. / Dissertation (MMedVet)--University of Pretoria, 2013. / gm2014 / Companion Animal Clinical Studies / unrestricted

No description available.

Master of Science / Department of Electrical and Computer Engineering / Steven Warren / Pulse oximetry, a noninvasive circulatory system monitoring technique, has been widely adopted in clinical and homecare applications for the determination of heart rate and blood oxygen saturation, where measurement locations are typically limited to fingertips and earlobes. Prior research indicates a variety of additional clinical parameters that can be derived from a photoplethysmogram (PPG), the fundamental time-domain signal yielded by a pulse oximeter sensor. The gap between this research potential and practical device applications can be decreased by improvements in device design (e.g., sensor performance and geometry, sampling fidelity and reliability, etc.) and PPG signal processing. This thesis documents research focused on a novel pulse oximeter design and the accompanying PPG signal processing and interpretation. The filter-free reflectance design adopted in the module supplements new methods for signal sampling, control, and processing, with a goal to acquire high-fidelity raw data that can provide additional physiologic data for state-of-health analyses. Effective approaches are also employed to improve signal stability and quality, including shift-resistant baseline control, an anti-aliasing sampling frequency, light emitting diode intensity autoregulation, signal saturation inhibition, etc. MATLAB interfaces provide data visualization and processing for multiple applications. A feature detection algorithm (decision-making rule set) is presented as the latest application, which brings the element of intelligence into the pulse oximeter design by enabling onboard signal quality verification. Two versions of the reflectance sensor were designed, built, calibrated, and utilized in data acquisition work. Raw data, which are composed of four channels of signals at a 240 Hz sampling rate and a 12-bit precision, successfully stream to a personal computer via a serial connection or wireless link. Due to the optimized large-area sensor and the intensity autoregulation mechanism, PPG signal acquisition from measurement sites other than fingertips and earlobes, e.g., the wrist, become viable and retain signal quality, e.g., signal-to-noise ratio. With appropriate thresholds, the feature detection algorithm can successfully indicate motion occurrence, signal saturation, and signal quality level. Overall, the experimental results from a variety of subjects and body locations in multiple applications demonstrate high quality PPGs, prototype reliability, and prospects for further research value.