ORCID Profile
0000-0003-0744-2365
Current Organisation
University of Tasmania
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Publisher: Frontiers Media SA
Date: 16-09-2020
Publisher: Springer Science and Business Media LLC
Date: 28-07-2017
DOI: 10.1007/S10916-017-0782-8
Abstract: Imaging systems have applications in patient respiratory monitoring but with limited application in neonatal intensive care units (NICU). In this paper we propose an algorithm to automatically detect the torso in an image of a preterm infant during non-invasive respiratory monitoring. The algorithm uses normalised cut to segment each image into clusters, followed by two fuzzy inference systems to detect the nappy and torso. Our dataset comprised overhead images of 16 preterm infants in a NICU, with uncontrolled illumination, and encompassing variations in poses, presence of medical equipment and clutter in the background. The algorithm successfully identified the torso region for 15 of the 16 images, with a high agreement between the detected torso and the torso identified by clinical experts.
Publisher: Wiley
Date: 10-06-2020
DOI: 10.1111/APA.15353
Publisher: BMJ
Date: 28-08-2023
DOI: 10.1136/ARCHDISCHILD-2023-325849
Abstract: To investigate the impact of a pre-emptive apnoea triggered oxygen response on oxygen saturation (SpO 2 ) targeting following central apnoea in preterm infants. Interventional crossover study of a 12-hour period of automated oxygen control with an apnoea response (AR) module, nested within a crossover study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking 12-hour periods of manual control. Neonatal intensive care unit Preterm infants receiving non-invasive respiratory support and supplemental oxygen median (IQR) birth gestation 27 (26–28) weeks, postnatal age 17 (12–23) days. Automated oxygen titration with an automated control algorithm modified to include an AR module. Alterations to inspired oxygen concentration (FiO 2 ) were actuated by a motorised blender. Desired SpO 2 range was 90–94%. Apnoea detection was by capsule pneumography. Duration, magnitude and area under the curve (AUC) of SpO 2 deviations following apnoea frequency and duration of apnoeic events. Comparisons between periods of manual, automated and automated control with AR module. In 60 studies in 35 infants, inclusion of the AR module significantly reduced AUC for SpO 2 deviations below baseline compared with both automated and manual control (manual: 87.1%±107.6% s, automated: 84.6%±102.8% s, AR module: 79.4%±102.7% s). However, there was a coincident increase in SpO 2 overshoot (AUC (SpO 2 SpO 2(onset) ) manual: 44.3±99.9% s, automated: 54.7%±103.4% s, AR module: 65.7%±126.2% s). Automated control with a pre-emptive apnoea-triggered FiO 2 boost resulted in a modest reduction in post-apnoea hypoxaemia, but was followed by a greater SpO 2 overshoot. ACTRN12616000300471.
Publisher: BMJ
Date: 07-05-2021
DOI: 10.1136/ARCHDISCHILD-2020-321538
Abstract: To evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency. Interventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each). Neonatal intensive care unit. Preterm infants receiving non-invasive respiratory support and supplemental oxygen median birth gestation 27 weeks (IQR 26–28) and postnatal age 17 (12–23) days. Automated oxygen titration with the VDL1.1 algorithm, with the incoming SpO 2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO 2 ) adjustments actuated by a motorised blender. The desired SpO 2 range was 90%–94%, with bedside clinicians able to make corrective manual FiO 2 adjustments at all times. Target range (TR) time (SpO 2 90%–94% or 90%–100% if in air), periods of SpO 2 deviation, number of manual FiO 2 adjustments and oxygen requirement were compared between automated and manual control periods. In 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51–64)% vs automated 81 (72–85)%, p .001), less time at both extremes of oxygenation and considerably fewer prolonged hypoxaemic and hyperoxaemic episodes. The algorithm functioned effectively in every infant. Manual FiO 2 adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25–32)% and automated 26 (24–32)%, p=0.13). The VDL1.1 algorithm was safe and effective in SpO 2 targeting in preterm infants on non-invasive respiratory support. ACTRN12616000300471.
Publisher: BMJ
Date: 09-02-2022
DOI: 10.1136/ARCHDISCHILD-2021-323486
Abstract: To study the feasibility of automated titration of oxygen therapy in the delivery room for preterm infants. Prospective non-randomised study of oxygenation in sequential preterm cohorts in which FiO Delivery rooms of a tertiary level hospital. Preterm infants <32 weeks gestation (n=20 per group). Automated oxygen control using a purpose-built device, with SpO Proportion of time in the SpO Time in the SpO Automated oxygen titration using a purpose-built algorithm is feasible for delivery room management of preterm infants, and warrants further evaluation.
Publisher: Wiley
Date: 16-07-2019
DOI: 10.1002/PPUL.24451
Abstract: The factors influencing the severity of apnea-related hypoxemia and bradycardia are incompletely characterized, especially in infants receiving noninvasive respiratory support. To identify the frequency and predictors of physiological instability (hypoxemia-oxygen saturation (SpO Respiratory pause duration, derived from capsule pneumography, was measured in 30 preterm infants of gestation 30 (24-32) weeks [median (interquartile range)] receiving noninvasive respiratory support and supplemental oxygen. For identified pauses of 5 to 29 seconds duration, we measured the magnitude and duration of SpO In total, 17 105 isolated and 9180 clustered pauses were identified. Hypoxemia and bradycardia were more likely after longer duration and temporally-clustered pauses. However, the majority of such episodes occurred after 5 to 9 second pauses given their numerical preponderance, and short-lived pauses made a substantial contribution to physiological instability overall. Birth gestation, hemoglobin concentration, form of respiratory support, caffeine treatment, respiratory pause duration and temporal clustering were identified as predictors of instability. Brief respiratory pauses, especially when clustered, contribute substantially to hypoxemia and bradycardia in preterm infants.
Publisher: Wiley
Date: 07-05-2021
DOI: 10.1111/APA.15888
Publisher: BMJ
Date: 12-08-2020
DOI: 10.1136/ARCHDISCHILD-2020-319092
Abstract: Nasal continuous positive airway pressure (NCPAP) can be applied via binasal prongs or nasal masks both may be associated with air leak and intermittent hypoxia. We investigated whether the latter is more frequent with nasal masks or prongs. Continuous 24 hours recordings of inspired oxygen fraction (FiO 2 ), pulse rate, respiratory rate, pulse oximeter saturation (SpO 2 ) and CPAP level were made in preterm infants with respiratory insufficiency (n=20) managed on CPAP in the NICU at the Royal Hobart Hospital. As part of routine care, nasal interfaces were alternated 4-hourly between mask and prongs. In each recording, the first two segments containing at least 3 hours of artefact-free signal for each interface were selected. Recordings were analysed for episodes with hypoxaemia (SpO 2 % for ≥10 s) and bradycardia (pulse rate /min for ≥4 s) and for episodes of pressure loss at the nasal interface. Data were compared using Wilcoxon-matched pairs test and are reported as median (IQR). Infants had a gestational age at birth of 26 (25-27) weeks and postnatal age of 17 (14–24) days. There was no difference in %time with interface leak between prong and mask (0.9 (0–8)% vs 1.1 (0–18)%, p=0.82), %time with SpO 2 % (0.15 (0–1.2)% vs 0.06 (0–0.8)%, p=0.74) or heart rate /min (0.03 (0–0.2)% vs 0 (0–0.2)%, p=0.64). Three infants had interface leak for % of the time with prongs and 5 with the mask. Both interfaces resulted in a similarly stable provision of positive airway pressure, and there was also no difference in the occurrence of intermittent hypoxia.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.EARLHUMDEV.2021.105462
Abstract: For the preterm infant with respiratory insufficiency requiring supplemental oxygen, tight control of oxygen saturation (SpO
No related grants have been discovered for Andrew Marshall.