Neonatal neurocritical care – finding and filling the gaps€¦ · Creation of well-annotated multi-centre database of high-fidelity monitoring data Automated sleep analysis on

BrainInjuryHealthcareTechnologyCo-operative

TheNIHRBrainInjuryHealthcareTechnologyCo-operativeisdeliveredinpartnershipbetweenCambridgeUniversityHospitalsNHSFoundationTrustandUniversityofCambridge 1

Neonatalneurocriticalcare–findingandfillingthegaps

WorkshopfacilitatedbytheInstituteforManufacturing,

EducationandConsultancyServices,Cambridge,24May2016



Contents

1.Workshopsummary......................................................................................................................................3

2.Aims,objectivesandapproach.....................................................................................................................5

2.1Aimsandobjectives................................................................................................................................5

2.2Approach.................................................................................................................................................5

Preparationandparticipation..................................................................................................................5

Developingthelandscape........................................................................................................................5

Prioritisingthefindings.............................................................................................................................5

Overviewofapproach..............................................................................................................................6

3.Landscapedevelopment...............................................................................................................................6

4.Selectedtopicdevelopment.........................................................................................................................9

4.1Real-timevideomonitoringforparents...............................................................................................10

4.2Individualisedmanagementofpreterminfantsinneonatalneurocriticalcarebasedonreal-timemultimodalmonitoring...............................................................................................................................12

4.3ContinuousEEGmonitoringforearlyseizurediagnosis.......................................................................14

4.4Neuroprotection...................................................................................................................................16

4.5Sleepmeasurement..............................................................................................................................18

5.Feedbackandnextsteps.............................................................................................................................20

Appendices......................................................................................................................................................21

Appendix1:Workshopdelegates...............................................................................................................21

Appendix2:Workshopoutputsshowingdelegatevotes...........................................................................22

A2.1Trendsanddrivers..........................................................................................................................22

A2.2Patientpathwayexperienceandunmetneeds..............................................................................24

A2.3Enablingprojectsandresources....................................................................................................25

Appendix3:Delegatefeedback..................................................................................................................26



1.Workshopsummary

Thishalf-dayworkshopwasdesignedtoexplorewaystoimproveoutcomesacrossthepatientjourney,createoutlineideasforfutureresearchandservice-developmentprojects,andencouragewidercollaborationbetweenbraininjuryprofessionalsandserviceprovidersintheseprojects.LedbytheUniversityofCambridgeInstituteforManufacturingEducationandConsultancyServices(IfMECS),theworkshopemployeda‘fast-pass’versionoftheIfMlandscapingmethodology.Delegatesidentifiedtargetsforreducingcostsandachievingearlierdiagnosisaskeydrivers.Toprovidetheevidence-baserequiredtosupporttheintroductionofnovelsolutionsandapproachestomeetthesetargets,theestablishmentofaneonatalearly-stageresearchnetworktoenableaccesstodataonrareconditionswasdiscussedandagreedasanimportantprimarystep.Thepatientpathwayexperienceischaracterisedbyextensivemonitoringbutlimitedreal-timeanalysis(e.g.nocomprehensivebigdataanalysisormachinelearningtechnology).Anotablechallengeistheabsenceofautomatedearlydiagnosisofseizures.Akeyenabler/resourceidentifiedisanongoingtrialfocussedontheautomaticdetectionofseizuresintermbabies.Afurtherchallengeisthatresearchisnotseenasanessentialpartofthepatientpathway.Delegates’visionforneonatalneurocriticalcareenvisagesanewsetofdriversandtrends:

• Wearabletechnology• 3Dprinting• Creationofwell-annotatedmulti-centredatabaseofhigh-fidelitymonitoringdata• AutomatedsleepanalysisonICUtoimproveneurodevelopment

Inthisvision,thepatientpathwayexperienceischaracterisedbyindividualisedbedsidemonitoringandinformationmanagementaswellasefficientuseofrepurposeddrugsforrareneurologicaldisorders.Associatedenablersandresourcesincludewearableimagingtechnologiesforcontinuousmonitoringofoptical,ultrasoundelectroencephalography(EEG),(MRIeventually)andultimatelyartificialintelligenceandcomputervision(3D)forcontinuousmonitoring.

Fivepotentialprojectswereproposedforfurtherdevelopment:• Real-timevideomonitoringforparents• Individualisedmanagementofpreterminfantsinneonatalneurocriticalcarebasedonreal-time

multimodalmonitoring• ContinuousEEGmonitoringforearlyseizurediagnosis• Neuroprotection• Sleepmeasurement

Table1(page4)summariseskeydetailsoftheselectedopportunities.

Delegatesfoundtheworkshopstimulating,enjoyableandinsightful.Nextstepsarereviewanddevelopmentofthefivepotentialprojectopportunitiesinordertoapplyforgrantfunding.



Title Opportunityoffers…

Benefits Keyactions

Real-timevideomonitoringforparents

Deeperparentalinvolvementinneonatalcare

Theneedtopromoteparentalwell-beingandfamilybonding.Addresses:

• increasedparentalanxiety• physicalbarriers(travel,

familycommitments,disability/health)

• • Atthesametimeenablesneurodevelopmentalcare(newbornbehavioursandcommunication,sleep)andteachingandresearchandclinicalmanagement

• Seekethicalapproval(incorporateotherpotentialusesofdata,i.e.teaching,clinical,research,legal)

• Seekfinancialsupport,i.e.NIHR(equip.+ITsupport);DLISS/SPARISS

• Datastorageandmanagement(accessibility)

• Educationofstaffandparents• Considermanagementofacute

scenarios/timedelayandhowtomanageresuscitation,audiocaptured

• Costofdatastorage(howtomanagethedata?)

Individualisedmanagementofpreterminfantsinneonatalneurocriticalcarebasedonreal-timemultimodalmonitoring

Amethodologyforintegrating,interpretingandexploiting(inrealtime)multimodalneuro-monitoringdataforpreterminfants

• Improvedoutcomeusingindividualisedstrategybasedonreal-timemultimodalmonitoring

• Decreasedburdenofpretermbirthonindividual,families,society,economy

• Datacollectionnetworkwithcentraliseddatabaseofhigh-resolution,high-fidelitydata

• Establishedclinicalannotationparadigm

• Expertsystem(s)forreal-timeclassificationofseverityofinjury,earlywarningindicators

• Newhardwareifrequired

ContinuousEEGmonitoringforearlyseizurediagnosis

Objectivelydetectseizures,predicttheironsetandimproveneurodevelopmen-taloutcomes

Acumulativeeffectacrossthelife-spanofindividual

• Createevidencebaseforbesttreatment

• Identifynetworks• Identifymaturetechnologies• Fluidfundingforconsortium

NeuroprotectionReducethenumberofchildrenwithbraindamage

• Wecanidentifysometypesofinjuryatatimewhenitcanbetreated

• Improveoutcomesandreducesuffering

• Addtherapytohypothermiae.g.EPO• Possibletherapyforpreterme.g.SMA• Personalisedmedicineforraregenetic

disorders• Images,genetics,delivery,trials,

laboratoryinvestigation

Sleepmeasurement

ImproveinfantssleepontheNICU:‘Chronomedicineisthefuture’

• Poorqualitysleepisassociatedwithadverseoutcomesatallages

• Thisisparticularlytrueforthedevelopingbrain,makingmillionsofneuronalconnections(ornot)ontheNICU

• Developmultimodalwearabletechnologies

• Studytheimpactofsleep(orlackof)ininfantsontheNICU

• ProvidearobustevidencebasetocommercialisethistechnologyacrossNICUandbeyond

Table1KeydetailsofselectedopportunitiesforfurtherdevelopmentNeonatalneurocriticalcareworkshop,NIHRBrainInjuryHealthcareTechnologyCo-operative,24May2016



2.Aims,objectivesandapproach

2.1AimsandobjectivesThiseventwasdesignedtoenabletheNIHRBrainInjuryHealthcareTechnologyCo-operative(HTC)toexploregapsintheareaofneonatalneurocriticalcare,andidentifyopportunitiesforenablingprojectstoaddressthosegaps.Itsobjectiveswereto:

• Determineifhealthcaretechnologiescanhelpimproveoutcomesacrossthepatientjourneyintheneuroneonatalintensive-careunit(‘neuroNICU’)

• Createoutlineideasforfutureresearchandservicedevelopmentprojects• EncouragewidercollaborationbetweenHTC,brain-injuryprofessionalsandserviceprovidersin

theseprojects

2.2Approach

PreparationandparticipationTheworkshopon24May2016broughttogether16delegatesrepresentingacross-sectionofthoseinvolvedinthepatientpathway,foraninteractivefive-hourprogramme.Alistofdelegatesisshowninappendix1(page21).

DevelopingthelandscapeInthefirstpartoftheworkshop,delegatesdevelopeda‘neonatalneurocriticalcarelandscape’,buildingonindividualpreparatorywork.Thelandscapedevelopmentenabledidentificationofkeytopics,outofwhichpotentialopportunitiesforresearchandenablingprojectswereexplored.Thelandscapingprocesswasbasedonthefollowingquestions:

• Whydoweneedtotakeaction(particularlyasregardsdevelopingneeds)?• Howcanthepatientpathwayexperiencebedevelopedtorespondtothoseneeds?• Whatenablingprojectsandresourcesarerequiredtodeliverthatpathwayexperience?

IfM’slandscapingprocessemploysindividualreflection,groupdiscussionandvotingtogenerateinformationandideas,capturesanddevelopstheseonalargewallchart(thevisualformathighlightingpotentialgaps,links,opportunitiesandchallenges),thenranksbyvoting.Thethreelayersofthelandscapeareaggregatedtoidentifylinkagesandclusters(ona‘linkagechart’)andhencepossibleprioritiesforaction.Inthis‘fast-pass’versionoftheprocessdelegates,havingpreparedtheirindividualnarratives,presentedtheirkeyperspectivesdirectlyontoallthreelayersofthelandscapeinaseriesof2–3minute‘pitches’.

PrioritisingthefindingsDelegatescollectivelyreviewedtheimportanceoftheitemsidentifiedthenvotedonprioritiesforeachlayer.Thefacilitatorandclient-leadthenproposedwhichthemestoinvestigate.



Havingidentifiedanumberofpriorityopportunitiesbythismethod,delegatesformedsyndicategroups,eachtodeveloponeoutlineresearchorenablingproject,usinga‘projectproposalexploration’template.Inthefinalsession,syndicatespresentedtheirfindingsforwhole-groupreview.

OverviewofapproachFigure1illustratestheworkshopapproach.Subsequentsectionsofthisreportoutlinethemainoutputsfromtheprocess.

Figure1Processemployed,Neonatalneurocriticalcareworkshop,NIHRBrainInjuryHealthcareTechnologyCo-operative,24May2016,showingtemplatesforindividualreflection,whole-grouplandscapedevelopmentandsyndicateworkfortopicdevelopment.

3.LandscapedevelopmentThefiguresbelowsummarisethekeyelementsofthelandscape(figure2)andassociatedlinkagechart(figure3).



Figure2Neonatalneurocriticalcarelandscape,NIHRBrainInjuryHealthcareTechnologyCo-operativeworkshop,24May2016

Current2016

Short term2016–17

Medium term2018–20

Long term2020–25

Vision 2025+

Biomarkers

Signal processing/neurophysiology

Novel/multimodal imaging

Other

Cambridge Brain Injury Healthcare Technology Co-operative: Neonatal neurocritical care landscape

Tren

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STEEPLSocial, Technological, Economic, Environmental, Political, Legal developments

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Tech

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Wearabletechnology

3Dprinting

Targetsforreducing costsandachievingearlerdiagnosis Complex casesrequire asynthesisofcomplex datainrealtime

Neonatalearlystageresearchnetworktoenableaccesstorareconditions

Earlydetection ofdegreeofinjury/earlier prediction ofprognosis

Creation ofwell-annotatedmulti-centre databaseofhigh-fidelitymonitoring data

AutomatedsleepanalysisonICUwill improveneurodevelopment

Continuous EEGmonitoring ofinfantsatrisk

Extensivemonitoring butlimited realtimeanalysis(nocomprehensive bigdataanalysisormachinelearning)

Better identification ofpretermsatrisk

Automatedearlydiagnosisofseizuresisabsent

Individualisedbedsidemonitoring andinformationmanagement

Enableefficientuseofrepurposed drugsforrareneurological disorders

Researchnotseenasessentialpartofpatient pathway Real-timevideomonitoring ofinfantforparents

Norobust methodtodetermine howdamagedthenewborninjured brain Useofblood samplestodetermine thebraininjury

NIRStechnology/signal processing

Multi-modal datacollection toreviewwhether brainmetabolism canpredict outcome earlyatcotside Developnovelearlydiagnosistechnologies forPAIS

Molecularunderstanding oftertiary damage

Wearableimagingtechnologies forcontinuous monitoring ofoptical,ultrasound EEG,(MRIeventually)

Artificial intellegence andcomputer vision(3D)forcontinuous monitoring

Ongoingtrial inprogressonautomaticdetection ofseizuresintermbabies Set uptrialinwhich sleepispromoted toseeifitimprovesoutcome



Figure3Neonatalneurocriticalcarelinkagechart,NIHRBrainInjuryHealthcareTechnologyCo-operativeworkshop,24May2016

Medium term

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Automated early diagnosis of seizures is absent1 2

1 1 1 1

Research not seen as essential part of patient pathway1 1 1 1 1 1 1 1 1 1

2 1 1 2 2 1 1

Continuous EEG monitoring of infants at risk1 1 2 2

1 1

Real-time video monitoring of infant for parents1 1 1

1 1 1 1 1 1

Better identification of preterms at risk1 2 1 1 1 1 1 1

1 2 1 2 1 1

Individualised bedside monitoring and information management1 1 1 1 2 1

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Workshop output



Thelinkagechartvisualisesrelationshipsbetweenpatientpathwayexperiences/unmetneedsanda)trendsanddriversandb)enablingprojectsandresources.Itislargelyderivedfrominformationandideascontributedbydelegates(shownasdark-bluesquares),butalsoincludeslinkagesaddedretrospectivelybyIfM(light-bluesquares).

Appendix2(page22)liststhefulloutputrelatingto1.Trendsanddrivers,2.Patientpathwayexperienceandunmetneeds,and3.Enablingprojectsandresources,showingdelegateviewsoftheimportanceandtimeframeattachedtoeachitem.

4.SelectedtopicdevelopmentTables2–6belowshowthetopicdevelopmentoutputsasexploredbydelegatesinsyndicategroups:

• Real-timevideomonitoringforparents• Individualisedmanagementofpreterminfantsinneonatalneurocriticalcarebasedonreal-time

multimodalmonitoring• ContinuousEEGmonitoringforearlyseizurediagnosis• Neuroprotection• Sleepmeasurement



4.1Real-timevideomonitoringforparents

Proposedproject:Whatproblemarewegoingtosolve?

Parentalinvolvementinneonatalcare Teammembers:KellySpike,PingYipandMariaChalia

Whyshouldwedothis? • Parentsaresometimeunabletovisittheirbabies(becauseofdistance,siblings,twins)

• IncreasedmaternaldepressionintheNICU(anddads!)• Enablebonding,attachmentandcloseness(reduce

anxiety?)• Helpclinicaldiagnosisincertaininfants• Neurodevelopmentalteaching/care;NIDCAP;newborn

behaviourandcommunication;sleep• Forresearchandteachingpurposes

Wehaveaneed/opportunityfor:Deeperparentalinvolvementinneonatalcare

Whatisthescaleoftheproblem?

Everyneonate;neonatalnetworks

Requiredoutcomeandtimingtocomplete

Ethics;allowparentaloption(facetimeinstead);NHScomputingfacilities

Stageddeliverablesanddates Now Because:• Theneedtopromoteparentalwell-being

andfamilybonding• Increasedparentalanxiety• Physicalbarriers(travel,family

commitments,disability/health)• Atthesametimeenable

neurodevelopmentalcare(newbornbehavioursandcommunication,sleep)andteachingandresearchandclinicalmanagement

Whatismissingtoday,forexampleinformation?

Novideomonitoring

Currentrelevantresearchandotheractivities

• Chipsubcutaneousimplant(motiondetectionandtemperature)for24-hourmonitoring

• Infrared24-hourmonitoring(esp.duringnight)



Keyactions(includingproposedteamtoaddress)

Actions:Ethicalapprovaltovideoforparental,clinical,legalandresearch;Dataprotection(pass-wordedandencrypted?).Educationofstaffandparentsonhowtouseequipment(passwordprotected)

Teammembers:ConsultantinchargeofmanagingmonitoringneuroimagingdeviceswithITsupport&neurodevelopmentalcaresister

Actionstodeliver:• Seekethicalapproval(incorporateother

potentialusesofdata,i.e.teaching,clinical,research,legal)

• Seekfinancialsupport,i.e.NIHR(equip.+ITsupport);DLISS/SPARISS

• Datastorage&management(accessibility)

• Educationofstaff&parents• Considermanagementofacute

scenarios/timedelayandhowtomanageresuscitation,audiocaptured

• Costofdatastorage(howtomanagethedata?)

Resourcerequirements(financialandmanpower)

Equipment/finance–videorecorderspercot;onlinesystem

•

Otherenablersandbarriers Audiocapture?Outputmightbeusedforlegalproceedings;acutescenariosorprocedures(timedelay?,witnessornottowitness?);couldincreaseparentalanxiety;on-goingdatastorage(1hrofrecordingis~9,000,000MB)

Table2TopicdevelopmentReal-timevideomonitoringforparents.Neonatalneurocriticalcareworkshop,NIHRBrainInjuryHealthcareTechnologyCo-operative,24May2016



4.2Individualisedmanagementofpreterminfantsinneonatalneurocriticalcarebasedonreal-timemultimodalmonitoring


Earlywarningsystembasedonmultimodalneuro-monitoringsysteminpreterminfantsforimprovedoutcomeProblem:inabilitytoutilisethemultimodalmonitoringforimprovingpretermneuro-criticalcare

Teammembers:PeterSmielewski,SubhaMitraandRobCooper

Whyshouldwedothis? • Pretermbirthinassociationwithsignificantmorbidities,mortalitiesandneuro-developmentaloutcome

• Increasingprevalenceofpretermbirth• Hugeeconomicandsocialcost

Wehaveaneed/opportunityfor:Amethodologyforintegrating,interpretingandexploiting(inrealtime)multimodalneuro-monitoringdataforpreterminfants

Whatisthescaleoftheproblem?

£4billionayear


• Multicentreresearchprogrammewithcentraliseddataanalysis• Largemultimodallongitudinaldatasetwithclinicalannotation• Expertsystemsofannotatedidentificationandclarificationofinjuryseverityandsecondaryinsults

Stageddeliverablesanddates

• Unifiedlocaldatacollectionsystem(hardwareandsoftware)• Centraliseddatacollectioninfrastructure;clinicalannotationparadigm;datacollectionphase

• Dataanalysis;datavalidation(newhardware)

Because:Improvedoutcomeusingindividualisedstrategybasedonreal-timemultimodalmonitoringtodecreaseburdenofpretermbirthonindividual,families,society,economy

Whatismissingtoday,forexampleinformation

• Activeinvolvementofclinicianswithreal-timeannotation• Standardisation


• EEG&seizure(Cork)• AdultTBIdatacollectionanalysisprojects;Centre-TBI;Track-RBI• PaediatricADAPTdatacollectionstudy




Actions:EstablishingcareteamTraining/standardisation

Teammembers: Actionstodeliver:• Datacollectionnetworkwithcentraliseddatabaseofhigh-resolution,high-fidelitydata

• Establishedclinicalannotationparadigm

• Expertsystem(s)forreal-timeclassificationofseverityofinjury,earlywarningindicators

• Newhardwareifrequired


• Significantresourcerequirement• Fundingfordatacollectionsystems;datacollectioninvestigators;centraliseddatabase

• integration&management;dataanalysis;rollingoutexpertsystemforvalidation;andprototypes

Otherenablersandbarriers

Ethics;reliableannotation(standardised);cannotpilot!;objectivereliableoutcomes

Table3TopicdevelopmentIndividualisedmanagementofpreterminfantsinneonatalneurocriticalcarebasedonreal-timemultimodalmonitoring.Neonatalneurocriticalcareworkshop,NIHRBrainInjuryHealthcareTechnologyCo-operative,24May2016



4.3ContinuousEEGmonitoringforearlyseizurediagnosis


ContinuousmonitoringEEGforearlyseizurediagnosis

Teammembers:GeneDempsey,JohnSucklingandHeikeRabe

Whyshouldwedothis? • Prevalence–highimpactofintervention;seizuresarebadforpatients

• Opportunitytotestanewintervention;dissociationbetweenclinicalandelectricalseizures

• Interferenceorwithdrawalofcase/decisiontocontinue

Wehaveaneed/opportunityfor:• Objectivelydetectseizures• Predicttheironset• Improveneurodevelopmentaloutcomes

Whatisthescaleoftheproblem? Disabilitylong-termoutcome


• Seizureburdenreduction• Improveneurodevelopmentaloutcome

Stageddeliverablesanddates • CE/qualityofEEGcaps/othertechnology;wireless• Trialsofvariousmeasurementofseizuredetection• Trialsbenchmarkperformancealgorithm/expert–differentcredentials/agegroup;diseasespecific

• Trialintroduceintervention(whichone,when?)

Because:• Acumulativeeffectacrossthelife

spanofindividual• Createevidencebaseforbest

treatmentWhatismissingtoday,for

exampleinformation• Analysisofpublishedanimalwork–uniformhumanstudies?• Meta-analysis;existingpublicationonseizureburdenandneurodevelopmentaloutcome;wirelesstechnology

• EEGcapstoputoneasilyasstandard;• Developmentof‘brainhealth’index;algorithmforseizuredetection;literaturereviewsoncurrenttreatmentsandtheiroutcomes;integrationofriskfactorsforseizuresintodecisionpathways


• Ongoingstudy…….seizuredetectionalgorithm;• Ongoing…..ondrugsfortreatingseizures(Bumetanide,Lignocaine)




Actions:Engagewithmanufacturers(CE)–regulatingapprovals;engagewithgroupsdevelopingalgorithm

Teammembers: Actionstodeliver:

• Identifynetworks• Identifymaturetechnologies• Fluidfundingforconsortium


• Funding–HTA/,WilliamTrust,EC;steeringgroups• Patientorparentinvolvement

Otherenablersandbarriers • Collaborationwith…• Treatmentexisting;mechanicalmaterials;EUBC;learnedsocieties;WCseizuregroup

Table4TopicdevelopmentContinuousEEGmonitoringforearlyseizurediagnosis.Neonatalneurocriticalcareworkshop,NIHRBrainInjuryHealthcareTechnologyCo-operative,24May2016



4.4Neuroprotection


• Rare/geneticregenerativeinNICU• Preterm;term–(HIE/stroke)

Teammembers:DavidRowitch,DavidEdwardsandDivyenShah

Whyshouldwedothis? • Improveoutcome;economic;reducesuffering

Wehaveaneed/opportunityfor:Reducethenumberofchildrenwithbrain

damage

Whatisthescaleoftheproblem? Collectively,large


Stageddeliverablesanddates • Inflammatory:ReduceBBBleak;reactiveastrocytes;microglia-nanoparticles

• Genomics:injurypathways;extremephenotype;raredisorders

• Followup:EMR;clinicforsevereoutcome(CP,IDD)

• Delivery:convention;IV-BBB;direct(cells)

• Smallmolecule;ERT;gene;cells;gas

Because:• Wecanidentifysometypesofinjury

atatimewhenitcanbetreated• Improveoutcomesandreduce

suffering


Alloftheabove


• Diagnosticimaging• Animalmodels;humanneuropathology• Humancell-basedmodels




Actions:Leadcompounds;injury–SAG,EPO;rare–MPS7,TaySachs-identifycohortsacrossregions

Teammembers: Actionstodeliver:• Addtherapytohypothermiae.g.EPO• Possibletherapyforpreterme.g.SMA• Personalisedmedicineforraregeneticdisorders

• Images,genetics,delivery,trials,laboratoryinvestigation


Fullassessmentrequired,butsignificantresourcelikely

Otherenablersandbarriers Patientadvocates/engagement

Table5TopicdevelopmentNeuroprotection.Neonatalneurocriticalcareworkshop,NIHRBrainInjuryHealthcareTechnologyCo-operative,24May2016



4.5Sleepmeasurement


ImprovedqualityofsleepininfantsonNICU;lackof/interruptedsleep–poorbraindevelopment

Teammembers:JeroemDudnick,JeremyHebdenandTopunAustin

Whyshouldwedothis? ProblemaffectsallpatientsintheICU(ofanyage!) Wehaveaneed/opportunityfor:

Improveinfants’sleepontheNICU:‘Chronomedicineisthefuture’

Whatisthescaleoftheproblem? ProblemaffectsallpatientsintheICU(ofanyage!)


Technologiestomonitormotion–motionsensors,infraredsensors,EMGsensor1. Bringinallthemonitoringtechnologies(identifythe

optimalwayofmeasuringsleep)2. Developawearabledevice,integratingthetechnologies

identifiedin(1.)

Stageddeliverablesanddates Technologiestomeasuresleep–circadianrhythm,EEG/aEEG,melatonin?,cortisol?

Because:• Poorqualitysleepisassociatedwithadverseoutcomesatallages

• Thisisparticularlytrueforthedevelopingbrain,makingmillionsofneuronalconnections(ornot)ontheNICU


• Tailorcareandmanagementaccordingtosleepe.g.feeding,drugs(n.b.caffeine)

• Technology-wearable,cameras,integrateddataanalysis• Undertakemeaningfulresearchintosleepqualityoutcome


• Researchimpactofsleepondevelopingbrain• Improvedsleep• Improvedoutcomes




Actions:Developtherequiredtechnologies

Teammembers: Actionstodeliver:• Developmultimodalwearable

technologiesStudytheimpactofsleep(orlackof)ininfantsontheNICU

• ProvidearobustevidencebasetocommercialisethistechnologyacrossNICUandbeyond


Alargegrantislikelytoberequired

Otherenablersandbarriers Challengeofundertakingmeaningfulresearchgivenwhatisperceivedtobeaninherentbiasamongnursingstaff

Table6TopicdevelopmentSleepmeasurement.Neonatalneurocriticalcareworkshop,NIHRBrainInjuryHealthcareTechnologyCo-operative,24May2016



5.FeedbackandnextstepsDelegatefeedbackasgivenviatheend-of-workshopquestionnaireissummarisedinappendix3(page26).Alldelegatesfelttheywereabletocontribute,foundtheworkshopstimulating,enjoyableandworthwhileandthoughtthatitprovidedusefulinsights.Theworkshopprocessandstructurewerejudgedasgood.Somedelegatesfeltthatbroadeningworkshopparticipationtoinclude,ifpossible,educationandpatient/parentrepresentativeswouldhavebeenbeneficial.Thereweresomeconcernsabouttemperaturecontrolinthevenue.Thisreportoftheworkshopisadraftforcirculation,toinvitecommentsfromdelegatesbeforefinalisation.Followingfinalisationofthereportdelegateswillbeinvitedtocontributetofurtherdevelopmentoftheidentifiedopportunitiesinordertosupportapplicationforgrantfunding.



Appendices

Appendix1:WorkshopdelegatesDelegates:1. DrTopunAustin,ConsultantNeonatologist,CambridgeUniversityHospitals

2. DrRobCooper,DepartmentofMedicalPhysicsandBiomedicalEngineering,UniversityCollegeLondon

3. ProfessorGeneDempsey,ProfessorofNeonatology,UniversityCollegeCork

4. DrJeroemDudnick,Neonatologist,SophiaChildren’sHospital,Rotterdam

5. ProfessorDavidEdwards,ProfessorofNeonatology,King’sCollegeLondon

6. ProfessorJeremyHebden,HeadofDepartmentofMedicalPhysicsandBiomedicalEngineering,University

CollegeLondon

7. MariaChalia,ClinicalResearchFellow,CambridgeUniversityHospitals

8. ProfessorHeikeRabe,ProfessorofNeonatology,BrightonandSussexMedicalSchool

9. SubhaMitra,ClinicalResearchFellow,UniversityCollegeLondon

10. DrRobRoss-Russell,ConsultantPaediatrician,CambridgeUniversityHospitals(a.m.only)

11. ProfessorDavidRowitch,HeadoftheDepartmentofPaediatrics,UniversityofCambridge

12. DrDivyenShah,ConsultantNeonatologist,RoyalLondonHospital

13. DrPeterSmielewski,SeniorResearchAssociate,DepartmentofClinicalNeurosciences,Universityof

Cambridge

14. MsKellySpike,NeonatalNeurocriticalCareNurseSpecialist,CambridgeUniversityHospitals

15. ProfessorJohnSuckling,DirectorofResearch,DepartmentofPsychiatry,UniversityofCambridge

16. DrPingYip,LecturerinNeurotrauama,QueenMary,UniversityofLondon

Facilitators:

AndrewGill,PrincipalIndustrialFellow,IfMEducationandConsultancyServices,Cambridge

SteveChicken,PrincipalIndustrialFellow,IfMEducationandConsultancyServices,Cambridge

Alsosupporting:

PeterJarrett,DeputyDirectoroftheBrainInjuryHTC

MitaBrahmbhat,ProgrammeManageroftheBrainInjuryHTC

TalissaGasser,ProgrammeCoordinatoroftheBrainInjuryHTC



Appendix2:WorkshopoutputsshowingdelegatevotesA2.1Trendsanddrivers

Swimlane Description Votes Timing Date

STEEPLSocial,Technological,Economic,Environmental,Political,Legaldevelopments

Wearabletechnology 7 longterm n/a

3Dprinting 5 longterm n/a

Autonomoustechnologies 2 vision n/a

Strategichealthcarecontext

Targetsforreducingcostsandachievingearlierdiagnosis 6 shortterm n/a

Complexcasesrequireasynthesisofcomplexdatainrealtime 6 mediumterm 2020

NHSIssuesofspecialtyandresearchsilos/pooraccesstocardiorespiratorydata 2 current 2016

Fewerchildrenwithsevereneurocognitiveorneuropsychologicalimpairmentaftertermasphyxia 2 vision n/a

Neonatalnetworks

TelemedicineforregionalanddistrictNICUs 3 shortterm 2017

Neonatalearly-stageresearchnetworktoenablebetteraccesstodataonrareconditions 5 shortterm 2018

Creationofwell-annotatedmulticentredatabaseofhigh-fidelitymonitoringdata 6 longterm n/a

AutomatedsleepanalysisonICUwillimproveneurodevelopment 7 longterm 2019



Earlydetectionofdegreeofinjury/earlierpredictionofprognosis 4 longterm 2020

Targetsandstrategicoutcomesandintentionsforpatientpathway

Needforricherclinicalinformationaroundpretermbraininjury 2 current 2016

Improvedlong-termoutcomesforpreterminfants 3 vision n/a



A2.2Patientpathwayexperienceandunmetneeds


Identificationofthevulnerable/at-riskinfant

ContinuousEEGmonitoringofinfantsatrisk 6 mediumterm n/a

Identifyhigh-riskpatients 3 longterm 2018

Betteridentificationofpretermatrisk 4 longterm n/a

Individualisedbedsidemonitoringandinformationmanagement 7 vision 2025

Conditiondiagnosis

Extensivemonitoringbutlimitedreal-timeanalysis(nocomprehensivebig-dataanalysisormachine-learningtechnology) 4 current 2016

Needforearlydiagnosistoenablepotentialtherapiestobedeveloped 3 shortterm 2016

Automatedearlydiagnosisofseizuresisabsent 4 shortterm 2018

Measurementofreal-timebrainmetabolismatcotsideleadingtoanovelneuroimagingtechnique 3 mediumterm n/a

Neuroprotectioninterventions Efficientuseofrepurposeddrugsforrareneurologicaldisorders 5 longterm 2019

Familycommunications

Researchnotseenasessentialpartofpatientpathway 4 current 2016

Realtimevideomonitoringofinfantforparents 7 mediumterm n/a



A2.3Enablingprojectsandresources


Enablingprojects Ongoingtrialinprogressonautomaticdetectionofseizuresintermbabies 4 shortterm endof

2016

Technologies

Biomarkers

Norobustmethodtodeterminehowdamagedthenewborninjuredbrain 3 current n/a

Useofbloodsamplestodeterminethebraininjury 3 mediumterm 2018

Signalprocessing/neurophysiology NIRStechnology/signalprocessing 3 shortterm n/a

Novel/multimodalimaging

Multi-modaldatacollectiontoreviewwhetherbrainmetabolismcanpredictoutcomeearlyatcot-side 3 shortterm n/a

DevelopnovelearlydiagnosistechnologiesforPAIS 3 longterm 2020

Other

Molecularunderstandingoftertiarydamage 3 longterm n/a

Wearableimagingtechnologiesforcontinuousmonitoringofoptical,ultrasoundEEG,(MRIeventually) 11 longterm 2018

Artificialintelligenceandcomputervision(3D)forcontinuousmonitoring 7 vision 2025

Organisation,processes,peopleandculture

Set-uptrialinwhichsleepispromotedtoseeifitimprovesoutcome 3 medium

term n/a



Appendix3:Delegatefeedback

Neonatal neurocritical care – finding and filling the gaps€¦ · Creation of well-annotated multi-centre database of high-fidelity monitoring data Automated sleep analysis on

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