System integration and automation

• Cellular Energy Index (CEi)

Cellular Energy Index (CEi) is derived from variable light absorption of the skin at two wavelengths (685 nm and 850 nm)  in response to changes in oxygen utilization in skin tissue. Remarkably, CEi covers the full range of cellular oxygen status from insufficient to excessive. By comparison, pulse oximetry only offers insight into the “deficient-to-normal” end of blood oxygen saturation and cannot indicate cellular oxygen utilization or excessive cellular oxygen exposure.

• Oxygen control

The first few breaths are critical for premature infants. Clinicians caring for them need relevant and reliable instruments to measure the safety and effectiveness of the breathing gas offered. Avoidance of injury needs to recognize and accommodate the root cause, which is not apparent by pulse oximetry or blood gas measurements. Continuous adjustment of the level of oxygen delivery needs to be closely timed and regulated, and based on reliable and relevant information. We propose that this function calls for closed-loop control based on cellular chemistry response to oxygen supply.

• Ventilator integration

Medical ventilator functions needed for short term application during newborn transition care differ from those needed for long-term NICU support. Accurate and timely measurements of rapidly varying lung mechanics and of cellular oxygen need and tolerance are needed to supply the feedback information that controls the operation of the ventilator and the breathing gas blender.

• Transition care

Premature infants are also vulnerable to thermal stress and interruption of their nutrient supply. NICU technology currently automates regulation of warming, but this capability is often lacking during transition care prior to admission to the NICU. Where the fetus received a continuous supply of nutrients and fluids via the placenta, these needs following birth are currently left to manual regulation by skilled clinicians, but with limited and intermittent feedback indicators of the infant's status. Closed-loop automation of the transition from continuous placental "feeding" to receiving nourishment and fluids via the gut is possibly another area of infant medical care that may be beneficially impacted by technology.

• Analytics

The physiologic transition at birth is dynamic and needs to be tracked in an accurate and timely fashion to enable optimum care. Detailed, relevant data needs to be continuously obtained, appropriately applied, and automatically recorded for later review to enable continuous optimization of the technology and care process.

• Closed-loop systems

As much as possible, the newborn infant transition care system needs to be automated to enhance the accuracy and  timeliness of adjustments. Warming, breathing support pressure and breath timing, oxygen delivery, and nutrients need to be administered and regulated based on relevant biometrics. Skilled clinicians are needed to supervise and adjust the system in ways that cannot be automated.

• Physiologic control layer

The complex birth transition process is a combination of mostly predictable events and changes, combined with unexpected variations that need to be quickly recognized and accommodated. The time, attention, and skill level of the clinicians needs to be optimized to focus on those tasks that they do best; leaving as much as possible of the rest to automation.