Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care
Ha Uk Chung, Bong Hoon Kim, Jong Yoon Lee, Jungyup Lee, Zhaoqian Xie, Erin M Ibler, KunHyuck Lee, Anthony Banks, Ji Yoon Jeong, Jongwon Kim, Christopher Ogle, Dominic Grande, Yongjoon Yu, Hokyung Jang, Pourya Assem, Dennis Ryu, Jean Won Kwak, Myeong Namkoong, Jun Bin Park, Yechan Lee, Do Hoon Kim, Arin Ryu, Jaeseok Jeong, Kevin You, Bowen Ji, Zhuangjian Liu, Qingze Huo, Xue Feng, Yujun Deng, Yeshou Xu, Kyung-In Jang, Jeonghyun Kim, Yihui Zhang, Roozbeh Ghaffari, Casey M Rand, Molly Schau, Aaron Hamvas, Debra E Weese-Mayer, Yonggang Huang, Seung Min Lee, Chi Hwan Lee, Naresh R Shanbhag, Amy S Paller, Shuai Xu, John A Rogers, Ha Uk Chung, Bong Hoon Kim, Jong Yoon Lee, Jungyup Lee, Zhaoqian Xie, Erin M Ibler, KunHyuck Lee, Anthony Banks, Ji Yoon Jeong, Jongwon Kim, Christopher Ogle, Dominic Grande, Yongjoon Yu, Hokyung Jang, Pourya Assem, Dennis Ryu, Jean Won Kwak, Myeong Namkoong, Jun Bin Park, Yechan Lee, Do Hoon Kim, Arin Ryu, Jaeseok Jeong, Kevin You, Bowen Ji, Zhuangjian Liu, Qingze Huo, Xue Feng, Yujun Deng, Yeshou Xu, Kyung-In Jang, Jeonghyun Kim, Yihui Zhang, Roozbeh Ghaffari, Casey M Rand, Molly Schau, Aaron Hamvas, Debra E Weese-Mayer, Yonggang Huang, Seung Min Lee, Chi Hwan Lee, Naresh R Shanbhag, Amy S Paller, Shuai Xu, John A Rogers
Abstract
Existing vital sign monitoring systems in the neonatal intensive care unit (NICU) require multiple wires connected to rigid sensors with strongly adherent interfaces to the skin. We introduce a pair of ultrathin, soft, skin-like electronic devices whose coordinated, wireless operation reproduces the functionality of these traditional technologies but bypasses their intrinsic limitations. The enabling advances in engineering science include designs that support wireless, battery-free operation; real-time, in-sensor data analytics; time-synchronized, continuous data streaming; soft mechanics and gentle adhesive interfaces to the skin; and compatibility with visual inspection and with medical imaging techniques used in the NICU. Preliminary studies on neonates admitted to operating NICUs demonstrate performance comparable to the most advanced clinical-standard monitoring systems.
Conflict of interest statement
H.U.C., B.H.K., J.Y.L., J.L., K.L., S.X., and J.A.R. are inventors on a patent application (U.S. 62/753,303) submitted by Northwestern University and the University of Illinois. H.U.C., S.X., and J.A.R. declare equity ownership in a company that is pursuing commercialization of the technology described here. J.A.R. also declares an advisory role with this company.
Copyright © 2019, American Association for the Advancement of Science.
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References
- Harrison W., Goodman D., Epidemiologic trends in neonatal intensive care, 2007-2012. JAMA Pediatr. 169, 855–862 (2015). doi: 10.1001/jamapediatrics.2015.1305; pmid:
- Cartlidge P. H., Fox P. E., Rutter N., The scars of newborn intensive care . Early Hum. Dev. 21, 1–10 (1990). doi: 10.1016/0378-3782(90)90105-R; pmid:
- Lund C., Medical adhesives in the NICU. Newborn Infant Nurs. Rev. 14, 160–165 (2014). doi: 10.1053/j.nainr.2014.10.001
- Tottman A. C., Alsweiler J. M., Bloomfield F. H., Harding J. E., Presence and pattern of scarring in children born very preterm. Arch. Dis. Child Fetal Neonatal Ed. 103, F277–F279 (2018). doi: 10.1136/archdischild-2016-311999; pmid:
- Bouwstra S., Chen W., Feijs L., Oetomo S. B., in 2009 Sixth International Workshop on Wearable and Implantable Body Sensor Networks (IEEE, 2009), pp. 162–167. doi: 10.1109/BSN.2009.40
- Sharma O., Lewis S. N., Telang U., D’Almeida L., Lewis L. E. S., Design of a Bluetooth Enabled Health Monitoring System for Infants Using Wearable Technology. J. Adv. Res. Dyn. Contrl. Syst. 15, 887–894 (2017).
- McLane K. M., Bookout K., McCord S., McCain J., Jefferson L. S., The 2003 National Pediatric Pressure Ulcer and Skin Breakdown Prevalence Survey: A multisite study. J. Wound Ostomy Continence Nurs. 31, 168–178 (2004). doi: 10.1097/00152192-200407000-00004; pmid:
- Kim D. H., et al. , Epidermal electronics. Science 333, 838–843 (2011). doi: 10.1126/science.1206157; pmid:
- Harris K., Elias A., Chung H.-J., Flexible electronics under straIn: A review of mechanical characterization and durability enhancement strategies. J. Mater. Sci. 51, 2771–2805 (2016). doi: 10.1007/s10853-015-9643-3
- Gao W., et al. ., Fully integrated wearable sensor arrays for multiplexed in situ perspiration analysis. Nature 529, 509–514 (2016). doi: 10.1038/nature16521; pmid:
- Walsh J. A. 3rd, Topol E. J., Steinhubl S. R., Novel wireless devices for cardiac monitoring. Circulation 130, 573–581 (2014). doi: 10.1161/CIRCULATIONAHA.114.009024; pmid:
- Halcox J. P. J., et al. , Assessment of remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: The REHEARSE-AF study. Circulation 136, 1784–1794 (2017). doi: 10.1161/CIRCULATIONAHA.117.030583; pmid:
- Jang K.-I., et al. ., Self-assembled three dimensional network designs for soft electronics. Nat. Commun. 8, 15894 (2017). doi: 10.1038/ncomms15894; pmid:
- Ma Y., et al. , Soft Elastomers with Ionic Liquid-Filled Cavities as Strain Isolating Substrates for Wearable Electronics. Small 13, 1602954 (2017). doi: 10.1002/smll.201602954; pmid:
- Coskun V., Ozdenizci B., Ok K., The survey on near field communication. Sensors 15, 13348–13405 (2015). doi: 10.3390/s150613348; pmid:
- Majumder S., Mondal T., Deen M. J., Wearable sensors for remote health monitoring. Sensors 17, 130 (2017). doi: 10.3390/s17010130; pmid:
- Dang W., et al. , Stretchable wireless system for sweat pH monitoring. Biosens. Bioelectron. 107, 192–202 (2018). doi: 10.1016/j.bios.2018.02.025; pmid:
- Visscher M., Taylor T., Pressure ulcers in the hospitalized neonate: Rates and risk factors. Sci. Rep. 4, 7429 (2014). doi: 10.1038/srep07429; pmid:
- Lund C. H., Tucker J. A., in Neonatal SkIn: Structure and Function, Hoath S. B., Maibach H. I., Eds. (Dekker, ed. 2, 2003), pp. 299–324.
- Evans N. J., Rutter N., Development of the epidermis in the newborn. Biol. Neonate 49, 74–80 (1986). doi: 10.1159/000242513; pmid:
- Rutter N., The immature skin. Br. Med. Bull. 44, 957–970 (1988). doi: 10.1093/oxfordjournals.bmb.a072303; pmid:
- Gent A. N., Hamed G. R., Peel mechanics. J. Adhes. 7, 91–95 (1975). doi: 10.1080/00218467508075041
- Smyser C. D., Kidokoro H., Inder T. E., Magnetic resonance imaging of the brain at term equivalent age in extremely premature neonates: To scan or not to scan? J. Paediatr. Child Health 48, 794–800 (2012). doi: 10.1111/j.1440-1754.2012.02535.x; pmid:
- Melbourne L., et al. , Clinical impact of term-equivalent magnetic resonance imaging in extremely low-birth-weight infants at a regional NICU. J. Perinatol. 36, 985–989 (2016). doi: 10.1038/jp.2016.116; pmid:
- U.S. Food and Drug Administation , Establishing Safety and Compatibility of Passive Implants in the Magnetic Resonance (MR) Environment (2014); .
- Puch-Kapst K., Juran R., Stoever B., Wauer R. R., Radiation exposure in 212 very low and extremely low birth weight infants. Pediatrics 124, 1556–1564 (2009). doi: 10.1542/peds.2008-1028; pmid:
- Pan J., Tompkins W. J., A real-time QRS detection algorithm. IEEE Trans. Biomed. Eng. 32, 230–236 (1985). doi: 10.1109/TBME.1985.325532; pmid:
- Kamal A. A., Harness J. B., Irving G., Mearns A. J., Skin photoplethysmography—A review. Comput. Methods Programs Biomed. 28, 257–269 (1989). doi: 10.1016/0169-2607(89)90159-4; pmid:
- Kim J. S., Chee Y. J., Park J. W., Choi J. W., Park K. S., A new approach for non-intrusive monitoring of blood pressure on a toilet seat. Physiol. Meas. 27, 203–211 (2006). doi: 10.1088/0967-3334/27/2/010; pmid:
- Geddes L. A., Voelz M. H., Babbs C. F., Bourland J. D., Tacker W. A., Pulse transit time as an indicator of arterial blood pressure. Psychophysiology 18, 71–74 (1981). doi: 10.1111/j.1469-8986.1981.tb01545.x; pmid:
- Fanaroff J. M., Fanaroff A. A., Blood pressure disorders in the neonate: Hypotension and hypertension. Semin. Fetal Neonatal Med. 11, 174–181 (2006). doi: 10.1016/j.siny.2006.01.002; pmid:
- O’Shea J., Dempsey E. M., A comparison of blood pressure measurements in newborns. Am. J. Perinatol. 26, 113–116 (2009). doi: 10.1055/s-0028-1091391; pmid:
- Murray J. S., Noonan C., Quigley S., Curley M. A., Medical device-related hospital-acquired pressure ulcers in children: An integrative review. J. Pediatr. Nurs. 28, 585–595 (2013). doi: 10.1016/j.pedn.2013.05.004; pmid:
- Baserga M. C., Puri A., Sola A., The use of topical nitroglycerin ointment to treat peripheral tissue ischemia secondary to arterial line complications in neonates. J. Perinatol. 22, 416–419 (2002). doi: 10.1038/sj.jp.7210713; pmid:
- Smith L. A., Dawes P. J., Galland B. C., The use of pulse transit time in pediatric sleep studies: A systematic review. Sleep Med. Rev. 37, 4–13 (2018). doi: 10.1016/j.smrv.2016.11.006; pmid:
- Wippermann C. F., Schranz D., Huth R. G., Evaluation of the pulse wave arrival time as a marker for blood pressure changes in critically ill infants and children. J. Clin. Monit. 11, 324–328 (1995). doi: 10.1007/BF01616991; pmid:
- Galland B. C., Tan E., Taylor B. J., Pulse transit time and blood pressure changes following auditory-evoked subcortical arousal and waking of infants. Sleep 30, 891–897 (2007). doi: 10.1093/sleep/30.7.891; pmid:
- Ahlstrom C., Johansson A., Uhlin F., Länne T., Ask P., Noninvasive investigation of blood pressure changes using the pulse wave transit time: A novel approach in the monitoring of hemodialysis patients. J. Artif. Organs 8, 192–197 (2005). doi: 10.1007/s10047-005-0301-4; pmid:
- Chen W., Kobayashi T., Ichikawa S., Takeuchi Y., Togawa T., Continuous estimation of systolic blood pressure using the pulse arrival time and intermittent calibration. Med. Biol. Eng. Comput. 38, 569–574 (2000). doi: 10.1007/BF02345755; pmid:
- Sinclair L., Crisp J., Sinn J., Variability in incubator humidity practices in the management of preterm infants. J. Paediatr. Child Health 45, 535–540 (2009). doi: 10.1111/j.1440-1754.2009.01555.x; pmid:
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