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Chapter 8 ■ Cardiorespiratory Monitoring 55

E. Equipment

Standard features of most neonatal monitors

Emerging Technologies

A. Background

Given the known limitations and potential complications of

current methods for cardiac/respiratory monitoring in neonates (i.e., ECG and impedance technologies), research

continues to find alternate techniques for monitoring with

similar or improved reliability.

B. Techniques under Review

1. Wireless monitoring using photoplethysmography (8)

a. Utilizes optical probe to detect/record heart and/or

respiratory rates

b. Can eliminate the need for skin electrodes and wires

utilizing abdominal belt/band and electronic data

receiver

c. Preliminary data suggest similar data reliability to

traditional electrode-based cardiac/respiratory monitoring systems

2. Piezoelectric transducer sensors (9)

a. Sensors placed in proximity to infant (i.e., under

infant) detect an acoustic cardiorespiratory signal

from which heart rate and breathing rate are calculated.

b. Minute movements made by the body are monitored via a transducer that converts the body movements into electrical signals to report the presence

or absence of respiration and normal heart rate.

c. Preliminary data suggest the noninvasive device

avoids skin irritation while providing accurate monitoring.

3. May be affected by “noise” from nearby equipment

C. Implications

Although preliminary reports regarding such alternative

monitoring devices are encouraging, additional research

regarding reliability and safety will be required before such

applications gain widespread acceptance.

The views expressed in this article are those of the author(s) and do

not necessarily reflect the official policy or position of the Department

of the Navy, Department of Defense, or the United States Government.

I am a military service member. This work was prepared as part

of my official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United

States Government.’ Title 17 U.S.C. 101 defines a United States

Government work as a work prepared by a military service member or

employee of the United States Government as part of that person’s

official duties.

The monitoring of vital signs in neonates provides an important

indicator of overall well-being. Progress in computer technology has

facilitated the development of bedside monitors that can integrate

multiple monitoring parameters into a single system. This chapter covers the fundamentals of cardiac and respiratory monitoring.

References

1. Cabal LA, Siassi B, Zanini B, et al. Factors affecting heart rate variability in preterm infants. Pediatrics. 1980;65:50.

2. Valimaki IA, Rautaharju PM, Roy SB, et al. Heart rate patterns in

healthy term and premature infants and in respiratory distress syndrome. Eur J Cardiol. 1974;1:411.

3. Di Fiore JM. Neonatal cardiorespiratory monitoring techniques.

Semin Neonatol. 2004;9:195.

4. Baird TM, Goydos JM, Neuman MR. Optimal electrode location

for monitoring the ECG and breathing in neonates. Pediatr

Pulmonol. 1992;12:247.

5. Jacobs MK. Sources of measurement error in noninvasive electronic instrumentation. Nurs Clin North Am. 1978;13:573.

6. Sahn DJ, Vaucher YE. Electrical current leakage transmitted to an

infant via an IV controller: an unusual ECG artifact. J Pediatr.

1976;89:301.

7. Hintz SR, Wong RJ, Stevenson DK. Biomedical engineering aspects

of neonatal monitoring. In: Martin RJ, Fanaroff AA, Walsh MC, eds.

Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the

Fetus and Infant. 8th ed. Philadelphia: Mosby; 2006:609.

8. Adu-Amankwa NA, Rais-Bahrami K. Wireless Cardio Respiratory

Monitor for Neonates. Abstract presentation at American Academy

of Pediatrics National Conference & Exhibition October 1, 2010.

9. Sato S, Ishida-Nakajima W, Ishida A, et al. Assessment of a new

piezoelectric transducer sensor for noninvasive cardiorespiratory

monitoring of newborn infants in the NICU. Neonatology. 2010;

98(2):179.

56

9 Blood Pressure Monitoring

M. Kabir Abubakar

Accurate blood pressure (BP) monitoring is essential for the

optimal management of critically ill infants in intensive

care. The recognition and treatment of abnormal BP states

has significant prognostic implication (1–4). Successful BP

monitoring should be easy to set up, reliable, and give continuous information or enable measurements to be made at

frequent intervals with minimal disturbance to the baby.

Neonatal BP monitoring may be performed by noninvasive

or invasive methods.

Noninvasive (Indirect) Methods

Noninvasive BP measurement can be done using

1. Auscultatory measurement (manual noninvasive) or

2. Oscillatory arterial BP measurement (automatic noninvasive)

Auscultatory Measurement

(Manual Noninvasive)

Utilized for intermittent BP measurements; is simple and

inexpensive.

A. Background

1. This technique uses a BP cuff, insufflator, manometer,