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IDEAL BEDSIDE NEWBORN INTENSIVE CARE UNIT MONITORING

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Goals

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Accuracy: Validation against gold standard measurements is needed. Accuracy of measurements must also span gestational age and birth weight differences of all patients in a newborn intensive care unit (NICU) setting. Movement of neonates should not significantly interfere with measurements. Fluctuation in temperature and humidity should also not affect monitoring.

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Reliability: Application, data acquisition, and removal of monitoring devices should not be affected by differences in caregivers. Measurements should demonstrate minimal variation with respect to time of monitoring, caregiver, and infant position.

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Feasibility: Devices should be minimally invasive, inexpensive, and easy to apply and remove for widespread use in a NICU setting. Minimal interference with patient care is essential, for example, with smaller-size neonatal sensors or with portable or wireless devices. Data would ideally be continuously recordable, easy to interpret, and compatible with simultaneous monitoring of other physiologic parameters. Real-time data collection would also allow personnel to respond to an event at the same time the data are being displayed.

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Patient safety: Sensors, leads, or other methods of acquiring data must be safe for patient use. Considerations of skin sensitivity have led to the development of smaller-size hydrocolloid sensors. Risk of infection is typically minimized by disposable equipment or limiting duration of patient exposure to monitoring device interfaces. Signal interference between different modes of monitoring and electromagnetic radiation shielding must be considered for neonatal use of any monitoring device.

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CARDIAC MONITORING

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Electrocardiogram

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Description: An electrocardiogram (EKG or ECG) provides measurement of electrical signals generated by cardiac cell potentials by a surface electrode. The most common type of electrode for EKG monitoring is a silver-silver chloride, foil-based electrode. Instead of requiring a separate electrolyte solution to be applied to the patient, most EKG monitoring electrodes now come packaged in sets of three with an adhesive electrolyte gel backing (hydrogel) that serves as the electrolyte interface solution as well as an adhesive. An approaching excitation wave to a surface lead is recorded as a positive potential and represented on the EKG as an upward deflection. Typical lead placement and EKG module diagram are shown in Figure 5-1.

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Indications: The EKG is used for measurement of heart rate for conditions potentially leading to cardiac instability. Basic arrhythmias and abnormal waveforms may be detectable. However, for complete evaluation of arrhythmias, a 12-lead EKG is recommended rather than the typical 3-lead EKG used for continuous-monitoring purposes.

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Accuracy/Reliability: Accuracy is dependent on skill level and experience of the interpreter. Computer-assisted interpretation should not be relied on for accuracy. Reliability for measuring heart rate is good, and signal is acquired more readily than pulse oximetry.

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Limitations:

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  1. Artifacts: Computer-based cardiac monitoring systems now have more sophisticated filtering components to reduce noise and ...

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