Jeremy N. Wong, Jessica R. Walter, Erin C. Conrad , Dhruv R. Seshadri ,Jong Yoon Lee, Husein Gonzalez, William Reuther, Sue J. Hong, Nicolò Pini, Lauren Marsillio †, Khrystyna Moskalyk, Mariana Vicenteno, Erik Padilla, Olivia Gann, Ha Uk Chung,Dennis Ryu, Carlie du Plessis, Hein J. Odendaal, William P. Fifer, Joyce Y. Wu, Shuai Xu
Abstract
Neurodevelopment in the first 10 years of life is a critical time window during which milestones that define an individual’s functional potential are achieved. Comprehensive multimodal neurodevelopmental monitoring is particularly crucial for socioeconomically disadvantaged, marginalized, historically underserved and underrepresented communities as well as medically underserved areas. Solutions designed for use outside the traditional clinical environment represent an opportunity for addressing such health inequalities. In this work, we present an experimental platform, ANNE EEG, which adds 16-channel cerebral activity monitoring to the existing, USA FDA-cleared ANNE wireless monitoring platform which provides continuous electrocardiography, respiratory rate, pulse oximetry, motion, and temperature measurements. The system features low-cost consumables, real-time control and streaming with widely available mobile devices, and fully wearable operation to allow a child to remain in their naturalistic environment.
Introduction
Neurodevelopment from birth to pre-adolescence is a sensitive period for attaining functional and cognitive milestones. During this timeframe, cerebral volume increases four-fold [1] to support structural and functional development occurring via various mechanisms such as neurogenesis, pruning, and myelination [2,3]. The result of such processes enables the achievement of behavioral and cognitive milestones as well as downstream effects on metabolism and organ development. Neurodevelopment can be adversely impacted by neurologic diseases such as birth trauma leading to hypoxic ischemic encephalopathy, perinatal stroke, and epilepsy. In particular, the latter is the most common chronic neurologic disorder affecting over 50 million people worldwide, over 40 million of whom live in developing countries and low-middle income settings [4]. Up to 4% of all children have epilepsy, with the highest prevalence in rural areas and developing countries [5]. Prompt seizure detection in infancy and childhood is critical as untreated ongoing seizures correlate with adverse neurodevelopmental outcomes [6].
Materials and method
The study and all experimental protocols were approved by the Institutional Review Boards (IRB) of Lurie Children’s Hospital of Chicago (IRB 2020–3266), Columbia University (IRB-AAAT2973), and Stellenbosch University (N21/03/034_Sub-study 1173). The caregivers of all participants gave informed consent, and the studies were performed in accordance with hospital wide regulations. Written informed consent from at least one parent was given for each participant prior to sensor placement.
Results
A four-layer flexible printed circuit board is fabricated for the ANNE EEG sensor that consists of a stack-up of copper, polyimide, coverlay, and soldermask. The sensor consists of the following; a system-on-a-chip (SoC, ISP1807, Insight SIP); high-precision and low noise analog-front-ends (AFE) for a maximum of 16 channels; and a power management unit for wireless charging and supplying power to the on-board electronics with a rechargeable Li-polymer battery (230 mAh). The SoC controls the two AFE with on-board low-noise PGAs and sigma delta ADCs to collect clinical grade EEG data, where each channel samples at 1 kHz with 24-bit resolution and 0.28 μVrms input noise. The sensor board is enclosed with a ruggedized plastic housing made of Acrylonitrile butadiene styrene (ABS) with 16 channel connectors to standard EEG electrodes.
Discussion
Neurodevelopment across the lifespan, in particular from birth to 10 years, is a key time period for which brain maturation occurs with long-lasting effects. Comprehensive monitoring of brain development, physical, and mental health is critical not only for the general population but in particular for socioeconomically disadvantaged groups [30] as a means of addressing health inequalities throughout the human lifespan. EEG is a direct measurement of cerebral activity that serves as a key marker of brain development [31]. Current wired, clinical-grade EEG systems are large, cumbersome, and expensive, requiring specialized technicians to operate. While there exist some wireless EEG systems, none currently integrate with other vital sign measurements or are designed for use in neonates and children.
Acknowledgments
The authors would like to acknowledge the technical assistance provided by Knute Martell, Jairo Chavez, and Brianna Kampmeier. We thank the Lurie Epilepsy Monitoring Unit for providing patient monitoring support.
Citation: Wong JN, Walter JR, Conrad EC, Seshadri DR, Lee JY, Gonzalez H, et al. (2023) A comprehensive wireless neurological and cardiopulmonary monitoring platform for pediatrics. PLOS Digit Health 2(7): e0000291. https://doi.org/10.1371/journal.pdig.0000291
Editor: Danilo Pani, University of Cagliari: Universita degli Studi Di Cagliari, ITALY
Received: July 1, 2022; Accepted: June 1, 2023; Published: July 6, 2023
Copyright: © 2023 Wong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data is provided as Supporting Information file.
Funding: JNW, WPF, SJH and SX recognize funding from the Bill and Melinda Gates Foundation (INV-019423). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: JRW reports a spouse with stock options in a private commercial entity commercializing the technology, and a royalty interest to patents related to the technology. SX, JYL, HG, DR, WR, DS, HUC, and OG are all employees with stock ownership of a private commercial entity commercializing the technology. EC receives consulting income from Epiminder, an EEG device company.
Source: https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000291#ack
