Face-based automatic pain assessment: challenges and perspectives in neonatal intensive care units

Abstract Objective: To describe the challenges and perspectives of the automation of pain assessment in the Neonatal Intensive Care Unit. Data sources: A search for scientific articles published in the last 10 years on automated neonatal pain assessment was conducted in the main Databases of the Health Area and Engineering Journal Portals, using the descriptors: Pain Measurement, Newborn, Artificial Intelligence, Computer Systems, Software, Automated Facial Recognition. Summary of findings: Fifteen articles were selected and allowed a broad reflection on first, the literature search did not return the various automatic methods that exist to date, and those that exist are not effective enough to replace the human eye; second, computational methods are not yet able to automatically detect pain on partially covered faces and need to be tested during the natural movement of the neonate and with different light intensities; third, for research to advance in this area, databases are needed with more neonatal facial images available for the study of computational methods. Conclusion: There is still a gap between computational methods developed for automated neonatal pain assessment and a practical application that can be used at the bedside in real-time, that is sensitive, specific, and with good accuracy. The studies reviewed described limitations that could be minimized with the development of a tool that identifies pain by analyzing only free facial regions, and the creation and feasibility of a synthetic database of neonatal facial images that is freely available to researchers.

Underdetection of Psychiatric Disorders During Prenatal Care: A Survey of Adolescents in São Paulo

This study estimetes the prevalecence of common mental disorders and the proportion and potential determinants of detection among adolescents attending prenatal care. Methods: We recruited 930 consecutive adolescens admitted for obstetric care, of which 457 participants had attended the hospital's prenatal care unit. Common mental disorders were assessed using the Composite International Diagnostic INterview (version 2.1). A detailed review od prenatal care records was used to identify detection of psychiatric disorders by orenatal healthcare professionals. Results: A total of 103 adolescents(22.5%) had some mental disorder but only one-fifth of them had had their psychiatric disorder detected during prenatal care. The most frequent diagnosis using the Compsite Internaional Diagnostic Interview (version2.1). was depression (13.5%), but only 21% had been detected. Alcohol and drug dependence were the least common mental disorders (2.4%), but they were the most commoly detected (45.5%), Physical chronic condition increased the likelihood of detecting psychiatric disorder. Conclusion: Mental health is not yet recognized as an integral component of practice in prenatal care, Given the potential effect of antenatal psychiatric morbidity on maternal and child outcomesm especially among aodlescents, practice needs to be changed and prenatal care professionals trained in the recognition and basic treatment of common mental disorders...

Prenatal tobacco exposure is related to neurobehavioral modifications in infants of adolescent mothers

INTRODUCTION: Prenatal tobacco exposure interferes with neonatal outcomes. OBJECTIVE: To determine the neonatal neurobehavioral effects of in utero tobacco exposure. METHODS: This prospective cross-sectional study included healthy, term, with birth weight appropriate for gestacional age neonates without exposure to alcohol, drugs, or infections, born to adolescent mothers without psychiatric disorders or post-traumatic stress. Infants were classified according to in utero tobacco exposure, as identified by the Composite International Diagnostic Interview administered to mothers. Neurobehavior was assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Both tools were administered between 24 and 72 hours after birth. Neurobehavioral outcomes were compared between exposed and nonexposed infants by ANOVA. The associations between neurobehavioral scores and number of cigarettes smoked were studied by linear correlation. RESULTS: During the study, 928 newborns of adolescent mothers were born, and 388 were included in the study. Of these, 23 were exposed to tobacco, and 365 neonates were not exposed. There were no differences between the groups in gestational age, birth weight, post-natal age at the exam, or time between last feeding and exam. Exposed neonates showed higher scores on arousal (p = 0.004), excitability (p = 0.003), and stress/abstinence signals (p = 0.019) and a lower score on regulation (p = 0.025). After adjusting for the type of anesthesia, mode of delivery, gender, age at neurologic exam, exam duration and time between last feeding and exam, differences in arousal and excitability remained significant. The mean number of cigarettes consumed daily was positively correlated with lethargy (p = 0.013) and inversely with attention (p = 0.043). CONCLUSIONS: Neonates exposed in utero to tobacco showed worse neurobehavioral performance between 24 and 48 hours of life.

Comparação entre três metodologias: ELISA, hematoaglutinação passiva e imunofluorescência indireta para detecção de anticorpos anti-Trypanosoma cruzi em soro humano em amostragempopulacional de regiões endêmica e não endêmica: avaliação da frequência da positividade da sorologia para doença de Chagas em diferentes grupos etários de região endêmica / Comparison among three methodologies: enzime immunoassay, passive hemagglutination and indirect immunofluorescence for the detection of IgG antibodies to Trypanosoma cruzi in human sera from endemic and nonendemic regions

Os autores comparam três métodos laboratoriais largamente empregados para a dosagem de anticorpos IgG anti-Trypanosoma cruzi em soro humano: Hemaglutinação Passiv (Chagasteste Trilab), Imunofluorescência Indireta (Suspensão Liofilizada de Trypanosoma cruzi Trilab, Conjugado anti-IgG Difco) e Ensaio Imuno Enzimático (Gull Laboratories); também efetuam a pesquisa de IgM Trypanosoma Cruzi por Imunofluorescência (Suspensão Liofilizada de Trypanosoma cruzi Trilab, Conjugado anti-IgM Difco). Analisam 300 amostras de soro, sendo 150 de moradores da região endêmica de Joaquim Távora e Santo Antônio de Platina, PR. A pesquisa de anticorpos IgM foi negativa em todas as amostras. A avaliação dos anticorpos IgG apresentou três amostras com resultados positivos por Hemaglutinação e Imunofluorescência, e negativos por Elisa. Os resultados sugerem bons níveis de correlação entre as três metodologias e os resultados discrepantes são analisados. As amostras provenientes de região endêmica foram divididas em três grupos de acordo com a idade: A (<13 anos), B (13-50 anos) e C (> 50 anos). A incidência de positividade de Imunofluorescência –igG para Doença de Chagas foi significantemente maior nos grupos B e C quando comparadas com a do grupo A (p<0,001).