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Technology detects infections before doctors know preemies are sick

Dr. Andrew James, with other members of the Artemis Project Team, visit with a baby girl in the neonatal ward of Toronto's Hospital for Sick Children. The team has developed better ways of monitoring and sharing data from children in their care. The people with Dr. James around the child are Dr. Edward Pugh, far left, research assistant Jennifer Liu, in pink, and research fellow Rishikesan Kamaleswaran, far right

Peter Power/The Globe and Mail

Researchers at Toronto's Hospital for Sick Children are developing new technology that tracks by-the-second data for premature babies, and alerts physicians that a life-threatening infection could develop before a child even shows signs of illness.

The research, now in the testing phase, may soon be of help to medical staff treating premature babies in remote communities.

Premature babies are at high risks of infections because their immune systems are underdeveloped. In this study, researchers are monitoring premature babies and watching for tell-tale changes in their heart rates that can occur up to 24 hours before an infection takes hold.

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The cutting-edge research synthesizes the deluge of information that monitors capture from neonates (over 1,000 recordings per second of physiological measures such as body temperature, heart rate, respiratory rate and blood pressure), and will soon allow researchers to create algorithms to to predict when a baby is at risk of infection.

The applications are far-reaching, says one of the lead researchers, Carolyn McGregor. The Canada Research Chair in Health Informatics at the University of Ontario Institute of Technology, Dr. McGregor partnered with Sick Kids hospital and IBM Canada in 2007 to develop this project, named Artemis.

She and her team analyze this cloud-streamed data being tracked at Sick Kids at her laboratory in Oshawa, Ont., and are just beginning to see the potential of the analysis. She was doing related work in her native country of Australia before she was invited to Canada to further her research at UOIT.

"Part of what interested me in coming to Canada was the similar situation, especially in the more rural parts of the country or the North, where access to neonatal intensive care units is rare," Dr. McGregor said. "And if this research works, we can monitor a premature baby in the north, analyze the data at a major hospital in a city and talk to the [remote] pediatrician or family doctor and say, 'Look an infection might be developing.' "

This analysis, she says, could have a significant impact on the child's health while waiting for a plane to fly south to a full-fledged neonatal intensive care unit (NICU).

Roughly eight per cent of babies born annually in Canada are premature, and the rate is increasing in developing countries. The cost to the system is significant; premature babies average nine days in intensive care at a cost of approximately $15,000 a day in Canada.

At Sick Kids, roughly 20 per cent of neonatal intensive care beds are hooked up to these monitors, and more will be added by the end of the summer, says Andrew James, associate clinical director of the NICU.

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Heart rates normally rise and fall throughout the day, he explained. But in a baby, when infection has set in, the fluctuations stop and the heart rate becomes unusually regular over time.

"When bacteria enter the bloodstream, you might see the initial signs but they are very nebulous and vague," Dr. James said. "The child might be a bit lethargic and have a flicker of a fever."

The data analysis, however, could let the doctor monitor the subtle changes in the heart rate. "The doctors and nurses are often too busy to watch a baby for several hours and monitor every single change," he said. "And even if I did have the luxury of an hour, there is no way I could process all the thousands of data points … in some cases, we're talking of entire medical records that, when printed, would be a stack of 3,000 pages."

Instead, the monitor's computations would alert the doctor, who can then make the decision to proceed with treatment or monitor more closely, Dr. James said. That would help prevent premature babies from getting sicker, resulting in shorter hospital stays and reduced costs.

Since the project started in 2009 at Sick Kids, data has been collected from 300 children. The research is about one-third completed, Dr. James said. Other university hospitals in the U.S. and China have already begun sending data from premature babies back to Dr. McGregor's lab for analysis.

"This is a new technology, really the first of its kind," said Aditya Pai, a managing consultant with the healthcare practice at IBM Global Services. "In this case, technology is the enabler …, but doesn't replace the work of the physician."

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It will be at least seven more years before all clinical trials have been completed.

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