The preterm neonate can experience stressors that affect the rate of brain maturation and lead to long-term neurodevelopmental deficits. However, some neonates who are born early follow normal developmental trajectories. Extraction of data from electroencephalography (EEG) signals can be used to calculate the neonate's brain age which can be compared to their true age. Discrepancies between true age and brain age (the brain age delta) can then be used to quantify maturational deviation, which has been shown to correlate with long-term abnormal neurodevelopmental outcomes. Nevertheless, current brain age models that are based on traditional analytical techniques are less suited to clinical cot-side monitoring due to their dependency on long-duration EEG recordings, the need to record activity across multiple EEG channels, and the manual calculation of predefined EEG features which is time-consuming and may not fully capture the wealth of information in the EEG signal. In this study, we propose an alternative deep-learning approach to determine brain age, which operates directly on the EEG, using a Convolutional Neural Network (CNN) block based on the Inception architecture (called Sinc). Using this deep-learning approach on a dataset of preterm infants with normal neurodevelopmental outcomes (where we assume brain age = postmenstrual age), we can calculate infant brain age with a Mean Absolute Error (MAE) of 0.78 weeks (equivalent to a brain age estimation error for the infant within +/- 5.5 days of their true age). Importantly, this level of accuracy can be achieved by recording only 20 minutes of EEG activity from a single channel. This compares favourably to the degree of accuracy that can be achieved using traditional methods that require long duration recordings (typically >2 hours of EEG activity) recorded from a higher density 8-electrode montage (MAE = 0.73 weeks). Importantly, the deep learning model's brain age deltas also distinguish between neonates with normal and severely abnormal outcomes (Normal MAE = 0.71 weeks, severely abnormal MAE = 1.27 weeks, p=0.02, one-way ANOVA), making it highly suited for potential clinical applications. Lastly, in an independent dataset collected at an independent site, we demonstrate the model's generalisability in age prediction, as accurate age predictions were also observed (MAE of 0.97 weeks).

The primary treatment for Parkinson’s disease (PD) is supplementation of levodopa (L-dopa). With disease progression, people may experience motor and non-motor fluctuations, whereby the PD symptoms return before the next dose of medication. Paradoxically, in order to prevent wearing-off, one must take the next dose while still feeling well, as the upcoming off episodes can be unpredictable. Waiting until feeling wearing-off and then taking the next dose of medication is a sub-optimal strategy, as the medication can take up to an hour to be absorbed. Ultimately, early detection of wearing-off before people are consciously aware would be ideal. Towards this goal, we examined whether or not a wearable sensor recording autonomic nervous system (ANS) activity could be used to predict wearing-off in people on L-dopa. We had PD subjects on L-dopa record a diary of their on/off status over 24 hours while wearing a wearable sensor (E4 wristband®) that recorded ANS dynamics, including electrodermal activity (EDA), heart rate (HR), blood volume pulse (BVP), and skin temperature (TEMP). A joint empirical mode decomposition (EMD) / regression analysis was used to predict wearing-off (WO) time. When we used individually specific models assessed with cross-validation, we obtained > 90% correlation between the original OFF state logged by the patients and the reconstructed signal. However, a pooled model using the same combination of ASR measures across subjects was not statistically significant. This proof-of-principle study suggests that ANS dynamics can be used to assess the on/off phenomenon in people with PD taking L-dopa, but must be individually calibrated. More work is required to determine if individual wearing-off detection can take place before people become consciously aware of it.

BackgroundSleep is an important driver of development in infants born preterm. However, continuous unobtrusive sleep monitoring of infants in the neonatal intensive care unit (NICU) is challenging.ObjectiveTo assess the feasibility of ultra-wideband (UWB) radar for sleep stage classification in preterm infants admitted to the NICU.MethodsActive and quiet sleep were visually assessed using video recordings in 10 preterm infants (recorded between 29 and 34 weeks of postmenstrual age) admitted to the NICU. UWB radar recorded all infant's motions during the video recordings. From the baseband data measured with the UWB radar, a total of 48 features were calculated. All features were related to body and breathing movements. Six machine learning classifiers were compared regarding their ability to reliably classify active and quiet sleep using these raw signals.ResultsThe adaptive boosting (AdaBoost) classifier achieved the highest balanced accuracy (81%) over a 10-fold cross-validation, with an area under the curve of receiver operating characteristics (AUC-ROC) of 0.82.ConclusionsThe UWB radar data, using the AdaBoost classifier, is a promising method for non-obtrusive sleep stage assessment in very preterm infants admitted to the NICU.