Newborns and premature babies staying in very hot or very cold environment can cause serious consequences. For these babies to maintain their body temperature, it is necessary to regulate the appropriate environmental temperature. Fluctuations in the ambient temperature impair the hemodynamic stability of the newborn. The gestational week, weight, and general condition of the baby are important for the neutral thermal environment limits. The environmental temperature of the newborn, whose gestational week and weight decrease, should be higher. Heat lost through evaporation can be minimized by protecting the body surface from the cooling effects of the environment. The cold air in the room is not humidified, and the skin is not covered with any cover/clothing, causing heat loss. Heat loss by air conduction (convection) occurs as a result of heat exchange between the baby's skin and the environment. Losses can be prevented by enabling the baby to gain heat from the warm indoor environment. It has been reported that one in 10 newborn babies is preterm. The infant mortality rate was reported as 9.1 per thousand in 2019, and 63.6% of deaths were infants who died before completing their 1st month. 12.3% of them died on the 1st day, 29.6% at 1–6 days, and 21.7% at 7–29 days. The rate of infants aged 1–4 months who died was reported as 23.3%. According to the Turkey Demographic and Health Survey report, 12% of babies born in the past 5 years have a low birth weight (birth weight <2500 g). The neonatal period includes the period from birth to 1 month. Babies born by completing the 37th week of gestation are defined as term/term, while babies born 366/7 and earlier are defined as premature. The adaptations of term and preterm newborns to the outside world are quite different, but one of the important problems for both groups during these periods is providing temperature control of the newborn, reducing exposure to light, and providing ambient sound control. Neonatal temperature control (thermoregulation) is the maintenance of the balance between heat production and heat loss to keep body temperature within the normal limits. In the organism, the skin and hypothalamus are organs with heat-sensitive functions. When the newborn skin feels cold, the adaptive response to cold is first stimulated by the central temperature sensors in the hypothalamus. It is known that while the feeling of warmth is in the hypothalamus in the newborn period, the feeling of cold occurs in the skin. The ambient temperature of the baby should be between 24 and 26°C. Changes in the environmental conditions affect skin temperature; fluctuations of 8–10°C are perceived by the skin, while temperature changes only ± 0.5°C in the hypothalamus. Under normal conditions, preterm infants regulate their central temperature at 37.5°C and term infants at 36.5°C. The heart center is warned to make appropriate arrangements for 0.5°C differences. Newborns try to maintain their body temperature by accelerating metabolic events in tissues and increasing oxygen consumption without increasing their physical activity. While epinephrine is secreted against cold, the brown adipose tissue-specific to the newborn oxidizes and provides heat. This event is insufficient to maintain the body temperature of the newborn. For this reason, the newborn should be kept in an appropriate (neutral) temperature environment. The heat loss and heat production of the newborn are in balance, i.e., it is homeothermic. Extremely high/low differences in the ambient temperature disrupt the balance between heat loss and heat production. In the neonatal period, the newborn experiences heat loss in four different ways in the heat transfer mechanism; The first is through the evaporation of the amniotic fluid in the baby's body (evaporation), the other is by conduction (conducting) when the baby is laid on a cold surface, the third is by radiation (radiation) as a result of laying the baby close to cold environments, and finally by transfer (convection) in a place where there is cold air. If there is airflow in an environment where the room temperature is high, the baby is also prone to cold stress. If hypothermia or hyperthermia is suspected in the newborn, for example, when the baby is warm in hypothermia or when the hyperthermic baby is cold, the baby's body temperature should be measured regardless of the cause. The newborn's normal body temperature is in the range of 36.5–37.5°C. Cold stress or mild hypothermia at 36–36.4°C, moderate hypothermia at 32–35.9°C, and severe hypothermia at 32°C and below. Newborn, it cannot provide temperature control due to reasons such as a prolonged care period, limited response to high body temperature, low birth weight, prematurity, and sepsis.
MATERIALS AND METHODS
Design of autonomous controlled integrated system
In this study, the autonomous controlled integrated system designed generally consists of three main modules. These modules can be summarized as analyzing the environmental conditions, making decisions based on artificial intelligence depending on the analyzed environmental conditions, and reporting the operations performed to the users using different communication structures. The general logical flow chart of the autonomous controlled integrated system for increasing comfort in newborns is shown in Figure 1. In this scheme, first, environmental measurements will be made, then these measurements will be evaluated according to the artificial intelligence map, and finally, all transactions will be reported on the cloud and mobile base. In Figure 2, the positioning of the integrated system to be designed on the baby bassinet is shown schematically. The fact that the designed system has a portable and flexible structure will allow users to make different positions on the baby cradle.
In the designed system, real-time control and reporting will be carried out using an Arduino-based development board. The fact that this designed development board has a flexible and easy interface will allow users to make the desired changes. EasyVR 3 Plus Voice Recognition Shield will be used for voice analysis and noise tracks in the integrated system. The Analog Light Sensor Module will be used to calculate the average lumen value of the crib environment. In addition, I2C Noncontact IR Temperature Sensor will be used to measure the temperature values in the crib environment. After analyzing and reporting the data produced by the integrated system, users will be informed by transferring them to the communication channel. As a communication channel, APM Bluetooth Module and GSM Shield structures will be integrated into the system. With this system to be integrated, users will be able to follow-up on the general health status of the baby with real-time data. This follow-up is aimed to decrease the anxiety levels of the users and increase their comfort levels. The data transfer rate of the Arduino Mega 2560 control card selected in data control and analysis within the scope of this study is capable of responding to the modules that can be added in the later stages of the study. A large number of input and output ports of the electronic card will allow adding modules to the system in the later stages. In Figure 3, the control card and modules are shown schematically. The crib interior temperature will be measured in real time using the I2C Noncontact IR Temperature Sensor. The lighting intensity and noise level of the cradle environment will be realized using the light sensor that can detect the environment changes in real time and the EasyVR 3 Plus Voice Recognition Shield. To summarize the working principles of the mentioned sensors, the I2C Noncontact IR Temperature Sensor measures the surface temperature by detecting infrared radiation energy and wavelength distribution. The IR temperature probe consists of an optical system, photoelectric detector, amplifier, signal processing, and output module. The optical system collects infrared radiation in its field of view, and the infrared radiation energy is converted into corresponding electrical signals as they converge in the photoelectric detector. After being processed by the amplifier and the signal processing circuit, the signal is converted to a temperature value. The MLX90614 module enables the production of real-time data by calibrating to the environment level. The Light Intensity Sensor Module generally consists of a closed circuit. This circuit includes special photo diodes and opamp devices. The ability of this structure to detect infrared lights in the range of 300 nm–1000 nm enabled the data mentioned in this project to be measured at a sufficient speed. In addition, using the EasyVR 3 Plus Voice Recognition Shield, it will be possible to distinguish the baby's voice, thus enabling the extraction and evaluation of need-based situations. In addition, the noise of the environment will be measured, and it will direct them to take action to reduce the noise level of the room. Finally, the interface of all active or recorded data, such as displaying all information, changing settings, and graphics of data analysis, will be provided with the LCD screen.
The communication module of the integrated system designed in this study will be implemented using the ArduPilot APM Bluetooth Module as shown in Figure 4. With this communication channel, temperature, light intensity, and noise data will be reported to the system in real time. In addition, these reported values will be analyzed, and commands will be given to the system based on artificial intelligence technology to create a suitable environment for the baby. The operation process performed will be sent to the system LCD screen to inform the user. In this way, the user will have information on baby's comfort by following the commands given by the system in real time. To summarize this information process, the information of the baby in the crib with crying, which is mentioned in Priscilla Dunstan's theory, will be analyzed with EasyVR 3 Plus Voice Recognition Shield, and the baby's need will be determined and the family will be notified. To give an example, the “Neh” sound made by the baby mentioned in Priscilla Dunstan's theory will be detected and resolved by the system, and the user will be informed that the baby's nutritional needs should be met by the family. In addition, the periods of these sounds that the baby makes will be reported and analyzed in this process. In this way, the periods of the baby's needs can be predicted under process.
Performing analysis on the environment by creating an artificial intelligence map
In the artificial intelligence map created in this study, the “body temperature” of newborns and premature babies with hyperthermia and/or hypothermia will be measured at regular intervals in order not to harm the health of these events. This process will be carried out with Arduino, which is one of the most widely used development boards and contains various microcontrollers, and various sensors connected to it. In addition to this, data transfer will be provided with various wireless connections, especially the wired connection that we will establish with the pins of the Arduino. After connecting the output pins of the noncontact IR Temperature Sensor with Arduino (uno, mega, and nano), temperature data will be measured and recorded in 15-min processes, which is the nominal measurement interval, in hypermetry-hypothermia cases in the health literature. The real-time temperature data obtained in the integrated system will be converted into two-dimensional and three-dimensional graphic reports, and information on the comfort of the baby will be obtained within the period. In addition, this information will be analyzed based on the artificial intelligence technology and will generate commands for the system to increase comfort.
Scientifically, a baby's sense of hearing is developed before birth, unlike vision. It is known that the baby can perceive and distinguish many sounds that fill the uterus months before birth. The baby can hear almost as well as an adult at the time of birth; hence, the part of the brain responsible for hearing, namely the auditory cortex, is highly developed. However, research has shown that newborns prefer a complex auditory stimulus such as the human voice, especially the mother's voice. Human voices can have very different frequencies, tones, and rhythms. It can be high or low treble or full, fast or slow. Since this development can continue after birth and not be damaged, the environment should not be noisy. In this system, which is designed to eliminate this problem, the noise intensity of the environment will be measured in real time. In the integrated system designed within the scope of this project, noise measurement will be measured in decibels with sound level measurement devices. For example, if we say X to a standard sound level, these measurements will be calculated by the system in the form of dB. In the literature, it is known that an increase of 10 dB makes the sound two times more. As the first step in controlling the sound level in the designed integrated system, real-time data will be obtained using the EasyVR 3 Plus Voice Recognition Shield for measurement. Afterward, these data will be converted into numerical values with the necessary software codes and used for the environment using “Genetic Algorithm and Fuzzy Logic” methods. Necessary suggestions and warnings will be notified to the user. In the later stages of this project, it is aimed to integrate this system into smart home automation and optimize the parameters that will reduce the noise level in the environment by giving commands. In addition to these warnings and suggestions, the recorded sound data will make predictions based on artificial intelligence about the baby's needs or problems, according to the baby's crying pattern, in addition to monitoring the environment. The American Academy of Pediatrics (APA) recommends that the noise level in the environment of the newborn baby be below 45 dBA during the day and 35 dBA at night. APA makes it mandatory not to exceed an average of 50–55 dBA and a maximum of 70 dBA at an hour when babies are present. In this system, when babies are exposed to excessive noise, system stimulation will be activated, and it is aimed to reduce the ambient noise and to avoid the harmful effects of excessive noise on the baby.
Scientifically speaking, vision is the baby's last sense to mature since the uterus received almost no stimulation in its dark environment. Therefore, the visual cortex, the part of the brain responsible for vision, is less developed at birth than, for example, the auditory cortex. Newborns have very limited vision, and babies can focus only 25–30 cms away. Vision at this stage of development is around 4% of adult vision. The easiest things for your baby to see are simply patterned objects with sharp contrasts that you place near. Between the 2nd and 3rd months, your baby's coordination skills will develop significantly. Controlled limb movements occur in the direction of visual stimuli. It is aimed to make the environment the healthiest for the baby for the visual development to progress in a healthy way. For this purpose, the light intensity of the environment will be measured by the integrated system. To briefly summarize the operation of the system, the light sensor uses a special photodiode and op-amp to measure the intensity of light. This designed structure has a wide detection scale, which can see infrared lights in the range of about 300 nm–1000 nm. With the Analog Light Intensity Sensor Module-CJMCU-101, the “light intensity” calculation over the Arduino-based system is performed with the light intensity formula, and the result is indicated with the abbreviation cd (Candela). The angle of the lens affects the intensity of the light as well as the intensity of the light emanating from the light source. The intensity of the light reflected from a narrow-angle lens is stronger than when reflected from a wide-angle lens. For this reason, although the lumen value, i.e., the total amount of light remains the same, the Candela can change. In this designed system, it will be ensured that the light level of the baby crib environment is kept in the range of a minimum of 10 lux and a maximum of 600 lux. By performing a system warning below or above this range, the user will be informed, and the environment will be brought to optimum conditions.
The autonomous controlled integrated system designed within the scope of this study will generally consist of two basic data storage and reporting modules. In Module 1, the system will provide real-time monitoring of the baby environment by transmitting the real-time data in the baby cradle environment to the user in the mobile environment. In addition, the system will analyze the information produced in this module with artificial intelligence technology and make suggestions to the users, thereby reducing the level of anxiety in the user. In addition, the user will contribute to the development of the system by giving feedback to the system. In Module 2, it is aimed to send the baby's found environmental data to the family health center in real time. In addition, the system will be able to intervene in the environment by enabling the family health center to connect with the user, apart from the optimum values that may occur in the baby.
No human or animal tissue was used in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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