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      Defining and distinguishing infant behavioral states using acoustic cry analysis: is colic painful?

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          Abstract

          BACKGROUND:

          To characterize acoustic features of an infant’s cry and use machine learning to provide an objective measurement of behavioral state in a cry-translator. To apply the cry-translation algorithm to colic hypothesizing that these cries sound painful.

          METHODS:

          Assessment of 1000 cries in a mobile app (ChatterBaby™). Training a cry-translation algorithm by evaluating >6000 acoustic features to predict whether infant cry was due to a pain (vaccinations, ear-piercings), fussy, or hunger states. Using the algorithm to predict the behavioral state of infants with reported colic.

          RESULTS:

          The cry-translation algorithm was 90.7% accurate for identifying pain cries, and achieved 71.5% accuracy in discriminating cries from fussiness, hunger, or pain. The ChatterBaby cry-translation algorithm overwhelmingly predicted that colic cries were most likely from pain, compared to fussy and hungry states. Colic cries had average pain ratings of 73%, significantly greater than the pain measurements found in fussiness and hunger (p < 0.001, 2-sample t test). Colic cries outranked pain cries by measures of acoustic intensity, including energy, length of voiced periods, and fundamental frequency/pitch, while fussy and hungry cries showed reduced intensity measures compared to pain and colic.

          CONCLUSIONS:

          Acoustic features of cries are consistent across a diverse infant population and can be utilized as objective markers of pain, hunger, and fussiness. The ChatterBaby algorithm detected significant acoustic similarities between colic and painful cries, suggesting that they may share a neuronal pathway.

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          Most cited references38

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          Pain and its effects in the human neonate and fetus.

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            Neonatal intensive care unit stress is associated with brain development in preterm infants.

            Although many perinatal factors have been linked to adverse neurodevelopmental outcomes in very premature infants, much of the variation in outcome remains unexplained. The impact on brain development of 1 potential factor, exposure to stressors in the neonatal intensive care unit, has not yet been studied in a systematic, prospective manner. In this prospective cohort study of infants born at <30 weeks gestation, nurses were trained in recording procedures and cares. These recordings were used to derive Neonatal Infant Stressor Scale scores, which were employed to measure exposure to stressors. Magnetic resonance imaging (brain metrics, diffusion, and functional magnetic resonance imaging) and neurobehavioral examinations at term equivalent postmenstrual age were used to assess cerebral structure and function. Simple and partial correlations corrected for confounders, including immaturity and severity of illness, were used to explore these relations. Exposure to stressors was highly variable, both between infants and throughout a single infant's hospital course. Exposure to a greater number of stressors was associated with decreased frontal and parietal brain width, altered diffusion measures and functional connectivity in the temporal lobes, and abnormalities in motor behavior on neurobehavioral examination. Exposure to stressors in the Neonatal Intensive Care Unit is associated with regional alterations in brain structure and function. Further research into interventions that may decrease or mitigate exposure to stressors in the neonatal intensive care unit is warranted. Copyright © 2011 American Neurological Association.
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              The development of a tool to assess neonatal pain.

              The objectives of this study were to (1) develop a behavioral assessment tool for the measurement of pain in the preterm and full-term neonate; (2) establish the construct and concurrent validity, interrater reliability, and internal consistency of the tool; and (3) examine the relationship between the pain scores and infant characteristics. Thirty-eight infants contributed to the 90 procedures videotaped for the study. The Neonatal Infant Pain Scale (NIPS) was used to score behavioral responses before, during, and after each intrusive procedure. The significant difference in NIPS scores over time indicates that the scale provides a measurement of intensity of infant responses to intrusive procedures. Concurrent validity was established by correlations, ranging from .53 to .84, between NIPS scores at each minute of observation and scores on the Visual Analogue Scale. Interrater reliability was high: Pearson correlations ranged from .92 to .97 across successive minutes of observation. The six component scores of the NIPS had high internal consistency: Cronbach's alphas were .95, .87, and .88 for before, during, and after the procedures, respectively. Although gestational age and five-minute Apgars were positively associated with NIPS scores over time, there was no association between these factors and responsiveness to pain, as measured by change in NIPS scores from before to during the procedure. Results are discussed in terms of the use of the NIPS in clinical trials and its clinical application in a neonatal intensive care unit.
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                Author and article information

                Journal
                0100714
                6400
                Pediatr Res
                Pediatr. Res.
                Pediatric research
                0031-3998
                1530-0447
                22 January 2020
                04 October 2019
                February 2020
                23 February 2020
                : 87
                : 3
                : 576-580
                Affiliations
                [1 ]Children’s Hospital of Pennsylvania, Philadelphia, PA, USA
                [2 ]David Geffen School of Medicine, University of California, Los Angeles, CA, USA
                [3 ]University of California, Los Angeles, CA, USA
                [4 ]Private Practice, Los Angeles, CA, USA
                [5 ]Gallaudet University, Washington, DC, USA
                Author notes

                AUTHOR CONTRIBUTIONS

                J.J.P., S.L., J.L., D.M.-W., L.Z. and A.E.A.: Drafting the article or revising it critically for important intellectual content and final approval of the version to be published. A.A., B.S., C.H., S.Y.B., S.E., M.D., L.D., U.N., D.S. and B.H.D.: Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data.

                Correspondence: Ariana E. Anderson ( ariana82@ 123456ucla.edu )
                Article
                NIHMS1067931
                10.1038/s41390-019-0592-4
                7033040
                31585457
                e186cc79-89f0-488b-85e8-6b62d853f197

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                Pediatrics
                Pediatrics

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