We develop a novel characterization of extremal dependence between two cortical regions of the brain when its signals display extremely large amplitudes. We show that connectivity in the tails of the distribution reveals unique features of extreme events (e.g., seizures) that can help to identify their occurrence. Numerous studies have established that connectivity-based features are effective for discriminating brain states. Here, we demonstrate the advantage of the proposed approach: that tail connectivity provides additional discriminatory power, enabling more accurate identification of extreme-related events and improved seizure risk management. Common approaches in tail dependence modeling use pairwise summary measures or parametric models. However, these approaches do not identify channels that drive the maximal tail dependence between two groups of signals -- an information that is useful when analyzing electroencephalography of epileptic patients where specific channels are responsible for seizure occurrences. A familiar approach in traditional signal processing is canonical correlation, which we extend to the tails to develop a visualization of extremal channel-contributions. Through the tail pairwise dependence matrix (TPDM), we develop a computationally-efficient estimator for our canonical tail dependence measure. Our method is then used for accurate frequency-based soft clustering of neonates, distinguishing those with seizures from those without.

Neonates are highly susceptible to seizures, often leading to short or long-term neurological impairments. However, clinical manifestations of neonatal seizures are subtle and often lead to misdiagnoses. This increases the risk of prolonged, untreated seizure activity and subsequent brain injury. Continuous video electroencephalogram (cEEG) monitoring is the gold standard for seizure detection. However, this is an expensive evaluation that requires expertise and time. In this study, we propose a convolutional neural network-based model for early prediction of neonatal seizures by distinguishing between interictal and preictal states of the EEG. Our model is patient-independent, enabling generalization across multiple subjects, and utilizes mel-frequency cepstral coefficient matrices extracted from multichannel EEG and electrocardiogram (ECG) signals as input features. Trained and validated on the Helsinki neonatal EEG dataset with 10-fold cross-validation, the proposed model achieved an average accuracy of 97.52%, sensitivity of 98.31%, specificity of 96.39%, and F1-score of 97.95%, enabling accurate seizure prediction up to 30 minutes before onset. The inclusion of ECG alongside EEG improved the F1-score by 1.42%, while the incorporation of an attention mechanism yielded an additional 0.5% improvement. To enhance transparency, we incorporated SHapley Additive exPlanations (SHAP) as an explainable artificial intelligence method to interpret the model and provided localization of seizure focus using scalp plots. The overall results demonstrate the model's potential for minimally supervised deployment in neonatal intensive care units, enabling timely and reliable prediction of neonatal seizures, while demonstrating strong generalization capability across unseen subjects through transfer learning.

The neonatal period is the most vulnerable time for the development of seizures. Seizures in the immature brain lead to detrimental consequences, therefore require early diagnosis. The gold-standard for neonatal seizure detection currently relies on continuous video-EEG monitoring; which involves recording multi-channel electroencephalogram (EEG) alongside real-time video monitoring within a neonatal intensive care unit (NICU). However, video-EEG monitoring technology requires clinical expertise and is often limited to technologically advanced and resourceful settings. Cost-effective new techniques could help the medical fraternity make an accurate diagnosis and advocate treatment without delay. In this work, a novel explainable deep learning model to automate the neonatal seizure detection process with a reduced EEG montage is proposed, which employs convolutional nets, graph attention layers, and fully connected layers. Beyond its ability to detect seizures in real-time with a reduced montage, this model offers the unique advantage of real-time interpretability. By evaluating the performance on the Zenodo dataset with 10-fold cross-validation, the presented model achieves an absolute improvement of 8.31% and 42.86% in area under curve (AUC) and recall, respectively.

Background: Neonatal seizures are a neurological emergency that require urgent treatment. They are hard to diagnose clinically and can go undetected if EEG monitoring is unavailable. EEG interpretation requires specialised expertise which is not widely available. Algorithms to detect EEG seizures can address this limitation but have yet to reach widespread clinical adoption. Methods: Retrospective EEG data from 332 neonates was used to develop and validate a seizure-detection model. The model was trained and tested with a development dataset ($n=202$) that was annotated with over 12k seizure events on a per-channel basis. This dataset was used to develop a convolutional neural network (CNN) using a modern architecture and training methods. The final model was then validated on two independent multi-reviewer datasets ($n=51$ and $n=79$). Results: Increasing dataset and model size improved model performance: Matthews correlation coefficient (MCC) and Pearson's correlation ($r$) increased by up to 50% with data scaling and up to 15% with model scaling. Over 50k hours of annotated single-channel EEG was used for training a model with 21 million parameters. State-of-the-art was achieved on an open-access dataset (MCC=0.764, $r=0.824$, and AUC=0.982). The CNN attains expert-level performance on both held-out validation sets, with no significant difference in inter-rater agreement among the experts and among experts and algorithm ($\Delta \kappa < -0.095$, $p>0.05$). Conclusion: With orders of magnitude increases in data and model scale we have produced a new state-of-the-art model for neonatal seizure detection. Expert-level equivalence on completely unseen data, a first in this field, provides a strong indication that the model is ready for further clinical validation.

Machine learning and deep learning are two subsets of artificial intelligence that involve teaching computers to learn and make decisions from any sort of data. Most recent developments in artificial intelligence are coming from deep learning, which has proven revolutionary in almost all fields, from computer vision to health sciences. The effects of deep learning in medicine have changed the conventional ways of clinical application significantly. Although some sub-fields of medicine, such as pediatrics, have been relatively slow in receiving the critical benefits of deep learning, related research in pediatrics has started to accumulate to a significant level, too. Hence, in this paper, we review recently developed machine learning and deep learning-based solutions for neonatology applications. We systematically evaluate the roles of both classical machine learning and deep learning in neonatology applications, define the methodologies, including algorithmic developments, and describe the remaining challenges in the assessment of neonatal diseases by using PRISMA 2020 guidelines. To date, the primary areas of focus in neonatology regarding AI applications have included survival analysis, neuroimaging, analysis of vital parameters and biosignals, and retinopathy of prematurity diagnosis. We have categorically summarized 106 research articles from 1996 to 2022 and discussed their pros and cons, respectively. In this systematic review, we aimed to further enhance the comprehensiveness of the study. We also discuss possible directions for new AI models and the future of neonatology with the rising power of AI, suggesting roadmaps for the integration of AI into neonatal intensive care units.

A timely detection of seizures for newborn infants with electroencephalogram (EEG) has been a common yet life-saving practice in the Neonatal Intensive Care Unit (NICU). However, it requires great human efforts for real-time monitoring, which calls for automated solutions to neonatal seizure detection. Moreover, the current automated methods focusing on adult epilepsy monitoring often fail due to (i) dynamic seizure onset location in human brains; (ii) different montages on neonates and (iii) huge distribution shift among different subjects. In this paper, we propose a deep learning framework, namely STATENet, to address the exclusive challenges with exquisite designs at the temporal, spatial and model levels. The experiments over the real-world large-scale neonatal EEG dataset illustrate that our framework achieves significantly better seizure detection performance.

Diagnosis of adverse neonatal outcomes is crucial for preterm survival since it enables doctors to provide timely treatment. Machine learning (ML) algorithms have been demonstrated to be effective in predicting adverse neonatal outcomes. However, most previous ML-based methods have only focused on predicting a single outcome, ignoring the potential correlations between different outcomes, and potentially leading to suboptimal results and overfitting issues. In this work, we first analyze the correlations between three adverse neonatal outcomes and then formulate the diagnosis of multiple neonatal outcomes as a multi-task learning (MTL) problem. We then propose an MTL framework to jointly predict multiple adverse neonatal outcomes. In particular, the MTL framework contains shared hidden layers and multiple task-specific branches. Extensive experiments have been conducted using Electronic Health Records (EHRs) from 121 preterm neonates. Empirical results demonstrate the effectiveness of the MTL framework. Furthermore, the feature importance is analyzed for each neonatal outcome, providing insights into model interpretability.

Annually 8500 neonatal deaths are reported in the US due to respiratory failure, this is a third of all neonatal deaths in the US. Recently, Lung Ultrasound (LUS), due to its ionizing-radiation free nature, portability, and being cheaper is gaining wide acceptability as a diagnostic tool used for lung diseases. However, lack of highly trained medical professional has limited its use especially in remote areas. To address this, an automated screening system that captures characteristics of the LUS patterns can be of significant assistance to clinicians who are not experts in lung ultrasound (LUS) images. In this paper, we propose a feature extraction method designed to quantify the spatially-localized line patterns and texture patterns found in LUS images. Using the dual-tree complex wavelet transform (DTCWT) and four types of common image features we propose a method to classify the LUS images into 6 common neonatal lung conditions. These conditions are normal lung, pneumothorax (PTX), transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), chronic lung disease (CLD) and consolidation (CON) that could be pneumonia or atelectasis. The proposed method using DTCWT decomposition extracted global statistical, grey-level co-occurrence matrix (GLCM), grey-level run length matrix (GLRLM) and linear binary pattern (LBP) features to be fed to a linear discriminative analysis (LDA) based classifier. Using 15 best DTCWT features along with 3 clinical features the proposed approach achieved a per-image classification accuracy of 92.78% with a balanced dataset containing 720 images from 24 patients and 74.39% with the larger (class unbalanced) dataset containing 1550 images from 42 patients.

This paper explores automated face and facial landmark detection of neonates, which is an important first step in many video-based neonatal health applications, such as vital sign estimation, pain assessment, sleep-wake classification, and jaundice detection. Utilising three publicly available datasets of neonates in the clinical environment, 366 images (258 subjects) and 89 (66 subjects) were annotated for training and testing, respectively. Transfer learning was applied to two YOLO-based models, with input training images augmented with random horizontal flipping, photo-metric colour distortion, translation and scaling during each training epoch. Additionally, the re-orientation of input images and fusion of trained deep learning models was explored. Our proposed model based on YOLOv7Face outperformed existing methods with a mean average precision of 84.8% for face detection, and a normalised mean error of 0.072 for facial landmark detection. Overall, this will assist in the development of fully automated neonatal health assessment algorithms.

This report describes a set of neonatal electroencephalogram (EEG) recordings graded according to the severity of abnormalities in the background pattern. The dataset consists of 169 hours of multichannel EEG from 53 neonates recorded in a neonatal intensive care unit. All neonates received a diagnosis of hypoxic-ischaemic encephalopathy (HIE), the most common cause of brain injury in full term infants. For each neonate, multiple 1-hour epochs of good quality EEG were selected and then graded for background abnormalities. The grading system assesses EEG attributes such as amplitude and frequency, continuity, sleep--wake cycling, symmetry and synchrony, and abnormal waveforms. Background severity was then categorised into 4 grades: normal or mildly abnormal EEG, moderately abnormal EEG, severely abnormal EEG, and inactive EEG. The data can be used as a reference set of multi-channel EEG for neonates with HIE, for EEG training purposes, or for developing and evaluating automated grading algorithms.