Theoretical basis for the use of non-invasive thermal measurements to assess the brain injury in newborns undergoing therapeutic hypothermia.

The aim of this paper is to propose a new non-invasive methodology to estimate thermogenesis in newborns with perinatal asphyxia (PA) undergoing therapeutic hypothermia (TH). Metabolic heat production (with respect to either a neonate's body mass or its body surface) is calculated from the newborn's heat balance, estimating all remaining terms of this heat balance utilising results of only non-invasive thermal measurements. The measurement devices work with standard equipment used for therapeutic hypothermia and are equipped with the Global System for Mobile Communications (GSM), which allows one to record and monitor the course of the therapy remotely (using an internet browser) without disturbing the medical personnel. This methodology allows one to estimate thermogenesis in newborns with perinatal asphyxia undergoing therapeutic hypothermia. It also offers information about instantaneous values of the rate of cooling together with values of remaining rates of heat transfer. It also shows the trend of any changes, which are recorded during treatment. Having information about all components of the heat balance one is able to facilitate comparison of results obtained for different patients, in whom these components may differ. The proposed method can be a new tool for measuring heat balance with the possibility of offering better predictions regarding short-term neurologic outcomes and tailored management in newborns treated by TH.

A combined study of heat and mass transfer in an infant incubator with an overhead screen.

The main objective of this study is to investigate the major physical processes taking place inside an infant incubator, before and after modifications have been made to its interior chamber. The modification involves the addition of an overhead screen to decrease radiation heat losses from the infant placed inside the incubator. The present study investigates the effect of these modifications on the convective heat flux from the infant's body to the surrounding environment inside the incubator. A combined analysis of airflow and heat transfer due to conduction, convection, radiation and evaporation has been performed, in order to calculate the temperature and velocity fields inside the incubator before and after the design modification. Due to the geometrical complexity of the model, computer-aided design (CAD) applications were used to generate a computer-based model. All numerical calculations have been performed using the commercial computational fluid dynamics (CFD) package FLUENT, together with in-house routines used for managing purposes and user-defined functions (UDFs) which extend the basic solver capabilities. Numerical calculations have been performed for three different air inlet temperatures: 32, 34 and 36 degrees C. The study shows a decrease of the radiative and convective heat losses when the overhead screen is present. The results obtained were numerically verified as well as compared with results available in the literature from investigations of dry heat losses from infant manikins.

A thermoregulation model for hypothermic treatment of neonates.

This paper presents a thermoregulation finite element model (FEM) to simulate hypothermia procedures for the treatment of encephalopathy hypoxic-ischemia (EHI) in neonates, a dangerous ischemic condition that can cause neurological damages and even death. Therapeutic hypothermia is the only recommended technique to reduce sequels caused by EHI in neonates; intervention with moderate cooling for neural rescue in newborns with hypoxic-ischemic brain injury is the culmination of a series of clinical research studies spanning decades. However, the direct monitoring of brain cooling is difficult and can lead to additional tissue damage. Therefore, the measurement of efficiency during clinical trials of hypothermia treatment is still challenging. The use of computational methods can aid clinicians to observe the continuous temperature of tissues and organs during cooling procedures without the need for invasive techniques, and can thus be a valuable tool to assist clinical trials simulating different cooling options that can be used for treatment. The use of low cost methods such as cooling blankets can open the possibility of using brain cooling techniques in hospitals and clinics that cannot currently afford the available expensive equipment and techniques. In this work, we developed a FEM package using isoparametric linear three-dimensional elements which is applied to the solution of the continuum bioheat Pennes equation. Blood temperature changes were considered using a blood pool approach. The results of the FEM model were compared to those obtained through the implementation of a user-defined function (UDF) in the commercial finite volume software FLUENT and validated with experimental tests. Numerical analyses were performed using a three-dimensional mesh based on a complex geometry obtained from MRI scan medical images.

Modelling and optimisation of the operation of a radiant warmer.

This paper presents numerical calculations of the temperature field obtained for the case of a neonate placed under a radiant warmer. The results of the simulations show a very non-uniform temperature distribution on the skin of the neonate, which may cause increased evaporation leading to severe dehydration. For this reason, we propose some modifications on the geometry and operation of the radiant warmer, in order to make the temperature distribution more uniform and prevent the high temperature gradients observed on the surface of the neonate. It is concluded that placing a high conductivity blanket over the neonate and introducing additional screens along the side of the mattress, thus recovering the radiation heat escaping through the side boundaries, helped providing more uniform temperature fields.

Heat and mass transfer under an infant radiant warmer--development of a numerical model.

The main objectives of this paper are to present a procedure of how to create and set up a model for the physical processes that take place within an infant radiant warmer and to validate that Computational Fluid Dynamics (CFD) can be used to resolve such problems. In this study, the results are obtained for a simplified model, both in terms of the geometry employed and the prescribed boundary conditions. The results were numerically verified in terms of the convergence history, monitor data and the physical correctness. This study shows that the physical situation is unsteady and the results tend to oscillate, almost periodically, around a mean value. The results presented in the paper are found to be in qualitative agreement with the experimental data. This gives us confidence that the techniques employed in this paper are appropriate and form the starting point for the inclusion of more realistic effects, e.g. real shape of the newborn and radiant lamp, heat generated inside the newborn, moisture transport, etc.

An overview of recent applications of computational modelling in neonatology.

This paper reviews some of our recent applications of computational fluid dynamics (CFD) to model heat and mass transfer problems in neonatology and investigates the major heat and mass-transfer mechanisms taking place in medical devices, such as incubators, radiant warmers and oxygen hoods. It is shown that CFD simulations are very flexible tools that can take into account all modes of heat transfer in assisting neonatal care and improving the design of medical devices.

Modelling of heat and mass transfer processes in neonatology.

This paper reviews some of our recent applications of computational fluid dynamics (CFD) to model heat and mass transfer problems in neonatology and investigates the major heat and mass transfer mechanisms taking place in medical devices such as incubators and oxygen hoods. This includes novel mathematical developments giving rise to a supplementary model, entitled infant heat balance module, which has been fully integrated with the CFD solver and its graphical interface. The numerical simulations are validated through comparison tests with experimental results from the medical literature. It is shown that CFD simulations are very flexible tools that can take into account all modes of heat transfer in assisting neonatal care and the improved design of medical devices.