Accurate prediction of neurologic changes in critically ill infants using pose AI.

IMPORTANCE: Infant alertness and neurologic changes are assessed by exam, which can be intermittent and subjective. Reliable, continuous methods are needed.

OBJECTIVE: We hypothesized that our computer vision method to track movement, pose AI, could predict neurologic changes.

DESIGN: Retrospective observational study from 2021-2022.

SETTING: A level four urban neonatal intensive care unit (NICU).

PARTICIPANTS: Infants with corrected age ≤1 year, comprising 115 patients with 4,705 hours of video data linked to electroencephalograms (EEG), including 46% female and 25.2% white non-Hispanic.

EXPOSURES: Pose AI prediction of anatomic landmark position and an XGBoost classifier trained on one-minute variance in pose.

MAIN OUTCOMES AND MEASURES: Outcomes were cerebral dysfunction, diagnosed from EEG readings by an epileptologist, and sedation, defined by the administration of sedative medications. Measures of algorithm performance were receiver operating characteristic-area under the curves (ROC-AUCs) on cross-validation and on two test datasets comprised of held-out infants and held-out video frames from infants used in training.

RESULTS: Infant pose was accurately predicted in cross-validation, held-out frames, and held-out infants (respective ROC-AUCs 0.94, 0.83, 0.89). Median movement increased with age and, after accounting for age, was lower with sedative medications and in infants with cerebral dysfunction (all P<5-10 -3 , 10,000 permutations). Sedation prediction had high performance on cross-validation, held-out frames, and held-out infants (ROC-AUCs 0.90, 0.91, 0.87), as did prediction of cerebral dysfunction (ROC-AUCs 0.91, 0.90, 0.76).

CONCLUSIONS AND RELEVANCE: We used pose AI to predict sedation and cerebral dysfunction in 4,705 hours of video from a large, diverse cohort of infants. Pose AI may offer a scalable, minimally invasive method for neuro-telemetry in the NICU.

KEY POINTS: Question: Can computer vision track infant movement and use movement patterns to predict neurologic changes in critically ill infants? Findings: In this retrospective study of 115 infants less than 1 year old, we trained a computer vision algorithm to track movement from video data and predict sedation and cerebral dysfunction. Meaning: Computer vision can monitor alertness and relevant neurologic changes in critically ill infants.