Peter Andriessen

• Doctor of Medicine
• Neonatologist at Maxima Medical Center

Objectives: Prediction of late-onset sepsis (onset beyond day 3 of life) in preterm infants, based on multiple patient monitoring signals 24 hours before onset. Design: Continuous high-resolution electrocardiogram and respiration (chest impedance) data from the monitoring signals were extracted and used to create time-interval features represent...

Objective In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25 ⁺⁰ to 24 ⁺⁰ weeks’ gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation. Design National cohort study, using data from...

Monitoring motion in preterm infants is crucial to evaluating their clinical condition and development. However, no quantitative automated method for continuous motion monitoring is currently clinically available, though innovative methods based on camera or mattress-based sensing are being developed. The aim of this study is to assess the use of E...

Aim This study aimed to classify quiet sleep, active sleep and wake states in preterm infants by analysing cardiorespiratory signals obtained from routine patient monitors. Methods We studied eight preterm infants, with an average postmenstrual age of 32.3 ± 2.4 weeks, in a neonatal intensive care unit in the Netherlands. Electrocardiography and c...

Movement patterns in preterm infants can offer crucial insights into their physiological state including maturational development and sleep. These patterns can also serve as early indicators of potential deteriorations, such as cerebral palsy, sepsis, and epilepsy. In this study, we investigated a novel two-dimensional optical fiber mat system for...

Objective: Monitoring of apnea of prematurity, performed in neonatal intensive care units by detecting central apneas (CAs) in the respiratory traces, is characterized by a high number of false alarms. A two-step approach consisting of a threshold-based apneic event detection algorithm followed by a machine learning model was recently presented in...

Objective After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks’ gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. Design Population-based cohort study....

Objective: Less invasive surfactant administration (LISA) has been introduced to preterm infants with respiratory distress syndrome (RDS) on continuous positive airway pressure (CPAP) support in order to avoid intubation and mechanical ventilation. However, after this LISA procedure, a significant part of infants fails CPAP treatment (CPAP-F) and r...

The classification of sleep state in preterm infants, particularly in distinguishing between active sleep (AS) and quiet sleep (QS), has been investigated using cardiorespiratory information such as electrocardiography (ECG) and respiratory signals. However, accurately differentiating between AS and wake remains challenging; therefore, there is a p...

Predicting the short- and long-term outcomes of extremely preterm infants remains a challenge. Multivariable prognostic models might be valuable tools for clinicians, parents, and policymakers for providing accurate outcome estimates. In this perspective, we discuss the opportunities and challenges of using prognostic models in extremely preterm in...

Abnormal body motion in infants may be associated with neurodevelopmental delay or critical illness. In contrast to continuous patient monitoring of the basic vitals, the body motion of infants is only determined by discrete periodic clinical observations of caregivers, leaving the infants unattended for observation for a longer time. One step to f...

Unlabelled: The introduction of rapid exome sequencing (rES) for critically ill neonates admitted to the neonatal intensive care unit has made it possible to impact clinical decision-making. Unbiased prospective studies to quantify the impact of rES over routine genetic testing are, however, scarce. We performed a clinical utility study to compare...

The aim of this study is to develop an explainable late-onset sepsis (LOS) prediction algorithm based on continuously measured multi-channel physiological signals that can be applied to a bedside patient monitor for preterm infants in a neonatal intensive care unit (NICU). The study highlights the complementary predictive value of motion informatio...

Introduction: Supplemental oxygen therapy is a mainstay of modern neonatal intensive care for preterm infants. However, both insufficient and excess oxygen delivery are associated with adverse outcomes. Automated or closed loop FiO2 control has been developed to keep SpO2 within a predefined target range more effectively. Methods: The aim of thi...

Late onset sepsis (LOS) is one of the main causes of death in preterm infants in a neonatal intensive care unit (NICU). LOS can be better treated with early detection, reducing its morbidity and mortality. In this study, an end-to-end deep learning model called DeepLOS was developed to predict LOS in preterm infants in a NICU. The model is based on...

Introduction: Less invasive surfactant administration (LISA) to preterm infants is associated with decreased risk for death or BPD. After LISA, a considerable proportion requires a second dose of surfactant because of ongoing respiratory distress syndrome, raising a clinical dilemma between intubation or performing a repeated LISA (re-LISA) proced...

Background and objective : Apnea of prematurity is one of the most common diagnosis in neonatal intensive care units. Apneas can be classified as central, obstructive or mixed. According to the current international standards, minimal fluctuations or absence of fluctuations in the chest impedance (CI) suggest a central apnea (CA). However, automati...

Objective To compare academic attainment at age 12 in preterm children born below 30 weeks’ gestation with matched term born peers, using standardized, nationwide and well-validated school tests. Study design This population-based, national cohort study was performed by linking perinatal data from the nationwide Netherlands Perinatal Registry with...

Preterm infants in a neonatal intensive care unit (NICU) are continuously monitored for their vital signs, such as heart rate and oxygen saturation. Body motion patterns are documented intermittently by clinical observations. Changing motion patterns in preterm infants are associated with maturation and clinical events such as late-onset sepsis and...

Premature infants are at risk of developing serious complications after birth. Communicative interventions performed in neonatal intensive care units (NICUs), such as music therapy interventions, can reduce the stress experienced by these infants and promote the development of their autonomic nervous system. In this study we investigated the effect...

p>This study describes a machine learning algorithm based on multimodal signals obtained from a regular clinical patient monitor to predict late-onset sepsis (LOS) in preterm infants in a neonatal intensive care unit (NICU). The algorithm uses features that contain information on heart rate variability (HRV), respiration, and motion, based on conti...

p>This study describes a machine learning algorithm based on multimodal signals obtained from a regular clinical patient monitor to predict late-onset sepsis (LOS) in preterm infants in a neonatal intensive care unit (NICU). The algorithm uses features that contain information on heart rate variability (HRV), respiration, and motion, based on conti...

Objective: In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected ag...

Background Current knowledge regarding differences in verbal intelligence scores (VIQ) and performance intelligence scores (PIQ) in preterm born children is limited. As early motor performance may be essential for developing later visual-perceptual and visual-motor skills, early motor performance may be associated with PIQ. Aims To evaluate whethe...

Liquid-based perinatal life support (PLS) technology will probably be applied in a first-in-human study within the next decade. Research and development of PLS technology should not only address technical issues, but also consider socio-ethical and legal aspects, its application area, and the corresponding design implications. This paper represents...

Apnea of prematurity (AOP) is a critical condition for preterm infants which can lead to several adverse outcomes. Despite its relevance, mechanisms underlying AOP are still unclear. In this work we aimed at improving the understanding of AOP and its physiologic responses by analyzing and comparing characteristics of real infant data and model-base...

Objective: To perform a temporal and geographical validation of a prognostic model, considered of highest methodological quality in a recently published systematic review, for predicting survival in very preterm infants admitted to the neonatal intensive care unit. The original model was developed in the UK and included gestational age, birth weig...

Motion patterns in newborns contain important information. Motion patterns change upon maturation and changes in the nature of motion may precede critical clinical events such as the onset of sepsis, seizures and apneas. However, in clinical practice, motion monitoring is still limited to observations by caregivers. In this study, we investigated a...

In neonatal intensive care units, respiratory traces of premature infants developing late onset sepsis (LOS) may also show episodes of apneas. However, since clinical patient monitors often underdetect apneas, clinical experts are required to investigate patients' traces looking for these events. In this work we present a method to optimize an exis...

Background: Preterm infants with pre- or postnatal growth restriction may have an additional risk of adverse neurodevelopmental outcome. Whereas reduced cognitive ability and behavioral problems have consistently been associated with prematurity, a more comprehensive evaluation is necessary to identify those preterm infants who are at increased ris...

Both Respiratory Flow (RF) and Respiratory Motion (RM) are visible in thermal recordings of infants. Monitoring these two signals usually requires landmark detection for the selection of a region of interest. Other approaches combine respiratory signals coming from both RF and RM, obtaining a Mixed Respiratory (MR) signal. The detection and classif...

Introduction: Retinopathy of prematurity (ROP) remains an important cause for preventable blindness. Aside from gestational age (GA) and birth weight, risk factor assessment can be important for determination of infants at risk of (severe) ROP. Methods: Prospective, multivariable risk-analysis study (NEDROP-2) was conducted, including all infant...

Aim: Long-term outcome data in preterm children is often limited to cross-sectional measurement of neurodevelopmental impairment (NDI) at the corrected age of 24-36 months. However, impairments may only become overt during childhood or resolve with time, and individual trajectories in outcome over time may vary. The primary aim of this study was to...

Objective To investigate the efficacy of automated control of inspired oxygen (FiO2) by Predictive Intelligent Control of Oxygenation (PRICO) on the Fabian ventilator in maintaining oxygen saturation (SpO2) in preterm infants on high flow nasal cannula (HFNC) support. Design Single-centre randomised two-period crossover study. Setting Tertiary ne...

Context: Prediction models can be a valuable tool in performing risk assessment of mortality in preterm infants. Objective: Summarizing prognostic models for predicting mortality in very preterm infants and assessing their quality. Data sources: Medline was searched for all articles (up to June 2020). Study selection: All developed or extern...

The transformation procedure of deriving amplitude-integrated (a)EEG from raw EEG has been well described in a purely analog prototype, however the inherent specifications within the prototype are not established or disclosed. In this paper, we aim at providing an accessible and digitalized aEEG algorithm that is evaluated quantitatively and valida...

Aiming at continuous unobtrusive respiration monitoring, motion robustness is paramount. However, some types of motion can completely hide the respiration information and the detection of these events is required to avoid incorrect rate estimations. Therefore, this work proposes a motion detector optimized to specifically detect severe motion of in...

Objective: This study aims to evaluate outcome after conservative management (no pharmacological/surgical intervention other than fluid restriction, diuretics, or ventilator adjustments) compared with active (pharmacological and/or surgical) treatment for patent ductus arteriosus (PDA) in preterm infants and analyze differences in outcome between r...

Context: There is an ongoing debate on the optimal management of patent ductus arteriosus (PDA) in preterm infants. Identifying subgroup of infants who would benefit from pharmacological treatment might help. Objective: To investigate the modulating effect of the differences in methodological quality, the rate of open-label treatment, and patient c...

Cardiorespiratory interaction (CRI) has been intensively studied in adult sleep, yet not in preterm infants, in particular across different sleep states including wake (W), active sleep (AS), and quiet sleep (QS). The aim of this study was to quantify the interaction between cardiac and respiratory activities in different sleep states of preterm in...

Sleep is essential for brain development, but being in a neonatal intensive care unit exposes preterm infants to multiple stimuli and care activities that disrupt their sleep. Monitoring can increase infants’ sleep duration and quality by modifying nursing and caretaking behaviours (1). Actigraphy has been validated as a non‐invasive and cost‐effic...

Objective: Presence of a patent ductus arteriosus (PDA) in neonates is assessed by echocardiography. Echocardiographic assessment has disadvantages, primarily its discontinuous nature. We hypothesize that the continuously measured ratio of arterial blood pressures (ABP) at the borders of a window surrounding the systolic peak ratio discriminates n...

Aim To address alarm fatigue, a new alarm management system which ensures a quicker delivery of alarms together with waveform information on nurses’ handheld devices was implemented and settings optimized. The effects of this clinical implementation on alarm rates and nurses’ responsiveness were measured in an 18‐bed single‐family rooms neonatal in...

Abstract Background In preterm infants with Respiratory Distress Syndrome (RDS), Less Invasive Surfactant Administration (LISA) has been established to reduce the need of mechanical ventilation and might improve survival rates without bronchopulmonary dysplasia. The aim of this study was to investigate whether NICU care has changed after introducti...

Respiration is monitored in neonatal wards using chest impedance (CI), which is obtrusive and can cause skin damage to the infants. Therefore, unobtrusive solutions based on infrared thermography are being investigated. This work proposes an algorithm to merge multiple thermal camera views and automatically detect the pixels containing respiration...

Doxapram is used for the treatment of apnea of prematurity in dosing regimens only based on bodyweight, as pharmacokinetic data are limited. This study describes the pharmacokinetics of doxapram and keto-doxapram in preterm infants. Data (302 samples) from 75 neonates were included with a median (range) gestational age (GA) 25.9 (23.9–29.4) weeks,...

This paper presents a simple yet novel method to estimate the heart frequency (HF) of neonates directly from the ECG signal, instead of using the RR-interval signals as generally done in clinical practices. From this, the heart rate (HR) can be derived. Thus, we avoid the use of peak detectors and the inherent errors that come with them.Our method...

A high fidelity baby manikin with a colour changing mechanism is required for medical training, especially for cyanosis skin colouration assessment in a newborn baby. However, commercially available baby manikin simulators do not have the real colour-change of cyanosis skin. The efforts in increasing the fidelity of the manikin might improve the ac...

Aims Racemic ibuprofen is widely used for the treatment of preterm neonates with patent ductus arteriosus. Currently used bodyweight‐based dosing guidelines are based on total ibuprofen, while only the S‐enantiomer of ibuprofen is pharmacologically active. We aimed to optimize ibuprofen dosing for preterm neonates of different ages based on an enan...

Preterm infant neuronal development is related to the distribution of their sleep states. The distribution changes throughout development. Automated sleep state monitoring can become a powerful aid for development monitoring in preterm infants. Three datasets including 34 preterm infants and a total of 18,018 30 s manually annotated sleep intervals...

Background: Late onset sepsis (LOS) in preterm infants is preceded by fecal volatile organic compound (VOC) alterations, suggesting an etiological role of gut microbiota in LOS rather than being primarily caused by central venous catheters (CVC). To increase our knowledge about the involvement of the gut microbiota in LOS, we analyzed fecal sample...

Chorioamnionitis and preeclampsia account for the majority of preterm births worldwide. Thus far, adequate methods for early detection or prevention of these diseases are lacking. In preeclampsia, accelerated villous maturation is believed to compensate placental insufficiency. However, little is known about the effects of placental inflammation in...

Objective To find propofol doses providing effective sedation without side effects in neonates of different gestational ages (GA) and postnatal ages (PNA). Design and setting Prospective multicentere dose-finding study in 3 neonatal intensive care units. Patients Neonates with a PNA <28 days requiring non-emergency endotracheal intubation. Inter...

We aimed at reducing alarm fatigue in neonatal intensive care units by developing a model using machine learning for the early prediction of critical cardiorespiratory alarms. During this study in over 34,000 patient monitoring hours in 55 infants 278,000 advisory (yellow) and 70,000 critical (red) alarms occurred. Vital signs including the heart r...

(Abstracted from Pediatrics 2019;143(6):e20183253) Guidelines on management of extreme prematurity differ regarding the lowest limits of gestation for which active support can or should be offered the recommendations for the role of parents in the decision making. In addition, the use of gestational age (GA) as a cutoff has been debated because oth...

Amplitude-integrated electroencephalography (aEEG) is a simplified method for long-term, continuous, and bedside monitoring of brain activity. While conventional Electroencephalography (EEG) is the gold standard of assessing brain function, aEEG is easy to operate and allows bedside interpretation of brain activity by health care providers without...

Background: Patient monitoring devices are responsible for producing many false alarms, leading to desensitization and alarm fatigue. More intelligent alarm management can lead to an improved clinical workflow with positive effects on patient safety. Until recently, the NICU of Máxima Medical Center (MMC), Veldhoven, used a distributed alarm manage...

Although sedative premedication for endotracheal intubation is considered standard of care, less invasive surfactant administration (LISA) is often performed without sedative premedication. The aim of this study was to assess success rates, technical quality and vital parameters in LISA without sedative premedication. Prospective observational stud...

The conclusion of our recent paper that performance of the STAN device in clinical practice is potentially limited by high false-negative and high false-positive STAN-event rates and loss of ST waveform assessment capacity during severe hypoxemia, evoked comments by Kjellmer, Lindecrantz and Rosén. These comments can be summarized as follows: 1) ST...

This study in preterm infants was designed to characterize the prognostic potential of several features of heart rate variability (HRV), respiration, and (infant) motion for the predictive monitoring of late-onset sepsis (LOS). In a neonatal intensive care setting, the cardiorespiratory waveforms of infants with blood-culture positive LOS were anal...

Frequent pain and discomfort in premature infants can lead to long-term adverse neurodevelopmental outcomes. Video-based monitoring is considered to be a promising contactless method for identification of discomfort moments. In this study, we propose a video-based method for automated detection of infant discomfort. The method is based on analyzing...

Objective Pulse transit time (PTT) refers to the time it takes a pulse wave to travel between two arterial sites. PTT can be estimated, amongst others, using the electrocardiogram (ECG) and photoplethysmogram (PPG). Because we observed a sawtooth artifact in the PTT while using standard patient monitoring equipment for ECG and PPG, we explored the...

This pictorial proposes an alternative mode of interaction between nurses and clinical alarm syste ms and shows how three concepts, developed to interact through the end user's periphery of attention, can be applied in a clinical setting to improve the workflow of nurses and wellbeing of patients.

Background Doxapram is used for intravenous and oral treatment of apnea of prematurity in preterm infants. Dosing is currently based on bodyweight, however pharmacokinetic and bioavailability data are limited. To develop individualized dosing strategies, we characterized pharmacokinetics of doxapram in this vulnerable patient population. Methods D...

Introduction Fluconazole is a first choice drug for neonatal cerebral candidiasis and for prevention of candidemia/invasive candidiasis in neonates. Selection of the optimal neonatal dose is difficult and requires solid multiple dose pharmacokinetic (PK) research to guide dosing decisions. We performed a pharmacokinetic study in preterm neonates wh...

Objectives: To develop a nationwide, evidence-based framework to support prenatal counseling in extreme prematurity, focusing on organization, decision-making, content, and style aspects. Methods: A nationwide multicenter RAND-modified Delphi method study was performed between November 2016 and December 2017 in the Netherlands. Firstly, recommen...

Analyzing heart rate variability (HRV) in preterm infants can help track maturational changes and subclinical signatures of disease. We conducted an observational study to characterize the effect of demographic and cardiorespiratory factors on three features of HRV using a linear mixed-effects model. HRV-features were tailored to capture the unique...

Although midazolam is a frequently used sedative in neonatal intensive care units, its use in preterm neonates has been off-label. Recently, a new dosing advice for midazolam for sedation on intensive care units has been included in the label (0.03 mg/[kg·h] for preterm neonates <32 weeks and 0.06 mg/[kg·h] for neonates >32 weeks). Concentration-ti...

Objective To evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome. Design Retrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed t...

Necrotizing enterocolitis (NEC) is a relatively common disease in very-low-birth-weight infants and is associated with high mortality and morbidity. In survivors, neurodevelopmental impairment is frequently seen. The exact etiology remains largely to be elucidated, but microbiota are considered to play a major role in the development of NEC. Furthe...

Objective: To determine the feasibility of unobtrusively monitoring the respiratory rate (RR) in preterm infants by using a film-like pressure sensor placed between the mattress and the bedding. Approach: The RR was simultaneously measured by processing the chest impedance (CI) and the ballistographic (BSG) signal acquired from the pressure sensor...

Objective: To date, mainly obtrusive methods (e.g. adhesive electrodes in electroencephalography or electrocardiography) have been necessary to determine the preterm infant sleep states. As any obtrusive measure should be avoided in preterm infants because of their immature skin development, we investigated the possibility of automated sleep stagi...

Workflow in a neonatal intensive care unit (NICU) is relatively unpredictable, which makes it difficult to plan activities. Simple tasks, such as checking device statuses may be forgotten, resulting in disturbing alarms. In this paper, we will present CheckMates, ambient lighting displays, which visualize device statuses to provide nurses with more...

Over 75% of severely thrombocytopenic neonates receive platelet transfusions, though little evidence supports this practice, and only 10% develop major bleeding. In a recent randomized trial, giving platelet transfusions at a threshold platelet count of 50x109/L compared to a threshold of 25x109/L was associated with an increased risk of major blee...

Background Fentanyl is frequently used off-label in preterm newborns. Due to very limited pharmacokinetic and pharmacodynamic data, fentanyl dosing is mostly based on bodyweight. This study describes the maturation of the pharmacokinetics in preterm neonates born before 32 weeks of gestation. Methods 442 plasma samples from 98 preterm neonates (me...

Background: Premedication for neonatal intubation facilitates the procedure and reduces stress and physiological disturbances. However, no validated scoring system to assess the effect of premedication prior to intubation is available. Objective: To evaluate the usefulness of an Intubation Readiness Score (IRS) to assess the effect of premedicat...

Continuously monitoring body movement in preterm infants can have important clinical applications since changes in movement-patterns can be a significant marker for clinical deteriorations including the onset of sepsis, seizures, and apneas. This paper proposes a system and method to monitor body movement of preterm infants in a clinical environmen...

This paper reports on the realistic color generation and color change due to cyanosis which refers to the blue coloration around the lips’ area. The design requirements for the manikin were identified based on the color measurement and corrections of cyanosis in images of real babies. The classification of the literature study is according to physi...