An openly available wearable, a diaper cover, monitors infant's respiration and position during rest and sleep

Aim: To describe and test the accuracy of respiratory rate assessment in long-term surveillance using an open-source infant wearable, NAPping PAnts (NAPPA). Methods: We recorded 24 infants aged 1–9 months using our newly developed infant wearable that is a diaper cover with an integrated programmable electronics with accelerometer and gyroscope sensors. The sensor collects child's respiration rate (RR), activity and body posture in 30-s epochs, to be downloaded afterwards into a mobile phone application. An automated RR quality measure was also implemented using autocorrelation function, and the accuracy of RR estimate was compared with a reference obtained from the simultaneously recorded capnography signal that was part of polysomnography recordings. Results: Altogether 88 h 27 min of data were recorded, and 4147 epochs (39% of all data) were accepted after quality detection. The median of patient wise mean absolute errors in RR estimates was 1.5 breaths per minute (interquartile range 1.1–2.6 bpm), and the Blandt-Altman analysis indicated an RR bias of 0.0 bpm with the 95% limits of agreement of −5.7–5.7 bpm. Conclusion: Long-term monitoring of RR and posture can be done with reasonable accuracy in out-of-hospital settings using NAPPA, an openly available infant wearable.