A Wearable Sensor System for Neonatal Seizure Monitoring
Hongyu Chen, Xiao Gu, Zhenning Mei, Ke Xu, Kai Yan, Chunmei Lu, Laishuan Wang, Feng Shu,
Qixin Xu, Sidarto Bambang Oetomo, and Wei Chen, Senior Member, IEEE

Abstract—A novel wearable sensor system for seizure
monitoring of neonates comprised of smart clothing, video
recording and cloud platform is presented. Textile electrodes
and Inertial Measurement Unit (IMU) are embedded in the
smart clothing to obtain ECG signal and motion signal whereby
epileptic seizure detection algorithm is performed. Moreover, a
video monitoring module provides real-time information about
patients. The cloud platform receives the pre-processed data
and enables remote monitoring, centralized signal processing
and data management. Comparison with commercial
instruments shows that the smart clothing is capable of
acquiring high-quality signals. Pilot tests under disinfection
operations at Children’s Hospital of Fudan University confirm
clinical feasibility of the proposed system. The scalability and
modularity of the unobtrusive wearable front end and the
design of system architecture based on cloud enable the whole
system with great potential in clinical practice and home
monitoring scenarios.
I. INTRODUCTION
Epileptic seizure is an important clinical sign of brain
dysfunction that occurs more commonly during infancy
compared to childhood [1]. Seizures often manifest as
repetitive motion of an arm, hand, leg and eye and sometimes
are accompanied by the contraction of muscles at a fluctuant
velocity in opposite directions [2]. An overall occurrence rate
of seizure about 1~5% in neonates is reported. As for
the preterm infants, it is about 6~13%, higher than that
among normal newborns [2] [3]. Furthermore, about half of
the neonates diagnosed with convulsion have various types of
brain dysfunction, with an overall mortality rate as high as
30% [4].
Hitherto, the Electroencephalogram (EEG) is the gold
standard for neonatal epilepsy diagnosis, but for some kinds of
Hongyu Chen is with the Center for Intelligent Medical Electronics,
School of Information Science and Technology, Fudan University, Shanghai,
China, and the Department of Industrial Design, Eindhoven University of
Technology, Netherlands. (E-mail: chenhongyudesign@outlook.com ).
Xiao Gu, Zhenning Mei, and Ke Xu are with the Center for Intelligent
Medical Electronics, School of Information Science and Technology, Fudan
University, Shanghai, China. (E-mail: 14307130126@fudan.edu.cn;
16210720037@fudan.edu.cn; 14307130144@fudan.edu.cn )
Kai Yan, Chunmei Lu, Laishuan Wang are with the Children’s Hospital of
Fudan University, Shanghai, China.( E-mail: laishuanwang@163.com )
Feng Shu and Qixing Xu are with the Shanghai Lvcheng Information
Technology Co., Ltd. (Email: feng.shu@outlook.com; djixqx@163.com )
Sidarto Bambang Oetomo is with the Department of Industrial Design,
Eindhoven University of Technology, and the Department of Neonatology,
Maxima Medical Center, Netherlands. (E-mail:
S.BambangOetomo@mmc.nl)
Wei Chen is with the Center for Intelligent Medical Electronics, School of
Information Science and Technology, Fudan University, and Shanghai Key
Laboratory of Medical Imaging Computing and Computer Assisted
Intervention, Shanghai China (Phone: +86-021-65643781; E-mail:
w_chen@fudan.edu.cn).
978-1-5090-6244-7/17/$31.00 ©2017 IEEE
infant seizures EEG signals are weak and illegible, which
makes them likely to be overlooked [5]. In addition, several
related research has been trying to develop Electrocardiogram
(ECG) based techniques to distinguish neonates with epileptic
seizure from healthy ones [6]. The movement information
aspect remains as a research niche in the field of automatic
diagnosis of neonatal seizure [7].
In clinical practice, diagnosis based on the observation on
EEG and/or video recording by experienced clinicians is
time-consuming and limited by the inter-observer variability
due to its subjective nature [8] [9]. Moreover, EEG monitoring
in neonates is available only in a dedicated environment like
the Neonatal Intensive Care Unit (NICU). Furthermore, cup
surface electrodes and gel electrodes used for monitoring may
cause skin lesions. The deployment of electrodes with wires
connected to monitoring devices may also interfere with the
movement of infant and lead to missing detection. Therefore, a
new seizure monitoring approach is needed with the
advantages of high accuracy and comfort for neonates.
Considering the rapid developments in the field of sensor and
wireless communication technology in recent decades, a new
concept of unobtrusive monitoring of infants using wearable
sensor system has been reported [10] [11] [12] [13].
In this study, a wearable sensor system is presented aiming
to provide an intelligent auxiliary diagnosis for neonates at
high risk of seizures. The system consists of smart clothing, a
video recording module and a cloud platform. Textile
electrodes replace the gel electrodes to circumvent possible
skin damage. Inertial Measurement Units (IMUs) are
embedded to obtain movement information whose potential in
automatic seizure detection is not well exploited yet. Given
the feasibility that has been confirmed by a pilot study on data
collection, transmission and management, the unobtrusive
wearable frontend together with the video recording module
and cloud platform enables the application in both hospital and
home-based scenarios.
In this paper, the overall system architecture and detailed
information about system implementation is presented
together with the results of signal quality tests and clinical
feasibility tests. The broader application potential of system is
also discussed.
II. SYSTEM DESIGN
A. Design requirements
We launched the design procedure of the system from
requirement design first based on previous research [14]. To
overcome the limitations of the diagnostic procedures for
neonates at risk for seizures we propose the following
requirements:
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  Continuous monitoring and recording of vital sign for
both daily use and automatic detection with minimal
disturbance to neonates.
 Continuous monitoring of body movements
 Automatic seizure detection algorithm and warning
with events logged.
 Data management for further use, like retrospective
analysis and longitudinal study.
 User-friendly interfaces for both professional
clinicians at hospitals and inexperienced users at
home without interference with existing electrical
devices.
 The skin-contacting part can be sterilized.
 Video monitoring for confirming the diagnosis.
B. System architecture
To meet the requirements mentioned above, the proposed
solution is described below.
A complete process of monitoring is composed of three
steps, data collection, data transmission, and data analysis and
feedback. As the system sketch shown in Fig. 1, data
collection is achieved by smart clothing (see below) and video
recorder, whereby smart clothing collects ECG signals and
motion signals, and video camera records video information.
The data generated by smart clothing are transmitted to mobile
terminal via Bluetooth, while the video recording is
transmitted to mobile terminal via Wireless Local Area
Network (WLAN).
Figure 1. System architecture
The cloud platform receives all the data uploaded from the
mobile terminals for concentrated processing and storage. An
authorized user can get access to the cloud platform and
download data with timestamps to any mobile terminal or
microcomputer with software kit installed. The software
provides real-time display of physiological signals and video
recordings as well as alarms when infant seizure is detected.
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III. System implementation and prototype
In this section, the detailed information about system
implementation is elucidated. The overall system consists of
two major parts, data acquisition and cloud platform. As for
data acquisition, ECG, motion data and video information are
obtained by smart clothing and video recorder and transmitted
to upper computer. Cloud platform with software and the
algorithms embedded in is in charge of data storage, analysis,
and feedback.
A. Prototype jacket
The smart clothing as a wearable front end is made of
cotton in a double-layer manner, as illustrated in Fig. 2. Two
silver textile electrodes (Shieldex Berlin RS) are sewn at the
mid lateral sides of the upper chest with two IMUs
(Invensense MPU9250) deployed near cuff between two
layers, respectively. The analog potential difference sensed by
textile electrodes is preprocessed by a commercially available
analog front end ADS1292 (TI). The difference is amplified
by the onboard amplifier and then converted to a digital signal
by a 24-bit high accurate Analog Digital Converter (ADC).
The corresponding digital signal and the motion signal
obtained from MPU9250 (Invense) are transferred to local
microcontroller unit (MCU) MSP430 via Serial Peripheral
Interface (SPI). Signal conditioning is performed on the MCU
including filtering and data packing. Therefore, transmission
bandwidth needed in the following stage can also be reduced
substantially.
Figure 2. Prototype jacket.
All the preprocessed data are sent to the upper computer
(usually, a mobile terminal) synchronously via Bluetooth
(CC2564). All the modules are integrated into a toy-like box
for the convenience of daily nursing and replacement. The
smart clothing as a whole is modularized, with the belt where
the textile electrodes are embedded in and the toy-like module
all detachable. It is convenient for replacement of specific
parts and subsequent cleaning and disinfection after each use.
B. Video recording module
The video recording module provides real-time
information about the monitored patient. Video information
enables remote monitoring, which is not only suitable for
home care scenarios, but also reduce the workload of clinical
staff. In particular, in current clinical practice, video
information is important as a reference. Physicians determine
the occurrence of seizures afterward with the help of EEG
waveform combined with video information. Thus, the video
recording is indispensable for event annotation on signal
waveforms, which is the premise of the development of
automatic diagnostic methods.
C. Seizure detection algorithm
Motion signal and ECG signal are utilized for seizure
detection.
As for the motion signal, a simple moving average
algorithm with fixed threshold is deployed. As shown in Fig. 3,
N is the length of the moving window and Θ is the threshold to
determine the motion with abnormal intensity caused by
seizure. A similar algorithm provided promising results in
tests on pediatric patients with frontal lobe seizures which
result in marked motor manifestations, like bicycle pedaling or
uncontrolled arm movements [15]. Its sensitivity to seizures of
infants needs to be verified with clinical tests.
As for ECG signal, Hjorth parameter, a normalized slope
descriptor (NSD) about waveform, which is usually used in
EEG analysis but also used in several related research for
infant seizure detection as time-domain feature [16], is used
due to its low computation cost for further classification.
Figure 3. Flow Chart of Algorithms.
D. Cloud platform and user interface
The collected data are transmitted to local mobile terminal
as described in Part II. The user can view the collected
physiological signals and video through the software installed
in the mobile terminal with the automatic diagnosis algorithms.
The software displays the waveforms of physiological signals
and video signal collected in real-time, together with the
real-time heart rate and the inter-beat (RR) interval histogram
which visualize the Heart Rate Variability (HRV). When a
seizure is detected by the algorithm, an alarm is raised with an
event logged.
Figure 4. The GUI of software
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All these data are periodically uploaded to the cloud
platform, which is capable of doing further offline analysis
and management for which the timeliness is not of high
priority, such as more complicated algorithms, longitudinal
modeling and individual electronic medical record. Multiple
monitoring tasks can share the resources of cloud platform.
Any authorized user can get access to the database, view the
data and analysis results on any convenient terminal.
IV. EXPERIMENT AND RESULTS
A. Signal quality test on ECG
We compare the ECG signals acquired by textile
electrodes on our prototype with that collected simultaneously
by a commercial instrument Shimmer3 with adhesive gel
electrodes at LA-RA lead at a sampling frequency of 250Hz.
The length of the signal is about ten minutes.
Morphology of waveforms, power spectral density (PSD)
of signal from prototype and shimmer3 (after elimination of
powerline interference at 50 Hz and then filtered by a low pass
filter with passband frequency at 70Hz and stopband
frequency at 80 Hz by MATLAB) together with two signal
quality indicators (SQI) defined in [17] are compared.
Figure 5. ECG waveforms of prototype and Shimmer device.
Figure 6. PSD of prototype and standard instrument
 TABLE I. SIGNAL QUALITY INDICATORS
Prototype System Shimmer3
pSQI 0.9049 0.5731
baseSQI 0.9759 0.9943
The comparison of waveforms reveals the similarity of
signal quality in a visual manner. The comparisons of PSD
and SQI show the similarity of signal in frequency domain.
The results manifest that the system acquires signals with
comparable quality with the commercial instrument.
B. Signal quality test on motion signal
Experiments on adults were carried out to validate the
motion analysis part of our system. The prototype and
shimmer 3 were attached to the left wrist as is shown in fig 7.
A standardized protocol was followed, where different types
of movements, including mimicking tonic and clonic seizures,
typing, handshaking, arm swing, etc. Measurement time of
each movement was 30 seconds. Fig. 7 shows the comparison
of the mean square values of 3-axis accelerations, which
confirmed the comparable data quality of the prototype.
Further clinical trials will validate its sensitivity and
specificity on neonatal seizure detection.
Figure 7. Motion signals acquired by prototype and standard instrument
C. Safety tests before application in the NICU
Safety tests were carried out before applying the prototype
for clinical trials. Together with a doctor, head nurse and
engineer, the hygiene and allergy risks are analyzed. The
performance of the prototype jacket together with electrodes
and circuits maintain the stability after 15 times of daily
disinfection operation in NICU at Children’s Hospital of
Fudan University. No obvious active and/or passive
interference with devices was observed.
Figure 8. Desinfection test at Children’s Hospital of Fudan University
30
V. DISCUSSION AND CONCLUSION
A novel wearable sensor system for seizure monitoring of
neonates with good modularity and scalability is presented.
More clinical trials are needed to validate the performance
of the algorithms, the maximum endurance of power supply
and sensitization aspects. Data fusion techniques and
optimization algorithm will be explored in the future with the
help of clinical data.
The system can be improved by adding more sensors in the
existing modalities and beyond. The robustness of the system
may be thus enhanced by data fusion techniques. And an
algorithm with higher performance is anticipated.
The system is ambitious to serve as an effective auxiliary
diagnostic method to the benefit of existing condition. Given
the characteristics mentioned above, it is also prospective in
fields like general movement assessment (GMA), early
intervention and home monitoring.
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