"The goal is to be able to anticipate on the clinical deterioration of a fetus rather than having to react to the reality."

When complications occur in pregnancy or childbirth, the frequency and variability of the heartbeat gives an indication of the health status of unborn or premature infants. The way this is currently monitored is mainly a snapshot.

Chantal Eenkhoorn (Erasmus MC, Department of Obstetrics and Gynecology), PhD researcher at the Medical Delta Institute of Fetal & Neonatal Care scientific program, is investigating new ways to continuously monitor heart rate patterns in fetuses. “Ultimately, I hope that this will allow healthcare providers to anticipate on the clinical condition of the fetus, rather than measuring when the fetus is already deteriorating.”

This interview is the seventh in a series of interviews with Medical Delta-funded PhD candidates and postdoctoral researchers. Chantal's research is funded by the Medical Delta Institute of Fetal & Neonatal Care scientific program.

Why did you start doing this research?

"I studied BioMedical Engineering at TU Delft and during that time I did an internship at a children's hospital. It fascinated me how we have an enormous influence on the course of life of the little ones through birth care. But in the field of monitoring there is still much to be gained, this has been done in the same way for years through wired systems. The measurements are snapshots, where a healthcare provider maps and analyzes the frequency and variability of heart rhythm patterns. This method of measurement ensures that you can only say something about the clinical condition at the time of the measurement, so signs of deterioration may well be overlooked. And when these signs are seen, the care provider can only react.

My goal is to use continuous monitoring by wireless sensors, to adapt the system so that care providers can anticipate cardiac rhythm patterns. Hopefully, this will allow more frequent prevention of complications in fetuses and neonates."

What new insights have you gained so far?

"I started my research with an inventory of available devices in the field of heart rhythm patterns. In the process, I obtained information about the comfort and use of different devices. This information was used to form a decision on which device would best fit the system I want to develop.

In addition, I am in the process of retrieving reference values of frequencies and variability of heart rate during pregnancy. Using these reference values, we hope to be able to determine whether or not a heart rate measurement deviates. This is of great importance in my research, because heart rate variability says something about the development of the fetus' autonomic nervous system. Here the cooperation with doctors is important, because they can make a statement about the condition of the fetus based on the data.

Third, I am working on a study of fetal and neonatal heart rate. The hypothesis is that the unborn child can already show signs of stress by an abnormal heart rate. With this, I try to explain why some children have a better start than others. In collaboration with physicians, I determine which patient group is interesting for this analysis."

What do you hope to achieve with this research?

"I have been working on my research for three years now. In my final year, I want to compile the information I have obtained into a single system that uses wireless sensors to continuously measure the frequency and variability of the fetus' heart rhythm. In this way, subtle changes in heart rate can be mapped. The goal is to combine this system with an automated alert system that will allow early signs of deterioration to be detected and, ultimately, to predict when the fetus might be worse. This will allow doctors to anticipate clinical deterioration instead of having to react to reality, as is often the case now."

What would you advise a future Medical Delta postdoc or PhD student?

"Through my studies, I have both a medical and a technical background. My experience is that the technicians show what all the possibilities are, and the medics determine the clinical relevance of these, in order to arrive at a technological solution that is well applicable within the clinic. I work with Erasmus MC, TU Delft and LUMC, and I see interdisciplinary collaboration as a prerequisite for my research. A lot comes together: big data, the equipment and technology used, and clinical practice and use by medics. Collaboration creates different perspectives on an issue.

My advice for just-starting researchers is therefore to engage in collaboration from the very beginning. That way you get a much fuller picture of your problem statement. What I like about Medical Delta is that the lines between disciplines are very short, so you can get in touch with each other in an approachable way."

The previous interviewee, Mike Broeders, is curious: In what ways can other disciplines not currently involved in the research benefit from the findings and results of your research?

"Continuous monitoring of vital signs can also be applied within other disciplines to detect clinical deterioration in patients early. Understanding the data infrastructure of our system or, for example, the methods we use to detect changes may be of interest to other disciplines that want to develop a similar early warning system."