Reimagining Neonatal Monitoring

In neonatal intensive care units, where the tiniest patients face the biggest challenges, outdated monitoring tools can pose serious risks—causing skin injuries, impeding family bonding, and offering limited insight into infant physiology. For Assistant Professor Brooke Krbec, DO, MS, a Neonatologist at Tufts Medical Center, these limitations are not just clinical they're personal. Motivated by early-career experiences and a deep commitment to improving outcomes, Dr. Krbec is leading a collaborative research initiative to develop non-contact sensing technologies tailored to the unique needs of neonates. Supported by the S-GATS Award from Tufts Clinical and Translational Science Institute (CTSI), her project brings together engineers, clinicians, and translational scientists from Tufts and MIT to create safer, more accurate, and more adaptable monitoring solutions—ones that could ultimately benefit patients across age groups, species, and care settings.

(This article originally appeared on Tufts CTSI)

Investigation of Non-contact Sensing Technologies and Methods for Vital Sign Monitoring in Neonates

PI: Brooke Krbec, DO, MS, Assistant Professor of Pediatrics, Tufts University School of Medicine, Attending Neonatologist, Division of Neonatal-Perinatal Medicine, Tufts Medical Center

Co-PI: Brian Anthony, PhD, Principal Research Professor, Institute for Medical Engineering and Science, Massachusetts Institute of Technology

Co-Is: Xiang Zhang, PhD, Research Scientist/Technical Lead, Center for Clinical and Translational Research, Massachusetts Institute of Technology; Evan Linton, MS, Clinical Research Scientist, Center for Clinical and Translational Research, Massachusetts Institute of Technology

Can you briefly describe your project and what motivated you to pursue it?
Dr. Krbec: In neonatology, we’re increasingly resuscitating infants at the edge of viability—sometimes as early as 22 weeks—but the monitoring tools we have are outdated and designed for adults. They can be inaccurate, cause serious skin injuries, and make it harder to provide kangaroo care, one of the most evidence-based practices for improving NICU outcomes. We also don’t fully understand what “normal” vital signs look like at this age, so interventions can sometimes do more harm than good.

My motivation for this project is both personal and professional. Early in my career, I cared for a premature infant who developed severe skin tears from EKG leads, then a fungal infection, and ultimately didn’t survive. That experience made clear how even small design choices can determine survival and convinced me that we could improve outcomes by creating devices that minimize harm, support bonding between families and babies, and provide accurate, reliable insights into their physiology.

When you first conceived this project, did you expect it would be generalizable beyond neonates, or was that something that became apparent over time?
From the start, we designed the sensors for neonates with an eye toward adaptation for other populations. Adult ICU patients and older adults often have fragile skin, so devices built for neonates could benefit them as well. Neonates’ vital signs differ a lot from adults—their heart and respiratory rates are much higher—so the algorithms need to be extremely precise. But if a device works for these tiny patients, there’s no reason it couldn’t work for larger ones.

Along the way, we found translational opportunities we hadn’t expected. Colleagues at the Cummings School of Veterinary Medicine, for example, also see an urgent need for better monitoring in animal patients. By starting with the most fragile neonates, we’re creating devices that could improve care across human age groups and species. And being translational doesn’t always mean a massive global rollout—sometimes it’s these smaller, practical adaptations that really expand where and how the devices can be used.

How did your multi-institutional, multidisciplinary team come together?
Coming out of fellowship, I already had experience in device research, which gave me the skills and confidence to keep working in this area. From that experience, I knew that bridging the gap between engineers and clinicians can be challenging due to different communication styles. Therefore, being present and proactive amongst my engineering colleagues was crucial. Once I identified a lab at MIT to potentially collaborate with, I started going there multiple times a week—sometimes just sitting at a computer doing other work—attending lunches, meeting people, and networking in person. Those in-person connections made all the difference.

You need to show that you’re hardworking, get people excited, and clearly communicate the problem. Taking the time to invest in relationships, being approachable, and understanding how your collaborators think helped our team get a foot in the door at a highly competitive lab and ultimately build a collaborative, multidisciplinary partnership.

What were some challenges you faced and/or accomplishments you experienced during your project?
A major accomplishment—and a bit of a surprise—was getting the NICU fully wired for research. Before this study, we couldn’t pull vital signs from all monitors and ventilators to a central database. This project changed that, paving the way for future studies and making it easier for researchers to access data. Even small technical fixes, like adding adapters to monitors, took months but have real translational value.

Scientifically, we’ve been productive: two publications so far, a review paper cited multiple times, and preliminary work presented at an international conference that will soon be published. We’re almost fully enrolled, and the next big step is building a machine learning platform that combines camera and radar data. Processing 72 hours of video per baby is tedious, but it’s already generating new questions to pursue.

Personally, the stakeholder engagement has been incredibly rewarding. One family whose baby had gone through very difficult time with their child asked me every time they saw me, “Is your device approved yet? We want it for our child—and every child in this NICU.” Sharing that with the MIT engineers highlighted the meaning behind our work. Nurses have been equally supportive, offering feedback and helping troubleshoot. Their combined buy-in reinforced the value of the project and made me realize just how impactful well-designed, carefully implemented technology can be for the most vulnerable patients.

You’ve already shared some helpful advice. Is there anything else you’d tell someone who sees our RFA and isn’t sure whether to apply?
I’d tell people not to think of translation too massively. Focus on smaller, concrete steps. You may not even know all the translational aspects at first—like wiring the whole NICU—but you can still outline the stages where something could be implemented. Translational science can happen on a very small scale, even within your own field, and that can be just as meaningful.

Stakeholder engagement doesn’t have to be overwhelming either. Even simple things—like surveys with the people you work with—can have real impact. Think about who could contribute, who will benefit, and who might add value in unexpected ways. Many of these people are ones you’re already working with. Translation doesn’t have to be a “meteor in space”; it can be the tiny stars.

The translational science value comes from not being too narrowly focused on your own study. The key is to think globally—what your project contributes to the broader research community, not just what it does for patients.