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IFAC PapersOnLine 55-4 (2022) 62–67
The use of artificial intelligence in the diagnosis of neonatal sepsis
The
The use
use of artificial intelligence in the diagnosis of neonatal sepsis
Dž. Gojak*,The use of
of Z.artificial
K. Gvožđar*, artificial intelligence
intelligence
Hećimović*,
in
A. Smajović*, in
the
the diagnosis
diagnosis
E. Bečić*,
of
ofL.neonatal
A. Deumić**, neonatal sepsis
sepsis L. Gurbeta
Spahić Bećirović**,
Dž. Gojak*,The use of
K. Gvožđar*, artificial
Z. intelligence
Hećimović*, A. Smajović*,
, in
E. the diagnosis
Bečić*, A. of
,Deumić**, neonatal
L. Spahić sepsis L. Gurbeta
Bećirović**,
Dž. Gojak*, K. Gvožđar*, Z. Hećimović*,Pokvić**
Dž. Gojak*, K. Gvožđar*, Z. Hećimović*,Pokvić**
***, A.
A. Smajović*, E.Badnjević* ***
Bečić*, A. Deumić**,
A. Smajović*,
,, L. Spahić Bećirović**, L. Gurbeta
E. Bečić*, A. ,,Deumić**, L. Spahić Bećirović**, L. Gurbeta
,***, A. Badnjević*,***
Pokvić** ,***, A. Badnjević*,***
Dž. Gojak*, K. Gvožđar*,
*University –Faculty
of Sarajevo Pokvić**
Z. Hećimović*, A. Smajović*,
of***, A.
E.Badnjević*
Bečić*,
pharmacy, A. Deumić**,
Sarajevo, L. Spahić
***Bosnia and Bećirović**, L. Gurbeta
Herzegovina
–Faculty ,of
*University of Sarajevo Pokvić** pharmacy,
***, A. Sarajevo,
Badnjević* ,
***Bosnia and Herzegovina
*University of Sarajevo –Faculty
of Sarajevo
*UniversityCorresponding –Faculty of pharmacy,
authorof(e-mail:
pharmacy, Sarajevo,
Sarajevo, Bosnia
Bosnia and
and Herzegovina
dzejlagojak@ffsa.unsa.ba) Herzegovina
Corresponding
*UniversityCorresponding
of Sarajevo –Faculty
(e-mail:
author of (e-mail: dzejlagojak@ffsa.unsa.ba)
pharmacy, Sarajevo,
kanitagvozdjar@ffsa.unsa.ba)
author (e-mail: Bosnia and Herzegovina
Corresponding
(e-mail:author (e-mail: dzejlagojak@ffsa.unsa.ba)
dzejlagojak@ffsa.unsa.ba)
kanitagvozdjar@ffsa.unsa.ba)
(e-mail:
(e-mail:
Corresponding
(e-mail: zinetahecimovic@ffsa.unsa.ba)
kanitagvozdjar@ffsa.unsa.ba)
author (e-mail: dzejlagojak@ffsa.unsa.ba)
kanitagvozdjar@ffsa.unsa.ba)
(e-mail: zinetahecimovic@ffsa.unsa.ba)
(e-mail:
(e-mail: alisa.smajovic@ffsa.unsa.ba)
(e-mail:zinetahecimovic@ffsa.unsa.ba)
(e-mail: kanitagvozdjar@ffsa.unsa.ba)
zinetahecimovic@ffsa.unsa.ba)
(e-mail: alisa.smajovic@ffsa.unsa.ba)
(e-mail:
(e-mail:
(e-mail:
(e-mail: ervina.becic@ffsa.unsa.ba)
alisa.smajovic@ffsa.unsa.ba)
zinetahecimovic@ffsa.unsa.ba)
alisa.smajovic@ffsa.unsa.ba)
(e-mail:
** Verlab ltd. ervina.becic@ffsa.unsa.ba)
Sarajevo, Sarajevo, Bosnia and Herzegovina
(e-mail:
(e-mail:
(e-mail: ervina.becic@ffsa.unsa.ba)
alisa.smajovic@ffsa.unsa.ba)
ervina.becic@ffsa.unsa.ba)
** Verlab ltd. Sarajevo, Sarajevo, Bosnia and Herzegovina
(e-mail:amar@verlab.ba)
** Verlab ltd. Sarajevo,
(e-mail:
** Verlab ltd. Sarajevo,
Sarajevo, Bosnia
Bosnia and
and Herzegovina
ervina.becic@ffsa.unsa.ba)
Sarajevo, Herzegovina
(e-mail:amar@verlab.ba)
(e-mail:lejla@verlab.ba)
(e-mail:amar@verlab.ba)
** Verlab ltd. Sarajevo, Sarajevo, Bosnia
(e-mail:amar@verlab.ba) and Herzegovina
** International Burch University Sarajevo - Faculty(e-mail:lejla@verlab.ba)
of Engineering and IT, Francuske revolucije bb, 71210 Ilidža, Bosnia
(e-mail:lejla@verlab.ba)
(e-mail:amar@verlab.ba)
(e-mail:lejla@verlab.ba)
** International Burch University Sarajevo - Facultyand of Engineering and IT, Francuske revolucije bb, 71210 Ilidža, Bosnia
Herzegovinaand
**
** International
International Burch
Burch University
University Sarajevo
Sarajevo -- Faculty of
of Engineering
(e-mail:lejla@verlab.ba)
Faculty Engineering IT, Francuske revolucije bb, 71210 Ilidža, Bosnia
and Herzegovinaand IT, Francuske revolucije bb, 71210 Ilidža, Bosnia
Corresponding
** International Burch University Sarajevo - authorand
Faculty of
and (e-mail: lemana.spahic@ibu.edu.ba)
Herzegovina
Engineering
Herzegovinaand IT, Francuske revolucije bb, 71210 Ilidža, Bosnia
Corresponding author (e-mail: lemana.spahic@ibu.edu.ba)
Corresponding author and (e-mail: lemana.spahic@ibu.edu.ba)
Herzegovina
Corresponding author (e-mail: lemana.spahic@ibu.edu.ba)
Corresponding author (e-mail: lemana.spahic@ibu.edu.ba)
Abstract: Neonatal sepsis is an infection that occurs in children up to 28 days of age. Bearing in mind that these are newborns,
Abstract:
the Neonatal
procedure sepsis
of diagnosis is an
and infection
then that occurs
treatment in children
is extremely up toBy28using
difficult. days artificial
of age. Bearing in mind
intelligence, that thesecan
diagnostics arebenewborns,
speeded
Abstract:
Abstract: Neonatal
Neonatal sepsis
sepsis is
is an infection
anthen
infection that
that occurs
occurs in
in children
children up
up to
toBy28 days
28using of
of age.
age. Bearing
days artificial Bearing in
in mind
mind that
that these are
thesecan
arebenewborns,
newborns,
the
up procedure
and of diagnosis
facilitated. Asepsis and
database of treatment
1,000 data is
was extremely difficult.
usedintochildren
develop the artificial neural intelligence,
network, diagnostics
ofmind
which 200 were speeded
healthy and
the procedure
Abstract:
the procedure of
Neonatal
of diagnosis
diagnosis and
is an
and then
then treatment
infection that
treatment is
is extremely
occurs
extremely difficult.
up
difficult.toBy
By28using
days
using artificial
of age.
artificial intelligence,
Bearing in
intelligence, diagnostics
that these
diagnostics can
are
can be speeded
newborns,
be speeded
up
800 and facilitated.
were sick. TheAobtained
database training
of 1,000effect
data was
was used to develop
98.93%, the artificial
sensitivity was neuralspecificity
98.75%, network, ofwaswhich
95.50%200andwereaccuracy
healthy and
was
up
the
up and
and facilitated.
procedure ofThe
facilitated. A database
diagnosis
Aobtained
database of
of 1,000
andtraining
then data
treatment
1,000 was
data was used to
is extremely
used develop the
difficult.
to develop theBy artificial
using
artificial neural
artificial network, of
intelligence,
neuralspecificity
network, of which 200
diagnostics
which 200andwere
can
were healthy and
be speeded
healthy and
800
98.33%were sick.
which indicates the importance effect
of was 98.93%,
artificial sensitivity
intelligence was
application 98.75%,
which is reflected inwas
the 95.50%
ability to accuracy
predict the was
course
800
up
800 were
and
were sick.
sick. The
facilitated.
TheA obtained
database
obtained training
of 1,000
training effect
data
effect was
was
was 98.93%,
used to
98.93%, sensitivity
develop the
sensitivity was 98.75%,
artificial
was neural
98.75%, specificity
network,
specificity was
of
was 95.50%
which
95.50%200 and accuracy
were
and healthy
accuracy was
and
was
98.33%
of thewerewhich early
disease, indicates the importance
diagnosis of
and earlyeffectartificial
access intelligence therapy.
to antimicrobial application which is reflected in the ability to predict the course
98.33%
800
98.33% which
sick.
which indicates
The
indicates the
obtained
the importance
training
importance of
of artificial
was
artificial intelligence
98.93%,
intelligence application
sensitivity was
application which
98.75%,
which is
is reflected
specificity
reflected in
in the
was
the ability
95.50%
ability to
to predict
and the
accuracy
predict the course
was
course
of the disease, early diagnosis and earlyrisk
access to antimicrobial therapy.machine learning, artificial neural network
Copyright
Keywords:
of the
98.33%
of ©
the disease,
which
disease, 2022
newborns,
early
earlyThe Authors.
neonatal
diagnosis
indicates
diagnosis and
the importance
and is anof
Thisearly
sepsis,
early open
access
access access
factors,
to article under
neurons,
to antimicrobial
artificial intelligence
antimicrobial the CC BY-NC-ND
diagnosis,
therapy.
application
therapy. which license in the ability to predict the course
is reflected
Keywords: newborns, neonatal
(https://creativecommons.org sepsis, risk factors,
/licenses/by-nc-nd/4.0/) neurons, diagnosis, machine learning, artificial neural network
Keywords: newborns,
of the disease,
Keywords: neonataland
early diagnosis
newborns, neonatal sepsis, risk
earlyrisk
sepsis, factors,
access neurons, diagnosis,
to antimicrobial
factors, neurons, diagnosis, machine learning,
therapy.machine learning, artificial
artificial neural
neural network
network
Keywords: newborns, neonatal sepsis, risk factors, neurons, diagnosis, machine learning, artificial neural network
1. INTRODUCTION
1. INTRODUCTION nutrition (Alcock et al., 2017). Early detection of sepsis and
1.
1. INTRODUCTION
INTRODUCTION
It is common knowledge that newborns are the most nutrition (Alcockcontribute
tailored therapy et al., 2017). to the Early detection
reduction of sepsis and
of mortality and
It is common nutrition (Alcock et
et al.,
al., 2017). Early detection of
of sepsis
vulnerable
It is common group knowledge
1. INTRODUCTION
subject
knowledge to manythat ofnewborns
that the healthare
newborns
the most
challenges
are the mostof nutrition
tailored
morbidity
(Alcockcontribute
therapy
of children,
2017).
to Early
the
sotoknowledge
detection
reduction of
of ofrisk
sepsis and
mortality and
factorsand is
It is common
vulnerable group knowledge
subject to that ofnewborns
many the health are the most
challenges of tailored
nutrition
tailored therapy
(Alcock
therapy contribute
et al.,
contribute 2017).
to the
the reduction
Early detection
reduction of mortality
of sepsis
mortality and
today.
It is The
vulnerable
common previous
group decade
subject
knowledge to was
many marked
that of the by
newborns a higher
health incidence
challenges
are the mostof morbidity
necessary of
for children,
achieving thisso knowledge
goal. Risk of
factors risk
that factors
cause sepsisis
vulnerable
today. group
The previous subject to
decade age, many
was i.e., of
marked the health
byfirst
a challenges
higher incidence of morbidity
tailored
morbidity of children,
therapy
of children,
contribute sotoknowledge
so knowledge
theRisk
reduction of ofrisk
of risk factorsand
mortality
factors is
is
of mortality
today. in
The previousthe
previous neonatal
decade was markedin the
by 28 days of life. necessary for achieving this goal. factors that cause sepsis
vulnerable
today.
of The
mortality group
in the subject
decade
neonatal toage,
many
was ofinthe
marked
i.e., by
the aa higher
health
first
higher
28
incidence
challenges
incidence
days of of can
life. necessary
morbidity
necessary
be: for maternal,
of achieving
children, external
thisso goal. (hospital)
Risk
knowledge factors
of and
that
risk cause internal
sepsis
factors is
Data
of from 2010 shows thatage,in i.e.,
40% of bynewborn deaths, the can be: formaternal,
achieving this goal. Risk
external factors that
(hospital) and causeinternal
sepsis
of mortality
today.
mortality
Data from
in
in the
The previous
2010
neonatal
theshowsdecade
neonatal that was
age,in marked
i.e.,
40%
in
inofthe first
first 28
28 days
a higher
thenewborn days of
of life.
incidence
deaths, life.
the (susceptibility
can
necessarybe: for
can be: maternal,
of the newborn
maternal,
achieving external
this goal. to infection)
(hospital)
Risk factors
external to (hospital)
(Shane
and
that cause et al.,
internal
and internalsepsis
cause
Data was some
from 2010 ofshows
the most that common
in 40% bacterial
of firstinfections, ofmost (susceptibility of the newborn infection) (Shane et al.,
of mortality
Data
cause from
was somein the
2010 neonatal
ofshows
the mostthatage,in i.e.,
common 40%in ofthenewborn
newborn
bacterial
deaths,
28 days
deaths,
infections,
the
life.
the 2017).
most (susceptibility
can be: maternal,
(susceptibility of
of the
the newborn
external to
newborn to infection)
(hospital)
infection) (Shane
and internal
(Shane et
et al.,
al.,
often
cause sepsis
was (Wynn et al., 2016). Given the lack of large data 2017).
Data
cause
often was some
from
sepsis 2010
some(Wynn
of the
ofshows
theet
most
most
al.,that common
in 40%
common
2016). Given
bacterial
of the
newborn
bacterial infections,
deaths,
infections,
lack of large
most
the 2017).
most
data Childbirth
(susceptibility
2017).
complications
of the are
newborn a common
to cause
infection) of
(Shane sepsis
et in
al.,
on thesepsis
often incidence(Wynn ofthe
sepsis
et al., in less developed
2016). Given the countries,
lack of broader Childbirth complications are a common cause of sepsis in
cause
often
on the was
sepsissome
incidence(Wynnof
of et most
sepsisal., in common
2016).
less Givenbacterial
developed the countries,
lack of large
infections,
large data
most newborns,
data Childbirth
broader 2017).
Childbirth
which
complications
complications
can lead
are
are
to
a
a
disability
common
common
accompanied
cause
cause of
of sepsis
sepsis
by
in
in
epidemiological
on the
often incidence
sepsis (Wynn monitoring
of sepsis
et al., in is needed
less
2016). developed
Given to countries,
the contribute
lack of broader
large the newborns,
to data permanent which can
neuronal damagelead ortodeathdisability
(Rožmanić accompanied
et al., by
2004).
on the incidence
epidemiological of sepsis
monitoring in less
is developed
needed to countries,
contribute broader
to the newborns,
Childbirth
newborns, which
complications
which can
can lead
are
lead to
a
to disability
common
disability accompanied
cause of
accompanied sepsis by
in
by
the permanent sepsisneuronal damage mostor death (Rožmanić et infections,
al., 2004).
discovery
epidemiological of global incidence
monitoring is and mortality in children
on the incidence
epidemiological
discovery of of sepsis
monitoring
global incidence is needed
in less developed
needed
and
to contribute
to countries,
contribute
mortality in
to
to the
broader
children permanent
Since
permanent
newborns, neuronal
is one of
neuronal
which damage
the lead
damage
can or
ortodeath
common
death (Rožmanić
nosocomial
(Rožmanić
disability et
et
accompanied al.,
al., 2004).
2004).
by
(Fleishmann-Struzek
discovery of et al., is2018). Neonatal sepsis tois an Since sepsis isinone
theof the most common nosocomial infections,
epidemiological
discovery of global
(Fleishmann-Struzek global incidence
monitoring
incidence
et al., 2018).
and
needed mortality
to contribute
and Neonatal
mortality in
in children
sepsis children the
isfirst apermanent
an Sincelonger
Since
stay
sepsis
sepsis is
isinone
neuronal
one of same,
the
the most
damage
ofsame,
increases
most deaththe
orcommon
common
risk of developing
nosocomial
(Rožmanić
nosocomial
the
et infections,
al., 2004).
infections,
invasive
discovery bacterial
(Fleishmann-Struzek
of infection
global et that
al.,
incidence most
2018).and often
Neonatal occurs
mortality in
sepsis
in the is
children an a longer
disease stay the
(Trajanoski., 2017).increases
A the
newborn risk of
in developing
good the
general
(Fleishmann-Struzek
invasive bacterial et
infection al.,
that2018).
most Neonatal
often occurs sepsis
in the is an
first a longer
aSince stay
sepsis
longer in
stayisinone the same,
theofsame,
the increases
most common
increases the risk of
the nosocomial
risk of developing the
infections,
developing the
90 days
invasive of life
bacterial
(Fleishmann-Struzek (Rožmanić
infection
et et al.,
that
al., 2004).
most
2018). A
often study
Neonatal occurs by in
sepsisJohnsons
the isfirst
an disease
condition,(Trajanoski.,
with identified 2017).risk A newborn
factors for thein good
development general
of
invasive
90 days bacterial
of life infection
(Rožmanić that
et al., most
2004). often
A occurs
study by in the
Johnsonsfirst disease
a longer
disease (Trajanoski.,
stay in the
(Trajanoski., 2017).
same,
2017). A newborn
increases
A newborn
the risk in developing
of
in good general
good general
the
90 al.
et days of
(2012) lifeshowed
(Rožmanić that the etthat
al., 2004).
incidence Aof study
neonatal byinJohnsons
Johnsons
sepsis is condition, with identified risk factors forhours.
the development of
90
et days
invasive of life
bacterial
al. (2012) higher (Rožmanić
infection
showedinthat et al., 2004).
most
the incidence A
often study
occurs
of neonatal by the
sepsis first sepsis, is
condition,
is disease
condition,
observed
with for
identified
(Trajanoski.,
with identified
a minimum
2017).risk
risk
of
factors
A 48for
newborn
factors for the
the
It is
indevelopment
good necessary
development of
general
of
significantly
et children born before the 37th week of sepsis, is observed for a minimum of 48 hours. It is necessary
et al.
90 days
al. (2012)
of life
(2012)
significantly
showed
(Rožmanić
showed
higher in
that
that the
the
children
incidence
et al., 2004).
incidence
born Aof
before
neonatal
of study
neonatal
the 37th
sepsis
by Johnsons
sepsis
week
is
is to
of carryisout
sepsis,
condition,
sepsis, is
diagnostic
observed
with
observed for
identified
for a
a
processing
minimum
risk
minimum
depending
of
factors
of 48
48forhours.
the
hours.
on Itthe
is nature of
necessary
development
It is necessary
of
pregnancy,
significantly
et al. (2012) which
higher
showed is a
in worrying
children
that the fact
born
incidencebecause
before
of premature
the 37th
neonatal weekbirths
sepsis of
is to
thecarry
risk out diagnostic
factors, and processing
the depending
application andon the nature
duration of
of
significantlywhich
pregnancy, higheris in children born
a worrying before the
fact because 37th week
premature birthsof to carry
sepsis,
to carryisout diagnostic
observed
out diagnostic for aprocessing
minimum
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of 48 hours.
depending on
on Itthe nature
is necessary
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are constantly
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In the case of and duration
suspected of
late
pregnancy,
are constantlywhich is a worrying
increasing, fact because
especially in premature
developed births the
countries to
the risk
carry
risk out factors,
diagnostic
factors, and the
processing
the application
depending
application and
andon duration
the nature
duration of
of
(Wynn
are et al.,
constantly
pregnancy, 2016).
which is aThe
increasing, occurrence
worryingespecially ofinsepsis
fact because developedin newborns
premature countries
births prophylaxis in the mother. In the case
in neonatal sepsis, in addition to diagnostic tests performed on of suspected late
are
(Wynn constantly
et al., increasing,
2016). The especially
occurrence ofinsepsis
developedin countries
newborns in prophylaxis
the risk sepsis,
prophylaxis in
factors,
in thethe mother.
and
mother. the In In the case
application
the case testsof suspected
andsuspected
of late
duration late of
the
(Wynnfirst 48al.,
et hours of life
2016). The is known, which isdeveloped
referred tocountries
as Late- neonatal in additionurineto diagnostic performed on
are
(Wynn
the constantly
first et
48 al., 2016).
hours of Theis occurrence
increasing,
life especially
occurrence
known,
of
ofinsepsis
which sepsis
is
in
in newborns
referred newborns
to as Late-
in suspected
in neonatal
prophylaxis
neonatal
early
sepsis,
in
sepsis,
sepsis,
in
the
in addition
mother.
addition to
to
culture
In the and
diagnostic
case
diagnostic
cultures
tests
of
tests
from other
performed
suspected
performed on
late
on
onset
the
(Wynn
the
onset
firstsepsis
48
et
firstsepsishours
48al.,
hours
(LOS).
of
of life
2016).
(LOS). The
life
Itis occurrence
causes which
known,
Itis known,
causes
significant
which is
is referred
of sepsis
significant referred
mortality
in to
to as
mortality as Late-
newborns Late-in suspected
and
and possible
suspected
neonatal
early
foci of sepsis,
early
sepsis, infection
sepsis,
in addition
urine
(eye
urine
culture
swab,
toculture
and
wound
and
diagnostic
cultures
swab)
cultures
tests
from
should
from
performed
other
be
other
on
morbidity
onset in
sepsis infants
(LOS). bornIt with
causes low birth weight.
significant Causes
mortality that
and suspected
possible early
foci of sepsis,
infection urine
(eye culture
swab, and
wound cultures
swab) from
should other
be
the
onsetfirst
morbidity 48
sepsishours of
(LOS).
in infants life
born is
It known,
causes
with which is
significant
low birth referred to
mortality
weight. Causes as Late-
and taken (Shane
possible
that possible
suspected foci et
of
early al., 2017).
infection
sepsis, (eye
urine swab, wound swab) should be
lead to
morbidity the
in risk
infants of LOS
born withinclude
low mechanical
birth weight. ventilation,
Causes that taken foci
(Shane of al.,
et infection
2017). (eyeculture
swab, and
wound cultures
swab)from should other
be
onset
morbidity
lead tosepsis
in
the (LOS).
infants
risk of bornIt
LOS causes
with low
include significant
birth weight.
mechanical mortality
Causes
ventilation,and
that The
takenclinical
(Shane
possible foci picture
et
of al., of neonatal
2017).
infection (eye sepsis
swab, can
wound be different
swab) in
should each
be
taken (Shane et al., 2017).
intravascular
lead
lead to
to the
morbidity
intravascularthe
catheters,
risk
risk of
in infants ofborn
catheters,
immaturity,
LOS
LOS with low and
include
include
immaturity,
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10.1016/j.ifacol.2022.06.010
 Dž. Gojak et al. / IFAC PapersOnLine 55-4 (2022) 62–67 63

pneumonia results in cough, chest pain, dyspnea; technology. The first breakthrough of ANN happened in the
inflammation of the kidneys result in frequent urination and late 90s of the last century, and confirmation of its
pain in the groin. In addition to these inflammations, there may effectiveness was recognizing that neural networks are capable
be primary inflammatory processes in the vascular system of learning any type of function and this has made neural
(endocarditis), nervous system (purulent meningitis), and in networks famous as universal approximators. Healthcare
the skin and subcutaneous tissue (phlegmon) (Amiri et al., facilities, such as hospitals, have recognized the benefits of
2020). digitizing data and the ability to collect and manage it. The
Several biomarkers have been evaluated as useful in the early ability to process large data sets and create efficient algorithms
detection of neonatal sepsis, but an ideal biomarker that meets makes machine learning a secret weapon of health. In
all the criteria has not yet been identified. The most commonly healthcare, neural network models have been successfully
monitored biomarker is C-reactive protein (CRP) used to predict quality determinants (response, safety,
(Mukhopadhyay et al., 2019). Although the diagnosis of sepsis efficacy) (Shahid et al., 2019).
is mainly based on blood tests, this method is limited to false-
negative results and sometimes too slow (Thatrimontrichai et The application of ANN in healthcare setting is becoming
al., 2014). There are many clinical signs of sepsis, as well as more and more pronounced each year (Alic et al., 2017;
possible laboratory disorders related to blood count, acid-base Badnjevic et al., 2016; Catic et al., 2018; Gurbeta et al., 2018
status, electrolytes, enzymes, glucose, creatinine, but none of Sejdinovic et al., 2017; Spahic et al., 2019). Table 1 presents a
these clinical signs and laboratory parameters are literature review of application of ANNs for diagnosis of
pathognomonic for sepsis (Oršolić M., 2017). Neonatal sepsis neonatal sepsis.
is most easily diagnosed by monitoring the C-reactive protein Table 1. Application of ANNs for diagnosis of neonatal
in blood culture, as well as using molecular methods, including sepsis
polymerase chain reaction (PCR) (Carbone et al., 2020).
Medical experts agree that artificial intelligence is the right
Reference Dataset ANN type Accuracy
path in the early detection of sepsis, more precisely an
infection that shows its symptoms outside the expected time Lopez et al., demographic, Perceptron Accuracy
intervals. A study conducted by Subramani Mani et al. (2014), 2019 obstetric, and 86,7%
included data from 299 newborn babies. Only those samples maternal
that were adequate 12 hours after blood sampling were used to effect data
create predictive models using machine learning algorithms.
After algorithmization of the available data, the parameters of Alvi et al, Demographic ANN 98,2%
the greatest importance were hematocrit, respiratory rate and 2020 , obstetric,
chorioamnionitis, which showed greater sensitivity, specificity and maternal
and diversity than other available data. Ultimately, the study effect data
justified expectations provided a strong incentive for further
Helguera- clinical, ANN 86,66%
research to be conducted using artificial intelligence and Repetto et anthropometr
provided greater accuracy in estimating the use of al., 2020 ic,
antimicrobial drugs in the treatment of neonatal sepsis to avoid microbiology
antibiotic resistance (Wynn et al., 2016). , antibiotics,
With the advancement of computer technology, interest in the laboratory,
use of artificial intelligence in medicine and bioengineering and NICU
has grown. A particularly interesting and highly studied branch documentatio
of artificial intelligence is the artificial neural networks n
(ANN). The primary idea of ANN is based on the belief that
the human brain and its functions can be mimicked using Hu et al., vital signs CNN 74,6%
2019 (heart rate
silicon and wires that will represent neurons and dendrites
(HR),
(Patel et al., 2007). However, neural networks have proven to
respiratory
be useful not only in the field of medicine, but also in the fields rate
of engineering and marketing, accounting and finance, as well (RR) and
as other scientific fields that require predicting and classifying blood oxygen
problems. saturation)
We mentioned the practical importance of using artificial
neural networks and machine learning, but this was not always
The aim of this study is to develop and test an artificial neural
the case. In the middle of the 20th century, most research was
network for diagnosis of neonatal sepsis and to provide
based solely on theory, as the practical application was still
substantial evidence that this practice would aid clinicians in
unavailable, due to the underdevelopment of computer
64 Dž. Gojak et al. / IFAC PapersOnLine 55-4 (2022) 62–67

decision making and timely response in cases of neonatal overwhelm the network with too many neurons for too few
sepsis. combinations available. The result of this scenario would be
overfitting where the neural network would constantly show
2. METHODS very low MSE but perform poorly in subsequent validation. In
2.1 Dataset order for the best possible model to be chosen for the final
architecture, particle swarm optimization (PSO) algorithm was
Databases containing the following parameters were used to used. This algorithm iteratively evaluates the performance of
develop the artificial neural network: (1) Body temperature, the model and improves it based on the quality measure
(2) C-reactive protein, (3) Leukocyte count (White blood cells estimate, which in case of ANNs is MSE.
– WBC), (4) Platelet count. These parameters are obtained
based on a complete diagnostic assessment which includes: Table 3. ANN design and development process
blood analysis, blood culture, urine culture, and lumbar
puncture if the newborn is capable of such a procedure. Blood Transfer Transfer Number of
sampling methods have been used because they are the gold function in function in neurons in
standard for diagnosing sepsis. Urine culture is a non-invasive MSE
the hidden the output the hidden
technique, so it is suitable for newborns, but equally effective layer layer layer
as blood collection methods, while lumbar puncture is still
considered a method that is high risk and still controversial, 5 1.2724e-13
and leaves space for further discussion of its effectiveness
(Trajanoski, 2017). Tansig Purelin 7 4.1214e-11
10 1.5116e-13
The presented data set contains 1000 samples divided into two 15 3.6806e-13
categories: (1) healthy subjects and (2) sick subjects. The 5 2.2771e-08
output is in the categorical form 0 or 1. The data set consists
of 20% of samples-200 healthy subjects (Minority class) and Tansig Logsig 7 3.7544e-07
80% of samples-800 sick subjects (Majority class). The 10 6.7690e-09
distribution of the data set is shown in Table 2. 15 1.5044e-09
5 2.9464e-05
Table 2. Training and testing dataset distribution
Logisg Tansig 7 1.2645e-13
Class 0 Class 1 Total 10 2.5999e-07
Training 180 640 15 1.6671e-04
Testing 20 160 1000
Total 200 800
2.3. Performance evaluation

2.2 ANN development As a performance measure for the overall performance of

ANN, a confusion matrix with parameters of specificity,
The purpose of the developed system is to classify cases of sensitivity and accuracy of the network is used. Parameters are
neonatal sepsis (majority class). The development process calculated according to equations (1), (2) (3):
starts with choosing the most suitable training algorithm by
𝑇𝑇𝑇𝑇 (1)
taking into account the characteristics of the dataset available. 𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠 =
The most commonly used training algorithm for substantial (𝑇𝑇𝑇𝑇 + 𝐹𝐹𝐹𝐹)
𝑇𝑇𝑇𝑇 (2)
number of samples in pattern recognition tasks such as this one 𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠 =
is Levenberg-Marquardt backpropagation algorithm. This (𝑇𝑇𝑇𝑇 + 𝐹𝐹𝐹𝐹)
algorithm enables the neural network to “learn” from each
iteration by automatically updating the network parameters. (𝑇𝑇𝑇𝑇 + 𝑇𝑇𝑇𝑇) (3)
𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎 =
The second step is the determination of the most appropriate (𝑇𝑇𝑇𝑇 + 𝑇𝑇𝑇𝑇 + 𝐹𝐹𝐹𝐹 + 𝐹𝐹𝐹𝐹)
transfer functions to be used in the hidden and output layers. TP – true positive; TN – true negative;
In most pattern recognition tasks, combination of logsig and FP – false positive; FN – false negative
tansig transfer functions respectively performs best. The last
step is to determine the number of neurons with which the
neural network performs best. The choice of neuron numbers 3. RESULTS AND DISCUSSION
is done by testing the performance indicators of the neural An artificial neural network developed for classification
network, such as mean square error (MSE) in each scenario. between healthy neonates and those suffering from neonatal
The lowest MSE means that the neural network is performing sepsis was developed. The architecture of the developed ANN
the classification task in the best possible manner. Care must is presented in Figure 1.
be taken when determining the number of neurons as to not
 Dž. Gojak et al. / IFAC PapersOnLine 55-4 (2022) 62–67 65

the case of this system, the F1 score is satisfactory, as the ideal

F1 score is 1. The MCC represents the quality of the developed
binary classifier, and in this case its value suggests that the
high accuracy obtained during subsequent validation is due to
overfitting of the system with the biased dataset.

The diagnosis of neonatal sepsis is made based on a clear

clinical picture, most often by taking blood culture. Early
detection of the disease is extremely important for newborns,
due to the weakness of their immunity. Laboratory parameters
are far more useful in monitoring patients and evaluating
treatment than in diagnosing sepsis itself. Awareness of the
need for early detection and treatment of sepsis has emerged
Figure 1. The architecture of the developed ANN from the results of various studies such as the study of Kumar
et al. (2016) who found that the use of the adequate
The ANN has 4 input parameters and 1 output parameter. For antimicrobial drug within the first hour of hypotension in
the final architecture of the ANN based on the training results, septic shock is associated with a survival rate of 79.9%, and
a neural network with 7 neurons in the hidden layer was with each hour of delay inadequate antimicrobial therapy
selected according to the testing results obtained through survival rate decreases in the first 6 hours by an average of 7,
multiple iterations of ANN training with different 6%. If adequate antimicrobial therapy is administered 5-6
combinations of transfer functions in hidden and output layer hours after the onset of hypotension, survival is only 42%, and
as well as varying numbers of neurons. The obtained if this is done after 9-12 hours, survival is 25.4% (Cavrić et al.,
subsequent validation accuracy was 98.93%. 2016).
The performance results of ANN during testing are presented The developed ANN is the first that utlizes conventional blood
in Table 4. parameters for automated diagnosis of neonatal sepsis. The
Table 4. System performance measure
neural network developed by Lopez et al., (2019) utilizes a
vast number of input data starting from descriptive data sucha
Predicted Predicted s demography and maternal preexisting conditions to obstetric
positive negative data collected from the fetus. The obtained accuracy of their
Output Output class Output class system is 86,7% which is much lower than the accuracy
class 1 0 1 – Subjects obtained in our study. This suggests that blood parameters are
Actual True positive False negative with disease better indicators of neonatal sepsis compared to the data used
positive (TP) (FN) Output class by Lopez et al., Alvi et al., (2020) have extended the study by
160 158 3 0 – Healthy Lopez et al., and used more samples and parameters to develop
Actual False True negative subjects
an ANN with the same aim and reached an accuracy of 98,2%
negative positive (FP) (TN)
which is significantly better than 86,7% achieved by Lopez et
20 1 19
Total Total al., (2020).
predicted predicted Total units A study by Helguera-Repetto et al., (2020) utilizes clinical,
∑ 180 positive negative anthropometric, microbiology, antibiotics, and NICU
Sensitivity Specificity Accuracy
documentation in addition to laboratory test results. The
98.75% 95.50% 98.33%
accuracy of their system is 86,66% which indicates that some
F1 score
of the used variables have interfered with the ANN
0.9875
MCC performance. However, the dataset used in their study is
0.8936 significantly more robust and larger than the one used for the
development of the ANN presented in our study, meaning that
there is a possibility that better performance of our ANN is due
The accuracy of the developed system, upon subsequent to the scarcity of available data.
validation is 98.33%, indicating, at first glance, very high
fidelity. However, ANNs performing this well in terms of Hu et al., (2020) have used vital signs HR, RR and blood
accuracy are commonly overfitted and accuracy estimate has oxygen saturation as input parameters for a convolutional
to be confirmed by other statistical parameters such as the F1 neural network which is more complex than the ANN
score and Matthews Correlation Coefficient (MCC). The F1 presented in this paper. The accuracy of their model was
score represents the harmonic mean between sensitivity and 74,6% in comparison with 98,33% achieved by the ANN
specificity thus indicating the realistic measure on how well presented in this paper. However, the obtained results are
does the system derive true positives from overall instances. In
66 Dž. Gojak et al. / IFAC PapersOnLine 55-4 (2022) 62–67
incomparable because different types of parameters were used
as input data.
CONCLUSION
The importance of the use of ANN in the treatment of neonatal
sepsis is reflected primarily in the ability to predict the course
of the disease, early diagnosis and early access to antimicrobial
therapy. In our study performance was very good, sensitivity
was 98.75% and specificity was 95.50%, so it can be
concluded that the ANN method has proven to be good in
predicting sepsis in newborns. Given the satisfactory outcome,
we can recommend that the system continue to evolve with
more input, which will allow the detection of sepsis in
newborns, before the clinical picture appears.
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