Analytical Study of Neonatal Cardiorespiratory Monitoring Signal Quality in Special Care Baby Units in Nigerian Teaching Hospitals

Continuous cardiorespiratory monitoring of preterm and sick neonates in special care baby units is a clinical standard that critically depends on signal quality from skin-surface electrodes, and the specific challenges of maintaining signal quality in Nigerian SCBU environments require empirical characterization to guide equipment selection and monitoring protocol design. This study analytically characterises cardiorespiratory monitoring signal quality in special care baby units at four Nigerian teaching hospitals in Lagos, Kaduna, Enugu, and Sokoto, examining the frequency, nature, and contributing factors of signal quality degradation. Signal quality data from one hundred and twenty four-hour monitoring records across the four SCBUs were retrospectively analysed from patient monitor data downloads and prospectively collected over a two-month period. Signal quality was quantified using automated signal quality index algorithms applied to ECG and respiration waveform data. Electrode adhesion, electrode replacement frequency, and environmental conditions were documented by trained research assistants. Results show that signal quality fell below clinically adequate thresholds for an average of 22 percent of total monitoring time across the four sites, significantly higher than published data from high-income country SCBUs (approximately 8 percent). Primary contributors to signal quality degradation were electrode adhesion failure attributable to neonatal skin fragility and perspiration (accounting for 41 percent of degradation events), motion artifact from nursing procedures (28 percent), and electrode placement errors attributable to inadequate staff training (19 percent). Facilities using hydrogel electrodes specifically designed for neonatal skin showed lower signal quality degradation rates. The study recommends neonatal-specific electrode use and SCBU staff signal quality management training. Keywords: neonatal monitoring, cardiorespiratory signals, signal quality, special care baby unit, Nigerian teaching hospitals.