Respiratory dysfunction is one of the leading causes of morbidity in Neonatal Intensive Care Units (NICUs), particularly among preterm infants who frequently require mechanical ventilation and prolonged respiratory support. Accurate assessment of diaphragmatic function is essential for evaluating respiratory muscle performance, predicting extubation readiness, and preventing respiratory failure. Although diaphragm ultrasound has emerged as a safe, radiation-free, and bedside-capable imaging modality, its clinical use remains largely dependent on manual measurements of diaphragm thickness and excursion, introducing significant intra- and inter-observer variability (El-Halaby et al., 2016; Bahgat et al., 2021). Neonatal diaphragm assessment presents additional challenges. The small anatomical size of neonatal structures, motion artifacts, irregular breathing patterns, and inherent ultrasound speckle noise complicate precise boundary identification and reliable measurement. In routine clinical practice, these limitations make reproducibility difficult and reduce the potential for standardized longitudinal monitoring. To address these limitations, our research introduces a standardized and semi-automated computational framework implemented in the DiaMetric platform, developed at the eHealthLab@CUT. The system transforms ultrasound cine loops into calibrated and reproducible biomechanical metrics, including inspiratory and expiratory diaphragm thickness, thickening fraction, and diaphragmatic excursion. By incorporating structured image-processing techniques and automated boundary tracking methods (Loizou et al., 2020), the platform significantly reduces operator dependency and enhances measurement consistency.

Importantly, to the best of our knowledge, no previous work has established a fully structured, neonatal-focused computational framework that standardizes diaphragm ultrasound acquisition into reproducible quantitative respiratory biomarkers. Existing studies primarily rely on manual assessment or limited semi-automated approaches, without offering an integrated, clinically oriented system tailored to neonatal physiology. Clinically, this approach provides physicians with objective and reproducible indicators of diaphragmatic performance that can support assessment of extubation readiness, early detection of respiratory muscle dysfunction, monitoring of ventilator-induced diaphragm fatigue, and longitudinal follow-up of vulnerable neonates. By transforming ultrasound imaging into a standardized quantitative tool, this work contributes toward more reliable decision-making and improved respiratory management in neonatal care. 

Representative References
El-Halaby H., Abdel-Hady H., Sayed S., et al. (2016). Diaphragmatic excursion and thickness in infants and children: Normative data and clinical implications. European Journal of Pediatrics, 175(6), 773–780.

Bahgat E., El-Kady T., Abdel-Hady H., et al. (2021). Sonographic evaluation of diaphragmatic thickness and excursion as predictors of successful extubation in mechanically ventilated preterm infants. European Journal of Pediatrics, 180(3), 899–908.

Loizou C.P., Petroudi S., Seimenis I., Pantziaris M., Pattichis C.S. (2020). Ultrasound diaphragmatic manual and semi-automated measurements: Application in simulated and in vivo data of critically ill subjects. Computer Methods and Programs in Biomedicine, 194, 105517.