Visual and Pupillary Behavior in Neonatal Pain Assessment using Eye-Tracking

Authors

Keywords:

Eye-tracking, Neonatal Pain Assessment, Visual Behavior

Abstract

This paper introduces the application of novel eyetracking metrics to assess visual attention and cognitive load in neonatal pain assessment. Our goal is to evaluate pediatrician experts, non-experts, and parents using the relative Explore- Exploit Ratio, along with the Task-Evoked Pupillary Response, while analyzing the frontal faces of distinct newborns before and after painful procedures. All the experiments were based on a benchmark image dataset considering clinically relevant areas of interest. The Tobii TX300 system was used to record the eye-tracking data in a closed room with controlled lighting. Our results disclose that the visual attention described by the traditional metrics does not correspond directly to the respective fixation patterns and pupillary changes quantified for all the sample groups of participants investigated, highlighting statistically significant differences in the visual behavior between participants with or without clinical experience only when using the novel metrics proposed instead.

Downloads

Download data is not yet available.

Author Biographies

Roberto Gonçalves de Magalhães Júnior, FEI

Roberto Goncalves de Magalhaes Júnior received his B.Sc. degree in Automation and Control Engineering and his M.Sc. degree in Electrical Engineering from the University College FEI, Sao Paulo, Brazil, in 2016 and in 2019, respectively. He is currently working toward the Ph.D. degree in the research area of Image and Signal Processing at FEI.

 

Rafael Nobre Orsi, Paula Souza Center

Rafael Nobre Orsi is an Associated Professor and Researcher at the Paula Souza Center, Government of the State of São Paulo. He holds the M.Sc. and Ph.D degrees in Electrical Engineering from University College FEI, Sao Paulo, Brazil, and a B.Sc. degree in Mathematics. His research interests include artificial intelligence, machine learning, and statistical methods for pattern recognition.

 

Tatiany Marcondes Heiderich, FEI

Tatiany Marcondes Heiderich is Physiotherapist (2000) from Universidade de Mogi das Cruzes (UMC), Sao Paulo, Brazil, Master’s in Biomedical Engineering (UMC, 2006), PhD in Pediatric Sciences (2015) from Escola Paulista de Medicina of the Federal University of São Paulo (EPM-UNIFESP), and PhD in Electrical Engineering from University College FEI (2024).

Marina Carvalho de Moraes Barros, UNIFESP

Marina Carvalho de Moraes Barros graduated in Medicine from the Escola Paulista de Medicina - Federal University of São Paulo, with specializations in Pediatrics (1990) and Neonatology (1992), and Master's (1996) and Doctorate (2005) from the same institution, including Master's in Business Administration from Ibmec - São Paulo (2009). She is Professor of the Postgraduate Program in Pediatrics and Sciences Applied to Pediatrics (since 2011) and Executive Editor of the Editorial Board of Revista Paulista de Pediatria since July 2015.

Ruth Guinsburg, UNIFESP

Ruth Guinsburg is Full Professor of Neonatal Medicine at Escola Paulista de Medicina of the Federal University of São Paulo (EPMUnifesp), Head of the Neonatal Intensive Care Unit at São Paulo Hospital/ EPM-Unifesp, Co- chair of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, Scientific Coordinator of the Brazilian Network on Neonatal Research and Editor-in-Chief of Revista Paulista de Pediatria.

 

Carlos Eduardo Thomaz, FEI

Carlos Eduardo Thomaz is is Full Professor of Electrical Engineering at University College FEI, Sao Paulo, Brazil. He is head of the Image Processing Lab at FEI. Carlos Thomaz received, in 1993, his B.Sc. degree in Electronic Engineering from the Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil. After working for six years in industry, he obtained the M.Sc. degree in Electrical Engineering from PUC-Rio in 1999. In October 2000, he joined the Department of Computing at Imperial College London, UK, where he obtained the Ph.D. degree in Computing in 2004. His main research interests are in Pattern Recognition, Cognitive Perception and Machine Learning.

References

K. A. Phillips, K. L. Bales, J. P. Capitanio, A. Conley, P. W. Czoty, B. A. Hart, et al., "Why primate models matter," American Journal of Primatology, vol. 76, pp. 801–827, 2014. [Online]. Available: https://doi.org/10.1002/ajp.22281

P. M. Fitts, R. E. Jones, and J. L. Milton, "Eye movements of aircraft pilots during instrument-landing approaches," Ergonomics, Major Writings, 2004, p. 56. [Online]. Available: https://www.semanticscholar.org/paper/227324185

V. Skaramagkas, G. Giannakakis, E. Ktistakis, D. Manousos, I. Karatzanis, N. S. Tachos, et al., "Review of eye-tracking metrics involved in emotional and cognitive processes," IEEE Reviews in Biomedical Engineering, vol. 16, pp. 260–277, 2021. [Online]. Available: https://doi.org/10.1109/RBME.2021.3066072

R. C. X. Balda and R. Guinsburg, "A linguagem da dor no recém-nascido," Documento Científico do Departamento de Neonatologia. Sociedade Brasileira de Pediatria, 2018.

G. Zamzmi, R. Kasturi, D. Goldgof, R. Zhi, T. Ashmeade, and Y. Sun, "A review of automated pain assessment in infants: features, classification tasks, and databases," IEEE Reviews in Biomedical Engineering, vol. 11, pp. 77–96, 2017. [Online]. Available: https://doi.org/10.1109/RBME.2017.2777907

R. V. E. Grunau and K. D. Craig, "Pain expression in neonates: facial action and cry," Pain, vol. 28, no. 3, pp. 395–410, 1987. [Online]. Available: https://doi.org/10.1016/0304-3959(87)90073-X

R. Guinsburg, "Avaliação e tratamento da dor no recém-nascido," Jornal de Pediatria (Rio J), vol. 75, no. 3, pp. 149–160, 1999. [Online]. Available: https://doi.org/10.25060/residpediatr

R. C. X. Balda and R. Guinsburg, "Perceptions of neonatal pain," Neoreviews, vol. 8, no. 12, pp. e533–e542, 2007. [Online]. Available: https://doi.org/10.1542/neo.8-12-e533

J. C. A. Soares, M. C. M. Barros, G. V. T. Silva, L. P. Carlini, T. M. Heiderich, R. N. Orsi, et al., "Looking at neonatal facial features of pain: do health and non-health professionals differ?," Jornal de Pediatria, vol. 98, no. 4, pp. 406–412, 2022. [Online]. Available: https://doi.org/10.1016/j.jped.2021.10.006

P. Majaranta and A. Bulling, "Eye-tracking and eye-based human-computer interaction," in Advances in Physiological Computing, pp. 39–65, 2014. [Online]. Available: https://doi.org/10.1007/978-1-4471-6392-3_3

R. R. Gameiro, K. Kaspar, S. U. Konig, S. Nordholt, and P. Konig, "Exploration and exploitation in natural viewing behavior," Scientific Reports, vol. 7, no. 1, p. 2311, 2017. [Online]. Available: https://doi.org/10.1038/s41598-017-02526-1

J. H. Goldberg and X. P. Kotval, "Computer interface evaluation using eye movements: methods and constructs," International Journal of Industrial Ergonomics, vol. 24, no. 6, pp. 631–645, 1999. [Online]. Available: https://doi.org/10.1016/S0169-8141(98)00068-7

N. Malem-Shinitski, M. Opper, S. Reich, L. Schwetlick, S. A. Seelig, and R. Engbert, "A mathematical model of exploration and exploitation in natural scene viewing," bioRxiv, 2020. [Online]. Available: https://doi.org/10.1101/2020.04.16.044677

V. Peysakhovich, "Study of pupil diameter and eye movements to enhance flight safety," Ph.D. dissertation, Université de Toulouse, Toulouse, France, 2016. [Online]. Available: https://doi.org/10.13140/RG.2.2.34241.35680

B. R. Manor and E. Gordon, "Defining the temporal threshold for ocular fixation in free-viewing visuocognitive tasks," Journal of Neuroscience Methods, vol. 128, no. 1, pp. 85–93, 2003. [Online]. Available: https://doi.org/10.1016/S0165-0270(03)00151-1

J. Beatty, "Task-evoked pupillary responses, processing load, and the structure of processing resources," Psychological Bulletin, vol. 91, pp. 276, 1982. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/7071262

R. N. Orsi, L. P. Carlini, T. M. Heiderich, G. V. T. da Silva, J. D. C. A. Soares, R. D. C. X. Balda, et al., "Visual attention during neonatal pain assessment: A 2‐s exposure to a facial expression is sufficient," Electronics Letters, vol. 59, no. 6, p. e12756, 2023. [Online]. Available: https://doi.org/10.1049/ell2.12756

A. Olsen, "The Tobii I-VT fixation filter." [Online]. Available: https://www.tobiipro.com/learn-and-support/learn/eye-tracking-essentials/

F. G. Tamanaka, L. P. Carlini, T. M. Heiderich, R. C. X. Balda, M. C. M. Barros, R. Guinsburg, and C. E. Thomaz, "Neonatal pain assessment: A Kendall analysis between clinical and visually perceived facial features," Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, vol. 11, no. 3, pp. 331–340, 2022. [Online]. Available: https://doi.org/10.1080/21681163.2022.2044909

V. Peysakhovich, M. Causse, S. Scannella, and F. Dehais, "Frequency analysis of a task-evoked pupillary response: Luminance-independent measure of mental effort," International Journal of Psychophysiology, vol. 97, no. 1, pp. 30–37, 2015. [Online]. Available: https://doi.org/10.1016/j.ijpsycho.2015.04.019

R. H. C. Lopes, "Kolmogorov-Smirnov test," International Encyclopedia of Statistical Science, Springer, pp. 718–720, 2011. [Online]. Available: https://doi.org/10.1007/978-3-642-04898-2_326

J. W. Pratt, "Remarks on zeros and ties in the Wilcoxon signed rank procedures," Journal of the American Statistical Association, vol. 54, pp. 655–667, 1959. [Online]. Available: https://doi.org/10.1080/01621459.1959.10501526

L. P. Carlini, G. A. S. Coutrin, L. A. Ferreira, J. C. A. Soares, G. V. T. Silva, T. M. Heiderich, et al., "Human vs machine towards neonatal pain assessment: A comprehensive analysis of the facial features extracted by health professionals, parents, and convolutional neural networks," Artificial Intelligence in Medicine, vol. 147, p. 102724, 2024. [Online]. Available: https://doi.org/10.1016/j.artmed.2023.102724

Downloads

Published

2025-08-30

How to Cite

Gonçalves de Magalhães Júnior, R., Nobre Orsi, R., Marcondes Heiderich, T., Carvalho de Moraes Barros, M., Guinsburg, R., & Eduardo Thomaz, C. (2025). Visual and Pupillary Behavior in Neonatal Pain Assessment using Eye-Tracking. IEEE Latin America Transactions, 23(10), 931–937. Retrieved from https://latamt.ieeer9.org/index.php/transactions/article/view/9742

Issue

Vol. 23 No. 10 (2025): Ordinary Issue

Section

Electronics