BackgroundPresently the heart rate is monitored in the Neonatal Intensive Care Unit with contact sensors: electrocardiogram or pulse oximetry. These techniques can cause injuries and infections, particularly in very premature infants with fragile skin. Camera based plethysmography was recently demonstrated in adults as a contactless method to determine heart rate.AimTo investigate the feasibility of this technique for NICU patients and identify challenging conditions.Study design and participantsVideo recordings using only ambient light were made of 19 infants at two NICUs in California and The Netherlands. Heart rate can be derived from these recordings because each cardiovascular pulse wave induces minute pulsatile skin color changes, invisible to the eye but measurable with a camera.ResultsIn all infants the heart beat induced photoplethysmographic signal was strong enough to be measured. Low ambient light level and infant motion prevented successful measurement from time to time.ConclusionsContactless heart rate monitoring by means of a camera using ambient light was demonstrated for the first time in the NICU population and appears feasible. Better hardware and improved algorithms are required to increase robustness.