Acute respiratory infections are the leading cause of global child mortality and respiratory conditions associated with premature birth contribute to about 30% of neonatal death. In developed health systems, such conditions can be treated using bubble Continuous Positive Airway Pressure (bCPAP), a therapy that delivers pressurized flow to an infant to prevent air sac collapse and makes breathing easier. However, the typical bCPAP setup used in such settings costs anywhere from $6,000, making it inaccessible to most health facilities in developing countries.
Over half of all infants are born with neonatal jaundice, and the majority of these infants in developing nations have no access to expensive phototherapy treatment. Neonatal jaundice is a condition in which a newborn's body is unable to degrade bilirubin which results in very high bilirubin levels, or hyperbilirubinemia. Hyperbilirubinemia is responsible for jaundice and can lead to potentially lethal complications if not properly treated. The standard treatment for neonatal jaundice is the use of phototherapy treatment. Phototherapy treatment consists of the application of strong blue light to the infant's skin. This light transforms bilirubin into a form that infants can more easily process which greatly reduces the chance of complications.
Neonatal jaundice affects approximately 24 million newborns each year. Jaundice is especially common in premature babies and, if left untreated, can result in severe, untreatable brain damage. Severe jaundice may not present until several days after birth, thus early monitoring of serum bilirubin levels is critical. In high-resource settings, tools to measure serum bilirubin levels are readily available, but have proven too expensive and complex to implement widely in low-resource settings. As a result, jaundice is diagnosed clinically in most low-resource settings using visual inspection of scleral yellowing, resulting in subjective diagnosis and poor accuracy.
Babies born prematurely are susceptible to a variety of life-threatening conditions, one of the most common being apnea of prematurity – a recurring condition in which a baby suddenly stops breathing for more than 20 seconds. Approximately 67% of babies who are born at less than 32 weeks gestation experience apnea. Fortunately, infants with apnea usually respond to simple tactile stimulation. In high resource settings, electronic monitors detect apnea; alarms alert nurses to intervene until breathing resumes. As the baby grows, apnea of prematurity is self-resolving. Unfortunately, existing monitors are too expensive for low-resource settings; instead, nurses visually monitor babies. In settings where one nurse may be caring for 20-30 babies, it is easy for apnea to be missed and premature babies continue to die needlessly.
Newborn infants are thermally unstable, especially if born prematurely. They are born wet with amniotic fluid and if not dried quickly and kept warm they rapidly get cold and cannot rewarm themselves. Cold babies become acidotic and are prone to infection and respiratory distress with a high mortality. Hypothermia is common in under-resourced settings; in Ethiopia, Zambia and Zimbabwe, over half of newborns evaluated were hypothermic. Our team observed this firsthand when we monitored admission temperatures of babies with respiratory distress at central and district hospitals in Malawi. Three-fourths of babies, most of whom were born in-hospital, were admitted with hypothermia. Average admission temperature was 35.1o C, nearly 2.0o C degrees below normal. Estimates suggest that rapid recognition and treatment of hypothermia could prevent up to 40% of neonatal deaths. In one large study, the risk of mortality associated with hypothermia increased by approximately 80% for every degree drop in a baby’s first recorded temperature. In lower resource settings the tools and processes to keep babies warm are lacking resulting in needless mortality and morbidity.
Diarrhea-induced dehydration is the second leading cause of death in children under five years old. Patients with diarrhea as well as malaria and dengue fever are at risk for dehydration. Combined, these conditions are responsible for the deaths of up to 1.4 million children under five years of age annually. Severe cases of dehydration are treated with IV fluid therapy. However, one risk of IV therapy in low-resource settings is over-hydration, particularly for babies and young children who require low volumes of fluid. Over-hydration can lead to complications and death. Due to the risk of over-hydration, the World Health Organization recommends that children who are severely dehydrated are given rapid IV therapy only with close monitoring. However, it is difficult to ensure that patients are constantly monitored to stop fluid administration at the appropriate time due to a limited availability of trained staff. In developed countries, infusion or elastomeric pumps and burettes are commonly used to regulate delivery of IV therapy to pediatric patients; but these are too costly and not appropriate for many developing world healthcare settings. These approaches are costly, require routine maintenance, consumables that are not generally available in the developing world, and electrical power that may not be reliable.