How a Tiny Bracelet Can Save Millions of Newborn Babies Every Year in India

Many newborn deaths from hypothermia in India can be easily prevented with regular temperature monitoring techniques and early intervention. A Bengaluru-based company has devised the perfect solution.

Divya lost her first baby to pneumonia within four weeks of his birth. Her second baby, Rithiksha, was born premature. After 10 days in the neonatal intensive-care unit (NICU) she was discharged and sent home with a bracelet like device tied around her wrist. One night, the device started beeping continuously – this meant Rithiksha was slipping into a state of hypothermia. When the alarm didn’t stop even after she was covered with a blanket, Divya took her daughter to the hospital. The doctors found Rithiksha was suffering from a gastrointestinal infection that caused hypothermia, and could have died if immediate action had not been taken.

Rithiksha is a healthy kid today, thanks in large part to the Bempu Hypothermia Alert Device – the bracelet responsible for saving her life.

Bempu is a continuous temperature monitoring bracelet with an inbuilt thermometer, which ensures that a premature and low birthweight baby maintains a healthy temperature. It has a built-in algorithm that indicates if the baby is hypothermic or is slipping into a state of hypothermia. All one has to do is place the bracelet on the newborn’s wrist and wait for five minutes. If the baby is warm, a blue light starts blinking every 30 seconds. If the baby is cold, the bracelet sounds an alarm and an orange light starts blinking. This means the baby is entering the first stage of hypothermia, giving parents enough time to take action. As an initial step, caretakers are advised to warm the baby by holding him/her against the skin or by swaddling.

If the device continues to beep, it means that the baby is slipping into hypothermia because of some infection that needs immediate medical attention.

The device works 24/7 for four weeks and has to be replaced if the baby still needs it.

Bempu, a Bangalore-based medical device social enterprise, was founded by Ratul Narain in 2013. After completing his graduation in Biomechanical Engineering and Master’s in Mechanical Engineering from Stanford, Ratul worked for about eight years in the cardiovascular and neonatal health space in different companies.

With the aim of using his biomedical engineering knowledge in the neonatal arena, he returned to India and carried out intensive on-ground field research for a year to explore gaps in need of attention.

Working with over 80 neonatologists and paediatricians across the country, he identified multiple problems. But what stood out most for him was that temperature monitoring, a very basic requirement for babies, was not being implemented in hospitals (usually because they were understaffed) or in homes (because most parents were unaware about this issue). A neonatologist told Ratul that once a baby was brought to her early in the morning and it was already dead. The most likely cause was the baby had suffered from hypothermia at night.

Had the mother been aware of the problem, she could have taken corrective action and the baby would have survived.

“Hypothermia is a condition that mostly affects high-risk, newborn, pre-term and low birthweight babies weighing less than 2.5 kg. Bempu is designed to take care of babies during the critical neonatal period – the first 28 days of a baby’s life,” says Mona Sharma, Product Designer at Bempu.

Hypothermia and infection are among the top causes of newborn deaths, which can be avoided with early intervention through temperature control. Hypothermia occurs when the body’s core temperature falls below 36.5 degrees Celsius (97.7 degrees Fahrenheit). “In India, about 92% of newborns will become hypothermic. One of three babies is born with low birthweight and 18-42% newborn deaths can be prevented with thermal care,” says Gini Morgan, Public Health and Partnerships Manager at Bempu.

In November 2014, Ratul was awarded a grant from the Bill and Melinda Gates Foundation to build a hypothermia alert device, which was prototyped and clinically tested within a year of funding.

The device was launched in October 2015 and has been commercially available since January this year. The company sells Bempu to doctors, who then prescribe it to patients. People can also order the bracelet online.

Sold for Rs. 2,000, Bempu is currently available in 150 clinics and pharmacies across India.

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Soft wearable sensors to detect disabilities in premature kids

Scientists have developed a soft, non-toxic wearable sensor that can be attached to the hand to monitor force of a grasp and the motion of the fingers.

Children born prematurely often develop neuromotor and cognitive developmental disabilities.
The best way to reduce the impacts of those disabilities is to catch them early through a series of cognitive and motor tests.

However, accurately measuring and recording the motor functions of small children is tricky.
As any parent will tell you, toddlers tend to dislike wearing bulky devices on their hands and have a predilection for ingesting things they shouldn't.

"We have developed a new type of conductive liquid that is no more dangerous than a small drop of salt water," said a researcher.

"It is four times more conductive than previous biocompatible solutions, leading to cleaner, less noisy data,"he said.

The sensing solution is made from potassium iodide, which is a common dietary supplement, and glycerol, which is a common food additive.

After a short mixing period, the glycerol breaks the crystal structure of potassium iodide and forms potassium cations (K+) and iodide ions (I-), making the liquid conductive.

Since glycerol has a lower evaporation rate than water, and the potassium iodide is highly soluble, the liquid is both stable across a range of temperatures and humidity levels and highly conductive.

"Previous biocompatible soft sensors have been made using sodium chloride-glycerol solutions but these solutions have low conductivities, which makes the sensor data very noisy, and it also takes about 10 hours to prepare," he said.

"We've shortened that down to about 20 minutes and get very clean data," he said.

The design of the sensors also takes the need of children into account.

Rather than a bulky glove, the silicon-rubber sensor sits on top of the finger and on the finger pad.

"We often see that children who are born early or who have been diagnosed with early developmental disorders have highly sensitive skin," said  an associate professor.

"By sticking to the top of the finger, this device gives accurate information while getting around the sensitively of the child's hand," said the associate Prof.

Researchers currently study motor function using motion capture.

While the technology can tell a lot about movement, it cannot measure force, which is critical to diagnosing neuromotor and cognitive developmental disabilities.

"Early diagnosis is the name of the game when it comes to treating these developmental disabilities and this wearable sensor can give us a lot of advantages not currently available," he said.
This paper only tested the device on adult hands.

Next, the researchers plan to scale down the device and test it on the hands of children.

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A tear-based screening test for childhood blinding condition

Retinopathy of prematurity (ROP) is one of the most common serious eye complications that occur in premature babies. It can lead to incomplete blood vessel growth in the retina, and eventual loss of vision. A group of researchers have identified a biomarker that can help detect the risk of ROP from just a teardrop.

Premature babies are administered oxygen to help them survive in incubators. This process, however, has to be monitored carefully as overexposure to oxygen can be highly toxic to blood vessels, including those in the retina. Overexposure to oxygen in neonatal care is a major cause of ROP.

Low oxygen levels in the retina when the child is out of incubator cause abnormal blood vessel growth in the retina, which in turn causes loss of neurons and vision loss. About 40 to 50 per cent of premature infants develop ROP, and of them 10 to 18 per cent progress to develop severe stages of this disease leading to blindness.

Researchers who have been working on genetic or protein-based markers for ROP for many years, have identified a few proteins that cause inflammation in the eye leading to abnormal blood vessel growth.

The levels of these inflammatory proteins—Complement component C3 and Matrix metalloproteinases 2 & 9—were found to be higher in tear samples of preterm babies with ROP. Based on these findings, the group is developing a diagnostic test for ROP.

Researchers have also explained the role of inflammation caused by reduced oxygen levels in the eyes in the development of this condition. During the last few years, a screening programme for ROP was conducted at all major neonatal intensive care units.

“While several risk factors for ROP such as low gestational age, low birth weight, oxygen supplementation, sepsis, multiple births and maternal health during pregnancy were thought to help in predicting the risk of ROP progression in premature infants, but these factors can’t help in predicting the risk of severe ROP,” says , a scientist.

“Besides identification of biomarker for this condition, our team is also working to fill the gap in existing knowledge about underlying molecular pathology of ROP”.

ROP is a ‘self limiting’ condition and it disappears by itself in most premature babies while progressing to severe stage in some. Therefore, early diagnosis can help identify those at risk. Vision loss in such babies can be prevented through early interventions like laser surgery or drug-based treatments likely to become available in future.

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Premature Baby Needs Care and Lactation Support

According to WHO, every year about 15 million babies around the world are born prematurely (before 37 weeks of pregnancy). Mother’s milk is the only source that can provide optimal nutrition for the baby, especially at this stage. In cases of mother-infant separation such as in the neonatal intensive care units (NICU), breastfeeding may become a challenge.

Therefore, at this stage it is important for the mothers to follow a routine and keep certain things in mind while taking care of their preemie along with good support system to help them in their journey.

Available Lactational Support for Mothers & Key Criteria

Here are the list of available lactation support for mothers and some of the key criteria.

Antenatal Education

All expectant mothers/couples should be educated about breastfeeding during pregnancy. Research has shown that 2nd trimester is the best time for antenatal education as the mother is receptive to information. In case, there is impeding premature labour/birth, breastfeeding should be an important aspect of counseling.

Informed Decision

Standardised information for NICU mothers must be provided by the support team (doctors and nurses at the NICU) about the value of mother's milk specifying techniques to build an adequate milk supply. Providing consistent and timely information to NICU families not only helps them feel included in their baby's care but also enables them to make an informed decision and understand options available.

First Expression of Milk Post Delivery

Hospital protocols should outline expression within 1 hour of birth; regular trainings of the NICU staff and audits of performance must be carried out. Stimulating the breasts in the first hours via expression is important. This supports timely initiation and long-term milk production.

Frequent Expression of Milk

Hospital protocols must also outline expressing 8 or more times per 24 hours, including in the night; regular monitoring must still be performed. Frequent expression is critical to achieving adequate volumes. Double pumping every two to three hours is beneficial for this. Mothers should be taught and made to practice both manual and pump expression.

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Caffeine in tea, coffee may be risky to foetus

Pregnant women who consume caffeine - whether it’s from coffee or tea - have smaller babies than those who abstain from the stimulant during pregnancy, new research suggests.

Even women who took in less than 200 milligrams of caffeine, the safe cutoff during pregnancy according to the doctors, had a significantly increased risk of delivering prematurely or having a low-birth weight baby.

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“Based on the consistent associations we observed, and because many pregnancies are unplanned, we would recommend women who are pregnant or seeking to become pregnant to at least limit their intakes of caffeinated coffee and tea,” lead study author said.

The study cannot prove cause and effect, he cautioned. But several previous studies have linked caffeine exposure in the womb to negative effects, the researchers said.

In most of those studies, coffee was the main caffeinated beverage consumed.

For the current study, the team looked at 941 mother-child pairs born in Ireland, where people drink more tea than coffee. Nearly half of the mothers in the study drank tea, while about 40 percent drank coffee.

Every additional 100 milligrams of caffeine consumed daily during the first trimester of pregnancy was associated with a 72-gram (2.5 ounce) lower birth weight, as well as significantly lower gestational age, birth length and head circumference.

Women who took in the most caffeine had babies weighing about 170 grams (6 ounces) less than those who consumed the least, the researchers found. Whether the caffeine came from coffee or tea made no difference to the results.

 “High caffeine intake can result in restricted blood flow in the placenta which may subsequently affect fetal growth,” the Dr. explained. “Caffeine can also cross the placenta readily, and because caffeine clearance slows as pregnancy progresses, caffeine accumulation may occur in fetal tissues.”

One 12-ounce cup (355 ml) of brewed coffee contains about 200 mg of caffeine, but tea generally contains less caffeine and the amount can vary by type of tea and how long it was brewed. The Lipton Tea company, for example, says its black tea contains about 83 mg caffeine in a 12-ounce cup.
The public doesn’t seem to recognize tea’s caffeine content, said the study’s senior author. “Thus, maternal intake of both tea and coffee need to be taken into account when trying to minimise overall caffeine intake during pregnancy. This is especially important where tea is the predominant caffeine source,” she told.

Doctor states that consuming less than 200 milligrams of caffeine per day in pregnancy “does not appear to be a major contributing factor in miscarriage or preterm birth.” The World Health Organization recommends that women consume less than 300 mg of caffeine daily in pregnancy.
 “This paper and other papers show that this is likely too high,” said a senior scientist. 

“Epidemiological findings based on self-reported caffeine consumption are usually not very precise. Thus, any cutoffs chosen by experts and WHO can only be considered as rough reference points. Biologically, it is unlikely that 300 mg is risky while 299 mg is safe,” the Dr. said .

“The message to women I would prefer would be ‘the less the better,’” the Dr. said. “Then the women can choose for themselves.”

Reports touting the health benefits of caffeine also need to include a caveat stating that it may be harmful in pregnancy, added the Dr., whose own research has linked caffeine consumption in pregnancy to miscarriage and childhood obesity. “My advice would be try to reduce as much as you can, if you can totally quit that would be even better.”

Researchers told  that it reviews all of its recommendations every 18 to 24 months, includes all new research in its reviews, and makes adjustments to recommendations as needed. “Until that time, ACOG’s current guidance still stands.”