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Improving treatment for infant respiratory distress in developing countries

Pneumonia is the leading cause of death for children under the age of five worldwide. And in the developing world, ineffective treatment for infant respiratory distress often caused by pneumonia is a severe problem for young patients.

Now, an interdisciplinary team of students in the Entrepreneurial Design for Extreme Affordability course at the Stanford's Institute of Design is working to solve the problem. The student team partnered with the International Centre for Diarrheal Disease Research, Bangladesh to develop a nasal tube interface, called AdaptAir, to prevent leakage and improve effectiveness of the Bubble CPAP device, which is used in treating infants with respiratory distress. The Center of Innovation in Global Health is among the organizations that helped fund the project.

In the following Q&A, David Janka, MD, a member of the team, discusses what prompted him and classmates to develop the AdaptAir, how the design process worked, and how the group is working to develop a business model to manufacture the product and distribute it to  low-resource health-care settings.

What was the catalyst for creating the AdaptAir?

Our ultimate motivation was to provide an innovation that could decrease the mortality of pneumonia in pediatric patients. Pneumonia, perhaps surprisingly to many, is the number one killer of children worldwide.

There are numerous challenges to providing therapy for severe pneumonia in resource-constrained settings. One intervention that has been seen as affordable and efficacious is known as Bubble CPAP. With oxygen, tubing and a bottle of water, it is possible to deliver respiratory support to children with pneumonia that compromises their ability to breath. However, the nasal interface that delivers pressurized oxygen must have a good seal at the child’s nostrils or the therapeutic benefits are lost. We found that a poor seal is often the greatest problem for physicians in the developing world attempting to administer Bubble CPAP. Our goal was to provide an effective seal to a range of pediatric patients at an affordable cost.

How did you and your teammates approach the process of developing the seal?

As part of the course we used a process grounded in principles of design thinking beginning with a human-centered approach. Before we even decided the material or form of the interface, we considered all the users relevant to the design problem and thought holistically about the environment and conditions important to the design space. We traveled to Bangladesh over spring break last year to meet the project partners and spent time on the pediatric ICU wards with pneumonia patients, their families and health-care providers. We visited urban and rural hospitals and documented our observations with notes, photos and video clips. This need-finding work was downloaded back at Stanford with the entire team providing the foundation of our ultimate decision to focus on the nasal interface. Once prototyping began it was rough and rapid allowing us to externalize ideas quickly and get immediate feedback. In terms of initial testing, we benefited from a wonderful relationship with staff at Packard Children’s Center for Advanced Pediatric and Perinatal Education. There we were able to use sophisticated pediatric simulation mannequins to evaluate and modify our designs.

What was the biggest challenge in designing the seal?

We spent a significant time brainstorming potential forms for the interface and, luckily, we were allowed to freely entertain many options. The design thinking process requires that at times you flare, thinking big and broad, pushing boundaries and ignoring constraints, but also necessitates points of focus where sacrifices are made so the project can move forward. We eventually had to focus on a single design to carry forward and this required healthy team dynamics to make a decision that all members had confidence in as we moved forward.

The device is currently being tested with health-care providers in Bangladesh and elsewhere. What are the next steps in developing the AdaptAir for commercial use?

This summer we took current versions of AdaptAir back to our partners in Bangladesh for face-to-face feedback. It was a great opportunity to put our innovation in the hands of doctors, nurses and respiratory therapists who could potentially use AdaptAir in the care of children with severe pneumonia. This experience provided important insights on product development. We are currently in the process of securing funding to work on refinement of AdaptAir so that we can finalize a version and make it available to those who need it most.

What did you enjoy most about working on this project?

Collaborating with passionate health-care professionals in Bangladesh has been amazing! Overall, the project has been a wonderful opportunity to combine several of my passions (medicine, design, global health) and do so in the context of a fast-paced, exciting environment with amazing people at the I consider myself extremely fortunate to have had such a phenomenal team and supportive place in which to do this work.

Previously: A low-cost way to keep premature babies warm and well, Anti-overkill: Low-cost, life-saving medical inventions and Reducing infant mortality rates in developing countries
Photo courtesy of David Janka

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