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Current situation

 

Every year around the world 300,000 babies are born. Unfortunately, 48,000 of them will born premature requiring specialized treatment such as Oxygen Therapy to develop correctly.


For the treatment to work correctly, oxygen must be supplied in a specific quantity depending on the baby condition. If it is not applied correctly, it can lead to auditive, cognitive or visual disorders such as Retinopathy, which is one of the principal causes for child blindness.

In Mexico, Retinopathy is responsible for 34% of the cases of child blindness, being two times more than in developed countries.

Bebé en brazos de la madre

The biggest challenge here is not the treatment itself, but rather the quick and unpredictable response of the baby to the treatment. Unfortunately, a continuous monitoring of the baby is not always possible due to a high workload in health system and limited resources. Therefore, once doctors notice this change it is probable the baby has already been exposed to an incorrect quantity of oxygen, increasing the risk of developing another conditions. 

 

So we asked ourselves: Can we do something about it?.... Yes, we can! 

 

but first, let's understand the basics...

Oxygen therapy

What it is and how it works

Oxygen therapy consists in supplying a specific quantity of oxygen to the premature to help him breathe until his respiratory system is strong enough to work by itself. For the treatment to work correctly, the quantity and time of exposure MUST be precise.

Specific quantity during the correct time = Successful Treatment

Treatment is divided in 3 phases depending on the severity of the baby's condition. Phase 1 and 2 are non-invasive treatments while Phase 3 is invasive (through intubation). Depending on the baby response and condition, the proper device is selected.

A good and successful treatment in either of the first two phases can significantly lower the risk of reaching a phase 3.

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Phase 1

Free flow

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Phase 2

CPAP nasal

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Phase 3

Mechanical ventilator

A successful treatment relies in 2 main actions:

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Monitor SPO2 - Oxygen saturation in blood

It indicates the level of oxygen in the blood. Normal condition is 90% or more. A decrease of it indicates a desaturation, meaning that quantity of oxygen supplied must increase. Once it returns to normal values, oxygen must be gradually decreased to avoid an overexposure.

Control FiO2 - Oxygen inspired fraction

This parameter checks the quantity of oxygen supplied and must be adjusted accordingly depending on the SPO2 value. A 100% value is used when baby enters into desaturation.

The challenge for the proper treatment besides the fact that baby conditions is rapidly changing is that every case is different from one another. For most treatments, a common practice is to start with low values of oxygen and then increase it gradually depending on the baby's response. Additionally, the lack of data has made it difficult to develop a better and more reliable protocol for oxygen therapy.

Retinopathy

A visual condition that can be avoided

Retinopathy is an abnormal development on the eye due to an excesive grow in blood vessels which eventually can lead to full blindness. It is provoked by an uncontrolled and excesive exposure to oxygen, this happens due to 3 major factors:

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Premature babies response to the treatment is unpredictable.

Oxygen flow is manually adjusted by doctors.

Continous monitoring is not feasible due to high workload and limited resources.

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5 stages of retinopathy

Stage 1

Blood vessels stop to grow and form a line that separates normal from pre-mature retin.Treatment results in disappearance of abnormal blood vessels with potential to develop a good vision.

Stage 2

Line formed in previous stage starts to grow tissue.

Stage 3

Fragile new abnormal blood vessels grow toward the center of the eye. At this point, the eye is still capable of repairing itself if tissue is removed and ROP is treated.

Stage 4

Partial retina detachment.  

Stage 5

Complete retina detachment. Severe impact on sight and low probabilities of good visual outcomes.

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