Helping newborn babies to start breathing

One in ten newborns need help to start breathing at birth. Australian company ResusRight is developing a world-first portable resuscitation monitor. The Nemo monitor shows paramedics and birth attendants how much air to give the baby, helping to avoid injury or death.

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General public

Baby’s first breath

Babies get oxygen from their mother’s blood while they are growing in the womb. At birth, the baby’s first breath brings air into their lungs so they can live outside their mother’s body.

But one in ten newborns need help to start breathing, as Dr Mark Tracy from Westmead Hospital, Sydney, explains. ‘Most births are uncomplicated, but a small number of babies struggle with illness and stress. Sometimes these stresses mean the baby has trouble starting to breathe. Birth attendants need to provide breathing at safe levels.’

Birth attendants often use a self-inflating bag to help the baby start breathing. The amount of air the baby needs depends on its size. ‘If you've got a tiny baby, who's maybe 500 grams, you need a little breath,’ Mark says. ‘With a big four-kilogram term baby that's having problems, you need a bigger squeeze to send through a bigger volume of air.’

It is essential to give each baby the right amount of air. ‘The first six breaths if done excessively can damage the baby,’ Mark explains. ‘Too much air may injure the brain. Too little air can exacerbate birth asphyxia.’

Self-inflating bags and other resuscitation devices are not reliable

Mark leads a research team that tested the self-inflating bags to see if they are reliable. ‘We tested 20 brands available internationally to see if a box of 10 would all work the same. We found half of the available brands failed,’ Mark says. ‘Some of them would fail completely and the end user wouldn't know. They would simply squeeze harder and suddenly the bag would react. The potential for a lung injury, perhaps even popping a lung and causing lung collapse was dramatic.’

The team also tested other resuscitation devices called T-piece resuscitators. For these devices, ‘what you set is often not what gets delivered or measured,’ Mark says. ‘We realised that we needed a monitor to guide birth attendants to give the right amount of air.’

A new resuscitation monitor prototype

Biomedical engineers Matthew Boustred and Matthew Croft were honours students at Mark’s lab. They were keen to use their engineering skills to improve birth outcomes. ‘MedTech is an incredible space where technological innovation improves the lives of people. This impact was what initially drew me to study biomedical engineering,’ Matt Boustred recalls.

Assisted by clinical engineer Dr Murray Hinder, the two Matts built a new resuscitation monitor prototype. This small battery-run monitor shows if the ventilator mask is properly sealed and the right volume of air is going into the baby during a resuscitation.

‘They did an amazing job,’ Mark remembers.

Translating the prototype into a product

The two Matts teamed up with Mark and Murray to set up the company ResusRight to develop the resuscitation prototype into a series of products. The Juno monitor helps train birth attendants to give ventilation and is now in use in 30 hospitals and universities in Australia and New Zealand. The Nemo monitor assists birth attendants to resuscitate babies.

‘Our current Juno model monitors volumes of air and leaks around the face mask. We are developing the Nemo monitor to also show airway pressures and carbon dioxide levels to the birth attendant while they are resuscitating a baby,’ Matt explains.

The first in-human trial

ResusRight conducted a trial of the Nemo monitor at Westmead Hospital. ‘We used the Nemo monitor to assist 12 vulnerable newborns with their first breaths,’ Matt says. ‘Using our monitor to help the babies go home to their families with good outcomes was quite an emotional moment.’

‘The knowledge we gained from the study was immense,’ Mark notes. ‘The device gave us great data. It is highly accurate, freestanding, quick and intuitive to use and it does not interfere with other aspects of the care of the patient.’

Usable around the world

Mark and Matt hope the monitors can be used around the world by paramedics and smaller hospitals and birthing services. The devices will help birth attendants that don’t have access to intensive care equipment to improve resuscitation outcomes for newborn babies.

‘Often it is a midwife or a junior doctor who starts the resuscitation,’ Mark says. ‘They need to know is the resuscitation technique going right and start to problem solve if the baby is still staying blue and the heart rate is slow. That's where our little device comes into play.’

MRFF funding of $800,000 provided through MTPConnect’s BioMedTech Horizons program supported ResusRight to conduct the Nemo monitor trial at Westmead Hospital.

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