Predicting the future: Why point of care diagnostics can save neonatal lives
by Azadeh Farzin
Neonatal infections account for over 1,000 neonatal deaths everyday with the vast majority (nearly 99%) of deaths occurring in resource-limited settings including Southeast Asia and sub-Saharan Africa. Sadly, many babies die from infections that are easily curable if they are identified in time and receive appropriate therapy and supportive measures. Unfortunately, early diagnosis of neonatal infections is exquisitely difficult and it is even more difficult to identify neonates at the highest risk of severe illness at the initial patient contact. Lack of a robust and rapid predictive technique for patient evaluation dilutes the already limited resources, making it more difficult for those with dire needs to receive appropriate interventions. Empowering the frontline health workers with a point of care diagnostic technique which provides information regarding predicted illness severity, would allow timely identification of at risk neonates, and optimize resource allocation to those at the greatest need for immediate care and vigilant monitoring.
What is wrong with my granddaughter?
I have had the privilege of working with the Sylhet Osmani Medical College (SOMCH), a tertiary care center located in Northeast of Bangladesh over the past two years. During my initial visit, I was approached by a young grandmother, tightly clutching a pale newborn in her arms. Her daughter, she explained was still sick and in the hands of the doctors who were trying to save her life. The newborn was small, and almost hidden in the arms of her loving grandmother. I noticed the child’s nostrils collapsing with every rapid breath, and the subtle use of her chest muscles drawing in and out, in an attempt to keep her delicate lungs from collapsing.
The grandmother inquired with anxiousness: Would the child survive? Did she need to be hospitalized? What type of medicine would she need? The admitting pediatrician and I quickly reviewed the possible diagnoses.
The child was delivered via cesarean section and her presentation could simply be a reflection of her “transitioning” while absorbing her excess lung fluid. Although there was no estimate on the child’s due dates, we both agreed that the child was likely premature by 3-4 weeks. The child was ultimately admitted to the neonatal intensive care unit and started on antibiotics for presumed sepsis.
The next day, I visited the child, only to find out that she had suffered a rough night. Her breathing status had worsened and the grandmother alerted the doctors regarding the blue appearance of her lips. One of the physicians had noticed that her pulses had become weak and the child would not cry.
Fortunately, timely application of oxygen, intravenous medicines and fluids had saved the child’s life and a week later, the child who was named Fahima was discharge home with the mother. The doctor disclosed that Fahima was fortunate since she was born at the hospital, and the family sought care in time. For every one newborn whose life is saved with timely interventions, there are many others who never have a chance to be evaluated or treated.
How can we help?
Our project goal is to investigate a new class of proteins (biomarkers) found in the blood plasma - which arise from lining of the blood vessels - to identify neonates who are at risk of severe illness right at the time of presentation. This approach would alter the care pathway for the sickest babies and can help health care providers orchestrate a timely, efficient, and life-sustaining management plan based on prediction of illness severity.
This research project is conducted in collaboration with the local physicians at a tertiary care center in rural Bangladesh (SOMCH) where the sickest infants from the region are referred. Over 400 sick neonates with suspected infection have enrolled in the study with the hope that the families’ generous participation will allow us to improve the care of future babies who are born in similar settings. If successful, this group of biomarkers can be routinely tested - using low-cost laboratory assays – at the time of hospital presentation and using an established algorithm provide an index of risk assessment for optimized triage and resource allocation. Among other emerging strategies such as improved care seeking, simplified antibiotic treatment, and a better understanding of causative organisms for newborn illness - we believe that timely triage and resource allocation will have a profound impact on improving neonatal outcomes in resource-limited settings.