Deceptively simple science aims to save premature babies

By Kathleen Bongiovanni, MIPH, MS; Photographs by Seattle Children's Hospital

Kathleen Bongiovanni serves as a Member at Large with UVP. She works as a Program Manager in the Center for Developmental Therapeutics at the Seattle Children’s Research Institute. She holds a Masters in Genetics and a Masters in International Public Health. Kathleen recently won the Gates Challenge Explorations award funded by the Bill and Melinda Gates Foundation. 

Sometimes even a simple idea can make a difference in people’s lives.  In my case, I hope that the creative adaptation of a simple science concept will one day save the lives of premature infants in the developing world.

As a program manager in the Center for Developmental Therapeutics, I support researchers working in the realm of preterm birth and neonatal health.  So far, the main focus of that work has been on treatment options for premature infants, including the development of the Seattle Children’s Positive Airway Pressure ( Sea-PAP) device, an easy to use respiratory support device for preemies.

The aim of my new research project is to investigate new ways of easily and inexpensively diagnosing lung immaturity in premature infants.  Premature birth is a leading cause of neonatal death in the U.S., but not many people realize that it is also a huge issue in developing countries.  New research has shown that 15 million premature babies are born each year, and helping preterm infants everywhere lead long, healthy lives is an important goal of my research.

In developing countries, especially in Uganda—which is where part of my research will take place—many mothers choose to give birth at home, and fewer than fifty percent of births occur with the assistance of a trained health care worker.  Premature infants are born with immature lungs that often lack the ability to make enough surfactant, a surface tension lowering fluid that opens up airways and makes it easier for us to breathe.  Without surfactant, a baby’s lungs are prone to collapse and the baby as risk for developing respiratory distress syndrome.  If problems go undetected and are not treated quickly, this syndrome can lead to death or lifelong disability.

Mothers in resource-limited countries may not be aware that their infant is born prematurely and may not recognize the danger signs of lungs immaturity, placing these infants at risk for developing respiratory distress syndrome.  About 50 percent of deaths that occur within the first 30 days of life are due to delays in problem recognition and care-seeking.  If a mother or trained health care worker is unable to recognize the danger signs of respiratory distress syndrome, the mother or family won’t know to take the infant to a health care facility.  The resulting delay in care, sometimes up to 3 days, can have a devastating impact on the health outcome of the infant.   

Tests for lung immaturity are available in the U.S. and other developed countries, but these tests are complex and expensive, and require invasive amniocentesis or gastric aspiration.  Alternative lung immaturity tests that are appropriate for use in developing countries do not yet exist. 

My research project revamps an old test that was originally developed in the 1970s.  I characterize it as being “deceptively simple,” and thanks to the newer, fancier tests, many people have overlooked it.  The test is called the foam stability test, or shake test.  It works by mixing amniotic fluid with ethanol and shaking the mixture by hand in a vial, then letting it sit for 10 minutes.  You then look at how many bubbles are in the vial.  Lots of bubbles means that the amniotic fluid contains enough surfactant to support an infant’s breathing- no respiratory distress syndrome.

Amniocentesis is not readily available in developing countries, and would be too expensive to implement.  My idea is that the foam stability test should work by taking and saving the oral fluid that is routinely suctioned out of an infant’s mouth right after s/he is born.  This fluid is similar to what you would collect through amniocentesis, and should perform well with the foam stability test.  Oral fluid can be collected noninvasively, and ethanol is not expensive.  The test is simple and can be conducted by someone with minimal training, making it perfect for use in developing countries. 

Right now, I am working with clinical colleagues at Texas Children’s Hospital to plan clinical studies that are necessary to assess the efficacy of this diagnosis technique. I am also traveling to Uganda in June, and will work with my collaborators there to hold focus groups and interviews with women and clinicians in rural settings. Our goal is to gain a better understanding of their feelings on suctioning and testing infant oral fluid, and how amenable they would be to the lung immaturity diagnostic test.

In addition to my work at the Seattle Children’s Research Institute, I am also a member of the board of directors for the Uganda Village Project. One of the reasons that I am conducting part of my research in Uganda is that the rate of preterm birth and infant mortality there is very high, and I believe that simple interventions can make a big difference. Uganda Village Project has a Safe Motherhood Program that provides education and improves access to appropriate medical interventions to people in rural areas, who would not otherwise be able to access these life saving services. As a board member I have the privilege of helping to shape UVP’s strategy and programs, and actually met one of my research collaborators, Dr. Peter Waiswa, through our mutual work with UVP. While in Uganda for my research project I also plan to visit the UVP offices in Iganga, and finally meet some of the people I see at our monthly teleconferences!

My research project  is possible because I won a Grand Challenges Explorations award, a rapid grant making initiative funded by the Bill & Melinda Gates Foundation.  Grand Challenges Explorations (GCE) provides funding to individuals worldwide so that they can explore ideas that break the mold in how we solve persistent global health and development challenges.  

Read more about Kathleen's work here: http://bit.ly/IQiM5B
Learn more about UVP's Safe Motherhood Program here: http://bit.ly/xD6Iaz