Project Firefly: Infant Phototherapy
Learn more about the technical and design aspects of Firefly by reading the Firefly phototherapy brochure. The brochure covers all aspects of the Firefly design from power consumption, per treatment cost, and phototherapy irradiance.
An infant receives phototherapy at the National Hospital of Pediatrics in Hanoi, Vietnam
10% of all newborns worldwide require jaundice treatment to prevent death or lifelong disability.
Phototherapy, shining a blue light on the skin, is the most cost-effective way to treat jaundice, however every year 5.7 million infants in South Asia and Africa do not receive any phototherapy.
Global health experts estimate 6-10% of newborn mortality can be attributed to jaundice and complications caused by jaundice.
Newborn jaundice is a simple condition with a simple cure that gives a child the same chance as all other healthy newborns at a long and healthy life. Firefly transforms national health systems by empowering local facilities, freeing up resources in higher-level hospitals so they can better address other, more complicated conditions Firefly can dramatically reduce infant mortality by promoting breastfeeding, lowering infection, treating mild jaundice at the local level and severe jaundice at the national level. We cannot reach millenium development goal #4: a ⅔ reduction of mortality for children under five by 2015 without addressing newborn jaundice.
In response, Design that Matters (DtM), the East Meets West Foundation (EMW) and Vietnamese manufacturer MTTS have launched a collaboration to develop a new infant care device that will treat newborn jaundice during the critical first days of life. This effort will build on EMW’s successful Breath of Life program and extensive network of collaborators across Southeast Asia, DtM’s experience in the design of newborn technologies for the poor, and MTTS's expertise in the production and support of context-appropriate medical devices.
PROJECT POINT OF VIEW
Infants in a NICU at Fabella Hospital in Manilla, Philippines
Low-resource hospitals providing overnight care that wish to improve treatment outcomes and reduce newborn referrals
- Need -
a cost-effective, intuitive, durable tool that can be placed in the mother’s room to provide individual infant phototherapy to otherwise healthy newborns with mild to severe jaundice while allowing infant warming.
NATIONAL-LEVEL HOSPITALS ARE OVERCROWDED AND STRAPPED FOR RESOURCES.
Jaundiced newborns receiving phototherapy at Philippines General Hospital in Manilla, Philippines. Although hospital crowding and limited clinical resources are serious issues, infants sharing beds create the risk of disease transmission.
In poor countries, 20-33% of newborn admissions in national hospitals are due to neonatal jaundice. Even in Vietnam, where hospitals have received many resources, the national-level hospitals are overcrowded, staffing is low, and there is not enough well-functioning equipment to meet the need. Families travel days seeking treatment while their newborns die in transit. Infants who arrive are housed in overflowing neonatal ICUs where multiple patients share beds under dim phototherapy, risking infection, and often ending in costly and dangerous exchange blood transfusion, disability, and death. The situation is even more dire in many other countries. In Ethiopia, Tikur Anbessa national teaching hospital had no phototherapy until residents made a home-grown version in January 2012.
A phototherapy device designed to provide rapid, intensive treatment to severely jaundiced patients in national-level hospitals will prevent costly and dangerous exchange blood transfusions and lead to earlier discharge of severely jaundiced infants, reduced infant disability and mortality. A device with minimal footprint that can also treat mildly jaundiced infants in mom’s room will free up neonatal ICU space and nurse time leading to faster treatment, better breastfeeding outcomes, and a higher quality of care for other patients in the facility with more serious clinical needs.
LOCAL HEALTH CENTERS ARE AN UNDERUSED NATIONAL HEALTH RESOURCE
Nurses rolling a blanket as a newborn headrest at Dai Tu District Hospital in Vietnam.
Few district hospitals have any equipment to treat any newborn conditions, and the staff have little training and low confidence. Even when equipment is available, it is usually not set up correctly or functioning well enough to provide effective treatment. As a consequence, these hospitals refer almost all newborn patients to secondary or national-level hospitals for care. Otherwise healthy newborns who arrive at local health centers with mild jaundice are at risk of dying or developing severe jaundice in transit, and once they arrive at the crowded referral facility they risk infection and further treatment delays.
A phototherapy device designed with intuitive controls and fixed treatment lights (a device that is, in fact, hard to use wrong) will lead to better treatment outcomes for all patients. An intuitive device will improve the confidence of local-level staff in treating otherwise healthy newborns with jaundice, leading to reduced referral to higher-level hospitals and increased staff determination to treat other newborn conditions at the local level. Fewer referrals will lead to lower rates of newborn infection and an overall higher quality of care for patients with more serious clinical needs such as complications of prematurity, respiratory distress and congenital heart defects at the national level.
BREASTFEEDING IS NOT SUPPORTED WITH CONVENTIONAL PHOTOTHERAPY
An overcrowded mother's recovery room at Philippines General Hospital in Manilla, Philippines.
Staff to patient ratio in all hospitals is very low. Staff do not trust complex, delicate devices to be stationed in the mother’s room. In some hospitals, exhausted new mothers are invited to stand or sit on the floor near waist-height equipment in the neonatal ICU to feed and monitor their babies through day and night. In other facilities, nurses must choose between leaving a jaundiced newborn in the ICU to receive phototherapy, or leaving them in their mother’s room for breastfeeding while tending to patients throughout the rest of the hospital. A 2003 study in the Lancet indicated breastfeeding could save 1.3 million lives annually. Every day a mother does not breastfeed exposes the infant to risk of infection and increases the likelihood that breastfeeding will discontinue permanently. Effective jaundice therapy requires both phototherapy and regular feeding, yet separation from mom leads to infant dehydration, infection spread by shared bottles, or dependence on sugar water, cow’s milk, or infant formula.
A phototherapy device specifically designed to be durable, small, and operate in the mother’s recovery room will promote breastfeeding on-demand, encourage mother-child bonding, and lead to superior treatment and patient supervision, relieving busy staff as family members watch over the children.
NEWBORN INFECTION IS A REAL RISK
Two infants sharing a phototherapy device at Nam Dinh OBGYN Hospital in Vietnam.
According to the WHO, more than 1 million of the estimated 3.3 million neonatal deaths around the world each year are caused by severe infections including sepsis/pneumonia, tetanus, and diarrhea - that’s 15% of all deaths for children under five worldwide. Conventional overhead phototherapy opens up six routes to deadly infection. Ineffective treatment leads to (1) longer hospital stays and (2) stunningly high rates of exchange blood transfusion. Over a 3-year period in Ethiopia’s national teaching hospital, 16% of all jaundiced patients received costly and dangerous exchange blood transfusions, including exposure to unclean needles and questionable blood sources. Separation of mother and child leads to (3) lack of breastfeeding immunity and (4) infection from shared bottles. Conventional overhead phototherapy’s form factor leads to (5) treatment of multiple newborns with umbilical cord or respiratory infections in a single bed (6) unsanitary bedding and equipment.
A phototherapy device designed to be easy to clean, bring mom and baby together, and encourage the isolation of newborns receiving jaundice treatment, will reduce the incidence of infection and therefore reduce rates of infection-related transfer to overloaded national-level hospitals while lowering under-five child mortality.
DOCTOR, NURSE, AND PARENT FEEDBACK ON FIREFLY
“Mother care is better than nurse’s care because there are not enough nurses to cover all the infant care needs. The nurses can teach the mother how to check simple vital signs such as whether they are crying, if they are feeding and sleeping well, and if they seem too hot or too cold.”
Dr. Phạm An Quang, Hai Duong Provincial Hospital
“We actually had to take this baby out of our other phototherapy unit so she could be breastfed by mom. Wow! Now we can do both!”
Dr. Jazel Manarang, Philippines General Hospital
“Laying next to Firefly, my eyes feel fine. I could even fall asleep right here. Using Firefly instead of the overhead phototherapy, I don’t have to worry where my baby is and I can lay comfortably and take care of him.”
Duo Thi Lu, Mother, Hai Duong Provincial Hospital
“We feel Firefly is easier to use than overhead phototherapy because we can put a blanket on top of the baby and still provide effective phototherapy from the bottom. Overhead phototherapy could be set at the wrong distance from the infant bed and it’s more cumbersome to use”
Dr. Trấn Van Thuân, Hai Duong Provincial Hospital
“The baby fits well in Firefly: there is not much space which is good because the baby feels more comfortable feeling boundaries. That’s a disadvantage with an incubator because the baby doesn’t feel close to something.”
Nurse Vu Thi Huong, National OBGYN Hospital
“The overhead phototherapy systems are tall, so you can’t clean on top of it or even see if they are dirty. Bugs can get inside the overhead units. Firefly is very small and easy to clean.”
Dr. Nguyễn Thanh Hả, Director, National OBGYN Hospital
“I like Firefly - it is very useful, light and portable, and very easy to wipe down.”
Nurse Hoa, Moc Chau District Hospital
“The intensity of Firefly is clearly higher than one-sided phototherapy, even MTTS V3000 overhead LED phototherapy. Given it is also 2-sided phototherapy, Firefly provides a great level of intensity for reducing treatment time and providing more effective treatment.”
Dr. Tran Van Thuan, Hai Duong Provincial Hospital
“The Firefly has very good light intensity for what we need - there is a top and a bottom light and it is very intense. Where other machines might take 3 days, I would imagine this should take no longer than 24 hours.”
Dr. Binh, Moc Chau District Hospital
ABOUT EAST MEETS WEST
These tools include:
- infant warming
- phototherapy for jaundice
- respiratory therapyinfection control
- training: teaching for doctors and nurses
To date, the EMW Breath of Life program has achieved the following:
- 500 CPAP and other medical devices currently in use, each with a three-year parts and service warranty.
- 140 hospitals in the EMW network in four countries (Vietnam, Laos, Cambodia and East Timor).
- Built first-ever NICUs in 20% of Vietnamese provinces, and the first public NICUs in the countries of Laos, Cambodia and East Timor.
- Over 2,000 doctors and nurses trained.
- 15-20,000 babies treated each year.
- Approximately 70% reduction in infant mortality in each hospital where the program is introduced.
- 95% of Vietnamese provincial and big-city hospitals now have an EMW NICU installed and in operation.
In addition, EMW conducts daily monitoring of each hospital in
the network, and twice-annual program evaluation visits to most
hospitals.
Learn more about our progress on the DtM Firefly blog.
~~~
1: M. Maisels and A. McDonagh, “Phototherapy for Neonatal Jaundice,” New England Journal of Medicine 358:9, 28Feb08
Latest News
Firefly Wins Top Award at 2013 Edison Awards
Firefly Phototherapy was voted a Gold winner for social impact at the April 25th event at Navy Pier in Chicago
Solidworks Profiles Firefly Phototherapy
Solidworks has been a fantastic DtM supporter for years. As part of their "Born to Design" series, the company recently created a video feature about DtM's Project Firefly.
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