BREATH

BREATH, is a smartphone application that provides real-time guidance to health care providers as they resuscitate newborns, given the limitations COVID-19 has created on staffing around the world.

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Inspiration

  • The team that we created was inspirational. Everyone on the team felt motivated to work toward a common solution to improve the care of newborns throughout the world during COVID-19, and beyond.

What it does

  • Our app guides users with simple yes/no questions through the first minutes of the baby's life.
  • It covers many different complications that may occur and tells the user exactly how to cope with the situation by using audio and video instructions (PPV, compressions, alternative airways...)
  • The delivery of a baby can be nerve-racking, and the interventions are time dependent, so to avoid the risk that the provider loses track of time, a stopwatch is always visible, tracking the age of the baby in minutes and seconds.
  • Precisely-timed data about newborns is currently not available but carries a huge potential. With our app, each use of the app represents the delivery of one baby. This data is tracked and timestamped. Information about each delivery and the complications that the baby suffered are sent to our back-end.

How we built it

  • Identified relevant complications we wanted to cover and how one should act in that case (followed universal NRP guidelines for care after delivery)
  • Built a flow-chart diagram with the expertise of Dr. Holly Martin (practicing UCSF Pediatric Hospitalist who provides neonatal resuscitation and care and has worked to develop this concept internationally as well)
  • Recorded audio files, modified existing video files
  • Implemented the front-end of the app in flutter
  • Code implementation of the entire algorithm is complete for the English language and we have provisions in place for expanding it to other languages (12 languages are available for implementation through the collective linguistic capacity of our team.)
  • Added a backend using flask REST API

Challenges We Faced

  • Quickly getting team up to speed on clinical scenario and the goal of the intervention, luckily we had the team leader, Holly Martin, who had conceived of this idea previously as well as team members from obstetricians to EMTs who also brought their experiences to bear
  • Creating team atmosphere while never meeting face to face - We met regularly via zoom, took full advantage of slack, and used our time together to talk about all aspects of the project, as well as also allowing for time to reflect on current events, the state of the world, and coming together after this as an even stronger team to work on the task at hand.

Next Steps

  • Use the MVP with UCSF trainees to improve their neonatal resuscitation skills. Gain feedback on user interface with their participation.
  • Develop multiple language versions to test in alternate sites around the world, including Peru, India, Pakistan, Nigeria.
  • Continue to communicate with possible collaborators, including San Francisco EMT and Fire Dept, Gates Foundation and USAID and UNICEF
  • Plan for Clinical trials as next stage testing of BREATH app ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Every year, one million babies die on the day they are born. With proper care, 80% would live. Proper care includes neonatal resuscitation in the first minutes after birth. 10% of all babies need this time-sensitive intervention or they would not survive. The U.S. is not exempt. Black infants die at twice the rate of white infants. The coronavirus outbreak is affecting new mothers. Nearly a million women in the U.S. are expected to give birth in the next three months. Pediatricians must carefully don PPE before entering the room to save a newborn's life. "Pregnant and Scared of 'COVID hospitals' They're giving birth at Home." Countless women changed their birth plans because of COVID-19 concerns.

Lives are being lost but we are here to offer a glimmer of hope. BREATH, a smartphone application that provides real time guidance to health care providers as they resuscitate newborns. Whether you are ...a labor and delivery nurse alone when the baby is born ...a midwife delivering a home birth ...a provider in Pakistan trying to save a baby ... or an EMT called emergently to a delivery.

The BREATH app was presented as a project for the UCSF COVID-19 Hackathon. Six incredible people volunteered for our team, bringing a wealth of skills and experience: software development, user interface, backend development, 911 dispatcher, obstetrics, marketing, and project management. We held virtual scrum meetings every other day to discuss accomplishments, roadblocks and plans. We effectively collaborated with team members in multiple states and countries. We tracked our progress and iterated on features while collaborating between meetings via Slack. Using lessons learned from prior feedback for our prototype, we started from scratch, developing and implementing a cross-platform application that runs on Android, iOS, and the web using the Flutter framework. With clinical guidance, we implemented the entire resuscitation algorithm. We included key features identified during the prototyping phase, the code timer, voice prompts, and media demonstrating the correct intervention. We also developed and deployed a REST API to collect de-identified resuscitation metadata to better understand pain points and usage patterns. See the video or Github for a demo of our MVP, with the potential for 12 language options. This MVP was built from the ground up during the UCSF COVID-19 Hackathon.

Using our integrated app and database, clinician-researchers will have access to never-before-seen information. This data will open a door, enhancing our understanding of the first minutes of life, and saving babies. Additionally, the app can be deployed immediately to train UCSF students and residents during the COVID pandemic. As we continue to focus attention on the institutional racism and bias that has led to disproportionately poor outcomes for black and brown families, BREATH provides an opportunity for improved, equitable care.

The UCSF Hackathon has the opportunity to truly "advance health worldwide" through this technology. We hope that the BREATH app will decrease neonatal mortality and the inequities that it represents throughout the world.

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