Historically, the development of paediatric health innovation and technology has taken place in a relatively emergent manner with little formal coordination. Today, with advances in technology such as personal health devices, robotics, 3D printing, biosensors and data analytics, we have the opportunity to move away from repurposing adult technologies to promote the development of bespoke health technology that is designed for children.
Omnia Health Insights spoke to RAK Hospital’s paediatrics and neonatology specialist Dr. Vishal Mehta about his views on how to deliver increasingly complex paediatric care in an era of rapid innovation in child health technologies.
Does innovation in paediatric medicine lag behind those of adults?
Innovation in paediatric medicine has lagged behind those of adults. One of the many reasons is that, unlike adults, paediatric are a diverse group of patients. Children are not miniature of adults. Growth, development, anatomy and a maturing body system differentiate them into different groups such as neonates, infants, toddlers and adolescents. Depending on the age group, we have a different set of problems, different challenges and different physiology. Newer technologies need to adapt to this whole range of changes with age. For example, blood pressure monitors for paediatrics requires a different size of cuff depending on the age and size of the child.
The second reason is that children are smaller in size and volume. This poses technical challenges for newer technologies. The third reason could be the ethical challenges in evaluating newer therapies in the paediatric age group, who cannot consent. Many newer technologies or therapies are established in adults and later repurposed or adapted to paediatric age groups. Lastly, unlike economically productive adults, paediatrics is age-dependent, so there is less incentive for the private sector to invest in paediatric innovations.
Should we have bespoke health technology for children?
Yes, many paediatric problems have unique challenges requiring bespoke solutions with newer innovation in health technology. For example, a temperature check for toddlers with traditional thermometers was always tricky. An anxious child would not tolerate the device for the recommended duration, so we required a device which can measure temperature quickly, accurately with minimal or no contact with the child. The solution came in the form of infrared thermometers – a non-invasive temperature sensor that scans the forehead in two seconds and provides a medically accurate body temperature.
Newer innovation and advances in artificial intelligence, virtual and augmented reality, robotics, 3D printing, new materials, biosensor technologies and data analytics can change how conditions are diagnosed and managed. But we have to move away from the traditional approach of repurposing adult technologies and provide a bespoke health technology for children that are anatomically, physiologically, developmentally appropriate and designed for children.
What are some of the newest devices and the latest developments in child health technology?
A. Paediatric micro sampling and painless phlebotomy device:
Paediatric micro sampling is a breakthrough in the collection of a blood sample from children. With this innovation, children’s comfort and safety is taken care of. Precise small-volume samples of blood are collected. Unlike venipuncture, micro sampling ensure that the child experience as little pain as possible.
B. Advanced wireless neonatal body monitors:
Babies in the neonatal intensive care unit (NICU) or paediatric intensive care unit (PICU) are monitored through a complex collection of sensors, each of which has a wire connected to a patient monitor. All these wires make it difficult for parents to bond with their children and for clinicians to access their patients. Wireless flexible sensor patches are developed to collect the same vital signs as wired devices. The new sensors can track the heart rate, respiration rate, temperature, and blood oxygenation as well as conventional sensors, and they also allow for monitoring of body movement and orientation, recording heart sounds, crying, and other audio biomarkers, and even provide a pretty accurate estimate of systolic blood pressure.
C. Smart Pill:
A sensor is built into this pill, which enables physicians and medical teams to accurately assess a patient’s condition from afar.
D. Biliblanket:
A Biliblanket is a portable phototherapy device consisting of a fibre-optic pad and a portable illuminator for the treatment of jaundice in a newborn at home. The light emitted from a Biliblanket is used to break up bilirubin in the baby’s blood, reducing the yellowing effect in the baby’s skin and whites of the eyes. While using this system, parents can still hold, feed and play with their child.
E. High flow oxygen therapy:
Humidified high flow oxygen therapy is a form of non-invasive respiratory support. The high flow and humidification help to improve the functional residual capacity and mucocililary clearance of secretions. This, in turn, reduces the work of breathing and the need for invasive respiratory support and intubation.
F. Virtual reality:
Virtual reality is used as distraction therapy; it immerses a child into being present in a different reality. Virtual reality content is developed so that children can swim with sharks, play with a favourite pet, walk with dinosaurs, be with family and learn or play a game. Virtual reality can help in paediatric pain management and to overcome phobias. This can be used during minor procedures, wound dressing and generally on the ward. It reduces anxiety to have procedures that may normally require sedation.
G. Gene therapy:
Gene therapy promises cures for many diseases and medical treatments. It can possibly prevent hereditary diseases such as cystic fibrosis and haemophilia or possibly cure heart disease, AIDS, and cancer. Gene therapy is a potential medical miracle, but still a risky procedure, so till now, the clinical trials have only been used for seriously ill children or those who cannot be cured by standard medical treatments.
How can devices that monitor a child's condition from afar enhance paediatric care?
Devices that monitor a child's condition from afar provide families and physicians with a way to manage their patients or children remotely, for example, blood glucose monitoring in a diabetic child or a chronically ill child on home oxygen. Many of these devices can be connected to mobile apps. It improves routine care and communication between a child’s family and their physician. Families can give the physician critical information on things such as allergies or medical equipment they rely on, along with emergency action plans, by showing the app or sending a snapshot via email. Parents can view the data in colourful graphs to see trends and patterns and communicate those patterns to a physician.
Is communication with parents more important than technology?
There is no technology to substitute for good communication with parents. Parents have a tremendous amount of anxiety over their child’s illness. Effective communication with parents giving clear facts, evidence-based advice, and a few words of reassurance may be more effective than the treatment itself.
Young children cannot express what they experience or feel and are also dependent on parents for treatment and monitoring. It is very important to educate parents to help them understand their child’s illness, treatment plan, medication, and monitoring and follow-up plans. Even though technology cannot replace effective communication with parents, technology can improve the effectiveness of communication by engaging them in interactive information sharing.
For example, the use of an audio-visual aid can help parents understand their child’s illness and treatment plan. Standard growth monitor applications in mobile phones can help them track the growth and wellbeing of their child. Immunisation software can send them reminders for vaccination due-dates. Hospital apps can give them access to laboratory tests results or book appointments with physicians. The use of telemedicine for chronic health issues or homecare can be helpful too.