Annamarie Saarinen and her newborn daughter were about to leave hospital in Minnesota when a paediatrician noticed her baby had a slight heart murmur. By coincidence, a paediatric heart specialist was in the ward that afternoon and could screen the two-day-old child. The doctor found a critical heart defect.

“She would have died within the first week of life,” said Saarinen. Nine years and two operations later, her daughter is completely healthy. Many babies are not so lucky. Routine newborn examinations fail to detect more than 40% of heart defects.

After her experience, Saarinen co-founded the Newborn Foundation in 2010. Her organisation uses affordable mobile technology to screen for heart problems, working with governments and hospitals from the US to China. So what is this life-saving technology, and how can a small non-profit hope to implement it around the world?

Life-saving technology

The foundation uses pulse oximeters — small clips which attach to a finger or toe and check levels of oxygen in the blood. These devices are fairly common, but in partnership with California med-tech company Masimo, the foundation has developed smartphone-enabled miniature versions designed to work for newborns. Most hospitals need just one, and at around $200 they’re fairly inexpensive.

Between 24 and 48 hours after the baby is born, the mini oximeter is attached for the screening. A score comes up on the smartphone attached to the clip, which shows the baby’s “oxygen saturation percentage” — the proportion of haemoglobin cells carrying oxygen. If the score is below 90%, this may indicate that the heart is struggling to get enough oxygen into the blood, and the baby is recommended for further checks and diagnosis.

A baby in Mongolia is tested with a smartphone-enabled pulse oximeter A baby in Mongolia is tested with a smartphone-enabled pulse oximeter

Not only do the pulse oximeters check for congenital heart defects, but the tech can identify pneumonia and sepsis too — low scores can also be caused by lung problems and blood infections respectively.

"The testing is now implemented in all US states, reaching the four million babies born each year"

Together, these three complications kill eight newborns every minute around the world. If the technology reaches all newborns, it “has the potential to save close to a million lives”, said Saarinen.

Working with government

The foundation’s “BORN” Project (Birth Oximetry for Newborns) started in the US. After medical trials in Minnesota and lobbying by the foundation, in 2011 the Department of Health and Human Services added the testing to their universal screening recommendations. It is now implemented in all US states, reaching the four million babies born each year.

The foundation has since worked all over the world, including China, the Philippines, India, Bolivia, Peru, Mexico and, most recently, Ecuador and Mongolia. In June 2018 the Newborn Foundation kicked off a partnership with the Mongolian Ministry of Health to provide tech to 40,000 newborns.

“For the Chinese government to engage with a foreign NGO to the degree they have in this project is quite remarkable”

In the Philippines and China, a $225,00 grant from the Global Innovation Fund kick-started a pilot to screen 93,000 newborns. Working closely with the foundation, both projects are rapidly expanding. Around 78,000 babies will be screened in the Philippines in 2018, while in China’s Szechuan Province another 24 hospitals — covering 20,000 babies a year — have been added to the scheme, and the government has identified four provinces for a province-wide pilot.

The partnership began when the foundation was approached by China’s National Office for Maternal and Child Health Surveillance. Congenital heart disease had become China’s number one cause of infant mortality, said Saarinen. They convened an international summit in 2013, including representatives from every province in China, and have since worked together very closely.

“For the government to engage with a foreign NGO to the degree they have in this project is quite remarkable,” said Saarinen. As the tech has been rolled out data has been fed back and monitored by a central lab, and the results have led the foundation to alter their recommendations to hospitals.

For example, the foundation has found that early detection and treatment has been more effective, and that newborns often leave hospital before 24 hours. They are therefore considering recommending that newborns are screened between 12 and 24 hours after birth, even though this may lead to more false positive results.

Building support

Owing to the distance from health services, rural areas tend to be where babies that most need screening “fall through the cracks”, said Saarinen. However, this lack of access also makes it difficult to scale the technology in the countryside, so implementation begins in cities. Once city hospitals have incorporated the screening tool, it can be rolled out elsewhere.

Diagnosis is just part of the picture. Building the infrastructure to provide babies with the treatment and surgery they need can be a large step for some countries: in the Philippines, for example, there is only one place in the entire country for heart surgery. Similarly, Mongolia doesn’t have the capacity for open heart surgery ­— at the moment children have to be flown to South Korea.

All of these changes take time, but with political will and clever implementation this technology could continue to spread rapidly around the world. One newborn girl in Minnesota could save hundreds of thousands of lives. — Jack Graham

(Picture credits: Newborn Foundation/Tibora Bea)