KEM Hospitals uses web application to reduce premature birth complications

The intricate process of a baby’s birth leads to the occerence of numerous physical changes in mother’s as well as the baby’s body. Babies need to make many physical adjustments to survive outside their mothers’ bodies. Leaving the womb means that babies are no longer totally dependent on their mothers for important body nutrition and many of their body functions change significantly from the way they did in the pre-natal phase. Being born prematurely with problems can make these changes even more difficult to process. Premature births, iow weight, infections and birth asphyxia accounts for 28 percent of all neonatal deaths in India, a number which has gone up by 52 percent in the last decade.

To avoid these neonatal deaths, minimize birth complications, prematurely born babies require proper and accurate ammounts of nutrition. Umesh Vaidya, M.D. D.N.B Pediatric, KEM Hospital Pune said, “The required nutrition of premature infants has to be calculated precisely to avoid complications and help the baby grow.” This critical, lifesaving process of supplying the right mix of nutrients through intravenous therapy is conducted manually across India, and therefore the number of neonatal deaths are increasing year over year.

The need

Given the fragility of life at the earliest levels, getting the right mix of nutrition—combination of proteins (amino acids), sodium, calcium, phosphate and magnesium—to support life, is a critical aspect in ensuring survival of premature babies. Managing this nutritional formula must also be at a satisfactory infusion rate with the right calorie nitrogen ratio to avoid problems and fatality.

However, there are several limitations—the concentration of solution has to be accurate and the infusion rate (speed of drip) has to be precise, else it could be fatal for the babies. Since this process of calculation used to be done manually at KEM hospital, it was prone to error, less accurate and definitely a time consuming process for doctors.

Vaidya explained, “The process of providing the right mix of nutrients was manual at our hospital—involved a lot of mathematical calculations, was taking a lot of time and quite often error prone too. This in turn discouraged doctors from doing total parenteral nutrition (TPN), which led to complications in babies’ growth.”

The solution

With Kimaya TPN, (Total Parenteral Nutrition), a cloud-based software, developed using Ruby on Rails, neonatologists can now calculate complete nutritional requirements of premature infants within a couple of minutes. The software provides the right mix of nutrients administered through intravenous therapy formulas and has a comprehensive set of in-built fail safe mechanisms to prevent errors.

Vaidya said, “The web application actually allows doctors to calculate the neonatal nutrition plan for each baby with very high accuracy rate and are less time consuming.”

He further added, “This process requires neonatologists to enter a set of data points into the web application, such as weight of the baby, amount of additives and lipids, etcetera, and the application will provide accurate information of TPN that is required for the baby.”

The application has been designed to provide100 percent accuracy in calculating the composition and concentration of additives and dextrose required by an infant. “It is a collaborative effort built with support and guidance from the neonatologists’ team of KEM. Kimaya TPN has proved instrumental in providing agressive nutirition to the babies, reducing the amount of time babies used to spent in ICUs, and thereby bringing down the infant mortality rate drastically,” said Vaidya.

The application is currently being used by 22 hospitals across the country, including KEM Pune. “Where it was considered to be impossible to get enteral and parenteral calorie intake among babies, Kimaya TPN has made it possible and this has generated global interest,” Vaidya added.

Impacts

The Kimaya TPN, aims to address the life critical challenge in neonatal intensive care units’s across the world. According to Vaidya the application assists neonatologists in calculating complete nutritional requirements of premature infants within a couple of minutes, and has shown extremely successful and encouraging results. The web application has reduced the period of time babies are kept in NICUs by 50 percent, giving them a fighting chance of survival and thereby reducing the mortality rate as well.

With Kimaya TPN software neonatologists can now save a lot of precious time than before. “Earlier, an experienced neonatologist took at least half an hour for each calculation, and to manage approximately five babies everyday it used to take a lot of their time. Now, with the application, a trained nutritionist can do all this at a fraction of cost and time spent,” said Vaidya.

The software also gives a very quick clinical outlook for a patient. The consultation time for doctors has also reduced because they now have measured information of enteral and parenteral energy intake for each baby. The software even provides the growth charts that track the growth of a baby. This is very important for clinicians and even gives parents a clear picture of how their baby is growing.