A mobile phone, text-based surveillance service that systematically transmits live APGAR data via soft patch sensors located on a newborn baby.
What is it?
Wearable, Anytime, Anywhere, Apgar (WAAA) is a low-cost neonatal health surveillance tool for newborns and NGOs. APGAR is an acronym for Appearance, Pulse, Grimace, Activity and Respiratory.
How is it used?
Two wearable soft patch sensors are attached to the chest and foot of a newborn baby upon their birth for a period of seven days.
What technologies does it incorporate?
The WAAA system incorporates proven, low-cost and low-power, commercially available wireless network technologies: respiratory, pulse and activity sensor patches, an XBee radio and gateway device and a mobile phone.
How does it work?
WAAA is a mobile phone, text-based service which systematically receives live data from a newborn baby that to several of APGAR criteria’s: Activity, Pulse and Respiratory. When predetermined alarm parameters are met, this triggers a SMS text alert to be sent to the supervising healthcare worker thereby instigating an emergency medical response. The period of active surveillance is purposefully designed to be limited; capturing data during the period where newborns are at most risk- the first minute, the first hour, the first day and first week of life. The system technologies we have specified are capable of monitoring multiple newborns over distances of 300ft to 40 miles. Within health facilities where human resources are stressed, WAAA de-skills and automates the process of clinical assessment to enable safe and efficient working. The remote monitoring of newborns can be extended to include distance supervision when mothers return to their village/ home- this overcomes problems of limited access community health workers.
Who uses it?
WAAA is designed for the wearer and mother, doctors and community health workers, health facilities and National Government Offices.
Why does it help?
It is said that “every baby born in a modern hospital in the world is looked at first through the eyes of Dr Virginia Apgar”. Virginia Apgar invented the Apgar score in 1952 as a method to quickly summarize the health of newborn children.
The Apgar scale is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. The five criteria are summarized using words chosen to form an acronym (Appearance, Pulse, Grimace, Activity, Respiration). A score of 7 and above is generally normal, 4 to 6 fairly low, and 3 and below is generally regarded as critically low. The test should be carried out at one and five minutes after birth, and may be repeated later if the score is and remains low. A low score on the one-minute test may show that the neonate requires medical attention, and it is important to note that the Apgar test’s purpose is to determine quickly whether a newborn needs immediate medical care.
However, over the years many researchers and clinicians have reported that the Apgar score as a ‘tool’ lacks sensitivity and specificity. Sensitivity measures how well the tool captures the infant’s condition at birth and specificity refers to how well the tool measures the differences between the values of the scores (0–2 for each of the five categories). Additionally, various authors have noted that great variability exists in how individual health care providers score the assessment indicating that the reliability of the instrument is limited.
Another concern is determining who has responsibility for assigning the APGAR score once the infant is born. According to Dr Apgar herself, the person assisting with the delivery of the infant should not assign the Apgar score. While in some respects the delivering individual seems the most logical choice, bias may be introduced into the score value, because Dr Apgar proposes the individual who attends the delivery may have a vested interest in the outcome. However, even in a modern hospital this is a highly unlikely scenario, even less so in a more remote, less developed setting. Furthermore, the universal recognition of the APGAR score means that much of the public, especially expectant parents, has some level of familiarity with it. However, many of these parents-to-be do not adequately understand the score or its capacities for both immediate diagnostic alert, and how scores can equally be interpreted for reassurance.
The mounting scientific evidence points to the need for a more objective, reliable and systematic method of applying the APGAR score – there is little doubt that the tool itself, if applied in this way, could help to prevent the 390,300 neonatal deaths that occur each day and provide reassurance to new parents or others who may attend a birth. Its strength lies in its immediacy, its universal recognition and its relative simplicity – these strengths are built into our proposed wearable device which will at the same time, eliminate the weaknesses that have been documented earlier. Ultimately, the wearable APGAR is tool applicable not just for health facilities in low-resource settings where the need for neonatal assessment is presently greater, but also in modern hospitals.
Dr. David Swann, Dr. Julia Meaton, Professor Minhua Ma, Dr. Serena McCluskey, Dr. Haydn Martin
Alert/Response, Diagnosis/Treatment/Referral, Data Collection/Data Insight
These pages have been pulled directly from applications submitted to the Wearables for Good Challenge in 2015. They represent the work of the individual teams and have subsequently not been edited.