Gentle treatment for premature babies with lung diseases

December 3, 2018, Fraunhofer-Gesellschaft
Demonstrator: Sensor film and nasal prong with integrated miniature aerosol valve on a preterm infant training dummy. Credit: Fraunhofer ITEM

Premature babies who are born before their lungs have finished maturing often suffer from a lack of surfactant – a substance necessary for lung development. They are also particularly susceptible to illnesses of the respiratory organ, which have to be treated by means of inhalation. However, the inhalation systems available are not geared to the needs of preterm infants and newborns. Researchers at the Fraunhofer Institute for Toxicology and Experimental Medicine ITEM are working with partners to develop a system that would allow drugs to be administered as aerosols in an efficient and breath-triggered manner. This would shorten therapy duration, thereby easing the strain on little bodies.

Worldwide, around 15 million babies are born prematurely every year – and the trend is growing. Industrialized countries are no exception to this development. According to World Health Organization (WHO) figures, the rate in Germany is 9.2 per 100 newborns. One of the most common complications in is bronchopulmonary dysplasia, a caused by the artificial ventilation that the infants often need. Also, because the ' immune systems are not fully developed, they have an increased risk of infection. Lung infections are best treated with inhaled drugs. However, there are no inhalation systems that are specially adapted to the needs of premature babies and other newborns, as developing the corresponding technologies is very complicated due to the specific breathing characteristics of the tiny patients. Preterm infants typically have a high respiratory rate of 40 to over 60 breaths per minute and short inhalation periods of 0.25 to 0.4 seconds. On top of this, neonatal lungs have only a small tidal volume, posing extra difficulties for inhalation treatment. For this reason, scientists at the Fraunhofer Institute for Toxicology and Experimental Medicine ITEM in Hannover are working together with partners from industry and research to develop a new inhalation system allowing premature babies to receive an efficient inhalation therapy that is gentle on their lungs.

"Administering drugs to premature babies by means of inhalation is difficult. The current method of continuously delivering aerosols – that is, drugs in the form of particles – into the airflow is inefficient. For one thing, a large portion of the expensive drug gets lost on account of the inhalation/exhalation ratio and thus provides no medical benefit. Moreover, the aerosol is immediately diluted by the airflow traveling through the respirator," says Dr. Gerhard Pohlmann, head of the Fraunhofer ITEM Division of Translational Biomedical Engineering. The project partners are developing a new breath-triggered method whereby the aerosol is administered directly to the nose only when the premature baby inhales. "For the first time, this opens the door to the highly efficient administration of drugs to preterm infants. This means that the amount of active ingredients can be reduced and therapy durations can be shortened. In addition, precise time control with very short inhalation boli permits the focused treatment of specific regions," says Pohlmann. A similar system would also be fundamentally suitable for adult patients who require daily inhalation therapy. Shortening the administration time can substantially improve their quality of life.

Sensor film for monitoring the respiration of premature babies

The innovative inhalation system combines two technologies: A nasal prong with a miniature aerosol valve that is directly applied to the nose of the preterm infant. With a response time of just a few milliseconds, the aerosol valve allows the active ingredient to be released in a rapid, targeted manner. Opening of the valve is controlled by a sensor film. Laid on the abdominal wall of the premature baby, this flexible matrix uses sensors to detect the movement of the upper abdomen, thereby measuring the exact moment the baby breathes in. For the precise release of the aerosol, the measurement signal controls the micro valve via an intelligent algorithm. "The timing of the inhalation must be caught with an accuracy of about 20 milliseconds. Placing normal sensors in the exhalation region of a respirator does not permit this level of precision," explains the researcher. The breath-triggered inhalation systems currently available are either reliant on measuring the breath signal in the breathing hose or else coupled to the ventilation system via an electrical connection. "Our ventilator-independent respiration recording system removes the need to interfere with an already approved device and thus reduces approval obstacles."

Both the sensor film with ultra-thin ICs and the breath-triggered technology are being developed by a consortium in the FLEXMAX project (see box). The German Federal Ministry of Education and Research (BMBF) is funding the project, which addresses key aspects of the New Electronic Systems for Intelligent Medical Engineering (Smart Health) tender.

In tests with adults and in trials using devices that simulate the breathing of premature babies, there was an increase in efficiency of 60 percent compared to conventional inhalation technology. To be able to test the sensor film at an early stage in realistic conditions, the project partners are also developing an artificial abdominal wall that moves like that of a premature baby.

The complete inhalation system is currently available as a demonstrator, and it will take about three to five years before it is production-ready, says Pohlmann.

Breath-triggered administration of dry-powder drugs

The team of experts at Fraunhofer ITEM are also carrying out research into application systems for the administration of dry-powder formulas by means of , which could be used, for example, to treat premature babies with infant respiratory distress syndrome. This syndrome arises when the not fully developed lung either does not produce enough surfactant or does not produce any at all. Without surfactant, which reduces surface tension in the pulmonary alveoli, the lung is unable to expand. The baby suffers from oxygen deprivation and breathing distress and needs artificial respiration. Usually, surfactant obtained from animal lungs is flushed into the lung in the form of a suspension. The problem is that this so-called instillation is traumatic and the surfactant administered in a suspension does not spread as evenly through the lungs as aerosols do. In contrast, if the surfactant is administered as a moistened dry aerosol to be inhaled, it is distributed more homogeneously and works more effectively.

Explore further: Bacteria passed on in the womb is linked to premature birth and breathing difficulties

Related Stories

Bacteria passed on in the womb is linked to premature birth and breathing difficulties

September 13, 2018
Babies born very prematurely are more likely to harbour Ureaplasma bacteria, according to new research to be presented on Sunday at the European Respiratory Society International Congress.

LISA best strategy to prevent chronic lung disease in preterm infants

August 9, 2016
Researchers from McMaster University have evaluated and determined the best ventilation strategy to prevent chronic lung disease, one of the most significant complications in preterm infants.

Tests to bolster lung function later in life

May 4, 2015
Scientists have recommended a combination of lung function tests for prematurely born babies and children to help prevent the worsening of chronic respiratory disease throughout adulthood.

Synthetic surfactant could ease breathing for patients with lung disease and injury

July 9, 2018
Human lungs are coated with a substance called surfactant which allows us to breathe easily. When lung surfactant is missing or depleted, which can happen with premature birth or lung injury, breathing becomes difficult. ...

Lung damage in ventilated preterm infants differs with gestational age, early research shows

August 27, 2018
Assisted ventilation is crucial to support very preterm babies, however the treatment often leads to chronic lung disease. While the survival of preterm babies has increased over the past 30 years, rates of chronic lung disease ...

New drug approved for antibiotic-resistant lung disease

October 1, 2018
(HealthDay)—Arikayce has been approved by the U.S. Food and Drug Administration to treat lung disease caused by Mycobacterium avium complex (MAC) bacteria among people who don't respond to conventional therapies, the FDA ...

Recommended for you

Study examines disruption of circadian rhythm as risk factor for diseases

December 11, 2018
USC scientists report that a novel time-keeping mechanism within liver cells that helps sustain key organ tasks can contribute to diseases when its natural rhythm is disrupted.

New light-based technology reveals how cells communicate in human disease

December 11, 2018
Scientists at the University of York have developed a new technique that uses light to understand how cells communicate in human disease.

Scientists have identified and modelled a distinct biology for paediatric AML

December 11, 2018
Scientists have identified and modelled a distinct biology for paediatric acute myeloid leukaemia, one of the major causes of death in children.

Expert proposes method to help premature infants thrive in the hospital

December 11, 2018
Even when they're not actively feeding, infants are perpetually sucking on toys, pacifiers, their own fingers—whatever they can get ahold of.

Siblings of children with autism or ADHD are at elevated risk for both disorders

December 10, 2018
Later-born siblings of children with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for both disorders, a new study led by Meghan Miller, assistant professor in the ...

Study may offer doctors a more effective way to treat neuroblastoma

December 7, 2018
A very large team of researchers, mostly from multiple institutions across Germany, has found what might be a better way to treat patients with neuroblastoma, a type of cancer. In their paper published in the journal Science, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.