Taiwan introduces innovative technology to improve maternal and newborn care

By Frances Huang

In response to "2022 World Patient Safety Day", HST and JCT organized a series of webinars in September and October, the topic covers different dimensions of how to improve patient safety. Dr. Pa-Chun Wang, CEO of JCT,  mentioned even the number of newborns has dropped over the year, but there are still numbers of tragedies happened which is not acceptable to the healthcare. To improve patient safety from improving the quality of maternal and newborn health care is the topic of the webinar on 4 October 2022.

Maternal Empowerment, Peace of Mind for Childbirth—Safe Maternal and Newborn Care

Ms. Mei-Fei Hsieh, Supervisor of the Department of Nursing at Chi Mei Medical Center, Liouying, shared her experience. Chi Mei Medical Center had been accredited as Baby-friendly Hospital in 2008, 2014, and 2018 to 2022. Chi Mei Hospital had been focusing on providing a gender-friendly medical environment for years, providing diversified prenatal education guidance, and supporting women with full maternal and prenatal information. Chi Mei Hospital also developed “Perinatal Period High-risk Pregnant Women (Child) Tracking Care Program” to track them and provide related care services to reduce the risk.

Maternity care for contemporary women can be divided into 3 models, medical model, midwifery model and collaboration model. Collaboration model combines the benefit of medical model and traditional midwifery model, providing different phase of maternity care service. Chi Mei Hospital also supports maternal women to set their own "Birth Plan" by providing professional suggestions and information according to their needs and will, enhancing maternal women have better understanding of the process of delivery and what they need to know and do during the pregnant. Their service covers diet, medical, environment, activity, education, and mood, not only for the parent but also for the newborns.

Ms. Mei-Fei Hsieh said, overall, we provide full information and knowledge about maternity and period of pregnant, delivery and postpartum care, empower the women with full knowledge and let them decide what kind of care they would like. Chi Mei not only focuses on the physical status of the maternal women but also care about their psychological status by observing their mood, providing support group, and organizing activities. After delivery, to improve parent-child attachment, the hospital provides various services such as room-in, teaching parents how to take care and feed newborns, help mother build their confidence. All our maternity and newborn care service are based on love and care, providing a friendly, safe, warm environment for parents and newborns.

Since COVID-19 had changed our way of life, many programs we used to provide had turned on-line, and we faced many challenges especially the networking, caregiving, and postpartum service. While everything goes online convey via video or audio had helped us a lot. Health care workers in Chi Mei hospital also gain benefits due to the alternative way of connection. We arrange many close discussions and meetings or studies to improve or optimize our program of empowerment maternal women.

How Smart Birth Center Technology Can Help Enhance Maternal Fetal Health Care

Unpredictable maternal, newborn mortalities and morbidities now remain the concern in hospitals. Around 50% of maternal deaths and one-third of neonatal deaths occur in the first 24 hours of birth, it's important for medical workers to stay focused in the first 24 hours to reduce the risk of labor. Nowadays various maternal early warning systems (MEWS) based on the maternal early warning criteria (MEWC) are developed and applied in the labor and deliver to avoid delays in recognition and intervention for obstetrical complications. However, there're still many factors lead MEWS malfunction.

Dr. Steven Shaw from Chang Gung Memorial Hospital, Taipei shared their newly designed project "Smart Birth Center" which supervised by Prof. Po-Jen Cheng from GeneJet Biotech Company Limited. Smart Birth Center is designed to reduce the workload of manually entering data and warning alarm fatigue which often derived from MEWS. Smart Birth Center is an informatics system combined with an auto reminder using MEWC and intrapartum care bundles for pregnant women in the labor and delivery room. The system incorporated a fetal heart rate interpretation algorithm and electronic portogram based on arevised definition of normal labor progress.

The Smart Birth Center will have a dashboard in nursing station for nurses to monitor all the pregnant women, patient information bedside terminals allow device collecting and analysis of the data, and the nursing control station. The Smart Birth Center itself is an architecture of secure intranet-based multi-function hardware and software. The bedside terminals connected by iward+DR which is an intelligent labor and delivery unit surveillance system, it receives, integrates, summarizes, and analyzes data from physiologic monitors, EHRs and other monitoring devices.

The information and data collected will be stored in SOL database to serve as CDSS of maternal health care, fetal health care ad individualized labor and delivery care. The system is designed to reduce unnecessary cesarean delivery and promote maternal fetal health by integrating the information for the healthcare workers and creating a smart working environment to prove safe maternity care service.

Pre-eclampsia is a leading cause of the maternal death, pre-eclampsia is ranked top of the cause of maternal death globally. Even in Taiwan, there still 2-5% of maternal death caused by pre-eclampsia, and the rate keep rating these years. So we have to worry about the pre-eclampsia especially the pregnancy induced tension. We need to control the blood pressure carefully and give the aspiring as early as possible.

Dr. Pa Chun Wang from JCT raised a further question about this issue and bring the discussion to another level, since most of the countries, the government had provided the prenatal care and service, for pregnant women to have regular check-up and follow-up care, but why are there still many potential problems can't be controlled or prevented? Is there anything or data missing within the process?

Dr. Shaw indicated that in most of the countries providing program of the screening for pre-eclampsia. In Taiwan, we routinely check for pre-eclampsia and screening, especially around 11 to 14 weeks. But even so, we still can’t control every single case of pre-eclampsia, however, we did reduce the rate of pre-eclampsia for we had provide the aspirin as early as possible. There still room for improvement for control the blood pressure of pregnant women.

Most of the high-risk pregnancy can be detected by regular checkup. High-risk pregnancy detection like GDM diabetic meters, we have a routine checkup around 24 weeks, so we will provide the water with sugar glucose water so we can check that she is high risk for the GDM or not. And we also provide pre-eclampsia screening around 11 to 14 weeks, so it's how we work to detect high risk pregnancy. Chang Gung Memorial Hospital also work with Hong Kong Chinese University, Prof. Leonard Ho, they had published 2 important research about the pre-eclampsia and work with around 11 countries in Asia for this issue. Routine checkup is the guideline for detecting high risk pregnancy and helps prevent tragedy happen.

This system Dr. Shaw shared can detect the abnormal fetal heart rate for they had the normal fetal heart rate in the system already, so when the system detected that the heart rate is decreasing or any sign shows that the rate is different from usual, the system will alarm on the dashboard and the nursing station and when the abnormal detected. At the same time, the signal will send to the personal device like smartphone or pad which the physician use while on duty, so the doctor will go double check with the nursing station first and have a look on the dashboard to know the alarm is correct or a false alarm, after that we'll let the staff know what to do next depends on the situation.

Dr. Jaundice—A Mobile App for Screening of Neonatal Jaundice

Jaundice is a phenomenon due to yellowish pigmentation of the skin and sclera due to excess of bilirubin. It may cause irreversible brain damage, but most of the newborns can be treated at appropriate time by early detection of Jaundice to reduce complication. Neonatal Jaundice is common in Asian newborns, there're 80-85% newborns have jaundice within 2 weeks after delivery in Taiwan, 10-15% newborns require hospitalization and only 0.1% of the newborns with jaundice have brain sequelae due to severe jaundice or delayed treatment. Usually, the jaundice will recover within 10 to 14 days after delivery. The risk of jaundice is evaluated based on the postnatal age and serum bilirubin level. Detection of jaundice is important in early phase, usually medical workers will detect via observation by eyes, Transcutaneous bilirubinometer (TCB) or blood test. Currently, there's no accurate and reliable jaundice screening tool for parents to use at home.

Due to the reason above, Dr. Hsin-Hsu Chou, Director of Department of Pediatric, Innovation and Incubation Center at Chia Yi Christian Hospital, and his team had developed a mobile app which makes jaundice detection accurate, safe, and convenient. Parents can screen their newborns for jaundice detection anytime anywhere and prompt result in real-time.

The app has exclusive patented color block configuration, excellent color normalization to make sure the color recognition won't be affected by light reflections which enhances the accuracy of detection. What user do is taking photo of their newborn, the image will be sent to cloud server for data analysis and comparison with SQL historical data record. After the that, the result will be sent back to user's mobile within 2 minutes including the risk of jaundice with related information and suggestion for parents as reference.

According to the research of the performance of detecting jaundice by smartphone application, the accuracy of the predicted bilirubin level is highly correlated with the standard blood test. Dr. Jaundice is applicable to all newborns, the accuracy of the detection help avoids unnecessary blood draw, and reduces irreversible brain sequelae.

However, Dr. Jaundice only enrolls Taiwanese babies in Dr. Jaundice's data. According to the research, the variation in the different babies from different races won’t be too much, so the variation should not affect the algorithm. Dr. Jaundice plans to enroll more data of babies from different races to expand the data to provide the service to people with different skin.

To maximum the utility of Dr. Jaundice, how to actively interact with medical family is important. Especially after experienced the pandemic time, most of the parents are worried to take their babies to hospital too often. Dr. Zhou said that it is also his concern to add on new function to interact with hospital and parents, parents can consult with doctors while their babies are identified any risk of having jaundice so the doctor can advise the parents to take some methods to prevent the progression of jaundice.

Smart Baby Care System with Non-invasive Fiber Optic Physiological Monitoring Technology

Founder and CEO of Huijia Health Life Technology, Ms. Shu-Chen Yang represent the perspective of medical and health care industry. Huijia Health Life Technology focusing on developing AI Smart Care System for remote monitoring of digital biomarkers to support precision health and precision medicine to take better care of people.

nFORT is a smart baby care system, it was developed more than 10 years ago and had been commonly adopted in hospitals and infant care centers around the world for years. The most advantage of nFOPT is no extra device needed, by symptoms tracking, it helps user monitor their beloved one remotely. nFOPT helps parents protecting their newborns by sensing and analyzing their breathing patterns, rate, and sleep quality. The data will be recorded and can be provided to professional medical team as reference for medical decision when needed.

nFOPT is designed for hospital, nanny and parents. While in the hospital, nFOPT will only send alarm when there's an abnormal situation detected for medical needs, that's why nFOPT has been applied in hospital and gained good reputation for 8 years. Speaking of caregivers, the situation can be different, especially moms. According to the research, the person who interested in this kind of monitoring device is due to their anxiety. At the meanwhile, we can also find the fun facts in the research that the main reason causes the user to feel anxious is the false alarm. The more frequently that false alarm happens, the more anxious and insecure they feel. Ms. Shu-Chen Yang said that's also the reason Huijia keep optimizing nFOPT to reduce and prevent the happen of false alarm, for the purpose is using technology to help people have a peaceful mind while taking care of their loved one. She said that "our user mostly are new moms, our product helps them taking care of their first baby. According to the feedback from our users, those moms still enjoy using our product even they have second or third baby".

Due to COVID-19, international movement has been restricted for 2 years. Before the end of the webinar, Dr. Pa-Chun Wang is happy to announce that the Smart Healthcare Exhibition will be held in March 2023. Welcome to Taiwan, and experience Taiwan's digital healthcare, innovation, and solutions. Together, with technology and innovation, we can make the world better.

The JCT established the Health Smart Taiwan (HST), a one-stop portal designed to promote Taiwan's high-quality smart healthcare solutions since 2019. HST combines Taiwan's cutting-edge smart healthcare solutions with the demo site in Taiwan, helping visitors to fully understand the application and development potential of smart healthcare, while creating a new model for smart hospitals. In addition, JCT also welcomes healthcare partners from all over the world to come to Taiwan for face-to-face exchanges on the application of innovative medical technologies.

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