Introducing the Awardees of the Johnson & Johnson Nurses Innovate QuickFire Challenge in Maternal and Newborn Health

Typical incubators are used to treat prematurity, low birthweight, breathing problems, jaundice, hypothermia and more critical health challenges for newborns. Our incubator prototype provides a new standard of care by providing a sterile, disposable infant housing that doesn’t require cleaning or disinfecting and a reusable battery supported controller that’s portable and compact. If a newborn requires an incubator, they can have an average length of stay anywhere from three to 90 days. Even though incubators must be cleaned and disinfected every seven days, they can still be a source of infection. We created a flexible, movable and disposable housing unit that can be used for up to seven days with the potential to reduce risks of infection, lower healthcare costs and address the lack of resources available for NICU infants worldwide.

The NICI™ provides the opportunity for babies who need incubators to be monitored in a less acute setting, such as smaller rural hospitals and clinics, which can help to reduce the burden on both parents and the healthcare system. In the event of an international crisis, it can be packaged, shipped and unfolded. There’s a place for our incubators in every ambulance. For rural communities far from NICUs, it can provide babies with high quality care before they even get to a hospital. We can hopefully revolutionize NICU care by providing this flexibility across the care continuum.

There really haven’t been innovations in neonatal intensive care incubators in decades, even though there is such a need for advancements in these settings. There is a global public health crisis of infant mortality and morbidity. According to the World Health Organization, each year over 2 million babies globally die during labor, childbirth or on the first day of life.[1] Around 15 million babies around the world are born prematurely, and one million newborns die before reaching the first week of life.[2] Not only is this devastating for families, but also for the development and advancement of communities and economies.

Current incubators are almost like cars. They are massive pieces of technology that are expensive and take up a lot of space in a hospital. We’ve created a portable model that has the potential to deliver much more than today’s incubators and can be used in any setting. Unlike other comparable devices available today, ours is able to provide multi-functionality because it can run on electricity, utilize WiFi and health data, is low cost and provides heat, humidity, phototherapy and ventilation.

[1] World Health Organization, & UNICEF. (2018). REACHING THE EVERY NEWBORN 2020 MILESTONES. Every Newborn Progress Report 2018 Executive Summary. Retrieved from https://www.healthynewbornnetwork.org/hnn-content/uploads/Summary-Every-Newborn-progress-report-2018.pdf
[2] World Health Organization, & UNICEF. (2018). REACHING THE EVERY NEWBORN 2020 MILESTONES. Every Newborn Progress Report 2018 Executive Summary. Retrieved from https://www.healthynewbornnetwork.org/hnn-content/uploads/Summary-Every-Newborn-progress-report-2018.pdf

Our innovation journey began with a personal experience with the challenges of neonatal care. In 1991, Dr. Wisam Breegi, the founder of Breegi Scientific, had a son born in Iraq and needed an infant incubator. His son was born in a warzone without electricity, so the family needed an incubator that could work in a challenging environment. This led him to learn more about infant mortality around the world and explore ways to improve the incubators currently available to health systems. One day, after I spoke on a panel about the significance of nurse-led innovation, Dr. Breegi asked if I could assist in the development his groundbreaking neonatal incubator.

By leveraging my experiences as a nurse, a founding member of the Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders (SONSIEL) and as the Senior Manager of Nursing Innovations at Boston Medical Center, I was able to advise on features the incubator needed to be better adopted by nurses and other healthcare workers. I converged feedback from nurses who advised on the entire design of the incubator, including its shape, what it could be used for, where the keypad should be located and more. As a nurse, I also understood the significance of bringing together other teams, such as doctors, scientists and respiratory therapists to improve the design.

Nurses are well-positioned to care for patients in an innovative way. Because nurses are there at the bedside, they constantly see opportunities for improving workflows and care delivery. We understand patient needs better than anyone else, so I believe anytime a healthcare product or solution is being developed, a nurse should be involved.

I’m incredibly excited and proud, largely because I know that a nurse’s perspective contributed to the success of this solution. With our new funding, we’re excited to take our NICU technology further with additional testing. And as we expand, we’ll be looking to nurses in governments and rapid response settings to advise on our development. I hope that this achievement can inspire more nurses to get involved in entrepreneurship. The sky is the limit.

There is a huge knowledge gap that prevents nurses from successfully developing their ideas. I would tell nurses to seek out the innovation leaders in their health systems and other educational opportunities that can prepare and equip them to innovate. I would also consider joining organizations like SONSIEL, which can be a great resource and network for nurses who have great ideas but don’t know where to bring them. Nurses should know there are many collaboration opportunities, like what I’m doing with Breegi Scientific. You don’t have to do this on your own.

My team and I have definitely been thinking through ways we can make variations of the NICI™ to create domes for frontline health workers or immobile patients. Our solution is now more relevant than ever, as there is a risk of mothers passing COVID-19 to their babies who may then infect other infants in the NICU. By offering these contained environments we can protect infants and other patients by limiting the transfer of this novel coronavirus. This belief is also fueled by what I’m seeing on the frontlines myself. My background is in critical care nursing, so I’ve returned to ICU to help the staff at my hospital develop workflows in how best to care for patients. It’s an honor to be delivering care with my team- I’m wearing scrubs for the first time in years.

Sigi Marmorstein, RN, PHN, MSN, FNP-BC, Founder and CEO at BabyLiveAdvice.com, created a telehealth platform that offers online support and advice from live healthcare providers for expectant mothers and parents.

I was working as a nurse practitioner in the NICU when I became pregnant with my first son. I had a very complicated pregnancy. I had a lack of knowledge around what was happening and experienced a lot of anxiety and post-partum depression. In 2009, I took on a telehealth consultant role and was asked to look at child morbidity in a community in California. The community largely consisted of Hispanic, migrant workers who lived miles away from a healthcare provider and we were looking at ways to use telehealth classes to help support these at-risk mothers, who arguably need more support than the average population. I felt so strongly that my own pregnancy experience could have been better with more knowledge and expertise, so I felt passionate about providing this support not just to mothers, but fathers, adoptive parents, grandparents and guardians as well. In 2014, I was asked to support a similar project through a healthcare system and this work lead to the concept of BabyLiveAdvice.

In 2014, we began providing educational training over the phone and realized how much women enjoyed these personalized interactions. We knew that women had a lot of questions, and realized we needed to expand to provide an email and chat feature. We also began to think through how to launch this as an open system that could be independent from insurance companies and more inclusive of mothers who may not be covered, so we decided to put together a team of experts. I put out an ad for nurses and midwives to join us and was so excited to create my first team of 16 healthcare workers. From 2014-2017 we piloted this platform, and BabyLiveAdvice.com went live in September 2018.

To date, we have over 3,000 members and have conducted over 14,000 consultations in both rural and urban communities for both men and women. We are online, have an app and are on all social media channels offering free chat advice, talking to groups and making ourselves available where these vulnerable mothers might be. BabyLiveAdvice now offers several membership packages for personalized prenatal, infant and toddler care. We also have contracts with insurance providers who can help cover the costs of membership and appointments. The feedback from our users has been amazing, and they are spreading the word. People across the entire country use BabyLiveAdvice, and a good number of our consultations have been done internationally. We’ve also developed a white label application which allows others to use our platform with their own healthcare providers, further helping us amplify our global reach.

One of the biggest drivers of maternal and infant mortality is healthcare deserts. In fact, according to the March of Dimes, over 5 million women are located in a healthcare desert.[3] Many women live far from their medical centers, which affects their ability to show up at appointments, learn about what they are experiencing and receive quality prenatal care. In the community I worked with in California, some mothers lived more than 100 miles away from their medical center and had to take between 4-5 buses to get to their appointments. There were no touchpoints between appointments. No one checking in on their mental health, monitoring their diabetes or treating their hypertension. There’s a lot of focus on mothers during their pregnancy and on the day of delivery, but not throughout the first year post-delivery when they are at risk for post-partum depression. Not only does BabyLiveAdvice provide guidance from nurse experts and midwives, we also offer specialists in lactation support, social work and care coordination, nutritional support and mental health services, beyond the first few days after the baby is born.

We are partnering with hospitals, employers, insurers, care organizations and non-profits to expand care outside of medical centers. When we do that, we know health outcomes for both mothers and their babies can improve. A nurse is the first person to know something is off with a patient. By providing a virtual care team online or through the phone, we can improve adherence and health outcomes for entire families. We are proud to report a 79% adherence rate for mothers attending their healthcare appointments, a 68% adherence rate for lactation and a satisfaction rate of 95%.[4]

[3] March of Dimes. (2018). Nowhere To Go: Maternity Care Deserts Across the U.S. Retrieved from https://www.marchofdimes.org/materials/Nowhere_to_Go_Final.pdf
[4] Now Babies Come With Instructions TM. (n.d.). Retrieved March 12, 2020, from https://www.babyliveadvice.com/

There are thousands of informational websites for expecting mothers. Women have information available, but they are confused and overwhelmed by it all. A personal touch with nurses and other healthcare providers makes us different. BabyLiveAdvice addresses every pain point and gap in care for new parents throughout their entire journey. We offer a platform that provides one-on-one conversations with parents in their own language and considers their own cultural background. Oftentimes, our mothers are paired with the same healthcare worker throughout the whole process. It is not something you can get through Google or such online search engines. Everything you need is in one place and we are with you from the beginning and throughout your parenthood journey.

BabyLiveAdvice was ready to support the influx of patients we received. Our business has grown tremendously over the last two months. Many pregnant women are currently unable to receive regular prenatal care or afraid to visit their health system. There is much fear about giving birth amid COVID-19 and many unanswered questions. Our staff was ready to support, educate and empower women and their families throughout this pandemic. In response to COVID-19, we also added several free services to ensure that we are part of the solution not the problem, such as COVID-19 chats, blogs, live online parenting and lactation classes, preparation for birth under COVID-19 classes and mental health support groups for pre- or post-natal anxiety and depression.

It is such an amazing honor. With this new support and funding, we are excited to expand our operations, do more with marketing and advertising, bring in more organizational support and continue to study health outcomes to make sure we are taking the right approach. Technology isn’t bound by state or country – we want to reach millions of moms wherever they are in the world, especially in those places where women are not allowed or encouraged to talk about maternal health. It is incredible to have an international company like Johnson & Johnson along in our mission to transform health.

The most important thing you can do is identify the real problem you are trying to solve. The actual, underlying problem. I would also say approach your solution from a place of caring. Nurses are great at putting patients at the center, and I think that is a great starting point to drive innovation.

Being awarded the Johnson & Johnson Nurses Innovate QuickFire Challenge means nurse innovators Sigi and Nicole and their teams will gain access to funding and support with the aim to help move their innovations forward, including grant funding of $50,000 each, mentoring and training opportunities from the Johnson & Johnson Family of Companies, and access to the Johnson & Johnson Innovation—JLABS ecosystem, which helps innovators accelerate discovery and get operational support to bring their healthcare solutions to life.