The Neonatal Intensive Care Unit at Pennsylvania Hospital is a busy place, with little room for error and inefficiency. Every day, the doctors and nurses at Penn’s NICU treat dozens of prematurely delivered babies, who require constant care and attention.
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Among the most urgent tasks for nurses on the floor is keeping track of the breast milk pumped by their patients’ mothers—breast milk, for preemies, is vital to healthy maturation. But overseeing the management of breast milk is remarkably complex: The milk has to be analyzed for nutrients regularly, and stored properly; nurses and doctors need to able to keep track of when mothers pump milk; and contact needs to be constant between mothers and medical professionals, in case an issue arises.
As you might imagine, the method of keeping track of all of these variables can be a damn nightmare. According to Laura Carpenter, a NICU lactation consultant at Penn, the systems for tracking breast milk have been unintuitive and error prone—until very recently.
Penn’s NICU is near completion of a trial run with a locally-developed breast milk tracking and analyzing megaprogram called Keriton, a software system and app that can be used by NICUs to track breast milk as it is pumped. Mothers at home, or anywhere, can use the app to input when and how much milk they’ve pumped; healthcare providers at the NICU use it to analyze mothers’ habits, and make recommendations. It even includes a feature that allows nurses to send moms pictures of their babies in care, which reportedly induces more lactation.
“Keriton links all the pieces: mom to lactation, mom to baby, mom to nurses,” says Carpenter. “Keriton tracks milk at home; it tracks milk wherever it is. It has all these pieces connected as opposed to being disconnected.”
Vidur Bhatnagar, an Indian immigrant and the founder, CEO and CTO of Keriton first experienced a preterm birth in 2011, when his sister delivered a premature baby who could not breastfeed for three weeks. Bhatnagar’s nephew is fine now, but he says the premature birth affected him deeply. “The experience was so emotionally strong that it stuck with me for a very long time,” he says.
“I think more men need to step up for female health issues,” Bhatnagar says. “Male interest in female health is starting to pick up; people are starting to realize that this is an important area that needs attention.”
Bhatnagar’s training and personal experiences came together in 2016, when he and a team were participating in the annual PennApps Hackathon. Bhatnagar and his team, as part of a prompt at the competition, were tasked with listening to the issues that nurses at Penn’s NICU face most regularly. Chief among them, of course, was keeping track of breast milk.
Bhatnagar says that the nurses at Penn’s NICU faced the same challenge that vexes nurses across the country: an antiquated, user-unfriendly system for monitoring, printing and cataloging the amount and nutritional content of breast milk. Each bottle can require up to 20 different notations, from confirming mother and baby’s names, to logging expiration dates, when it’s put in the fridge, how much is in each bag, which nurse used how much and when for the baby. Nationally, the country’s NICUs spend approximately 13,000 man-hours annually solely on breast milk management.
“We went with the nurses, we went to the NICU, and we realized that this is not just a problem of tracking moms’ pumping,” he says. “The entire breast milk management process is extremely manual. It’s very inefficient and error-prone.”
Bhatnagar, who has worked for SAP and is currently a candidate for a master’s degree in robotics from Penn—and also the former president of the college’s Engineering Master’s Advisory Board—saw a system that wasn’t just in need of disruption, but one that needed to be toppled. “I had seen these problems first hand,” he says. “I knew I could solve these problems.”
Armed with a wealth of personal experience, Bhatnagar—responsible for most of the development of the software and app— set about drafting what would be his opus: a system that would unify disparate aspects of breast milk tracking, and be accessible and easy to use for nurses, who have precious little time to contend with outdated, difficult to use systems. The prototype was called, Lact-O-Log (a little on the nose). That, eventually, became Keriton.
Keriton is like a Swiss Army knife of breastmilk tracking. With a simple-to-use app, it allows mothers to upload all the pertinent information about their milk—when, how much, where they pumped. It provides them with recipes that might improve the nutritional value of the milk. And it has a live camera feature to help doctors and nurses monitor and advise moms as they are pumping.
In the hospital, that information is automatically transmitted to a computer system, which lets healthcare providers automatically track the inventory and analytics for each mom and each baby. This cuts down on errors, and on time—allowing more nursing attention to be paid to patients, rather than data entry.
Premature births are increasing in the U.S. From 2014 to 2015, the percentage of preterm births grew from 9.57 to 9.63 percent. According to the Centers for Disease Control, 36 percent of infant deaths were related to preterm conditions.
The Keriton system provides some relief to the overworked folks who operate in neonatal care—which, vexingly, is a major industry in the U.S. The sad truth is that the United States has remarkably bad premature birth rates compared to other developed nations. According to the March of Dimes, there are only six countries in North America and South America combined that experience north of 10 premature births per 100 live births: Honduras, Costa Rica, Guyana, Uruguay, the Dominican Republic and the United States. And the U.S. is the only G20 country to average more than 10 premature births for every 100 live births.
The most disconcerting part of it all? Premature births are increasing in the U.S. From 2014 to 2015, the percentage of preterm births grew from 9.57 to 9.63 percent. There are myriad factors behind this. Prematurity runs in families, and is something of an inescapable sentence for some; but experts say that many premature births can be linked to autoimmune disorders and environmental hazards, including air pollution. The increase in assisted reproduction has led to an increase in multiple births, which are more likely to be born premature. Prenatal care in the U.S. is woefully underfunded, and under constant assault in many states in the form of cuts to women’s health clinics.
Nationally, the country’s NICUs spend approximately 13,000 man-hours annually solely on breast milk management.“The entire breast milk management process is inefficient and error-prone,” Bhatnagar says.
The richest country on the planet, as it turns out, is not even close to being among the best countries in the world in which to deliver a baby: According to the Centers for Disease Control, 36 percent of infant deaths were related to preterm conditions.
Bhatnagar admits that he can seem a little out of place in the world of breast milk analysis. Lanky, confident and all of 6’3”, he says that he certainly stands out in his chosen business universe. “I’ve been in meetings where I’m the only guy,” he says. “But I think more men need to step up for female health issues. Male interest in female health is starting to pick up; people are starting to realize that this is an important area that needs attention.”
In spite of his engineering chops and industry-shaking pitch, Keriton faced some issues getting off the ground. “Every single challenge that young companies face, we faced” Bhatnagar says. Even after the struggles with designing a product that solved the problem, Keriton dealt with the difficulty of business-to-business sales—it can be hard to sell major hospitals on a mostly-untested product. Penn’s NICU—the inspiration for the product—was the first to give Keriton a test run.
Penn’s Carpenter says Keriton was such a success that nurses on the floor were jostling over who would get to use the program next. “It’s so much quicker. The moms love it, the nurses love it. We want it to be our new system,” Carpenter says. “It’s been very, very well received.”
Keriton, which boasts a team of five full-time employees, including Bhatnagar, is a startup darling. It was named Startup of the Year at last weekend’s Philly Geek Awards. At least year’s SXSW, it won first place in the Impact Pediatric Health Pitch Competition, beating out 149 other contestants. It has secured investments from several major funders, including BioAdvance, the Wharton Innovation Fund and Penn Medicine itself; it was incubated, and supported with two rounds of funding, by Philly’s DreamIt, one of the top health startup accelerators and incubators in the world. The company, which is not yet profitable, has raised more than $1 million in funding so far.
Keriton, which is not yet profitable, will charge hospitals an annual fee based on the size of the hospital and the number of babies being tracked—about .85 percent of the average cost of care for a baby in the NICU. Currently, Bhatnagar says the company is negotiating trial runs with about a dozen hospitals across the country, and fielding calls from around the world. He is not shy about his ambitions—Keriton, he says, could sometime soon be the dominant breast milk analysis program in the world.
“It’s a never-ending problem,” Bhatnagar says. “Babies are going to be born, they are going to be premature, they are going to be in the NICU, and we want this technology to be ubiquitous around the world.”Header Photo: Flickr