Stories about: Innovation

Building a better bubble: Engineering tweaks bring safe IV oxygen delivery closer to reality

thin-shelled engineered oxygen bubbles
(Courtesy Yifeng Peng, Boston Children’s Hospital)

Everything from food aspiration to an asthma attack to heart failure can cause a patient to die from asphyxia, or lack of oxygen. For more than a decade, the Translational Research Laboratory (TRL) of Boston Children’s Hospital’s Heart Center has been pursuing a dream: tiny, oxygen-filled bubbles that can be safely injected directly into the blood, resuscitating patients who can’t breathe.

The lab’s first generation of bubbles were made with a fatty acid, but the lipid shells weren’t stable enough for long-term storage or clinical use. The bubbles popped open too easily.

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Digital doctoring, big data and AI: Five takeaways

digital health

Big data and artificial intelligence are reshaping our world. Earlier this month, at Computefest 2018, organized by the Institute for Applied Computational Science at Harvard University, held the symposium, “The Digital Doctor: Health Care in an Age of AI and Big Data.” Speakers were:

  • Finale Doshi-Velez, PhD, Assistant Professor of Computer Science, Harvard University
  • Matt Might, Director, Hugh Kaul Personalized Medicine Institute, University of Alabama at Birmingham
  • John Brownstein, PhD, Chief Innovation Officer and Director, Computational Epidemiology Lab, Boston Children’s Hospital
  • Marzyeh Ghassemi, PhD, Visiting Researcher, Google’s Verily; Postdoctoral Fellow, Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology
  • Jennifer Chayes, Managing Director, Microsoft Research New England and New York City
  • Emery Brown, PhD, Professor of Medical Engineering and Computational Neuroscience, Massachusetts Institute of Technology

Here are Vector’s five takeaways from the symposium:

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Five devices for pediatrics get help in advancing to market

kids with pediatric devices playing doctor

Medical devices for children tend to have small markets, so development can lag up to a decade behind similar devices for adults. The Boston Pediatric Device Consortium (BPDC), formed through an FDA initiative, aims to change that math.

This month, the BPDC and the Innovation and Digital Health Accelerator at Boston Children’s Hospital announced five winners of a national pediatric device challenge. Each winner will receive a combination of up to $50,000 in funding per grant award and/or in-kind support from leading medical device strategic partners, including Boston Scientific, CryoLife, Edwards Lifesciences, Health Advances, Johnson & Johnson Innovation, Medtronic, Smithwise, Ximedica and the Boston Children’s Simulator Program. These organizations will provide mentorship, product manufacturing and design services, simulation testing, business plan development, partnering opportunities and more.

“We have a major unmet need for pediatric medical devices that are specifically designed to address the demands of a growing, active child,” said BPDC leader Pedro del Nido, MD, chief of Cardiac Surgery at Boston Children’s, in a press release. “We are pleased to support these teams as they work toward accelerating their technologies from concept to market.”

The five Challenge winners are:

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‘Pull’ from an implanted robot could help grow stunted organs

Surgeons at Boston Children’s Hospital have long sought a better solution for long-gap esophageal atresia, a rare birth defect in which part of the esophagus is missing. The current state-of-the art operation, called the Foker process, uses sutures anchored to children’s backs to gradually pull the unjoined ends of esophagus until they’re long enough to be stitched together. To keep the esophagus from tearing, children must be paralyzed in a medically induced coma, on mechanical ventilation, for one to four weeks. The lengthy ICU care means high costs, and the long period of immobilization can cause complications like bone fractures and blood clots.

Now, a Boston Children’s Hospital team has created an implantable robot that could lengthen the esophagus — and potentially other tubular organs like the intestine — while the child remains awake and mobile. As described today in Science Roboticsthe device is attached only to the tissue being lengthened, so wouldn’t impede a child’s movement.

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Six technologies we backed in 2017

Boston Children's Hospital technology

Boston Children’s Hospital’s Technology Development Fund (TDF) to designed to transform early-stage academic technologies into validated, high-impact opportunities for licensees and investors. Since 2009, the hospital has committed $7.6 million to support 76 promising technologies, from therapeutics, diagnostics, medical devices and vaccines to regenerative medicine and healthcare IT projects. The TDF also assists with strategic planning, intellectual property protection, regulatory requirements and business models. Investigators can access mentors, product development experts and technical support through a network of contract research organizations, development partners and industry advisors.

Eight startup companies have spun out since TDF’s creation, receiving $82.4 million in seed funding. They include Affinivax, a vaccine company started with $4 million from the Gates Foundation, and Epidemico, a population health-tracking company acquired by Booz Allen Hamilton. TDF has also launched more than 20 partnerships, received $26 million in follow-on government and foundation funding and generated $4.45 million in licensing revenue.

Here are the projects TDF awarded in 2017, with grants totaling $650,000:

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2017 pediatric biomedical advances at Boston Children’s Hospital: Our top 10 picks

New tools and technologies fueled biomedicine to great heights in 2017. Here are just a few of our top picks. All are great examples of research informing better care for children (and adults).

1. Gene therapy arrives

(Katherine C. Cohen)

In 2017, gene therapy solidly shed the stigma of Jesse Gelsinger’s 1999 death with the development of safer protocols and delivery vectors. Though each disease must navigate its own technical and regulatory path to gene therapy, the number of clinical trials is mounting worldwide, with seven gene therapy trials now recruiting at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. In August, the first gene therapy won FDA approval: CAR T-cell therapy for pediatric acute lymphoblastic leukemia.

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Giving young organ transplant recipients a mobile reminder that might save their lives

Flow chart showing how the medication adherence app interacts with patients and a near-field-communication-enabled pillboxIn the U.S., more than 1,700 children receive organ transplants each year. Following transplantation, they must take immunosuppressants and steroids to protect their transplanted organ from being attacked by their own immune system.

But transplant teams know that kids are 60 percent more likely than adults to struggle with keeping a strict medication schedule. That puts the longevity of donated organs — and the lives of organ recipients — at unnecessary risk.

This challenge inspired a team of pediatric transplant experts at the Boston Children’s Hospital to develop a mobile application for smartphones that could serve as a portable reminder and a resource to support medication adherence.

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Bypassing a narrowed midaorta with a living, growing graft

Midaortic syndrome is marked by narrowing of the middle section of the aorta.

By the time he arrived at Boston Children’s Hospital, the 6-month-old boy was near death from midaortic syndrome — a rare but life-threatening condition marked by narrowing of the middle section of the aorta, the largest artery in the body. It had left him with severe hypertension, acute kidney injury and heart failure. As cardiologists worked to stabilize him, the surgical team weighed the options.

With diminished blood flow to the chest, abdomen and lower limbs, a significant number of people with untreated midaortic syndrome die from complications by age 40. The condition can be treated surgically, traditionally with a prosthetic graft made from synthetic material to perform an aortic bypass. But synthetic grafts can pose a number of challenges in children.

“Synthetic grafts don’t grow with the patient, which means that multiple surgeries may be necessary through the years to ensure appropriate graft size,” explains nephrologist Michael Ferguson, MD, who was a member of this patient’s care team. “Artificial grafts also carry a higher risk of thrombosis and infection.”

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A “half-hearted” solution to one-sided heart failure

Illustration showing how the system supports a failing right ventricle
Illustration showing sectional view of a heart with the soft robotic system helping to draw blood into (left) and pump blood out (right) of the heart’s right ventricle.

Soft robotic actuators, which are pneumatic artificial muscles designed and programmed to perform lifelike motions, have recently emerged as an attractive alternative to more rigid components that have conventionally been used in biomedical devices. In fact, earlier this year, a Boston Children’s Hospital team revealed a proof-of-concept soft robotic sleeve that could support the function of a failing heart.

Despite this promising innovation, the team recognized that many pediatric heart patients have more one-sided congenital heart conditions. These patients are not experiencing failure of the entire heart — instead, congenital conditions have caused disease in either the heart’s right or left ventricle, but not both.

Read our Vector story on the soft robotic heart sleeve that mimics cardiac muscles.

“We set out to develop new technology that would help one diseased ventricle, when the patient is in isolated left or right heart failure, pull blood into the chamber and then effectively pump it into the circulatory system,” says Nikolay Vasilyev, MD, a researcher in cardiac surgery at Boston Children’s.

Now, Vasilyev and his collaborators — researchers from Boston Children’s, the Harvard John A. Paulson School of Engineering and Applied Sciences and the Wyss Institute for Biologically Inspired Engineering at Harvard University — have revealed their soft robotic solution. They describe their system in a paper published online in Science Robotics today.

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Shunt-flushing device for hydrocephalus gets FDA clearance; could help patients avoid extra surgery

A new shunt-flushing device flushes out shunt blockages noninvasively.
Brain shunts frequently clog up, requiring surgical repair or replacement. A new device flushes out the blockages with the press of a button. (Wikimedia/Adobe Images)

Children with hydrocephalus often have shunts implanted to drain the excess cerebrospinal fluid that builds up inside their brain. Unfortunately, shunts have a tendency to plug up. This potentially life-threatening event necessitates emergency surgery to correct or replace the shunt.

“If you have a shunt, you are always worried about what might happen in the future,” says Joseph Madsen, MD, a neurosurgeon at Boston Children’s Hospital. “Close to half of shunts will have a revision within the first year of implantation. About 80 percent will require a revision within 10 years.”

Last week, the FDA cleared a device originally conceived by Madsen that can potentially flush out a clogged shunt noninvasively, avoiding the need for surgery in both children and adults. The neurosurgeon or other trained healthcare professional could simply press a button at the back of the patient’s head, just under the skin, in an office setting, Madsen says.

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