Digital tools can be employed in research to gather data efficiently, improve scientific insights, and support in the diagnosis and management of infant colic, regurgitation, and constipation.
by Dr Thomas Ludwig
Advances and opportunities in digital healthcare
In less than two years from now, there will be over 50 billion smart connected devices in the world, all developed to collect, analyse and share data.1 In 2015, Google announced that more searches were done on mobile devices as compared to desktop computers.2 Knowledge, including that around clinical diagnostics, is no longer exclusive.
Moreover, the way researchers and healthcare professionals gather real-life information and interact with families at the same time is inevitably changing. For example, parents have been found in a study to be more likely to search for health information online about their children than from their relatives upon signs of common illnesses.3
Functional gastrointestinal disorders (FGID) such as regurgitation, infant colic, functional constipation and related signs and symptoms, which affects approximately 50 percent of children from birth to six months of age, is a common source of worry for parents.4,5 It can impact parent-child relationships in the short and long-term and incur significant personal and public healthcare expenditures.6,7 With the availability of online portals, parents can exchange personal experience and treatment recommendations via social media and access health articles online, however, not all online information pertaining to management for regurgitation, infant colic, functional constipation and related signs and symptoms are scientifically substantiated. In addition, scientific literature and evidence-based resources may not be widely accessible or easy to understand.
This article looks at how adopting digital technologies can help in paediatric research and clinical practices, particularly for FGID management. Firstly, through digital technology, healthcare professionals can have access to the most updated patient information and monitor patient’s progress in real time, which will enable them to provide targeted reassurance and nutritional advice to parents in a timely manner. Furthermore, from a research perspective, new advances in Artificial Intelligence (AI) tools such as Machine Learning, Internet of Things (IoT) and data analytics can be used to improve scientific insights by increasing efficiency and reducing human error in research. New insights can help optimise management of common gastrointestinal issues in children and reduce the inappropriate use of medication or dietary interventions, which may ultimately save personal and public healthcare costs.7,8
Digital innovation closes gaps in healthcare
Existing help provided to parents to better manage FGID during infancy includes education, reassurance and nutritional advice.8 With increasing smartphone usage, parents are turning to mobile apps9 and smart connected tools to monitor babies’ vitals and health or make diagnosis on symptoms.10 Yet, with the proliferation of parental apps, it is vital that healthcare experts are involved in the developing process to ensure that parents are provided with the right information.11
Given that healthcare professionals are unable to physically attend to every baby at all hours of the day, chatbots and telemedicine services open an interesting additional channel to provide diagnosis, treatment advice, and reassurance to parents.12 AI based chatbots have advanced rapidly over the past years to a degree where they can reliably offer consultation based on personal medical history and the latest guideline-based medical knowledge, as well as live video consultations with a real doctor. A chatbot for dispensing medical advice was even used by the UK’s National Health Service for a trial period in 2017, which can potentially reduce manpower costs.13
Digital technology also has a key role to play in ensuring faster and accurate medical diagnosis. With the help of technology, healthcare professionals can detect symptoms efficiently while reducing human errors and cut down consultation time. For diagnosis and management of the most frequent gastrointestinal issues in children, a mobile or desktop application such as GIDiApp, which has been developed by clinicians and researchers, is available to guide healthcare professionals.14
Smarter approach to paediatric research
Digital technologies such as machine learning can be applied in FGID research in infants. The aetiology of FGIDs is multifactorial and complex.15,16 Without digital research tools, it can be challenging to assess how multiple factors interact to impact a baby’s risk of developing various illnesses, especially when analysing multiple data samples.
This limitation can be circumvented with machine learning algorithms that can detect patterns from multiple nodes across big samples. The principle behind this technology is that the more data it receives, the more accurate the predictive analysis.17 Machine learning has been applied in other medical fields with considerable success. For instance, the technology has shown promising results in identifying and predicting risk outcomes for complex diseases such as cerebral palsy, 18 and has been increasingly explored in paediatric research to identify and predict a child’s risk for anxiety disorders and autism.19
For scientists and healthcare providers alike, AI can be a game-changer in improving knowledge and understanding of FGID which remains poorly understood as its symptoms can arise without any identified biological abnormalities.20
Improve research accuracy and efficiency
As infants have yet to learn to articulate their distress, many studies on infantile conditions such as colic rely heavily on parents’ recordkeeping21 or questionnaire responses.4,22 This methodology has its limitations when it comes to accuracy and long-term compliance.
The adoption of digital tools such as wearable devices and smartphone apps allow researchers to access data efficiently and free from bias. For example, until recently, no method for the automated detection and quantification of crying and fussing existed for diagnostic or clinical study purposes. Danone Nutricia Research has developed in collaboration with the Lena Research Foundation a new methodology to automatically identify, quantify, and distinguish periods of crying versus fussing.
The new approach utilises the LENA (Language ENvironment Analysis) system, which comprises a small digital audio recording device fitted in specialised clothing worn by the child plus processing software.23 The device is able to distinguish between crying and fussing with more than 90 percent overall accuracy. This was achieved through the application of machine learning algorithms, which allows the device to reliably and objectively identify and quantify both crying and fussing. As compared to parental diaries, this innovation offers ease of use, objectivity, and high temporal resolution.23
In addition, through IoT, which is defined as an embedded network of objects which can exchange data, digital devices can capture and transmit reliable data in real-time without interruptions to the users.24 Various technology companies and organisations are starting to recognise the potential of IoT in improving maternal and child health. UNICEF have launched an incubation programme called ‘Wearables for Good’ that fosters collaborations between tech start-ups and sees the development of low-cost baby health monitoring tools for malaria and fever in rural communities.25
Globally, the digital health market is forecasted to grow to US$379 billion by 2024.26 In Asia, current healthcare applications for digital technology focus on improving systems efficiency and health literacy1 or helping parents monitor their child’s health.5 However, there are still other exciting opportunities to explore.
As more parents continue to embrace technology as means to monitor and ensure their babies’ health, it presents an avenue for researchers and healthcare professionals to collaborate and gain scientific insights and ultimately provide targeted, tailored interventions.
- Ericsson. (2011). More than 50 billion connected devices. Ericsson. Retrieved from http://www.akos-rs.si/files/Telekomunikacije/Digitalna_agenda/Internetni_protokol_Ipv6/More-than-50-billion-connected-devices.pdf
- Zakrzewski, C. (2015). Mobile Searches Surpass Desktop Searches At Google For The First Time. Retrieved from https://techcrunch.com/2015/10/08/mobile-searches-surpass-desktop-searches-at-google-for-the-first-time/
- Van der Gugten, A., de Leeuw, R., Verheij, T., van der Ent, C., & Kars, M. (2016). E-health and health care behaviour of parents of young children: a qualitative study. Scandinavian Journal Of Primary Health Care, 34(2), 135-142. doi: 10.3109/02813432.2016.1160627
- Vandenplas, Y., et al., Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age. J Pediatr Gastroenterol Nutr, 2015. 61(5): p. 531-7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977935/
- Iacono, G., et al., Gastrointestinal symptoms in infancy: a population-based prospective study. Digestive & Liver Disease, 2005. 37(6): p. 432-8.
- Raiha, H., et al., Excessively crying infant in the family: mother-infant, father-infant and mother-father interaction. Child Care Health Dev, 2002. 28(5): p. 419-29.
- Mahon, J., et al., The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England. BMJ Open, 2017. 7(11): p. e015594.
- Salvatore, S., Abkari, A., Cai, W., Catto Smith, A., Cruchet, S., Gottrand, F., ... & Staiano, A. (2018). Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatrica.
- Lee, V. (2017). App ways to parent. The Straits Times. Retrieved 20 April 2018, from http://www.straitstimes.com/lifestyle/app-ways-to-parent
- Imison, C., Castle-Clarke, S., Watson, R., & Edwards, N. (2016). Delivering the benefits of digital health care. Nuffield Trust. Retrieved from https://www.nuffieldtrust.org.uk/files/2017-01/delivering-the-benefits-of-digital-technology-web-final.pdf
- Comstock, J. (2018). Study: There's still very little evidence that health apps work. Mobihealth News. Retrieved from http://www.mobihealthnews.com/content/study-theres-still-very-little-evidence-health-apps-work
- Yager, P. H., Clark, M., Cummings, B. M., & Noviski, N. (2017). Parent Participation in Pediatric Intensive Care Unit Rounds via Telemedicine: Feasibility and Impact. The Journal of Pediatrics, 185, 181-186. Retrieved from http://www.jpeds.com/article/S0022-3476(17)30320-7/pdf
- Burgess, M. (2017). The NHS is trialling an AI chatbot to answer your medical questions. Retrieved from http://www.wired.co.uk/article/babylon-nhs-chatbot-app
- Danone Nutricia Early Life Nutrition and Biocodex Pharmaceuticals. GIdiApp. Retrieved from http://gidiapp.com/
- Drossman, D. A. (2016). Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology, 150(6), 1262-1279.
- Shamir, R., et al. (2013). Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms. Journal of Pediatric Gastroenterology and Nutrition. 57, S1.
- Luo, G. (2015). MLBCD: A Machine Learning Tool For Big Clinical Data. Health information science and systems, 3(1), 3. Retrieved from https://link.springer.com/article/10.1186/s13755-015-0011-0
- Zhang, J. (2017). Multivariate Analysis and Machine Learning in Cerebral Palsy Research. Frontiers in Neurology, 8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742591/
- Kokol, P., Završnik, J., & Vošner, H. B. (2017). Artificial intelligence and pediatrics: A synthetic mini review. Pediatric Dimensions, 2(4): 1-5. Retrieved from https://pdfs.semanticscholar.org/ce9f/ddb79227627a2c7a12324486372ab29519bd.pdf
- Cai, W., Bharadia, L., Juffrie, M., Cheah, F. C., Quak, S. H., Titapant, V., … Ludwig, T. (2018). Prevalence and Management of Functional Gastrointestinal Disorders in Infants: An Asian Perspective. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 76–77. http://doi.org/10.5223/pghn.2018.21.1.76
- Vandenplas, Y., Abkari, A., Bellaiche, M., Benninga, M., Chouraqui, J. P., ÇokuÐraþ, F., ... & Miqdady, M. (2015). Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. Journal of pediatric gastroenterology and nutrition, 61(5), 531. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631121/pdf/jpga-61-531.pdf
- Chogle, A., Velasco-Benitez, C. A., Koppen, I. J., Moreno, J. E., Hernández, C. R. R., & Saps, M. (2016). A Population-Based Study On The Epidemiology Of Functional Gastrointestinal Disorders In Young Children. The Journal of pediatrics, 179, 139-143. Retrieved from http://www.jpeds.com/article/S0022-3476(16)30878-2/pdf
- Ludwig, T., Richards, J.A., Coulter, K.K, Roy, P., Foussat, A.C., Hannon, S.M. (2018, May). Automated detection of infant crying and fussing for clinical applications. Paper presented at the 51st annual meeting of the European Society for Paediatric Gastroenterology Hepatology and Nutrition, 2018
- Haghi, M., Thurow, K., & Stoll, R. (2017). Wearable Devices In Medical Internet Of Things: Scientific Research And Commercially Available Devices. Healthcare informatics research, 23(1), 4-15. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334130/pdf/hir-23-4.pd
- The Wearables For Good Challenge. Unicef Wearables For Good. Retrieved from http://wearablesforgood.com/catalogue/
- Global Digital Health Market will achieve 25.9% CAGR to cross $379 billion by 2024. (2018). Business Insider. Retrieved from http://markets.businessinsider.com/news/stocks/global-digital-health-market-will-achieve-25-9-cagr-to-cross-379-billion-by-2024-1013308867
Dr Thomas Ludwig is a medical doctor and principal scientist of pediatric gastroenterology at Danone’s Precision Nutrition D-lab. His research area is in early life nutrition, functional gastrointestinal disorders and the development of the digestive system.