System treats gastroschisis in developing countries

The standard treatment in Western hospitals is a sterile silicone bag that holds the intestines in place over the child and allows gravity to slowly pull them back into the abdominal cavity, a process that can take five to 10 days. But the custom bag and its mounting equipment are too expensive for hospitals in Uganda, where an infant with the condition has a nearly zero chance of survival.

Dr. Bindi Naik-Mathuria, a pediatric surgeon at Texas Children’s Hospital, works with hospitals in Uganda. She learned from Dr. Nasser Kakembo, an expert in gastroschisis at Mulago Hospital, Kampala, that makeshift solutions are generally inadequate to save a child.

Naik-Mathuria approached bioengineer Meaghan Bond, a postdoctoral research associate with the Rice 360˚ Institute for Global Health, who brought the problem to the undergraduate team early this year.

Si-Low is a play on the “silo bags” used to treat gastroschisis, so-called because they roughly resemble their larger gravity-fed cousins. “We thought, we’re coming up with a lower-cost alternative to the bag, so why not call it Si-Low,” said sophomore Sanika Rane, who is majoring in kinesiology and minoring in global health technologies.

She shares an interest in global health with teammates Sajel Dutt and Owais Fazal, both freshman social policy analysis majors. For their solution, which cuts the cost of a bag from $240 to roughly $28, they were awarded the Excellence in Engineering Award and $5,000 at this year’s George R. Brown Engineering Design Showcase at Rice.

The students recognised early they would have to create a bag from scratch in a manner that could easily be duplicated in Uganda – or anywhere. That meant getting the right material, in this case a heavy-duty silicone that would keep its slightly tapered shape and retain the intestines in a warm and moist environment while they worked their way down.

The bag has to be hand-sewn. “We got a silicone sheet online and played with a lot of different adhesives to try to glue it together, and nothing worked,” Rane said. “We found out that silicone is really hard to bond to itself and realised quickly that we would have to come up with something else to make this bag. So we decided to sew. It turned out to be a lot stronger than we expected.”

The two other components are both 3D-printed, one an adjustable ring that slips under the infant’s skin to hold the bag in place and the other a bracket that secures the top of the bag and allows it to be suspended from an intravenous stand.

“We want to make sure the bags hold the intestines tight enough to make sure they reduce slowly, because the cavity can only expand gradually,” Fazal said. “If we have a bag that doesn’t conform tightly enough to the intestines, they might just plop right in and not give enough time for the cavity to expand to accommodate them. That can result in all kinds of complications.”

Testing took place at the bio lab of Rebecca Richards-Kortum, Rice’s Malcolm Gillis University Professor, a professor of bioengineering and director of Rice 360º, where it was easier to work in a sterile environment and kept other teams at Rice’s Oshman Engineering Design Kitchen from having to look at a clear bag of pork intestines every day.

The team plans to do further testing before graduation and must seek institutional review board approval before any validation with patients. In addition, Dutt will accompany a Rice 360˚ group to Malawi this summer to seek the advice of clinicians.

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Image credit: Rice University.