Five Questions and an Elevator Pitch: Motilitech

1. What is the need that your project seeks to address?

Ariana: Approximately 114,000 preterm infants are born in the US each year before their intestines are fully developed. Because their digestive systems aren't ready to absorb nutrients, these infants initially receive nutrition intravenously through a method called total parenteral nutrition (TPN).

The ultimate goal is to transition them from TPN to enteral feeding – where nutrients are delivered directly into the intestines – and eventually to oral feeding. However, this transition often occurs prematurely or without adequate intestinal development causing infants to revert to TPN. This cycle prolongs their stay in the neonatal intensive care unit (NICU), increases healthcare costs, and creates additional burdens for nurses and caregivers.

We are focused on developing a way to enhance gut motility (the passage of food through the digestive system) in preterm infants on total parenteral nutrition, born between 30 and 34 weeks gestation, to accelerate the transition to voluntary feeding.

2. How does your solution work?

Grace: Currently, NICU nurses manually perform abdominal massages on preterm infants in a specific triangular movement, known as the "Bermuda Triangle" pattern. Nurses apply varying levels of pressure with their fingers, depending on the infant's response and needs. These massages help stimulate gut motility and promote intestinal development. But because nurses do it manually, the stimulation is inconsistent and intermittent.

Ariana: Our solution is a wearable device that replicates this manual massage, freeing nurses to allocate their time more effectively and improving patient outcomes through consistent and optimized stimulation.

Grace: The device consists of an adjustable sleeve that wraps comfortably around the infant's abdomen. Within this sleeve, we use silicone balloon actuators placed strategically in the same triangular pattern nurses currently use. These balloons sequentially inflate and deflate, applying gentle, controlled pressure to the infant's abdomen to mimic the nurses' manual massage and the natural peristaltic movements of the intestines. The sleeve also has an outer, non-elastic but flexible layer to ensure that, when the balloons inflate, the pressure is directed inward toward the abdomen rather than outward, maximizing the effectiveness of the massage.

Sruthi: We want the massage to adapt in real-time based on the infant's physiological responses. To achieve this, we're exploring ways to integrate vital signs monitoring into the device to help us understand how well the infant is tolerating the massage and allow the device to automatically adjust the pressure and pattern accordingly.

Alvaro: These massages should ideally be performed every time an infant is fed – about three times a day — but current staffing constraints make that frequency unfeasible. What’s more, it requires specialized certification, which not all NICU nurses possess, even at well-resourced hospitals.

While preterm infants are our initial target group, we see potential for broader application of our technology to other infants experiencing feeding intolerance or delayed intestinal development.

3. What motivated you to take on the project? And what activities have you undertaken?

Alvaro: The idea of directly helping infants ultimately leave the NICU faster was incredibly motivating. As we explored this area of opportunity, we realized there were numerous unmet needs and partial solutions, but few comprehensive approaches addressing the root cause of feeding intolerance. We were inspired by the chance to tackle this fundamental issue directly.

Ariana: Feeding is fundamental to infants' neurological development and long-term health. Despite its importance, we found limited innovation in this area, particularly within NICU settings. These infants represent an extremely vulnerable, high-risk population and we saw tremendous potential to make a tangible, expansive impact on their lives.

We've developed a  prototype of our wearable sleeve device and successfully demonstrated sequential inflation and deflation of three compartments within the sleeve. Our next steps involve refining the silicone balloon actuators to precisely replicate the "Bermuda Triangle" massage pattern. We're considering using nine silicone balloons arranged in this specific triangular pattern to ensure accurate coverage and effective stimulation.

Grace: Additionally, we're focusing on ensuring the device's sterility and compatibility with the NICU environment, as well as integrating a dynamic feedback mechanism based on vital signs monitoring. We want to ensure the device is comfortable and safe for preterm infants, and that it minimizes noise to avoid disturbing the infants or other patients in the NICU. We have several clear milestones ahead, and we're motivated to create a fully functional, coherent prototype.

4. What’s the most important thing you learned in advancing your project?

Grace: One of the most important lessons we've learned is the value of grounding ourselves deeply in unmet clinical needs. It's easy to become excited about a particular technology and have a solution-oriented mindset. However, the Biodesign process emphasizes starting with the need first and then exploring potential solutions.

Sruthi: The power of networking and collaboration within the Stanford ecosystem has been incredibly beneficial and motivating. Throughout our project, we've reached out to numerous labs, professors, and industry experts for guidance and collaboration. We've also connected with CEOs of medical device companies and start-up founders, learning from their experiences and gaining inspiration for our own project.

Ariana: We've found that talking directly with stakeholders – physicians, nurses, parents, and others – has been invaluable for understanding the true nature of the problem and for providing insights into their perspectives and experiences. At the same time, the sheer number of opinions and recommendations can be overwhelming, especially when clinicians have their own ideas about technologies or solutions they want to see developed. While these suggestions were valuable, we quickly realized the importance of stepping back and focusing on the underlying clinical need rather than immediately pursuing suggested solutions.

5. What advice do you have for other aspiring health technology innovators?

Maroussia: Many aspiring innovators likely experience uncertainty in how to turn an idea into a reality. My advice is to seek guidance from people who've successfully navigated this process before. Experienced mentors can help you break down your big idea into smaller, manageable proof-of-concept steps. This guidance was crucial for us, helping us move to a tangible, achievable plan.

Alvaro: You don't have to reinvent the wheel. Instead, draw insights from experts, existing solutions, and your broader community.

Grace: Surround yourself with people who believe in you and your project. Innovators inevitably face ups and downs, so building a supportive network is essential. We had mentors and supporters who encouraged us, believed in our capabilities, and helped us overcome obstacles.

Sruthi: You'll inevitably encounter people who don't immediately see your vision or understand how your solution addresses the need. If you've carefully followed the Biodesign process and identified a genuine unmet clinical need, trust your work and stay committed. Remember that your solution may have the potential to help thousands, if not millions of patients. Don't be discouraged by skepticism. Stay focused and confident in your mission.

Ariana: Invest time in building strong relationships within your team. Our team made a conscious effort to spend time together outside of class, and this significantly strengthened our collaboration. I'm incredibly grateful for the camaraderie, humor, and mutual support we've developed. Innovating in healthcare is challenging, and having a supportive, cohesive team makes a huge difference.