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How a passing comment on an old medical test won a $100K Gates grant

Bubble check diagnostics

Gates Grand Challenges award winner Kathleen Bongiovanni demonstrates how a simple idea may save the lives of millions of premature babies

Earlier this week, the Bill & Melinda Gates Foundation announced the latest 100 winners of $100,000 grants from its Grand Challenges Exploration program aimed at supporting high-risk, creative approaches to improving health and fighting poverty in poor countries.

Celebrated for funding “wild” and “wacky” ideas, this year’s batch of Gates Grand Challenge winners included proposals to develop, as the AP reported, unmanned drones to deliver vaccines, tattoos for monitoring pregnancy and a “tuberculosis breathalyzer.”

The Seattle Times followed up with an overview of the three local winners:

  • Kathleen Bongiovanni, a program manager at Seattle Children’s Research Institute, won for proposing a simple test to identify premature babies.
  • Two immunization technology improvement teams at PATH also each won a $100,000 Gates grant. Lauren Franzel of PATH won to do research using bar codes to improve vaccine delivery logistics. PATH’s Shawn McGuire and Nancy Muller got support for work aimed finding better refrigeration techniques during vaccine transport in poor countries.

None of these three local winners’ projects sounded too wacky to me.

PATH has long been a leader in creating new vaccine technologies so not much surprise or wackiness or wildness there.

Bubble check diagnostics

No, the wildest story here is about how Bongiovanni got the idea for her project and applied for the Gates grant despite a bit of skepticism about her chances from more experienced colleagues.

“It was just a passing comment,” she explained. Bongiovanni works in program administration for a project focused on respiratory diseases caused by premature birth at Seattle Children’s Research Institute. She is, in fact, pretty low on the totem pole. Her mentor there, Dr. Tom Hansen, is an expert neonatalogist and, well, an old guy.

During a routine meeting, Bongiovanni overheard Hansen talking about the ‘old days’ and this abandoned method of testing babies for respiratory distress by combining routine amniocentesis fluid with alcohol.

Hansen mentioned it in passing, she said, as he went on to discuss more sophisticated, modern analytical means for diagnosing respiratory distress in newborns.

“Basically, you’re just looking for foam,” Bongiovanni said. “It’s a beautifully simple and cheap test.”

Premature birth in the developing countries is a massive problem, and a major killer of infants, as this recent report noted. Bongiovanni said she has long been driven by trying to find some way to reduce the toll of this problem in poor countries.

“We don’t really understand why (premature birth) happens or how to prevent it, in many cases,” said Bongiovanni, who was just accepted to attend medical school at the UW, by the way. In the U.S., she noted, we have the technology and expertise so that mothers can know if their baby is pre-term and health workers can react appropriately. In poor countries, she says, that’s usually not the case.

“Up to half of the neonatal deaths are due to delay of referral to care, to the lack of recognition of illness and prematurity,” Bongiovanni said. Lungs are the last to develop in babies, she noted, so respiratory distress is both the biggest risk of premature birth as well as the best way to diagnose it.

What Hansen was talking about in his passing comment was the old “foam stability test,” a medical test long ago abandoned as the American health care system moved toward the use of ultrasound and other more sophisticated testing techniques.

Bongiovanni’s insight was to replace the amniocentesis fluid (taken by syringe) with the much-easier-to-obtain fluid routinely removed at birth from a newborn’s nose and mouth (technically, lung surfactant but journalistically known as baby spit or goo).

“My idea was to revamp the old test so that it can be used with oral fluid from a newborn’s mouth,” she said. The make-up of the fluid is essentially the same and the Gates grant allows her to see if this modification will work to create a new test by combining baby spit with alcohol. Lots of bubbles means healthy lung function. Low bubble count means respiratory distress.

“I thought to myself that this could be really useful in poor countries,” Bongiovanni said.

She told her colleagues at Children’s that she’d like to explore this and apply for a Gates Grand Challenge grant to launch the research project. They expressed doubt that her simple idea (and, perhaps, her position) would hold be able to impress this philanthropy that tends to favor more cutting-edge approaches. Wacky approaches.

“Nobody really thought I’d get it,” Bongiovanni smiled.

But she did, and will soon begin doing initial phase research at Texas Children’s Hospital. In June, she heads to Uganda to explore with health workers and local communities the idea of setting up a pilot project.

Bongiovanni hasn’t been to Africa before this but already has some ties to Uganda, as she serves on the board of a small non-profit organization, the Uganda Village Project. The NGO works on a number of community-based programs in Uganda focuses on improving health, access to water and education.


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.