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#180 - 🚀 Tech Tuesday - NICUtrition, an innovative tool to optimize nutrition in the NICU





Hello Friends 👋

For the first episode of Tech Tuesday (though we are releasing this a bit late on a Thursday 🫣) of 2024 we welcome Tracy Warren, co-founder and CEO of Astarte Medical, on The Incubator Podcast for an in-depth conversation about NICUtrition. This episode focuses on the specific advantages NICUtrition offers for neonatal care, its evidence-based design, and practical integration tips for NICU professionals. Join us to explore how Astarte Medical's innovation is shaping the landscape of neonatal nutrition.

Enjoy!


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Learn more about Astarte Medical Here: https://www.astartemedical.com/


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The transcript of today's episode can be found below 👇


Ben Courchia MD (00:00.965)


Hello, everybody. Welcome back to the Incubator Podcast. It is Tuesday. We are back with a new episode of Tech Tuesday. Daphna, how are you this morning?



Daphna Yasova Barbeau, MD (she/her) (00:10.45)


I'm doing very well. I, you know, I love Tech Tuesday episodes. We love to hear about new things.



Ben Courchia MD (00:15.021)


Yeah. And so for the people who were at the Delphi conference in March, everybody's been, we've gotten great feedback from the conference. And we are posting pretty much every talk that's been given on YouTube for free. However, there was a pitch session where people came and sort of shared their ideas. Some of it are not ready to be released. So it was a very private affair.



And so I always wonder about the people who didn't get to see the pitch sessions at Delphi and what they've missed. So.



Daphna Yasova Barbeau, MD (she/her) (00:51.498)


Yeah, sorry. I just want... The pitch session was super cool, right? Like that was one of the most popular things that we did at Delphi. And it was basically... It was different than an abstract session, right? It's stuff that is totally up and coming or stuff that is already out there and being studied. And gosh, we learned a lot. People were really excited.



Ben Courchia MD (00:55.074)


Yeah.



Ben Courchia MD (01:15.657)


And one of the people that presented was Holly Clark from Astarte Medical. And so we're quite excited to be able to talk to our guest today, who is none other than Tracy Warren. Tracy is the CEO and co-founder of Astarte Medical. Tracy, good morning and thank you for joining us.



Tracy Warren (01:34.347)


Nice to see you guys, thanks for having me.



Ben Courchia MD (01:36.481)


Now a pleasure is all ours. And I guess we're going to do exactly like we do for every Tech Tuesday. We're going to begin from the standpoint of somebody listening in the car saying, I have never heard of this company before. So can you give us in a few minutes what is Astarte Medical and what are the solutions you are offering to providers in the NICU?



Tracy Warren (01:54.519)


Sure. So our vision here to study medical is really that clinical nutrition is probably the most powerful way to influence medicine beyond simply survival and especially in our preterm infant population. We think it can be a very powerful tool to improve outcomes for neonatal populations. So our platform is an EMR integrated clinical decision support tool. We use hospital feeding protocols. We embed that in the workflow and we alleviate



that can be associated with nutrition and feeding. So gathering all that data, running all those calculations and making it as straightforward as possible to make the best evidence-based decisions relating to helping our babies grow.



Ben Courchia MD (02:39.737)


I think this is a very important point. The tool itself is called NICUtrition, if I'm not mistaken. And the cool thing about this is that as we've noticed ourselves, and I think other providers, that the care of medically complex patient is so dependent on optimizing nutrition. And we all know that optimizing nutrition is a tall task. We're not really talking about



making sure you have the right total food volume. We're not talking about making sure you're using appropriate calories, but the big questions are, how do we do patient-specific planning? How do we make sure that macronutrients are adjusted appropriately? And I think this is really the level of details in which a start in medical and nutrition are going into. Is that correct?



Tracy Warren (03:31.307)


That's correct, and I think part of the challenge, as you said, are these decisions are being made almost on a daily basis, looking for intolerance, measuring and assessing almost on a continuous basis. But you don't know if you're right for a long period of time, right? It's a long game, unlike putting a kid on a respirator vent and you know, right, they're breathing. This is very different, and I think that's where we're trying to help.



Clinical teams have greater confidence in those decisions and making it easy to make the best decision.



Daphna Yasova Barbeau, MD (she/her) (04:05.986)


So can you tell us a little bit how it actually works? Like what's the user experience like?



Tracy Warren (04:12.255)


Sure, and as you guys may recognize, every hospital has its own feeding protocol, and they vary widely, vastly, and continue to be evaluated and changed. So it's an evolving part of clinical practice that our tool, we take that hospital's own feeding protocol, so it's your consensus-based.



philosophy on how to feed. We embed that right into your Epic or Cerner or other EMR so that when you're in a patient, you have a NICUtrition tab and it helps you gather all the data, the growth velocity, the milestones, the metrics, and it recommends based on your feeding protocol. We obviously recommend.



recognize that practitioners will make the orders because there's a lot that I'm sure is assessed and not covered. But we wanna take the tediousness out of knowing what was actually delivered, how's the baby growing, what other things may have crept up, especially if you haven't been on service for a few weeks. And we give you sort of some visualizations to make that picture holistic so you can really start to understand that baby's journey.



Ben Courchia MD (05:19.793)


Yeah, I mean the tabs look so good. There's the data visualization aspect of it is great. So number one, you can see the patient's weight Z-scores. You can have the feeding rates. It also tells you the kind of feeding you are on, the number of feeds that were delivered. And what I really like about it is that, as you said, an important piece of this is that it really...



marries itself seamlessly with a unit's dedicated feeding protocol. And so in a, in, in part of the Nick Nutrition tab, you'll get sort of what you're at, which is your completed tab versus the suggested tab. So saying, uh, maybe you should be on mother's milk, uh, 100% if, if that's what the protocol dictates. And so it's a great tool also to make sure that, uh, you're staying up, up to par with the expectation of your own.



unit.



Tracy Warren (06:16.231)


Absolutely, and one of the things we hope to do is support centers that may not have registered dietitians or nutritionists on staff where that, you know, that burden of data collection and analysis may fall to the prescribers or the nursing staff, but also just to have a communication tool among the team. So everyone's looking at the same data. Okay, I like it.



Ben Courchia MD (06:36.525)


I'm going to disagree with you on that. Because I think that even if you have dietitians, we've worked in institutions that we had 120 beds and the dietitians were running like chickens without heads because it is like, what, there was what, three of them and we have a hundred bed, we have a hundred bed unit and for them to do all the calculations, for them to see all the babies and be ready on rounds with all the data that we needed to make.



Daphna Yasova Barbeau, MD (she/her) (06:39.215)


Okay.



Daphna Yasova Barbeau, MD (she/her) (06:44.142)


Mm-hmm.



Daphna Yasova Barbeau, MD (she/her) (06:55.594)


Yeah, it's just too much. Yeah.



Ben Courchia MD (07:05.649)


feeding decisions, that was super hard. Like I remember they were stressed and you know how it is with budget. And if they were to cut their hours, maybe half an hour more, the whole edifice would fall down. So I think even if you have dietician, this can actually streamline their work and make their efficiency so much higher. And again, if you do not have dieticians, then even more reason, if there are any budgetary reason for not having a dietician, or if there's just no workforce available to hire.



Daphna Yasova Barbeau, MD (she/her) (07:26.039)


Mm-hmm.



Ben Courchia MD (07:34.273)


I think this is true, but I still think that if you have a large unit with dieticians that are strained and are really stretched thin, NICU-Trition still has room to play. Would you agree with that?



Tracy Warren (07:44.083)


I certainly would, obviously, and thank you for the commercial. But we just did a webinar, actually. We hosted a webinar by three RDNs who really talked about ratios, and much to your point, right? Having one or having two on an 80 or 100 bed unit is still not sufficient, and they can only round on patients every week and really do that deep dive. And so I do think we do help improve those ratios. And one of the things we're looking at in some of our early clients is



Ben Courchia MD (08:04.623)


Right.



Tracy Warren (08:13.997)


How many patients can you now support in a day with a full analysis, right? All of those calculations, all of those assessments, and can we help them practice top of license where they're actually spending more time, not in Excel or on a piece of paper and a calculator, but really in the dialogue and trying to help the clinical teams make the best decision.



Daphna Yasova Barbeau, MD (she/her) (08:27.522)


Mm-hmm.



Daphna Yasova Barbeau, MD (she/her) (08:35.094)


Yeah, what I thought was really interesting, and this just comes on the heels, Ben, you just presented a paper about babies aren't getting what we think they're getting, right? So we put in an order and then that's not always what the babies are getting, but with this system, you know exactly what they're getting. And I think even in the units with the best dieticians, some of the…



micronutrients, things like that really get overlooked. But what I liked about this was really kind of the QI potential for an individual unit to say, we want to change X something, whatever it is, but we don't even know what our starting point is. And I think this would be really, really valuable for any unit who's just saying, what is our starting point? And when we make a change, what does that look like?



So I was hoping you could spend some time on some of the lesser glorified nutritional aspects because I think those get missed. And I wanted to hear more about the ECI.



Tracy Warren (09:46.463)


Yes, the equitable care, sure. So I think your point is exactly right. And honestly, we see the platform as an opportunity to gather evidence-based data, honestly, independent of protocol, and look at it on a de-identified basis. So there's still a lot of debate. Do you fortify? Do you not fortify? Feed early, feed slowly. And as much as some of the studies tend to lean us in one direction or another, there isn't a large body of data from a QI or research perspective.



to say, look, when you look at the outcomes and you work your way backwards, right, we tediously benchmark ourselves, but the intricate details of how we fed or how these babies developed over time before you got to that outcome is just impossible to report.



Right? You can't imagine reporting feed by feed to the Vermont Oxford network and try to get, you know, sort of a sense of what's been successful. So to your point on QI, I mean, what we really hope to support is you've introduced a new fortifier, you've introduced a new practice, you've hired another lactation consultant. Do you have greater human milk rates on your unit?



now that you've hired additional people. It can be a tool to assess all kinds of elements of practice that affect those babies getting optimal nutrition and reaching their milestones. So it really is meant to be an innovation tool. We wanna encourage more new technologies being developed for this patient population and we get real time before and after. Are you seeing in a week or two of a new QI project, those actual implications, instead of finishing it in six months,



spending another three months and getting the data to see if it works, right? So I think that's to your first point. The equitable care intelligence platform, which is what we're really looking at on a health disparities level, is with our tool, you can parse the data in any way, shape or form and track it in real time.



Tracy Warren (11:44.679)


So one of the big use cases is certainly looking at, say, for example, black versus white infants, human milk utilization, growth rates, comorbidities, are babies on the unit being treated equitably? And can you, while they're still in your unit, identify those opportunities to keep them on par? And we've had some great data come out of Arkansas Children's where their black babies did great until human milk at discharge.



We published that at one of the recent conferences. And so supporting that now from a QI perspective, it's those days before discharge and really supporting that practice so that you can improve and reduce that gap. But it's a great tool for teams to actually make impact while the babies are still in the unit.



and whether that be process improvements, product introductions, etc. We want the data to serve up options for our customers to help them support families where it matters most.



Daphna Yasova Barbeau, MD (she/her) (12:47.862)


Yeah, I think that's such an important point that, you know, we sometimes say, oh, this is our fishbone, our driver diagram. And these are the things we think are the problems. But sometimes we don't even know what the problems are. But having a kind of a more comprehensive overview and the graphics that this provides are really phenomenal. I mean, you can really highlight so many different things.



where not just are the disparities, but like where are we falling short across the board that you may not have even considered as a place to make change. But I think this will actually help units identify where some of the problems lie that they hadn't considered previously.



Tracy Warren (13:38.219)


Yeah, and I think one of the things we like of having the data sort of tagged, right, if you are putting up a small baby unit, if you are creating a QI in a particular surgical cohort, or you really wanna kind of double down or dig in on a particular group, you can create dashboards that favor that group. And so every time a baby who may fit that profile is rounded on, or there's some kind of an assessment, you kind of have those metrics front and center.



consistency of care does elevate because it's, this is the baby, this is what we're doing. Just a reminder, you know, these are the things we want to work on. And you can parse that data, which you cannot do seamlessly in your EMR. And even when you get reports from your informatics groups, they're static, right? This is real time and you can help to help support care.



Daphna Yasova Barbeau, MD (she/her) (14:27.878)


Mm-hmm, mm-hmm, dynamic.



Daphna Yasova Barbeau, MD (she/her) (14:33.135)


I wanted to say one more thing about the ECI database is it's tracking not just quote unquote nutrition stats. So is that pulling diagnosis data from the EMR?



Tracy Warren (14:49.075)


Yeah, we pull a lot of things we don't represent on the dashboard because a lot of it does influence protocols if babies are on particular medications or they have particular diagnoses, they're contraindications to feeding often. So while we don't always display that, but in our reporting, we do track outcomes. We do track sort of clinical observations. So an intolerance observation or charting. So we have a lot in the back.



that helps support that and then when we do reporting or if you're looking to ask a particular research question, a lot of that's in a less visualized form but it's there and that tells that comprehensive picture.



Daphna Yasova Barbeau, MD (she/her) (15:31.694)


But like here, I see this slide of outcomes overview, even you have mortality, neck, sepsis, IVH, CLABSIs, BPD, and all by, I guess, components potentially of race or other factors in your unit, which is a whole nother level of data tracking that I'm not sure people would have thought a nutrition add-on would be covering.



Tracy Warren (15:59.735)


Right? We can do that by zip code. We can do that by a lot of other demographic or bio-demographic profiles for babies. So yes, the goal is to let your data help you interrogate practice and then elevate it to support the best practices.



Ben Courchia MD (16:21.545)


Anne Hansen, the medical director at Boston Children told us that when something new rolls out she never wants to be the first, she doesn't want to be the last. And I think it's important to mention that NICUtrition is not, if people are interested, they are not going to be the first to try this. You've actually have accumulated experience with this tool in various NICUs. And I just want you to speak maybe a little bit about some of the things that Holly presented at Delphi, which is...



What you've noticed in a before and after sort of scenario, what were you able to achieve for these NICUs in terms of some of these outcomes that we all care so much about?



Tracy Warren (17:03.015)


Yes, and we do have four clients, many of them children's hospitals, but also a regional level three community, NICU. And what we've been able to show and have presented is that we can statistically show a difference in improvements in feeding milestones. So reaching full feeds, earlier transition to oral feeding, reducing length of stay pretty dramatically. We've shown



Tracy Warren (17:32.367)


and reducing parenteral nutrition days and central line days. So some pretty big targets that we've shown, even in small units that may be under 20 beds or at 20 beds, the ability to help improve care and improve protocol compliance. So we haven't talked a little bit about that, but most centers think they do 70 to 80% if you pull them. That number's usually south of that. And so even...



Ben Courchia MD (17:58.217)


We came to this sad realization not too long ago when our dietician presented that data to us. So, uh, yes, you're preaching to the choir here.



Daphna Yasova Barbeau, MD (she/her) (18:02.626)


That's right, we're well aware.



Tracy Warren (18:05.331)


Yeah, it can be sobering, but it's also room for improvement. And it is things that within the practice, you can relatively change in shorter periods. It doesn't have to take years. It can happen in weeks and months. And so even just improving by 15% to 20% your compliance, we see these changes. And it is really reducing that variability and providing that feedback loop. So those are the things that we hope to continue to demonstrate.



Ben Courchia MD (18:16.357)


Mm-hmm.



Tracy Warren (18:33.735)


Some of the softer things we're working on this year is looking at workflow. Can we reduce the burnout? Can we improve ratios? Can we make sure that, you know, patient satisfaction, parent satisfaction is going up, people can spend more time at the bedside using the tool? Some of the softer things from a return on investment, because I do think those, especially in today's labor environment, can be quite important.



Ben Courchia MD (18:58.005)


Yeah, I mean, I have from experience, it's totally subjective, but this is one of the most important aspect of care for parents. It is one of the few cares they understand completely. They may not understand ventilator and why you switch this machine for that machine, but how much their babies are getting fed, what they're getting fed is something that matters very truly to them. And so I think the more efforts we can do in order to make this aspect of the care more...



easier to understand and also make yourself look good if you have that much if you show that you have this kind of data available parents usually say while these guys have this together and they know what they're doing so I agree wholeheartedly We're coming close to the end of our discussion and so I wanted to maybe spend some time on technical things if that's okay because I Think if people are listening and this okay, I'm actually interested But now I don't know if this is gonna be for me or not. You mentioned that this is a basically a tool



Tracy Warren (19:45.426)


Absolutely.



Ben Courchia MD (19:54.713)


that integrates into your EMR. So it is sometimes we've interviewed companies and they have other forms. So they have like a web portal or something like that. So in the case of Nick Utrition, we're talking about only EMR integration or are there other ways to access this tool?



Tracy Warren (20:10.707)


Yeah, no, we have multiple ways and sort of a, actually a series of opportunities. So if people wanna wait in and try the tool, one of our early opportunities, more of a project-based where we actually look at your retrospective data. So we do a one-time poll, so it's not full integration. So if you're doing a EMR crossover, this is a good pilot way to look at things. But we pull your historic data, it can also help inform developing a protocol, revisiting a protocol, looking at your outcomes.



and that's a one-time fee. And that's sort of a very capitated way to kind of look at the tool. You can play with it and have users integrate with it. We can do asynchronous where we don't fully integrate, but we do that in a periodic way. So maybe every month you pull your data, every quarter for reporting to Vaughn, et cetera.



And then there's the sort of the Tesla version, if you will, the full integration where we sit and your it's your login to your EMR. There's no additional sign on and there's no additional documentation. So as I said, it sits right in your workflow. So it's transparent to you as a user from as far as data acquisition and data presentation.



Ben Courchia MD (21:22.573)


Which EMR are you guys able to accommodate at this time?



Tracy Warren (21:27.955)


Right now we're Epic, Cerner, and Meditech.



Ben Courchia MD (21:46.025)


I guess the last question that I have for you on, in terms of logistics is let's say we reach out to you, we want to integrate what is the process timeline from the point that from first contact with Astarte Medical to actually me being able to use the tool in my EMR.



Tracy Warren (21:51.899)


Okay.



Tracy Warren (22:16.191)


Yeah, so let me answer that. By time we sign a contract, which can have committees and legal and all those things. So once we sign a contract, if the hospital has a resource available, and that's usually our first gating item is to make sure we have an IT resource from the hospital side available. You can have data within 30 days on that project basis that I talked about. We have most of the queries available and less than 90 days for full integration.



relatively quickly. The biggest gating item is usually we're competing with U.S. News and World Reporting, Epic Integrations or upgrades, etc. So assuming we have resources, it's less than 90 days.



Ben Courchia MD (23:00.141)


Right, but I think it's important. Even if, we're not gonna hold you to this timeline, but I think people are, no, because I think people are wanting to know what is the order of magnitude? Am I talking like a year until this can actually get integrated? Am I talking like a few weeks? Am I talking many months? Or am I talking a few days? And I think all these things matter because that is, depending on how you pitch this to your C-suite, how do you pitch this to your team? Like this matters tremendously. So thank you for that.



Tracy Warren (23:04.769)


Mm-hmm.



Ben Courchia MD (23:29.866)


I mean, I don't have any further questions. I've not. Did you have anything before we close out?



Daphna Yasova Barbeau, MD (she/her) (23:33.266)


Yeah, I just had one more question about some of the other resources you guys offer. Some webinars from your website, a collaboration with the March of Dimes and the Next Society.



Tracy Warren (23:46.187)


Yeah.



So we do, we've done a series of purely educational webinars. We've had top speakers on infant and neonatal nutrition. As I mentioned, we talked about RD, the evolution of RDs in the NICU. We believe there aren't a lot of forums, and I think that's why you guys are so successful for this audience. And so we did our part, I think, on some of our educational webinars. So they're on demand on our website. You can just view them. And then we do, we work with the March



We've done a Meals That Matter campaign with them, and we were Next Society champions. So we think these are amazing organizations that serve our families in a way that we can't always, as a clinical decision support company, we're kind of the tech inside, but we believe these are tremendous organizations.



Ben Courchia MD (24:35.205)


That's awesome. Tracy, thank you so much for making the time. We will have all the opportunities for people to get in touch with you and with Astarte Medical on the episode page. And this is a very impressive tool. By the way, as usual for Tech Tuesday, full disclosure, we have no conflict of interest. We are not users yet. I would love to be a user. But yeah, so congratulations and good luck on your future endeavors.



Tracy Warren (25:03.223)


Great, thank you for having me.



Daphna Yasova Barbeau, MD (she/her) (25:05.198)


Thanks.


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