Introduction
Kangaroo Care refers to the method of holding an infant in an upright and prone position, skin-to-skin, on the parent’s chest for a period of time. It was developed primarily due to the lack of resources for preterm neonates and low birth weight babies in developing countries where incubation facilities were not prevalent. Today, there is enough evidence to show that kangaroo care is as effective as regular hospital incubation in terms of mortality rate of stabilized preterm neonates. One of the main advantages of kangaroo care is that it can be continued at home once the parents are properly trained in the hospital. Thus, kangaroo care is an effective and inexpensive method of incubation. However, in recent times kangaroo care has been deemed to have more benefits than just thermal regulation as studies have shown it to have a positive impact on breastfeeding, growth, general metabolism and stress levels in newborn infants. (World Health Organization. Reproductive Health World Health Organization, UNAIDS, 2003)
Execution of kangaroo care in the most efficient manner is extremely important to ensure that the infant is getting adequate benefit through skin to skin contact. Proper kangaroo care can only be done if the infant in a particular position. To ensure this, a wrap may be used around the infant to provide a secure kangaroo-like pouch. This wrap is wearable and helps in supporting the preterm baby reducing the effort involved in carrying it for hours together. The wrap also works as a small insulating wall for maximum heat transfer. For convenience of use, it is washable and reusable also. Another aspect is that time can be noted on a report card before putting in and after taking out the preterm infant from the wrap. Hence, we may manually calculate the duration for which a baby is in kangaroo care along with a secure way of holding the baby. (Jackson, Yamile, 2012)
While using the wrap is one of the most ergonomically effective ways of kangaroo care, there have been a lot of issues pertaining to data collection manually using a report card since there may be multiple kangaroo parents and so a lot of room for human lapses and errors. In addition to errors, manual record keeping of data makes it majorly inconvenient for a doctor to review the effectiveness of kangaroo care on the baby. In many, developing countries, it might even be difficult to access a doctor at hand and so the stress builds up in parents over whether the care their newborn is receiving is adequate or not. This paper aims at addressing these concerns by incorporating a smart device in the already existing wrap to ensure that the baby is in kangaroo mode during its entire duration of skin to skin contact. Further we aim to make the data in this device accessible using a pre-existing app that will collect this data from the device via Bluetooth.
Design objectives
In order to determine the time duration it is mandatory to understand what it means by a proper kangaroo mode. A baby is said to be in kangaroo mode if it is in proper kangaroo position and if it is receiving adequate heat and skin to skin contact from the kangaroo parent. A proper Kangaroo position occurs when the infant is upright with chest to chest contact with the parent and the head, turned to one side, is in a slightly extended position. The tilt of the head ensures proper respiration and enables eye contact between kangaroo parent and the baby. Also, the top of the wrap should be just under baby’s ear and forward flexion and hyperextension of the head must be strictly avoided. It must also be ensured that the hips should be flexed and extended in a “frog” position with the arms flexed as well. (World Health Organization. Reproductive Health World Health Organization, UNAIDS, 2003).
Thus, it may be safe to infer that the time duration for which a baby is in proper kangaroo position with the vitals of the infant being stable can be counted as the time duration for kangaroo care mode. Moreover the vitals required to be monitored will be the same as the vitals that can convey information of whether the baby is in the wrap and how long it is present there viz. heart rate and blood oxygenation. Using these presumptions, we may proceed to design a device that can monitor crucial vitals of the baby and can ensure that it is in proper position. (Gates, Phase 1 proposal, 2017)
The objective is designing a user friendly device for baby/parent dyad that improves the safety, practice, monitoring, duration, and frequency of kangaroo care. Adding a digital component to a proven ergonomically designed wrap, data collection and analysis are improved and behavioral feedback can be provided during kangaroo care in all settings for mothers/babies, especially those in low-resource and remote areas. The device will consist of a sensor system in a secure, safe and comfortable casing to improve behavioral feedback and a platform for objective analysis of clinical indicators that help remote monitoring and achieve/incentivize kangaroo care goals. Another proposal is to incorporate an insulation pad to the battery that not only prevents over heat but also reuses the heat for further incubation in a way that is not harmful to the baby in any way. The components of the device include a (1) positioning component to check if the baby is in kangaroo position (2) a sensor measuring heart rate and blood oxygenation levels (3) a sensor housing (4) an attaching component to enable incorporation of the device in the wrap. Additionally, these sensors transmit their data using a microcontroller and Bluetooth wireless connection to a smart phone via the already existing app to the mother and in turn it will be sent via cellular signal securely to the cloud to be monitored by the healthcare team. Therefore, using this data one may be able to access the time duration of kangaroo care in the form of charts and figures on the app (Jackson, Yamile, 2017)
Methods
A team along with a stakeholder was chosen to develop the design. The method used by the team is the adaptive design approach. The main idea was to follow a design method wherein there was scope of incremental improvement during designing phase. Furthermore, at each design step decisions were made using a decision matrix to choose the best alternative possible for our design problem. The weights of each parameter of the matrix was decided by majority vote in a poll where team members participated and voted based on solid citable facts. (Jong De, Kenneth, 1980; Triantaphyllou, Evangelos, 2000; Lewis, Chen, Schmidt, 2006). Note that some external body design decisions have been taken by inference from solid theories of Human Factors and Ergonomics. (Lee, Wickens, Liu, 2017)
Environment
The device is intended on being used in under developed countries with parents being exceedingly underexposed to technology. It will be running for about 18 hours a day on a rechargeable battery and will also be extremely close proximity to the preterm neonate. This device is intended for use in under developed countries where parents are relatively new to handling technology.
Variables
The variables in designing this device varies from component to component. For the sensor component, the variables to be analyzed while choosing the optimal option is safety of the baby followed by the flexibility in positioning the sensor and also comfort levels of the infant since this device will be running for 18 hours near it and any indentations may occur on the preterm infant’s skin if not proceeded with caution. Cost and features of the sensors are also taken into consideration. The variables involved in selecting the best sensor housing design are external body design and material. Additionally, body design has alternatives to choose from that was a result of team’s brainstorming session and materials are considered on the basis of insulation, availability, cost and durability. For the positioning component our variable is best design out of various design alternatives. Lastly, since the securing component is determined using ergonomic principles as reference the variable is advantageous features used for identifying optimal solution.
Procedure
Firstly, start by choosing the best sensor. This is done by analyzing all the sensors available in the market using the variable set available and feeding it to the PU chart. The information of various sensors in the market, such as its cost and features can easily be looked up on any comparative online shopping website (in this case: Google catalogue). Secondly, for the sensor casing analyze the best shape using principles of ergonomics that in this case state that the casing should be durable, comfortable and tremendously well insulated from the sensor battery heat. In continuation, analyze the materials available using the corresponding variables in a PU chart again. Next, choose the most feasible positioning component option using engineering analysis. Finally, the securing component along with the final assembly is determined using ergonomic principles to extract most beneficial features out of two design alternatives and incorporate it to obtain the optimized design. Note that for the materials of the securing component, the decision matrix of the sensor housing component has been reused for the securing component materials since the requirements of both were analogous. A more detailed procedure for the alternatives considered during decision making is given as follows.
Heart Rate and Oxygenation Sensor Component
The alternatives chosen were marketed sensors. For ease of comparison similar devices in the markets have been grouped and analyzed. While an initial execution of one design cycle revealed that none of the marketed sensors were apt for the wrap using an adaptive design approach, a substitute analysis has been considered where a non marketed sensor that was identified will also be reflected as one of our alternatives. The stakeholder’s approval has also been sought in order to include this. The sensor that has been considered is a PPG sensor that can be put on any part of the baby and the bias can be compensated through machine learning. ( Gil, Eduardo, 2008; Allen, John, 2007; Cheng, Bukkapatnam, Le 2015)
Sensor Housing Component
For materials that will be used to build the securing components as well as sensor housing, we look towards finding the material that had a heat resistive threshold of Max 185 °F (85 °C), since operational temp of ion battery is in that range. Since the wrap is planned to be used in developing areas of Africa the material also had to be easily manufactured, allowing it to be produce in mass amount, cheap and commonly used in the industry. The three type of material for sensor housing and securing components taken into consideration are Polypropylene (PP), Polycarbonate (PC) and ABS Plastics. PP has a high enough melting point, making it heat resistive, as well as easily manufactured. In addition, PP is cheapest of the all other options. ABS plastic has low heat resistivity and is commonly used for room temperature base applications but has the lowest cost of manufacturability. PC has the highest melting point, it is however not cheap to manufacture. (Smock Doug, 2015; Hazima Nur, 2015)
Positioning Component
In order to ensure the baby is upright, two alternatives are chosen. One being an MEMS sensor to detect position of the baby and the other being lining the wrap itself with demarcations to show where the baby must be positioned. (Khoshnoud, Farbod, 2012). Use engineering analysis to select the best alternative.
Securing Components and Final Assembly Design
Reuse the PU chart for material selection of the securing components. The design alternatives that were brought out after the brainstorming session is as follows. Talk about both designs and incorporating it. Using agronomic principals and common-sense analysis, two alternate design were taken into consideration. Design 1 key components were boxed shaped sensor, with a battery packed attached on the back,that slips in and out for replacing or recharging the batteries.
The sensor will be placed in a pocket, with the pocket side facing the baby will have a whole cut so the LED of sensor can read the baby’s vital. Design 2 key components were a round shaped sensor, a sensor securing components, and sensor housing which will be integrated into a hole in a pocket.
Results
The results from the decision making processes have been documented as follows. Subsequently, a prototype design has also been documented that can be considered the alpha prototype.
Pulse and Blood Oxygenation Sensors
The decision matrix is as follows. It is safe to conclude that the sensor to be used is the PPG sensor.
Pulse Ox Sensor System
Alternatives
Safety
Flexibility
Comfort
Cost
Features
Total
Weights
0.3
0.2
0.3
0.1
0.1
10
Owlett Sock and similar devices
8
2
9
4
9
6.8
MonBaby and similar devices
8
8
6
4
9
7.1
Conmed Cshape and similar devices
8
2
5
8
5
5.6
Photoplethysmography and similar devices
8
8
9
5
4
7.6
Pediatric fingertip pulse and similar devices
8
2
4
9
8
5.7
Polar heart rate sensor band and similar devices
7
2
5
7
7
5.4
Neopenda Hat sensor and other similar devices
7
2
4
5
8
5
Materials Chart
Decision analysis for the material to be selected for the sensor housing and the securing component is given as follows. Clearly polypropylene is the best alternative.
Alternatives
Heat Resistivity
Manufacturability
Comfort
Cost
Total
Melting Temp
Cost Per Pound
Weights
0.4
0.1
0.2
0.3
10
ABS Plastic
6
9
7
8
7.1
105 °F
$1.50
Polypropylene (PP)
8
9
8
9
8.4
266 °F
$0.88
Polycarbonate (PC)
9
7
8
7
8
600 °F
$2.10
Positioning Component
After decision analysis the cheapest and simplest method was chosen which is markings indicating position of the baby on the inside of the wrap according to WHO standards.
Final Design and Assembly
The final design is explained as follows. After incorporating best feature of both designs, we create a final design with 2 clips, one placed on the inside of the pocket and one placed outside. A sensor housing with groves, which can be tightened into the securing clips by twisting in as shown in the picture below. The holes in the clips and pockets are parallel to the hole in wrap which will allow the LED of sensors to read on baby’s vital. The front of the sensor will also have an option to choose a care taker type in order to turn it on. The options vary from “mom”, “dad” and “other”. A rough drafted design drawing has been provided for ease of visualization below.
Discussion
Advantages of this Prototype
The sensor system will be able to determine how long a baby is in kangaroo care mode.
All the specifications in initial requirements have been met.
The device has enough cushion to enable the baby to be comfortable.
The cushiony design of the device even prevents it from damage in case the parent drops the device and hence increases durability.
The covering and the box are detachable, with the covering made out of materials that are hand washable and the box is wipeable to ensure as much as sanitation as possible for the baby.
Multiple casings/coverings give us close to perfect insulation.
Most importantly the device once assembled works as a one component device with a simple on/off button and charging port to ensure that it is extremely simple to use for even a layman parent.
Limitations and Suggestions
This device has not yet been tested for 18 hours working period and so it is recommended to perform all primary tests on it.
References
HFES. (2014). HFES 2014 Formatting Guidelines. Retrieved from HFES.org: https://www.hfes.org/web/HFESMeetings/2014FormattingGuidelines.pdf
(De Jong and Cybernetics 1980, Triantaphyllou 2000, Health, Organization et al. 2003, Lewis, Chen et al. 2006, Jackson 2012, Jackson 2017)
Cheng, C., et al. (2015). “Time series forecasting for nonlinear and non-stationary processes: a review and comparative study.” 47(10): 1053-1071.
De Jong, K. J. I. T. o. S., Man, and Cybernetics (1980). “Adaptive system design: a genetic approach.” 10(9): 566-574.
Health, W. H. O. R., et al. (2003). Kangaroo mother care: a practical guide, World Health Organization.
Jackson, Y. (2012). Infant care garment, Google Patents.
Jackson, Y. (2017). “Gates Phase 1 Proposal.” Bill Gates Foundation Proposal 1(1): 5.
Khoshnoud, F., et al. (2012). “Recent advances in MEMS sensor technology–biomedical applications.” 15(1).
Lewis, K., et al. (2006). “Decision making in engineering design.”
Triantaphyllou, E. (2000). Multi-criteria decision making methods. Multi-criteria decision making methods: A comparative study, Springer: 5-21.
Lee, John & Wickens, Christopher & Liu, Yili & Boyle, Linda. (2017). Designing for People: An introduction to human factors engineering.
(Khoshnoud, de Silva et al. 2012)
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