144 - Needs Assessment and Prototyping of a Portable Incubator to Facilitate Safe Transport of Newborns in Resource-limited Settings

Poster Number: 144
Publication Number: 144.111

Elizabeth M. Collins, Beth Israel Deaconess Medical Center, Department of Neonatology, Durham, NC, United States; Shelby D. Cherkas, Duke University School of Medicine, San Mateo, CA, United States; Darcy Ayers, Duke University School of Medicine, Friday Harbor, WA, United States; Ather Williams, Duke University, Franklin Lakes, NJ, United States; Leonardo D. Gutierrez, Duke University School of Medicine, Fairfax, VA, United States; Wendy Dong, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Ruopu Jiao, Locus Biosciences, Durham, NC, United States; Geovanni Janer Carattini, Duke University, Durham, NC, United States; Remmy C. Mushi, Kilimanjaro Christian Medical Center, Kilimanjaro, Kilimanjaro, Tanzania; Eric S. Richardson, Duke University, Durham, NC, United States; Ronald M. Mbwasi, KIlimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania; Dorothy Dow, Duke University Medical Center, Pediatric Infectious Diseases, Durham, NC, United States; Ann Saterbak, Duke University, Durham, NC, United States

Background: Many resource-limited countries, such as Tanzania, have high neonatal mortality. At the Kilimanjaro Christian Medical Center (KCMC), a referral hospital in northern Tanzania, neonatal deaths account for 28-34% of deaths in children under 5 years old. A medical device that can be locally sourced and produced may provide safer conditions for neonates during transport, but design criteria for such a device is not well understood.

Objective: We aimed to understand logistics of neonatal transfers to KCMC and contributions of hypothermia and unsafe transport on neonatal mortality. This data informed requirements for a novel incubator design using locally sourced materials to produce an affordable and safe neonatal transport mechanism.

Design/Methods: Four semi-structured in-depth interviews were conducted with local engineers and physicians from KCMC and nearby clinics by three engineering students and a local engineer to determine health risks, safety, and logistics of neonatal transport. Peer-reviewed articles from the last 10 years regarding incubators and transport devices in resource-limited setting were analyzed to find evidence of or requirements for successful devices. The engineering design process was used by four other engineering students (mentored by engineers and pediatricians) to design an incubator for transport in this context.

Results: Sepsis, hypothermia, and subsequent deterioration are major causes of death for neonates during transport and upon arrival at KCMC. Basic unequipped sports utility vehicles (SUVs) rather than equipped ambulances are often used for transport, and skin-to-skin contact has been encouraged to warm infants; however, family members are not always available, so many infants are simply held on an open bed during 1- to 2- hour trips. A portable incubator prototype was created of wood, heated rice packs, and basic electronics (Figure 1). In preliminary tests (Figure 2), the incubator maintained an air temperature above 35ºC for 72 minutes (Figure 3).Conclusion(s): A safe portable incubator prototype for neonates in a low-resource country maintained an appropriate temperature for the majority of a typical neonatal transport time. Using locally available materials, we are refining a cost-efficient, safe, hygienic portable incubator that could ultimately be easily mass-produced and scaled-up to reduce infant mortality in Tanzania and similar resource-limited settings.  Acknowledgments We acknowledge and thank Duke University and the Duke Bass Connections Student Research Award for funding this project.
Figure 1. Final incubator prototype product created after generating a Computer-Aided Design (CAD) modelPicturePrototypeWithBabyPlusLabels.jpegA. outer box
B. inner box
C. drawer for rice packs
D. handles
E. mesh mattress
F. temperature display
Figure 2. Results of each tested design objective