NeoNook is a ground-breaking care solution for preterm infants, providing a physiologically beneficial environment and improved breathing assistance.

Preterm infants miss out on development time in their mother’s womb, and must recover in the stressful incubator environment. Many infants also require breathing assistance from Continuous Positive Airway Pressure treatment, leaving scars, disrupting their recovery, and crucially, reducing their healing time in their parents’ arms.

Inspired by ground-breaking neonatal research, NeoNook simulates the womb environment and provides the comforting, familiar biorhythms of the infant’s mother. Breathing assistance is also improved, enhancing flow, reducing facial pressure, and enabling easier cradling by parents.

The designers were tasked with improving the provision of Continuous Positive Airway Pressure (CPAP) treatment in the neonatal care environment. The project was conducted with a leading med-tech company and a world-leading hospital for neonatal care and research. The project spanned 10 weeks and was scoped widely to allow for explorative solutions in the broad context of neonatal care.

The Problems with CPAP Treatment in Particular:

Many severely preterm infants require breathing assistance from CPAP treatment, which is disturbing and uncomfortable for the infant, can cause long-term facial damage, and is not always effective. The existing solutions require sealing pipes to the infant’s nostrils, and it’s both difficult to create an effective seal and to avoid tissue and skeletal damage from the fixation pressure. The fixation requires constant adjustment, and our research indicates infants can be disturbed up to 200 times per day, yet for optimal recovery preterm infants need extensive, undisturbed sleep.

The Problems with the Wider Neonatal Care Environment:

The incubator is an unexpected and stressful environment for preterm infants, where they’re deprived of their mother’s comforting biorhythms and voice, and are often exposed to intense noise, light, and unexpected movement. Stable infants can fortunately be cared for in “kangaroo care”, where the parents hold their infant, but unstable infants must spend most or all of their time in an incubator. As well as negatively affecting the infant, this challenges the mother’s bond to her child, especially if they were separated at birth for days.

Early on during the research phase we identified that if we could help the infant to relax and reduce its stress levels, the infant would need less CPAP treatment, or less airflow during CPAP, and could recover faster. Coupled with this, if the infant was more relaxed, it would move less, significantly reducing the need for adjusting the fixation of the CPAP pipes, the primary cause of disruption to the infant’s rest.

At this point we determined the provision of CPAP could be drastically improved by not just focusing on the CPAP treatment itself, but the whole care environment including the incubator and transfers to and from kangaroo care (where parents cradle the infant outside of the incubator). This is the point of view we took into the design phase, focusing first on the care environment, and then looking to create a cohesive solution improving the environment and CPAP treatment together.

Our research also highlighted the need to foster the maternal bond, helping the mother (and father) to connect emotionally and physically to the infant whilst it recovers at the hospital. On the one hand this means encouraging kangaroo care whenever possible (our research indicates this leads to improved recovery), and on the other hand helping the parents both emotionally connect and relax whilst their child recovers isolated in a high-tech incubator, surrounded by complex machines and tubes. Understanding this need, we made it a guiding principle to improve this connection between parents and child.

This project was founded on extensive research and understanding of the different users involved. Beginning with an introduction into CPAP treatment by leading nurses, doctors, and medical engineers, we got to grips with the equipment involved, the purpose of the treatment, and had the opportunity to handle various existing products in use today.

This introduction was followed up with numerous visits to the collaboration hospital, including to a neonatal ward and the equipment repair workshop, to understand the real use contexts and user needs of the infants, parents, nurses, doctors, and even service technicians.

After deciding on our direction of improving the care environment, and learning how beneficial kangaroo care was for the infants, we decided to investigate simulating the mother’s biorhythms to comfort the infant inside the incubator. We met with the hospital’s leading specialist, (a highly qualified practising nurse and researcher) on kangaroo care, who confirmed recent cutting-edge research has indicated this is possible, include research he had conducted with a team himself. From this specialist we received research papers to learn more from, and validated it was either confirmed or plausible to provide infant comfort via sound, smell, motion, and light. This became the driving focus of our project.

Throughout the design process we continued to meet with nurses, doctors, and our med-tech collaboration partner’s experts, to refine and validate our design direction. This included testing a prototype in an incubator at the hospital, and engineering advice on the CPAP breathing mask we were developing. We also continued to meet with the hospital’s specialist for his opinion on our biorhythm simulation concepts. These frequent meetings allowed us to ensure the nurses and manufacturer needs were accounted for, as well as the infant’s needs, and a lot of effort was placed into understanding work tasks, ergonomics, emergency situations, and efficiencies needed by the neonatal nurses.

As the project was focused on infant comfort, we also researched the best methods for monitoring comfort/stress levels, and determined with the help of a specialist that Galvanic Skin Response (GSR) was the most suitable method. GSR monitoring has recently been scientifically validated as an optimal method and is now under pilot usage in Norway, and likely to be widely adopted worldwide in the near future.

In terms of project realism, we ensured the product would retrofit market leading incubators, and designed the product to use easily implementable, existing technologies. The construction itself uses medical-grade antibacterial fabric and an ultrasonically welded plastic shell for hygiene and cleaning in the hospital environment.

In consideration of the mother-child bond, a pendant form factor was chosen to symbolise the connection, and premium materials were selected to emphasise the precious nature of this connection. Specifically, titanium was selected as the contact material, for its physical warmth as well as aesthetic qualities.

Overall we believe the product has a sound scientific background, is well validated and streamlined for the neonatal environment, and would truly have a significant positive effect on the health outcomes for neonatal infants.

The NeoNook offers value on many levels.

Social Context: The incidence of premature birth continues to rise in the developed world, and is a traumatic, dangerous, and costly event. In the United States, preterm birth now accounts for 1 in 8 births, and accounted for 35% of all infant deaths in 2009, more than any other single cause. Preterm birth is also a leading cause of neurological disabilities in children, and cost the U.S. healthcare system more than $26 billion in 2005 (CDC.gov). NeoNook can play a significant role in the healthy recovery for preterm infants, reducing these severe social costs.

Paradigm-shifting: NeoNook totally embraces an emerging facet of neonatal care, providing environmental comfort via multiple senses, and particularly through simulating the mother’s biorhythms. This is unprecedented and offers broad benefits throughout the care cycle, from reduced stress to improved CPAP treatment.

Workplace: By reducing stress on the infant, the infant requires less attention and less adjustments of body position and CPAP fixation, drastically reducing demands on nurses in a challenging, and sometimes high-paced, stressful work environment.

Parental: The mother-child both is strengthened through NeoNook’s function and interface, establishing an improved parental relationship from day one. The comforting aesthetic appearance of NeoNook also provides much needed reassurance for parents. Research also suggests improved infant comfort leads to a quicker departure from hospital.

Social: The improved CPAP interface reduces pressure on the infant’s face, lowering the chance of permanent disfigurement for the infant, avoiding social challenges later in life.