There is a substantial market for combined devices, especially for infant incubators and phototherapy systems with radiant warmers and transport incubators with the capabilities of a mobile NICU.

Fetal and neonatal care equipment are vital tools with increasing frequency for prevention and evaluation of diseases and in prenatal and postnatal care of newborn infants. There have been profound advances in the fields of prenatal diagnosis and fetal intervention, ultrasonography, magnetic resonance imaging, fetal dopplers, infant warmers and incubators, phototherapy equipment, and respiratory assistance and monitoring devices.  Increasing incidences of preterm births and high level of awareness along with an increase in demand and affordability for prenatal and neonatal care equipment are the major factors driving the growth of fetal and neonatal equipment market. Preterm infants face the risk of long- and short-term complications and require warmth, respiratory assistance and breastfeeding support, leading to a consequential rise in the use of these devices.

Market Dynamics

The global neonatal and fetal care equipment market is forecast to reach USD 5.96 billion by 2019 at a CAGR of 6.88 percent during 2015-19, according to Mordor Intelligence. As a consequence of continuous R&D activities being carried out by various market players, the market is highly dynamic and is growing rapidly. Increasing demand for improved and technologically advanced equipment including double walled closed incubators, highly portable fetal dopplers will further add to the growth of this market. Respiratory assistance and monitoring devices is the largest sub-segment with over 40 percent share of the neonatal equipment market. As the market in the developed nations is driven only by the replacement of older devices and sale of accessories, several big market players have started to develop various ways to differentiate their products by offering a complete package of products and services to their customers.

North America dominates the market with the largest market share, followed by Europe. The Asia-Pacific region is expected to witness a lucrative growth rate owing to increase in disposable income, increasing birth rate, and rising awareness among the patients. Growth in Asia-Pacific, Latin America, Middle-East and other emerging economies is expected to be driven by the rising birth rates, increase in demand for technologically advanced fetal monitoring products, and an improvement in the healthcare infrastructure. Driven by the growing number of middle-class population and the rise in initiatives taken up by governments toward child and infant care, the sales of new cost-effective units is expected to grow in developing countries.

There is a substantial market for combined devices, especially for infant incubators and phototherapy systems with radiant warmers and transport incubators with the capabilities of a mobile NICU. The entrance of a large number of companies into the manufacturing of neonatal warming equipment is expected to boost the market growth. Leading market participants often bundle products and offer heavy discounts. Various non-profit organizations along with the governments are attempting to offset the effect of consolidation by funding the hospitals to increase the number of beds and staff in the NICUs. Key market players in the fetal and neonatal equipment market are CareFusion Corporation, Covidien PLC, Cooper Surgical Inc., Fisher & Paykel Healthcare Limited, Dragerwerk AG & Co. KGaA, GE Healthcare, Fujifilm SonoSite Inc., Philips Healthcare, Getinge AB, and Natus Medical Inc.

Technology Trends

Fetal MRI. The recent developments in fetal imaging have provided a major impetus to the advancement of fetal medicine. Fetal magnetic resonance imaging (MRI) is one of the major emerging trends in the fetal and neonatal equipment market. The development of multi-planar imaging has offered a large field of view of the fetus and placenta with excellent soft-tissue resolution of the brain, brainstem, spinal cord, airways, lung parenchyma, and abdomen. Faster MRI sequences have provided high-resolution multi-planar images that help in completing the diagnosis of complex or large anomalies in the fetus, and enhances the capacity to detect brain injury and altered brain development and assists in the prediction of high-risk children who warrant surveillance and early intervention. Research demonstrates that conventional MRI is strongly associated with neurodevelopmental outcome in childhood. Neonatal MRI is predictive of later neurodevelopment but is dependent on appropriately trained specialists and should be interpreted in conjunction with other clinical and social information. Combined fetal ultrasound and MRI studies are a unique strength. Ultrasound is important not only in the identification of anomalies, but also in the assessment of fetal well-being and growth. Fetal MRI can confirm or exclude the presence of lesions noted by fetal ultrasound and detect subtle anomalies that are not well visualized by ultrasound but may alter the outcome.

Second Opinion
Advancements in Neonatal Care

Neonatal care services aim to provide a healthy and disease-free life for newborn infants. Apart from a team effort of doctors, nursing staff, and other hospital manpower, technology in the form of various life saving and monitoring equipment provide valuable aid in achieving common goals. Traditional equipment including baby warmers, incubators, phototherapy units, ventilators, and pulse oximeters continue to be the back bone of basic neonatal intensive care. Various advances which make these systems baby- and doctor-friendly have been incorporated in the last few years. Neonatal incubators have safety features for babies and also their design allows parents to sit near their babies decreasing their stress levels. They are designed with workflow in mind, including an in-bed scale, oxygen delivery, and trending capabilities thus emphasizing developmental care principles on exceptional patient/caregiver interaction.

Newer equipment include infant resuscitators used at the time of birth, which provide continuous positive-end expiratory pressure; cooling devices like techotherm and miracradle used in the management of hypoxemic birth injury; and nitric oxide systems for babies who cannot be managed on traditional and high frequency ventilators. Their use is expected to grow manifold, especially in tertiary care centers. Closed loop FiO2 control systems maintain oxygenation targets within a prescribed range and are helpful in preventing oxygen toxicity in the vulnerable preterm infants. These products would soon become an integral part of level-III neonatal intensive care units. Masimo technology pulse oximeters measure oxygen saturation levels even in babies with shock and are an effective tool in screening babies for congenital heart diseases.

High initial costs of some of these equipment deter their usability on a larger scale. However, newer low cost innovations such as embrace (heating device to maintain newborn baby temperature especially during transport) and miracradle (low cost cooling device) have become extremely popular both in smaller and larger neonatal units. Though the advantages of the new and improved technology are manifold for neonatal care, their procurement and usage has to be justified according to individual centers.


Dr Anil Batra
Senior Application Manager,
Asian Institute of Medical Sciences, Faridabad

Phototherapy for neonates. Phototherapy is the most common treatment for hyperbilirubinemia in neonates. The technology of phototherapy devices has shifted from fluorescent lamps to LEDs over the past decade, improving the amount of light emitted but on a smaller surface. LED phototherapy systems have become increasingly popular for their intensive irradiance and low maintenance requirements. Phototherapy is a safe, effective method for decreasing or preventing the rise of serum unconjugated bilirubin levels and reduces the need for exchange transfusion in neonates.

The traditional phototherapy units using fluorescent tubes contain standard blue, daylight, and cool white lamps. Those with a high energy output near the maximum absorption peak of bilirubin special blue lamps are most efficient for neonatal phototherapy as they have more than twice the energy output at 450 mm than the standard blue bulbs. LED lights that commercially available for use are the safest phototherapy devices as they do not emit light in the ultraviolet and the infrared radiation range. Fiber optic phototherapy systems are widely considered to be more convenient than overhead lights.

The technology currently provides the clinician with three different modes of phototherapy delivery - fiber optic, low intensity, and high intensity phototherapy. In case of fiber optic systems, light is delivered from a halogen bulb through a fiber optic cable and is emitted from the sides and ends of fibers inside a plastic blanket which is protected by a disposable cover. For low intensity phototherapy, overhead lamps are typically set at a distance of 50 cm from the patient. High-intensity phototherapy is achieved by using a unit with eight special blue lamps 25 cm above the naked infant who is on a fiber optic phototherapy blanket in a bassinet, while wearing a tie-on surgical mask as a diaper.

Neonatal incubators. Hospitals are demanding technologically improved and sophisticated devices, which include hybrid warming devices that can be configured as open or closed incubators and double-walled incubators. The neonatal incubators segment has grown to encompass a variety of equipment that assist in the growth and survival of the newborn by providing them nutrition and suitable environment, including oxygen supplementation, continuous positive airway pressure (CPAP) mechanism, mechanical ventilation, air humidifiers, intravenous provisions, pulse oximeters, cardio-respiratory monitors, neonatal defibrillators, and neonatal ventilators.

Neonatal ventilators. The introduction of mechanical ventilation is one of the major new interventions in neonatology, which provide life-saving support for infants with respiratory failure. Along with other technological advancements, such as the administration of antepartum corticosteroids and surfactant replacement therapy, mechanical ventilation has led to improved neonatal survival, especially for premature infants born less than 30 weeks gestation with immature lung function. Tidal volume accuracy and understanding of compressible volume loss in the circuit rank are other important concerns when ventilating neonates. Today's medical equipment market has a number of ventilator models that address the issues of both volume control/pressure and endotracheal tube leaks. Several new generation neonatal ventilators that incorporate conventional as well as high frequency ventilation (HFOV) are available in the market. Most of them offer the possibility to use HFOV in a volume-targeted mode, despite absence of any preclinical data. They provide much needed alternative ventilatory support for the patient. Reduction of airway pressure, improved oxygenation, recruitment of alveoli, and redistribution of ventilation are the major advantages of these new models.

Advances in neonatal care - from the amount of oxygen administered to how a neonate's temperature is monitored - have made the process of caring for a premature baby more safe and comprehensive than ever. With a shortage of healthcare resources, standards of care have been redefined to meet the needs of underserved populations. Despite impressive advancements for the care of preterm infants, the greatest reduction in global neonatal mortality can be achieved by ensuring universal access to essential newborn care. Simple low-cost evidence-based interventions such as clean delivery practices, immediate warming, umbilical cord care, and neonatal resuscitation could prevent 40-70 percent of newborn deaths globally, but many obstacles preclude the provision of those basic interventions for all newborns, particularly in low-resource regions. On the technology front, vendors are likely to introduce patient-friendly innovative devices of high quality that are also cost-effective. These adaptable technologies will minimize the time of treatment, thus reducing patients' stay in hospitals and ultimately cost of care.

10 Diagnostic Imaging Trends for 2018



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