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NICU – Encouraging parental bonding

The care for preterm infants has improved considerably in the last decades, and although the outcome improved, prematurity is still a large global health issue and is ranked in the top 10 of the WHO list of leading causes of burden of disease.

Historically, much progress in neonatal care was made through the use of technology. The chances of survival for preterm infants increased by the development of an infant incubator. Later on, preterm infants were able to survive by the use of a mechanical ventilator specifically designed for neonates. However, preterm infants on mechanical ventilation developed classic bronchopulmonary dysplasia, indicating that exposing fragile patients to technology can also have negative consequences. For this reason, the technology in neonatology is in a continuous process of improvement. A double-walled servo-controlled incubator now protects preterm infants, and more sophisticated mechanical ventilators are used with built-in algorithms, guaranteeing that even the smallest tidal volumes can be delivered in a safe manner.

Currently, technology combined with computer intelligence can support the caregiver in their daily task. Neonatal caregivers are aware that preterm infants are a very fragile patient population and that they work daily with only narrow ranges of normal and safe values, and injury can easily occur when the infant is outside the margins. Technical devices with built-in algorithms will help caregivers to maintain preterm infants within these ranges. Thus, minimizing the occurrence and duration of injurious moments can be very challenging. There is an ongoing development of technical applications, specially designed to solve neonatal problems.

New technology in neonatology
The field of neonatology is constantly evolving. With the advent of new prenatal diagnostic options and fetal interventions, some newborns receive significant medical care even before delivery. After birth, advances in neonatal intensive care have led to improved survival in preterm infants born at progressively younger gestational ages. Advances in technology, surgical techniques, and therapeutics have dramatically changed the management, timing of treatment, and outcomes of common neonatal diseases.
An interdisciplinary Northwestern team has developed a pair of soft, flexible wireless sensors that replace the tangle of wire-based sensors that currently monitor babies in hospitals’ neonatal intensive care units (NICU) and pose a barrier to parent-baby cuddling and physical bonding.

The team, involving materials scientists, engineers, dermatologists, and pediatricians, recently completed a series of first human studies on premature babies at Prentice Women’s Hospital and Ann & Robert H. Lurie Children’s Hospital of Chicago. The study was published in the journal Science.

The scientists concluded that the wireless sensors provided data as precise and accurate as that from traditional monitoring systems. The wireless patches also are gentler on a newborn’s fragile skin and allow for more skin-to-skin contact with the parent. Existing sensors must be attached with adhesives that can scar and blister premature newborns’ skin.
The study includes initial data from more than 20 babies who wore the wireless sensors alongside traditional monitoring systems, so Northwestern investigators could do a side-by-side, quantitative comparison. Since then, the team has conducted successful tests with more than 70 babies in the NICU.
The benefits of the Northwestern team’s new technology reach beyond its lack of wires – measuring more than what is possible with today’s clinical standards.
The dual wireless sensors monitor babies’ vital signs – heart rate, respiration rate, and body temperature – from opposite ends of the body. One sensor lies across the baby’s chest or back, while the other sensor wraps around a foot. (The chest sensor measures 5 cm×2.5 cm; the foot sensor is 2.5 cm×2 cm. Each sensor weighs about the same as a raindrop.) This strategy allows physicians to gather an infant’s core temperature as well as body temperature from a peripheral region.

The device also could help fill in information gaps that exist during skin-to-skin contact. If physicians can continue to measure infants’ vital signs while being held by their parents, they might learn more about just how critical this contact might be.

The wireless sensor communicates through a transmitter placed underneath the crib’s mattress. Using radio frequencies, the same strength as those in RFID tags, the antenna transmits data to displays at the nurses’ station. Although it can be sterilized and reused, the sensor is cheap enough (about `700) that it can simply be discarded after 24 hours and replaced with a new one to eliminate any risk of infection.

Global market
The global fetal and neonatal care equipment market size is expected to reach USD 10.6 billion by 2026, expanding at a CAGR of 6.9 percent, predicts Grand View Research. The market growth can be attributed to factors such as a growing birthrate in developing countries, coupled with rising prevalence of associated premature births, also known as preemies. Furthermore, neonatal hospital-acquired infections such as central line-associated bloodstream infections (CLABSI) and healthcare-associated pneumonia are additional notable factors responsible for the market growth. Various aspects such as delayed maternal age, induced fertility, and lack of proper prenatal care are considered to be major factors contributing to the birth of premature babies. To address the complications associated with babies born prematurely, the demand for fetal and neonatal care equipment is expected to rise significantly. In addition, consequences of supportive government policies, coupled with rapid technological advancements in modern fetal and neonatal medical equipment, are expected to contribute for growth in the long term.
High purchase and maintenance cost of equipment and the availability of alternative treatments are the major factors hindering the market progress. The different cost of medical equipment affects the cost of medical treatment in every country in the world. There are various alternative options, which restrain the fetal and neonatal equipment market size. A simple method to maintain the temperature of the baby is skin-to-skin contact with the mother and covering both with a blanket, which is known as thermal care. Such alternative techniques could possibly reduce the incubator market.

Growth in the in-fetal dopplers segment can be attributed to factors like the growing demand for digital dopplers over conventional dopplers and increasing launches of home-use products. The growing popularity of and demand for fetal doppler devices is increasing with due to the procedural advantages these devices offer, such as ease of use, mobility (handheld and battery-operated products), novel features, and display functionalities. The rising adoption of doppler imaging (especially in first trimester of pregnancy and for the diagnosis of restricted fetal growth), growing preference for the assessment of the fetal-placental circulatory system, expansion of application horizon for fetal doppler imaging (such as in aneuploidy screening and transfusion syndrome), and the growing availability of home-use and new smartphone-based fetal monitoring systems are other key factors driving the growth of this segment.
An incubator is a closed environment where temperature, moisture, and oxygen levels can be regulated. However, babies in incubators are less accessible as compared to warmers. The major factor driving the growth of this segment is the rising incidence of neonatal hypothermia. The large share of the Incubators segment can be attributed to development of novel neonatal incubators, rising incidence of neonatal hypothermia, and increasing number of NICU admissions. Hypothermia is common in infants born at hospitals (annual prevalence range 32 percent to 85 percent) and homes (annual prevalence range 11 percent to 92 percent), even in tropical environments, and is among the reasons for neonatal mortality.

North America is one of the major revenue-generating regions in the global fetal and neonatal care equipment market. The large share of this regional segment can mainly be attributed to the high premature birth rate in the region, presence of good reimbursement structure, significant incidence of neonatal abstinence syndrome (NAS), maternal mortality rate, lifestyle challenges (such as obesity, smoking, diabetes, and poor nutrition), and the availability of well-equipped NICU centers.

Mergers, collaborations, and product development are the key strategies being undertaken by the market players. For instance, in June 2019, Clinical Computer Systems, Inc. entered into an agreement with Huntleigh Healthcare Limited to commercialize OBIX BeCA, a fetal monitor, in the US.

Some of the prominent players in the fetal and neonatal care equipment are GE Healthcare, Philips Healthcare, Drägerwerk AG & Co. KGaA, Medtronic plc., and Masimo Corporation.

Way forward
Technology has revolutionized all aspects of care in the NICU – design, monitoring, diagnosis, documentation, and home care. Efforts to improve outcome in high-risk infants foster the emergence and integration of new technology in NICUs. Some of them include amplitude-integrated electroencephalogram (aEEG), therapeutic hypothermia, and devices for communication and remote viewing, to name a few. As more technology is integrated into the clinical arena, parents and clinicians face technological, moral, and ethical challenges. Learning to use and interpreting technology and making it meaningful for families can increase the workload of clinicians. Enabling families to participate in care and facilitate bonding requires skill, motivation, and confidence from a compassionate care team. Judicious use of technology may offer hope and comfort to families, although it will not replace human caring.

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