Low-cost infant incubator developed at UMBC completes successful clinical trial in India

Published: Feb 22, 2021

Innovative technologies don’t have to be expensive or complicated. 

UMBC’s Govind Rao, professor of chemical, biochemical, and environmental engineering and director of the Center for Advanced Sensor Technology, has been developing a low-cost solution to improve the care of babies born prematurely. 

A standard incubator found in a newborn intensive care unit costs between $1,500 and $35,000—beyond the means of many hospitals in low- and middle-income countries. Public impact research initiated by Rao and UMBC students has culminated in the successful clinical trial of an incubator that costs only $200.

Three men in suits are in a lab gathering around a table looking at a cardboard box with a baby doll inside simulating an incubator.
Govind Rao, center, presents a prototype incubator to then-Maryland Secretary of Commerce Mike Gill in 2017. Photo by Marlayna Demond ’11 for UMBC.

“This will be a game-changer,” says Rajeev Seth, managing trustee of BUDS, a nonprofit that advocates for the health and welfare of children in India. 

Student project beginnings

The low-cost incubator traces its roots to a UMBC course on sensors in 2011. There, Rao asked students to come up with solutions for real-world problems. Kevin Tran ’12, chemical engineering, was part of a team that designed a low-cost infant incubator. He continued on the project that summer. 

“As an engineer, [when] you start something, you can’t leave it half-finished,” Tran says. He and his teammates tested out prototypes built with different materials, like wood and PVC. The team ultimately took a trip to India to visit various healthcare settings and receive feedback on their design.

A group of nine people of different ages stand in a group in front of a one floor stone house with terracotta
Govind Rao, third from left, with UMBC students and research partners, during a trip to India. Photo courtesy of Kevin Tran.

The students encountered facilities that faced frequent power outages and lacked resources they’d taken for granted in the U.S. One healthcare center had broken incubators that sat unused, Tran says, because they couldn’t be maintained, even if it was a simple fix.

The team was accompanied by Geetha Mohanram, a retired elementary school teacher who acted as a translator. Mohanram now lives in the U.S. but is from Karnataka, one of the areas the team visited. She bridged the gap between the engineers and the nurses and doctors, not only through fluency with the local dialect, but also because of familiarity with the local culture. This helped the UMBC team access the medical staff’s observations and insights.

Feedback gathered during the trip guided updates to the design, such as smaller dimensions and cardboard construction for single use. The design work culminated in a paper published in the Journal of Laboratory Automation in 2014. It provided recommendations for a prototype suited to a clinical trial.

Cardboard incubator in action

An updated version of the cardboard incubator has now proven successful in a clinical setting. In an EClinicalMedicine study, published by The Lancet, the low-cost incubator maintained the body temperatures of premature babies as well as a more expensive, standard incubator over 48 hours.

The low-cost incubator is made up of a cardboard chamber, designed to be disposed of after use by one infant, and a reusable heating unit. The cardboard packs down flat, so it can be easily transported. It is straightforward to assemble—almost like a pop-up book, Rao says.

Careful monitoring

The clinical trial was a collaborative effort supported by the U.S. Food and Drug Administration. Subawards supported Phoenix Medical Systems, which provided the cardboard incubators, and researchers at Sri Ramachandra Institute of Higher Education and Research (SRIHER), who conducted the study.

The study involved 96 preterm babies, ranging from 32 to 36 weeks old, without health complications. By limiting the clinical trial to babies that were relatively well, the researchers were able to focus on the performance of the incubators, says Ashok Chandrasekaran, associate professor of neonatology at SRIHER. 

The babies spent 48 hours in either a standard or cardboard incubator, with continued monitoring by medical staff. Skin sensors tracked the babies’ temperatures. They raised alarms if temperatures deviated over half a degree Celsius (0.9 degrees Fahrenheit) from 37 degrees Celsius (98.6 degrees Fahrenheit). Nurses also checked the infants using underarm thermometers every four hours and adjusted the incubator temperature as needed.

A black and white rectangular push cart with two levels carries a card board box with small blue flowers on the front of the box. Inside the box is a baby doll. A plastic ribbed tube is inserted into the end of the box that connects to a digital medical monitor box beneath.
A prototype of Rao’s cardboard incubator. Photos courtesy of V. Sashi Kumar.

There were cases where the babies’ temperatures were slightly low with both incubators, as well as several instances of mild hypothermia. But, overall, the performance of the low-cost incubator was on par with the standard incubator.

Avoiding hospital-acquired infections

The surfaces of the low-cost and standard incubators were disinfected daily, but in two cases the standard incubator harbored bacteria responsible for hospital-acquired infections. None of the low-cost incubators were positive for surface bacteria. The disposable nature of the cardboard incubator would also prevent infectious outbreaks, since each chamber would only be used by a single infant. 

“One of the major killers of preterm babies in developing countries is infection,” Chandrasekaran says. “Especially hospital-acquired infections.”

Future studies will assess how well the low-cost incubator performs over longer periods of time and whether premature babies continue to gain weight, says Binu Ninan, director and professor of neonatology at SRIHER. Future iterations of the incubator could include sensors to track babies’ weight and cameras to monitor babies more closely.

“You don’t necessarily need to have very expensive interventions to improve outcomes,” Rao says. “You can come up with something simple that works, that can have a huge impact.”

Banner image: “Happy Foot” by Natesh Ramasamy, Flickr CC BY-NC 2.0.

Article written by Jack J. Lee for UMBC News

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