JOHNS HOPKINS UNIVERSITY

An Alternative Infant
Incubator
Incubators for Third World Countries
Qingwen Kawaji

An infant incubator designed for third world countries in Eco Health

Engineering led by Dr. Thakor.

Medical Need and Background Information:

Incubator is the most common device that can provide an environment
where newborn babies can healthily grow in. Although incubators are used for all
infants, they are especially important in the case of preterm babies. There are a
few reasons that contribute this need. Firstly, infants large surface area, poor
thermal insulation and a small mass (especially for those with a low birth weight)
all contribute to infants bodies behaving as a heat sink, which is why infants
have poor temperature regulation.i Secondly, infants arent like adults; when they
are cold, they cannot help themselves with a blanket. Babies exchange heat with
their environment by conduction, radiation, convection, and evaporation. Preterm
babies are at especially high risk of heat loss due to a high surface area to
volume ratio and increased transepidermal water loss.iiFurthermore, the normal surge

in metabolic rate that occurs after birth is much reduced, which results in limited heat production.
Finally, development in the control of skin blood flow is also delayed in the immature baby,
reducing the ability to maintain heat by peripheral vasoconstriction. iii With heat loss through
four different methods and an inability to produce and maintain heat, preterm infants are at high
risk for medical complications and death.
To make matters worse, preterm infant birth rates are especially high in
developing countries, where the facilities and the after-birth care are the worst.
The combination of poor facilities, poor after-birth care, and a lack of knowledge
propelled preterm birth to be one of the leading causes of infant mortality in
developing countries. According to World Health Organization, it is estimated that in 2005,

12.9 million births, or 9.6% of all births worldwide, were preterm. iv About 85%, or 11 million
of all preterm births took place in Africa and Asia, deeming preterm birth is a leading cause for
neonatal mortality and morbidity.v
Several studies have shown that infant survival rates significantly increase when
their surrounding environment is ideal. vi Infants thrive at a specific temperature
range, the temperature thats very similar to body temperature. Preterm infants
lose heat quickly and cannot regulate their own body temperature. Being able to
provide such warmth is a great value to a babys health, this is especially true for
preterm infants. Hospitals all over the United States use incubators to provide a
steady and ideal environment for preterm babies. However, this luxury does not
exist in developing countries.

Two major obstacles that are keeping the developing countries from having these
helpful devices are accessibility and price. An example of the state of the art
incubator, used often in high ranking hospitals in the US, is the Giraffe Incubator
produced by GE health care.

These incubators not only have extremely precise

and accurate temperature control, they also have
countless other functions such as controlled
humidifier, built in scale, oxygen intake measure,
and etc. These incubators are also smart, in a
way that they can record data and be connected to
Figure 1 Giraffe Incubator From GE

the main computers at the hospital to be controlled

virtually. Incubators with such complicated process programs cannot be used anyone.
One must receive proper training provided by GE Health Care in order to be qualified to
operate. These trainings alone cost up to $4000 dollars. One can only imagine the actual
cost of the machine. Of course, this is an incubator thats on the top of the shelf.
However, the average cost of incubators in most hospitals is still more than just a few
thousands. This price, may be reasonable to hospitals in the developed countries, is
impossible for third world countries. Before price, there is also the question of
accessibility. Even if developing countries were to obtain incubators as a donation from
developed countries, it would be hard for them to learn an entire system of operations of
these new machines. Also, because these machines are built elsewhere, it is virtually
impossible to find the same parts for replacement or fix-ups in these developing countries
if anything were to go wrong with these incubators.
The purpose of this project is to strike a balance between price and functionality,
to invent an incubator thats good at what it must do -- to keep baby warm and healthy,
but does not cost a whole villages fortune. Also, the incubator must be built with
materials that are readily accessible in the home country so that trained staff can easily
replace and rebuild.
Analysis of Current Devices:

The problem of incubators has been tackled by a variety of organizations. Currently, there
are a few incubators available to third world countries. Although each one has its merits
in one way or another, they all have areas that need improvements. Before diving into our
design, we must assess each of the already existed projects to gain
insights as to how ours can be more useful.
The Embrace is one of the current devices in providing infant care. The
design costs $25. However, although the device is very cheap, it has many
downfalls. The mechanics of this device involves heating the phasechange material in the device using hot water or an electric heating pad. The pouch will
heat up to 37 degrees (the ideal incubator temperature) and placed into the sleeping bag.vii
Figure 2 The Embrance

The sleeping bag then wraps the baby inside to keep them warm. The
phase change material will stay around the same temperature for about

four hours. Then it would need to be heated up again. Although innovative, this incubator
does not have any temperature control within, which is crucial to any device. Without an
temperature control, no one would notice if anything were wrong with the device, if it
would to be defective. Furthermore, wrapping the baby in a sleeping bag forbids
caregiver to observe the baby openly, which is important in many cases
to determine a babys reaction to the environment or whether or not
they are sick.
The Car Part Incubator is another interesting innovation. The idea of
this incubator is to provide an device that can reuse old car parts. This
solution, while mildly low cost ($1000), need vehicle parts, which can be expensive and
Figure 3 Car Part
Incubator

unattainable.viii In third world countries, working car parts cannot be

cheap. Most of these parts are used to build new cars or to fix cars

rather than to be sold for incubators. Another problem with this design is that there is no
access to the infant through sleeves. It has not been tested for its ability to prevent
infections and bacteria growth. It is also fairly complicated to build.

The HEBI (Hemel Baby Incubator) is an incubator project launched by Dr. Hemel and
first used in Uganda in 1968.ix This incubator cost about $500, not including the light
bulbs. It also has to be shipped from Amsterdam airport to any developing countries in
Figure 4 HEBI Incubator

need. This incubator uses incandescent light bulbs are a

source of heat. It has been tested to prevent infection and

bacteria growth. However, it does not have temperature control unit as it is heated solely
by turning on and off the lightbulbs. Another problem with this incubator is that it uses
the fact that incandescent light bulbs are inefficient and therefore emit heat. However,
because of this inefficiency, incandescent light bulbs have also been replaced by
fluorescent light bulbs and to make the world a greener place, most companies have
stopped producing them.
Solution and Design
Through studies and analysis of the current designs, we have gathered their pros and cons
and created our very own incubator.
Incubator Material
Incubator heat source

Wood
Car Heater

Incubator ventilation

Used PC Fans

Incubator Humidifier

Aluminum foil cooking pan

Incubator window

Polyethylene sheets and Window film

Incubator Temperature Control

Digital Temperature Control with Sensor

LM 335

The incubator will be built from wood due to its accessibility and price. Also, we have
contacted the HEBI organization and through them we learned several reasons why they
used wood as the construction material for incubators: 1) wood gives a strong
construction; 2) wood has good insulation; 3) its easy to regulate relative humidity; 4)
its easy to obtain especially in third world countries. The material of the observation
window in most incubators is acrylic glass. This material is expensive and hard to get in
third world countries. In order to replace acrylic glass with another material thats safe to
use and also provide insulation and clear observation, we contacted 3m company and
decided to use polyethylene sheets. Firstly, when polyethylene sheets breaks, it will not
harm the baby in anyway. Secondly, polyethylene sheets are cheap and easily available.
In order to improve the UV reflection ability of these polyethylene sheets, window films
are used to adhere to the polyethylene sheets.

As for heat source, car heaters

are used due to their availability,
price, and efficiency. This heater
is also part of the humidifier
system embedded under the main
incubator. The humidifier system
involves a cooking pan filled
with water, heater, and PC fans.
Used PC fans are used for
ventilation of the incubator to
allow exchange of air. Finally, the thermo-regulator unit is used to adjust and relay the
system. When the temperature rises above 38 degrees, the regulator turns off the heater
until the temperature inside the incubator has fallen down to a specified 36 degrees. The
fans will be turned on when the unit is above 38 degrees and off when its below 36
degrees. This relay system is important in the regulation of the temperature inside the
incubator. Below is a diagram of the thermo-regulation unit and of its inside circuitry.

Furthermore, in order to protect the

circuitry of the thermo-regulator unit,
a special case was specifically
designed using pro-engineering and
U-print 3D prototype printer. This
case perfectly encloses the thermoregulator unit while offering an LCD
screen view and exposing the
switches for temperature displays.

Cost analysis

Overall Design Analysis

i Lyon, Andrew. (2006) "Applied physiology: Temperature control in the newborn infant." Current
Pediatrics 16, 386-392
ii Lyon, Andrew. (2006) "Applied physiology: Temperature control in the newborn infant." Current
Pediatrics 16, 386-392
iii Lyon, Andrew. (2006) "Applied physiology: Temperature control in the newborn infant." Current
Pediatrics 16, 386-392
iv Beck, Stacy, et al. The Worldwide Incidence of Preterm Birth: A WHO Systematic Review of
Maternal Mortality and Morbidity. Bulletin of the World Health Organization (2009): 10.2471.
v Beck, Stacy, et al. The Worldwide Incidence of Preterm Birth: A WHO Systematic Review of
Maternal Mortality and Morbidity. Bulletin of the World Health Organization (2009): 10.2471.
vi Day, Richard L., et al. "BODY TEMPERATURE AND SURVIVAL OF PREMATURE INFANTS."
Pediatrics 34.2 (1964): 171-81.
vii The Embrance. Web. <http://embraceglobal.org/>
viii Design That Matters. Web. <http://www.designthatmatters.org/news/dtm-blog/project/incubator/>
ix HEBI Hemel Baby Incubator. Web. <http://www.hebiincubator.org/templates/heb/global/index.php?
lngid=2&sqlmode=1&fid=144>