Effect of high sun intensity on neonatal incubator functionality in a tropical climate

Model and prototype of mobile incubator using PID controller based on Arduino Uno

One of the causes of the high infant mortality rate in Indonesia is the lack of health support facilities in remote areas, including incubators, to keep the baby's body warm at a specific temperature. This research develops a model and prototype of a mobile incubator to carry and maintain the baby's temperature during emergencies to get further treatment to hospitals that have better facilities than incomplete health clinic facilities. The mobile incubator prototype uses a PID controller system with the optimum gain value Kp 1.501, Ki 0.016, and Kd -1,319 from the results of modeling and tuning in Matlab. The results of the bode plot analysis show that system stability was achieved with a gain margin of 109 dB. The incubator's operational mobility can last up to 59.6 minutes with two 12 V, 5 Ah batteries.

Neonatal hyperthermia and thermal stress in low- and middle-income countries: a hidden cause of death in extremely low-birthweight neonates

BACKGROUND

Over 70% of neonatal deaths in Nigeria occur within the first 7 days of life and, despite the millennium development goals, there has been no significant reduction of this figure.

OBJECTIVE

To investigate how rapid changes of temperature outside the physiologically allowable range in extremely low-birthweight infants are associated with increased mortality.

METHODS

Ninety-eight neonatal cases in three Nigerian tertiary-care hospitals were retrospectively recruited; on the basis of birthweight  < 1500 g, this number was reduced to 41 for a two-stage analysis. In the first stage, 34 cases recruited over 24 months were analysed. In the second stage, seven cases recruited over 6 months were analysed; these were neonates managed with a new temperature control technique (the 'handy approach') to enable comparison of outcomes. The mean (SD) birthweight of the infants analysed was 991 g (251), and 28 of them were of extremely low-birthweight (ELBW) [mean (SD) 846 g (128)]. A lifetime temperature plot with a clearly visible reference zone was developed, from which all thermal stresses and their duration associated with mortality were identified and defined on the basis of their characteristics. Methods of quantifying the magnitude and duration of these thermal stresses were devised to enable definition of critical values. This was then applied to calculate a measure of the various thermal stresses which may have contributed to neonatal death.

RESULTS

Hypothermic events were very common in all the infants in the study period, but were not significantly associated with mortality. However, hyperthermic events occurred in 35% of the infants and were more likely to be associated with mortality. Most neonates with prolonged hypothermia culminating in rapid hyperthermia survived. However, all ELBW neonates who experienced prolonged hyperthermia culminating in rapid hypothermia died within 8 hours of the event. There was greater ELBW survival (6/6) in the second stage using the 'handy approach' than in the first stage (2/22).

CONCLUSION

Hyperthermia is a high-risk event in ELBW infants and methods of cooling a high and prolonged temperature must be reviewed.

Challenges and frugal remedies for lowering facility based neonatal mortality and morbidity: a comparative study

Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one "control" were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria.

Synthesis and validation of a weatherproof nursery design that eliminates tropical evening-Fever syndrome in neonates

Neonatal thermal stabilisation can become challenging when uncontrollable factors result in excessive body temperature. Hyperthermia can rapidly slow down baby's progress and response to treatment. High sunlight intensity in tropical countries such as Nigeria manifests in incessant high neonatal temperatures towards early evenings. The ugly consequences of this neonatal evening-fever syndrome (EFS) can only be eradicated by the development of a controlled weatherproof nursery environment. Two laboratories and a ‘control ward' were applied. Lab-2 was a renovation of an existing room in a manner that could correct an existing nursery. Lab-1 was an entirely new building idea. The laboratories were assessed based on comparative ability to maintain environmental coolness and neonatal thermal stability during hot days. Data collection continued for 12 full calendar months. On average, at evaluated out-wind peak temperature of 43°C (range: 41°C–46°C), the control-ward peak was at 39°C, Lab-2 peak at 36°C, and Lab-1 peak at 33°C. All incubators in the control overheated during the hot periods but there was no overheating in Lab-1. Forty-four (86%) of sampled babies were fever-quenched by water sponging 131 times in the control whilst only one baby received same treatment in Lab-1. Nursery designs patterned after Lab-1 can significantly reduce EFS-induced neonatal morbidity.