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4/30/2009

A gift of warmth
Rice seniors refine 'hot cots' for infants in clinics around the world

BY MIKE WILLIAMS
Rice News staff

Lightbulbs in a plywood box -- how complicated could that be?

You'd be surprised.

When a team of Rice seniors took on the task of building a better incubator for premature babies, they knew enough to take every small issue seriously.

	JEFF FITLOW The hot cot design team includes (clockwise from left) Mimi Zhang, Lindsay Zwiener, Larissa Charnsangavej, Richard Romeo and McKenzie Smith.

Developing their project under the supervision of Maria Oden, director of the design kitchen and professor in the practice of engineering, the team had a simple goal: Save babies.

"The original hot cot design didn't come from us," said Oden. "Rebecca (Richards-Kortum, director of Rice 360°) and I found it at a hospital in Blantyre, Malawi, and they got the design from a student team in Kenya.

"I tasked my team with optimizing the design. Make it as inexpensive as you can but work as efficiently as possible."

There was nothing standard about the crude device they saw. "It fills a niche between having nothing and having an incubator," Richards-Kortum said. "It's really designed for low-resource settings to keep premature babies sufficiently warm."

Zhang, of Baker College, said some of the devices had angled planks to direct warm air up into the top chamber, and some had aluminum flashing on the bottom as insulation. "They had different gap sizes and heights and lightbulb wattages."

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Who knew you could build a better mousetrap in the kitchen? She said the professors asked them "to look at the parameters and figure out which were the most thermally optimal -- which combination would produce the cot that warms babies best with the least amount of energy." That meant analyzing airflow to maximize heat and maintain the right amount of oxygen in the infant's chamber, seeing how well it worked in hot and cold climates, finding the right electrical components to ensure the widest-possible use and building models to test all of the above.

The directive set the students on a quest to design a hot cot that could be built with materials common to as many parts of the world as possible. Their plans got a real-world trial when a team of students from Rice's Jesse H. Jones Graduate School of Management, under mentor Marc Epstein, distinguished research professor of management, took them to Rwanda on spring break. Within five days, the team found a way to get a cot built by local carpenters, demonstrated it briefly in a clinic and worked with local officials to begin to obtain regulatory approval.

The design kitchen team's final design, presented in various competitions over the past few weeks, is a stand-alone unit of plywood and Lexan, a highly durable plastic, that incorporates a heating chamber below the infant's bed and vents that allow heat to rise through the top chamber and out. Simple on-off switches control four lightbulbs, giving clinicians a way to regulate the amount of heat passing through. "Working with developing-world materials was a big constraint," said Smith, of Baker College. "We considered a few options for heat sources that weren't viable because they wouldn't be easy to get."

The design kitchen team's final hot cot design, presented in various competitions over the past few weeks, is a stand-alone unit of plywood and Lexan, a highly durable plastic, that incorporates a heating chamber below the infant's bed and vents that allow heat to rise through the top chamber and out.

The team also decided the angled heating chambers and metal components seen by their mentors in some hot cots were unnecessary. "The hospitals were buying these huge, expensive pieces of metal to direct the air, and it turns out they didn't need them," Zhang said. "We found we could get temperatures where they needed to be, so our plans save them the cost and headache of trying to find metal. We're banking on them being able to find plywood."

Ventilation tests proved the cots would be safe. "Basically, we had adults breathing into the chamber for about 20 minutes, the time required for the amount of carbon dioxide inside to stabilize, and measurements showed we were way out of the range of danger for CO2 saturation," Zhang said.

Smith said the cots are intended for infants born at 30 weeks or more. "We recognize 'kangaroo care,' where premature babies are held by the mother or a relative skin-to-skin for most of the day, is the preferred method of warming in developing countries, and it's been recognized by Western medicine as being better than incubators," she said. "But there are cases where an infant is very small or very sick or can't take the stimulus of being held constantly.

"That's what we expect this to be used for, when babies are too small to be warmed by kangaroo care or when relatives are not available."

Zwiener, of Brown College, is the only nonbioengineer among the group and ironically the only one who will dedicate herself to building hot cots this summer. A kinesiology, policy studies and political science major who is minoring in global health, Zwiener will work on the project in Nicaragua and Guatemala. Other Beyond Traditional Borders (BTB) interns will take plans to Ecuador, Haiti, Uganda, the Dominican Republic, Lesotho, Myanmar, Tanzania and Swaziland.

"We've trained 14 interns from BTB to put them together," Zwiener said. "All the interns have specific projects, but we know those aren't going to take them the entire eight weeks. They're going to need side projects, and we hope that's how this will fit in."

The team said input from Gerardo Cabrera-Meza, medical director of the International Neonatology Program at Texas Children's Hospital and an associate professor of pediatrics at Baylor College of Medicine, was also invaluable.

Zhang said plans for the cots would be refined next year, when undergraduates collect feedback from returning interns. "We're looking forward to leaving manuals for the cots at each site this summer," she said. "There are networks of health professionals who go back and forth between the central and rural areas, and we want them to spread them around."

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Bioengineering sophomore tweaks bili lights to cure babies of jaundice

Yiwen Cui knew she'd found a project worthy of her talents while studying in Mexico last summer.

"I went to a local government hospital, one of the main branches for children, and the pediatric ward had only one bili light for this huge, entire room," said the Rice bioengineering major, who was south of the border as part of a Beyond Traditional Borders (BTB) program. "They were constantly moving children in and out."

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