Hot enough for you? Keeping babies warm in developing countries

Newborns like this child have a high risk of hypothermia, even in warm climates. An innovative warming pad could be one potential fix. (Courtesy of Anne Hansen)

In the United States, we rarely worry about newborn babies getting dangerously cold, but in poorer countries the basic provision of warmth can be extremely challenging. Although the World Health Organization (WHO) considers newborn thermal care a critical part of neonatal care, hypothermia remains a leading cause of sickness and death globally.

Even in places with warm climates such as sub-Saharan Africa and South Asia, babies can quickly lose heat, and how hypothermia in newborns is treated reveals a dramatic contrast with the developed world.

The playing field may soon get more level, thanks to a device Boston Children’s Hospital’s Anne Hansen, MD, MPH, has been developing with collaborators at Lawrence Berkeley National Laboratory’s Institute for Globally Transformative Technology (LIGTT) since visiting Rwanda in 2010. That device is a warming pad that can keep a newborn warm for hours at a time with no electricity, and which can be used in a home, clinic, hospital or transport setting.

Heat source

A number of factors can make newborns in resource-limited environments susceptible to hypothermia. Some are clinical, such as delivery rooms that are not adequately heated, and some are procedural, such as not drying and wrapping the baby immediately after birth.

Others are cultural, including practices like oil massage, which families and caregivers believe improves the health of a baby’s skin but which can actually weaken it.

Biology plays an important role as well. Underweight and premature babies are especially susceptible to hypothermia, in part because they have less brown fat, a form of fat the body metabolizes to produce heat.

Nature provides newborns with a great source of warmth: the mother. Unfortunately, skin-to-skin contact with the mother, called “kangaroo care,” may be taboo in the culture, or the mother may fall ill or die after delivery, or she may simply have to return immediately to work.

In the U.S., incubators can effectively substitute for a mother’s warmth. But they are not necessarily a solution for developing countries. “Incubators are really expensive, require electricity, are hard to clean and complicated to use,” says Hansen, who is the medical director of Boston Children’s Neonatal Intensive Care Unit. “I thought there must be a simpler solution, a non-electric warmer based on the concept of a heating pad. Something inexpensive to make, simple to use and easy to clean.”

‘Baby burrito’

A prototype of the warming pad. The white color indicates that the pad's "phase-change" material is in its solid state. (Courtesy of Anne Hansen)

The result of Hansen and her LIGTT collaborators’ efforts may be the first to fit those criteria.

The warming pad is made up of two waxes that form a “phase-change” material—something that is hard at cool temperatures and becomes soft and pliable when heated, and that can retain heat for hours. Its plastic coating can easily be washed with soapy water, making it readily reusable.

To warm the pad, Hansen has turned to something all human cultures can access: hot water. Parents or caregivers can roll up the pad, roughly the size of a manila folder, and put it in a thermos with hot water. Hansen is working to add a color indicator to the pad, so that it’s visually clear when it’s warm enough, but not too warm.

When the temperature is right, a caregiver can put the baby on the unrolled pad as a flat surface. Or, if the baby is preterm, low birth weight, sick or already hypothermic, the pad can be wrapped around the baby, “like a baby burrito,” says Hansen.

A prototype of the pad has already been developed and shown to health care providers in Rwanda. Hansen is working with the Rwandan Ministry of Health, Partners in Health and LIGGT to study its safety and efficacy.

Although it’s not ready for mass production, Hansen hopes to design the infant warmer so it could be manufactured locally, allowing Rwandans to produce and sell the pads on their own terms. And if she can keep the price point low enough, hospitals, clinics and midwives could potentially purchase multiple pads, warming one up as another cools and keeping a newborn warm for days on end.

As the world struggles to meet the Millennium Development Goals, including reducing child mortality by two-thirds by 2015, the infant warmer could provide a simple, safe and inexpensive solution to hypothermia, whether for midwives delivering babies at home, for care providers in resource-strapped clinics, or during transport to a higher level of care.

“It’s 2013,” says Hansen. “Babies should not be dying of hypothermia. This has to be a fixable problem.”