Supporting maternal bonding with premature babies

When a child is born extremely premature, normal adaptation to the environment outside the womb is impossible. Instead, the child is confined to an incubator in a hospital neonatal intensive care unit (NICU) for several weeks or months. Various vital organs are not yet fully developed, and complications, such as organ failure and infections, are a constant risk. Medical staff strive to keep the neonate alive and ensure he or she develops as quickly as possible.

In the USA, numbers of premature births rose until 2006,¹ and since then the percentage of premature births has leveled off at around 12%.² Luckily, over the years, innovations in medicine and technology have raised the survival rate of these fragile infants,³ resulting in ever more children spending the start of their lives in the NICU. Unfortunately, this leaves a mark on the child.^4–8 External stimuli in the postnatal environment, such as light and noise, cause stress and sometimes even pain to premature infants.^{7, 9}

Although changes in clinical procedures generally take time, it is possible to rapidly implement successful interventions to help neonates cope with overstimulation.^{10, 11} For instance, during stressful interventions, techniques such as ‘facilitated tucking,’ in which the parent holds the infant's body in the foetal position by placing a hand on its head and the other on its legs and trunk, caressing and softly talking to the child, or providing skin-to-skin contact, help parents comfort their child.¹² Such actions have shown to soothe children more quickly and reduce pain during minor painful interventions, such as blood sampling. An overview is available elsewhere.¹³

Close personal physical contact between parents and child is the ideal. However, high levels of stress, the mother's postnatal medical treatment, or obligations at work or at home (such as other children), can make it unavoidable that parents are away from their child at times and unable to provide comforting stimulation. To overcome this, we set out to help parents maintain contact with and comforting stimuli to the baby in the NICU when elsewhere. To this end, we developed various conceptual prototypes, which we name the ‘FamilyArizing’ system, the Mimo, and the child-rocking incubator bed (CRIB).

The FamilyArizing system allows parents to stay in contact with their child and, in cases of distress, provide the child with a remote comforting ‘hug.’¹⁴ The child's movement (an indicator of stress) is communicated to a necklace worn by one of the parents. If the parent then ‘comforts’ the necklace, an intelligent mattress inside the child's incubator will warm up and physically hug the child, hence providing comfort: see Figure 1(a). The Mimo is a small pad producing rhythmic motions matching a prerecorded sample of the maternal heartbeat, placed on top of the child in cases of discomfort: see Figure 1(b).¹⁵ In its current form the, Mimo must be manually activated. However, we expect a future system to work autonomously by reacting to the child's emotional/behavioral state. The CRIB is a conceptual redesign of the incubator mattress into a crib-like form, mimicking the boundaries and rocking motion of a womb: see Figure 1(c).¹⁶

Figure 1. (a) The FamilyArizing system.¹⁴ (b) The Mimo prototype. (Image courtesy of Daniel Tetterroo.)¹⁵ (c) The child rocking incubator bed (CRIB) prototype.¹⁶

After re-evaluating these and other concepts, such as a maternal sound generator,¹⁷ we decided to focus on the child's sense of smell. Adults' primary sense is vision, but for a neonate it is smell.¹⁸ Furthermore, research shows that smells of amniotic fluid,¹⁹ maternal breast milk,²⁰ and vanillin²¹ are capable of providing effective comfort during maternal separation. However, to our knowledge, until now only limited research knowledge has found its way into practice.

We are now working to overcome the technical, clinical, and design complications of capturing, storing, and releasing comforting smells inside an incubator. We envision a completely autonomous comforting system, similar to our plans for the Mimo: see Figure 2. By gathering and combining existing clinical physiological information about the child, we will extract the child's emotional/behavioral state. If the child then experiences discomfort when the mother is absent, the system will provide a whiff of comforting scent. It should be noted that we do not view our technology as an adequate replacement for close physical contact between parents and child. Our aim is to make unavoidable periods of absence less stressful. In the future, we hope to provide prematurely born infants and their parents with mutual multi-sensorial stimulation during such periods of separation.

Figure 2. A scenario depicting our envisioned comforting procedure during a minor invasive procedure, finishing with a multi-sensorial pain relief system.