It was a cold and drizzly February night earlier this year when Beijing police officers dropped a baby off at Little Flower Orphanage. Staff gasped as they peered into the blanket that swaddled the abandoned boy, named Long. He weighed just 2 pounds, so small he could be held in the palm of one hand.
The premature boy had many health issues that would require medical attention, including bowel obstructions and respiratory difficulties, but that night the most pressing concern for the Little Flower staff was his dangerously low internal temperature. If they didn't find a way to warm him up, he wouldn't make it through the night.
If Long had been brought to Little Flower just a week earlier, he would have been wrapped in layers of blankets and placed in a crib with hot water bottles tucked under the mattress. It's not a terribly effective way to keep premature infants warm, but lacking access to incubators and radiant heaters, it's the best Little Flower staff could do.
In the past when Little Flower took in babies Long's size, they never lived more than a few days, typically dying from complications related to hypothermia. Without medical equipment it is impossible to keep premature and low birth weight babies at the temperature they need to safely grow and develop.
But things were going to be different for Long. Two days before he arrived at Little Flower, Linus Liang, an American friend of the orphanage manager, dropped off an invention he'd been working on. Though it just looked like a preemie sized sleeping bag, Little Flower staff were about to find out this was no ordinary blanket.
Every year, 20 million preterm babies like Long are born around the world. A quarter of them will die within the first four months of birth, according to Dr. Karsten Lunze, assistant research professor at Boston University School of Medicine. Preterm delivery makes infants vulnerable to all kinds of health issues. Underdeveloped lungs lead to respiratory infections, and immature livers cause jaundice. Many also suffer from urinary tract infections and gastrointestinal difficulties.
Notwithstanding the severity of these complications, the biggest threat to the health and viability of preterm babies is actually room temperature, which is literally freezing for a full-term infant. "A newborn placed naked in an environment of 23 centigrade at birth suffers the same cold as does a naked adult at 0 centigrade," Lunze said.
Preemies' underdeveloped physiology makes them feel the cold even more profoundly than the average newborn. Lacking the muscle mass needed to shiver, preterm infants cannot create their own heat. Moreover, the absence of body fat makes it difficult for them to retain what heat they have.
In the more prosperous countries, preterm infants like Long are placed in high-tech incubators that maintain the environmental conditions necessary for continued growth and development. But only a small portion of the preterm infants born into the world receive this care.
More than 60 percent of preterm births occur in Africa and South Asia where incubators, not to mention the electricity to run them, aren't available, according to data from the Partnership for Maternal, Newborn and Child Health, a Switzerland affiliate of the World Health Organization.
Not surprisingly, there is a dramatic survival gap for premature babies depending on where they are born. More than 90 percent of infants born before 8 months in low-income countries die within the first four weeks of life, while just 10 percent of babies at this gestation die in high-income countries, according to the World Health Organization. "The simple fact of babies getting cold is a huge threat to their survival everywhere except the developed world," Lunze said.
The little blue "sleeping bag" Linus Liang left at Little Flower was actually a prototype of an extremely low-cost incubator he developed with classmates at Stanford University. The device, which they call the Embrace Warmer, uses something called phase change technology. This technology, originally developed to protect astronauts from the extreme temperatures in space, is able to keep an infant warm up to six hours.
While standard incubators cost approximately $20,000 and require a steady supply of electricity, the Embrace Warmer costs just $200. The machine's design is meant to be intuitively easy to use — so easy, in fact, that a person doesn't need medical training to use it.
Baby Long was placed in the Embrace Warmer within minutes of arriving at Little Flower. Staff were not optimistic about his prognosis but miraculously, the baby made it through the night. They kept Long in the Embrace Warmer for a month. Passing the days enveloped by the warmth of his little blue sleeping bag, Long grew strong and put on weight. This allowed doctors to safely address some of his other medical problems, including operations for his respiratory issues.
Today, Long is a healthy 9-month-old. Notwithstanding a tough start, he is hitting all his developmental markers: he's crawling and sitting up and rolling over on his own. Little Flower staff hope they will be able to find an adoptive family for their first Embrace baby, said Anna Manzur-Allan, director of communications for Embrace.
By providing mothers and caregivers in the developing world a way to keep their smallest newborns warm, Liang and his Embrace co-founders hope to dramatically improve infant mortality and health. Kept warm, many preterm infants in the developing world will be able to grow up healthy, Manzur-Allan said.
How to get Embrace Warmers into the hands of the people who need them most will be the organization's challenge going forward, Lunze said. Although Embrace Warmers are just 1 percent of the cost of a traditional incubator, the $200 price tag is still prohibitively expensive for many of the clinics and birth attendants whose patients could benefit most from it.
Embrace has partnered with nonprofit organizations to distribute the devices free to clinics in developing countries around the world. They have placed their warmers in 10 countries, including India, China, Sudan and Zanzibar. In exchange for free Embrace Warmers, clinics provide feedback on the devices as well as records of how they are being used.
While this solution has a lot of potential for children who are born in clinics, more than half of the births in the world occur in home settings, Lunze said. Getting these devices into the hands of women who give birth at home will be key, Lunze said.
Although this challenge is immense, Lunze is optimistic about the resourcefulness of new mothers. "Women in Nepal got together to buy an ambulance for their community," he said. "These women are so creative and came together to find a way to share something they needed." He thinks they could do something similar with Embrace Warmers. "If they know about it and it will improve their babies' chances of survival, they'll find a way to get it."