New parents are encouraged to practise kangaroo care — cuddling their newborn against their skin promotes the baby’s health and development, and increases the mother’s breast milk supply.

But when the baby is premature or a preemie, challenges arise. At between 23 and 28 weeks, preemies are tiny, with some weighing as little as 500g. As they are usually underdeveloped, they need critical care support with their breathing, circulation and nutrition, and are often connected to many tubes and monitors. When parents hold their tiny babies for an hour or so, which maternity wards at Singapore General Hospital (SGH) and KK Women’s and Children’s Hospital recommend, many parents worry about dislodging the tubes, especially the breathing tube, which is often their lifeline.

“The attachments are secured to the parent’s arm or shoulder with a piece of surgical tape. Imagine sitting reclined, using a hand to support the baby — however light the baby is — for an hour while remaining still to avoid having the tapes supporting the ventilator tubings coming off the shoulder,” said Ms Lee Xiaoting, Senior Physiotherapist, SGH.

Thus, an idea emerged to develop a wearable device to help nervous parents practise kangaroo care as early as  possible. Named Joey, the wearable is a baby seat that is secured to the parent with a silicon belt and positioned to let the baby lean comfortably against the parent’s chest. A tube holder swivels over a base, keeping the breathing tubes secure while allowing the parent to move about easily.

Initiated and led by a former physiotherapy colleague, Ms Teh Wan Ying, the project involved a team of doctors, physiotherapists and nurses from the hospital’s Department of Neonatal and Developmental Medicine. The wearable was tested on hospital colleagues holding mannequin babies, and their comments helped the team to make improvements. Ms Lee has taken over as project leader, and is working towards testing the wearable on patients. The project was funded by the Allied Health Innovation Challenge 2021.

The environment in the Neonatal Intensive Care Unit (NICU) can stress preemies and affect their brain development. Early parental involvement helps to ameliorate the stress, leading neonatal staff to encourage parents to be involved in their baby’s care as early as possible.

Many studies have shown that kangaroo care is an effective way to meet babies’ needs — be they full term or premature — for warmth, stimulation, safety and love, said Ms Lee. “Infants who received regular kangaroo care showed a higher daily weight gain, and also had a shorter length of hospital stay,” she added.

With kangaroo care, mothers are significantly less stressed than when their babies receive conventional care. Breast milk production is also stimulated by skin-to-skin contact, with more milk expressed after holding their babies against their breasts during a kangaroo care session. “The earlier skin-to-skin contact is initiated, the greater the effect on breastfeeding,” said Ms Lee.

Fathers play an important role, too, in early infant care. “In Asian cultures, mothers usually stay at home for a month of confinement post-delivery recovery. Thus, fathers can provide early skin-to-skin contact for the newborn during their visit,” said Ms Lee.

Following renovations, Singapore General Hospital’s (SGH) new neonatal intensive care unit (NICU) is equipped with new features to not just promote babies’ development and well-being, but also to encourage closer parent-premature baby bonding.

While the rooms are separated by glass panels and glass doors for the care team to monitor the preemies closely at all times, curtains around each bed offer parents privacy when breastfeeding or practising skin-to-skin kangaroo care. The glass panels can also be turned opaque at the flip of a switch.

“The new NICU, which began accepting patients from 30 January 2023, is designed to facilitate infection control measures, breastfeeding, family-centred care and developmental care,” said Dr Poon Woei Bing, Senior Consultant and Head, Department of Neonatal and Developmental Medicine, SGH. 

The ward has two rooms of four beds each and two single rooms to isolate patients during infection outbreaks. The glass walls can be configured for extra single beds should additional contact precautions be needed.

Almost all the beds in the ward benefit from natural lighting during the day, compared to the harsh fluorescent lighting in the old ward. Lighting intensity is adjustable, while focus lighting shines only on the bed during examinations and procedures, minimising disturbance to other babies in the room. Noise meters, meanwhile, help maintain a quiet and calm environment.

The ward has a family care room for counselling families and teaching caregiver skills, for families to stay overnight, or for spending private moments with very sick babies in the event of imminent death.