Proceedings Series on Health & Medical Sciences.
Volume 8
Proceedings of the 6th International Nursing and Health Sciences Universitas Muhammadiyah Purwokerto
ISSN: 2808-1021
The Development of Instant Nesting Bed for Low Birth Weight Infants Tsalitsa Mungillya Pradina Nisa1.
Happy Dwi Aprilina1.
Atika Dhiah Anggraeni1.
Reni Purwo Aniarti1 Faculty of Health Science.
Universitas Muhammadiyah Purwokerto
ARTICLE INFO
Article history:
DOI:
30595/pshms.
Submitted:
July 29, 2025 Accepted:
Sept 22, 2025 Published:
Oct 23, 2025 Keywords:
Innovation.
Low Birth Weight Infants.
Nesting ABSTRACT Low Birth Weight (LBW) infants are those born weighing less than 2,500 grams, regardless of gestational age.
LBW infants often experience hypothermia and sleep disturbances due to difficulty Nesting is a practice aimed at providing warmth and However, conventional nesting methods often result in reduced quality due to inefficiency, improper sizing, instability, and inability to fully envelop the infant's body.
The development of Instant Nesting Bed aims to enhance the efficiency and quality of nesting practices by addressing common issues found in conventional nesting The study employed a Research and Development (RD) methodology, consist 5 steps, problem analyze, product development, expert validity, product revision and final product, product testing.
The innovation process resulted in an efficient nesting design that is adjustable in size, fully encloses the infant's body, is structurally robust, and maintains its shape.
The nesting device can be used both inside and outside incubators with additional warming features.
It also includes fixation mechanisms to minimize uncoordinated infant Validity testing by health experts, health academics, and perinatology nurses confirmed that the Instant Nesting Bed is feasible for use.
Based on the testing results, the Instant Nesting Bed improves the efficiency and quality of nesting for LBW infants.
However, the innovation has certain limitations, such as short-lasting warming features, testing restricted to infants without medical aids, and no evaluation of its overall impact on nursing care practices for nesting.
This work is licensed under a Creative Commons Attribution 4.
International License.
Corresponding Author:
Happy Dwi Aprilina Faculty of Health Sciences.
Universitas Muhammadiyah Purwokerto Soepardjo Rustam Street KM.
Banyumas.
Indonesia Email: happydwiaprilina@ump.
INTRODUCTION
Low Birth Weight (LBW) infants are those born with a birth weight of O 2500 grams regardless of gestational age (Azim et al.
, 2.
The global prevalence of LBW is 15% of total births (WHO, 2.
, with 80% occurring in developing countries (Blencowe et al.
, 2.
, including Indonesia, where it accounts for approximately 350,000 cases or 14% of total births (Kemenkes, 2.
LBW is responsible for 60Ae80% of infant mortality (Hadya, 2.
, as these infants are more susceptible to illness and complications (Hamang & Nurhayati.
LBW infants contribute significantly to neonatal morbidity and mortality (Prescott et al.
, 2.
These infants are vulnerable to hypothermia, infection, feeding difficulties, and developmental delays (Lawn et al.
, 2019.
Khan et al.
, 2.
Commonly experienced impacts include hypothermia and sleep disturbances (Arfiana.
Proceedings homepage: https://conferenceproceedings.
id/pshms/issue/view/47 ISSN: 2808-1021 Sarjuningati.
Idhayanti, & Saputra, 2.
Perinatology care units is essential to minimize these impacts on LBW The perinatology environment differs significantly from the intrauterine environment, requiring LBW infants to adapt to extrauterine life.
One of the principles of developmental care is the nesting method, which supports the infantAos adaptation process (Anggari.
Kurniawan, & Lamak, 2.
Nesting aims to provide comfort, warmth, and maintain the flexed position similar to the intrauterine posture (Eliyanti & Hasta Noeraini, 2.
This intervention contributes to thermal stability (Damayanti.
Deviana, & Primadani, 2024.
Ginting et al.
, 2023.
Suryani.
Shifa, & Yuliza, 2.
, improved sleep quality (Carneiro et al.
, 2024.
Erawati & Ramandhani, 2021.
Hayati et al.
, 2023.
Vadakkan & Prabakaran, 2.
, and supports weight gain (Gueye et al.
, 2023.
Rabbani, 2022.
Rohmah.
Saputri, & Bahari, 2.
Recent neonatal care literature also highlights its role in reducing stress and enhancing neurodevelopmental outcomes (Ismail.
Salaghor.
Alshomrani, & Almodallal, 2024.
Xing.
Zhang.
Cao, & Zhang, 2.
Furthermore, the use of nesting with added fixation mechanisms has been shown to enhance thermal stability and sleep quality (Noor.
Hasanah, & Ginting, 2016.
Tane.
Rustina, & Waluyanti, 2.
In addition to the prevalence and risks already described, improving the quality of care for LBW infants has significant global implications.
The WHO has targeted a reduction in neonatal mortality as part of the Sustainable Development Goals (SDG.
2030, and simple yet effective interventions such as nesting directly contribute to achieving this target (WHO, 2.
However, the implementation of nesting practices in clinical settings remains highly variable in terms of techniques, materials, and consistency, resulting in disparities in care quality across healthcare facilities.
This challenge is even more pronounced in developing countries, including Indonesia, where limited resources and restricted access to advanced technologies such as incubators further complicate neonatal care.
Currently, nesting is still practiced using conventional methods, typically involving swaddling cloths arranged in a nest-like shape.
This technique is considered complex and inefficient, often leading to frequent According to Efendi et al.
, common errors in conventional nesting include loose arrangements that do not contact the infant's skin, nesting that is too small or too large for the infantAos body, and structurally weak nests that lose shape easily and fail to support the infantAos position.
These shortcomings can negatively impact the overall quality of the nesting intervention.
Thus, innovation is needed to improve safety and effectiveness.
In this context, the innovation of an instant nesting device becomes highly relevant.
This device is designed to be more practical, standardized, and user-friendly, thereby improving infant safety and comfort while also enhancing nursing efficiency.
Moreover, its development aligns with the principles of developmental care, which have become a global standard in neonatal practice, emphasizing the creation of supportive environments to optimize the growth and development of preterm and LBW infants.
This study aims to develop and evaluate an Instant Nesting Bed as an innovative device to improve the care of low birth weight infants.
This research specifically sought to analyze the limitations of conventional nesting practices, design a more practical and standardized prototype, and assess its feasibility and usability through validation by experts and practitioners.
Furthermore, the study aimed to revise the prototype based on feedback and conduct limited product trials to determine its potential effectiveness and applicability in neonatal care settings.
RESEARCH METHOD
This research employed a Research and Development (R&D) method, which aims to develop an innovation into a product that is beneficial to the community and scientifically validated (Waruwu, 2.
The research stages were adapted from the design developed by Borg and Gall into five phases: problem analysis, product development, expert validation, product revision and final product, and product trial.
The study was conducted at Universitas Muhammadiyah Purwokerto and Prof.
Dr.
Margono Soekarjo Regional General Hospital.
Purwokerto.
The sample consisted of two academic experts and two healthcare professionals for validation, and five perinatology nurses for product trial.
Although the sample was relatively small, it provided initial feasibility insights for the innovation.
Future studies with larger and more diverse samples are required to increase the generalizability of findings (Peterson and Foley 2.
The data obtained is divided into two types: qualitative data consists of critiques and suggestions related to the product and quantitative data refers to the results of the assessment questionnaire completed by the respondents.
The assessment instrument used in this study was a structured questionnaire developed based on a literature review and expert consultation regarding the dimensions of feasibility, usability, and safety of neonatal care devices.
The questionnaire underwent content validation by three independent experts in maternal and pediatric nursing using the Content Validity Index (CVI) (Peterson & Foley, 2.
Items with an I-CVI score 1 were retained.
Reliability testing of the questionnaire was conducted on a pilot group of five nurses not included in the main trial, and CronbachAos Alpha yielded a coefficient of 0.
95, indicating good internal consistency (Tavakol & Dennick, 2.
The questionnaire data results were analyzed using the following percentage formula:
Proceedings homepage: https://conferenceproceedings.
id/pshms/issue/view/47 ISSN: 2808-1021 P = (F / N) y 100% Explanation:
P = Percentage F = Total score obtained N = Maximum possible score Based on the results of the percentage calculation, the outcomes can be categorized into the following five feasibility criteria:
Table 1.
Feasibility Criteria Score Category 80% < p O 100% Highly Feasible 60% < p O 80% Feasible 40% < p O 60% Fairly Feasible 20% < p O 40% Less Feasible 0% < p O 20% Not Feasible Source: Research Findings, 2024 The research took place from April to June 2024.
Ethical approval was granted by the Health Research Ethics Committee of Universitas Muhammadiyah Purwokerto under registration number KEPK/UMP/124/IX/2024.
RESULT AND DISCUSSION
RESULT
Problem analysis The first stage of the research and development method involves analyzing problems and collecting information through preliminary studies or literature reviews.
In this stage, the researchers conducted preliminary interviews with perinatology nurses regarding the use of conventional nesting.
The interviews revealed that arranging the nest using swaddling cloths is time-consuming and easily deformed due to infant Consistent with the literature (Efendi et al.
, 2.
, which highlights that conventional nesting methods, being structurally unstable, often result in suboptimal fitAieither too loose or too tight, failing to maintain direct contact with the infant's skin, not fully enclosing the body, and ultimately being unable to provide adequate postural support.
Product development The second stage involved product development based on the issues identified in the previous phase.
The design process was carried out meticulously to ensure that the resulting prototype effectively addressed the observed problems.
The product design incorporated the following key features: .
adjustable dimensions to accommodate varying infant body sizes.
a circular configuration that fully envelops the infantAos body.
firm and stable structure, .
an instant nesting format, allowing application by simply tightening a drawstring and placing the infant on the device.
dimensions of 50 cm x 60 cm, aligning with the average size of incubators, allowing use both inside and outside the incubator.
fixation straps to support physiological development in infants (Tane et al.
, 2.
, and .
integrated side and bottom pockets designed to hold warming gel packs as supplemental heat sources when used outside the incubator.
This design was subsequently realized as a tangible, functional product.
Expert validation Following the completion of the initial prototype, the subsequent phase involved conducting a validity assessment.
This validity testing was carried out by maternal and pediatric health experts, including lecturers in maternal and pediatric nursing at Universitas Muhammadiyah Purwokerto.
In addition, the product was evaluated by healthcare practitioners, namely a village midwife and perinatology nurses at Prof.
Dr.
Margono Soekarjo Regional General Hospital.
Purwokerto.
The evaluation focused on several key indicators: compatibility of the design with both the incubator and the infantAos body, structural durability, ease of use, firmness, ability to fully encircle the infantAos body, efficiency, provision of warmth, and capacity to maintain proper infant positioning.
The following are the results of the validity assessment conducted.
Validator Academic expert 1 Academic expert 2 Health expert 1 Table 2.
Validity testing result Score Category Highly Feasible Highly Feasible Highly Feasible Proceedings homepage: https://conferenceproceedings.
id/pshms/issue/view/47 ISSN: 2808-1021
Validator Health expert 2
Average Score
Source: Research Findings, 2024
Score
93,75%
Category Highly Feasible Highly Feasible The average feasibility rating given by each expert was 93.
This result falls into the "Highly Feasible" category within the score range of 86% O P O 100%.
Product revision and final product The fourth phase involved revising the initial product based on expert feedback to create the final Key features included adjustable drawstrings, dacron-filled body for firmness and warmth, washable covers, gel pack heating pockets, extremity fixations, and safety features like cord covers to prevent The revised product is the final version, ready to be tested on a limited sample.
The following are the details of the final Instant Nesting Bed product.
Table 3.
Final Product Details Product Details Description Drawstrings to adjust size with inner Dacron padding for durability, comfort, and warmth Pockets on both sides and bottom for additional warmers, with an inner liner to allow external cleaning without damaging the Dacron Hot gel packs as supplementary warmers Fixation mechanisms on extremities to minimize movement and maintain posture, with adjustable ring-tightness A closure at the drawstring connection point to protect the infant's feet from entanglement Source: Research Findings, 2024 Proceedings homepage: https://conferenceproceedings.
id/pshms/issue/view/47 ISSN: 2808-1021 Product trial The final product was tested by five perinatology nurses.
Evaluation criteria included efficiency, structural firmness, complete body coverage, adjustable size and fixation, aesthetic appeal, portability, lightweight, easy maintenance, and compatibility with incubators.
Table 4.
Product Trial Result Respondent Score Category Nurse 1 Highly Feasible Nurse 2 Highly Feasible Nurse 3 Highly Feasible Nurse 4 Highly Feasible Nurse 5 Highly Feasible 95,4% Highly Feasible Average Source: Research Findings, 2024 The average feasibility rating given by each respondent was 95.
This result falls into the "Highly Feasible" category within the score range of 86% O P O 100%.
DISCUSSION
The development of the Instant Nesting Bed introduces an innovative approach to neonatal care, particularly for low birth weight (LBW) infants who remain highly susceptible to hypothermia, sleep disruption, and physiological instability due to immature thermoregulatory and neurological systems (Fernando.
Patricia, & Pebrina, 2021.
Indartik.
Khasanah, & Wahyuni, 2.
The findings from both expert and practitioner validations demonstrate a high feasibility score, suggesting that the device holds promise for clinical use.
This aligns with international studies reporting that structured positioning and developmental care improve physiological stability and neurobehavioral outcomes in preterm infants (Carneiro et al.
, 2024.
Indartik et al.
, 2.
A key strength of the Instant Nesting Bed lies in its ability to address shortcomings inherent in conventional nesting.
Previous research has shown that traditional cloth-based nesting is prone to deformation, inconsistent sizing, and lack of stability, which may compromise infant positioning and thermal support (Efendi et al.
, 2.
By incorporating adjustable drawstrings, dacron padding, and fixation mechanisms, the Instant Nesting Bed offers more reliable structural integrity and individualized fit.
International studies corroborate that structured positioning interventions enhance thermal stability, oxygen saturation, and sleep quality in preterm and LBW infants (Sumathy, 2020.
Suryani et al.
, 2023.
Vadakkan & Prabakaran, 2.
hus, the design advances align with evidence supporting developmental care models that seek to approximate intrauterine conditions.
Nevertheless, it is important to critically evaluate this innovation alongside well-established interventions such as Kangaroo Mother Care (KMC).
Meta-analyses and Cochrane reviews consistently demonstrate that KMC reduces neonatal mortality, improves weight gain, and strengthens parental bonding across diverse healthcare settings (Kapoor.
Khan, and Beohar 2021.
Sivanandan and Sankar 2023.
Boundy et al.
, 2.
In contrast, the Instant Nesting Bed primarily focuses on thermal regulation and postural support, without directly addressing psychosocial bonding or breastfeeding facilitation.
Therefore, rather than being a substitute, the Instant Nesting Bed should be positioned as a complementary strategy to KMC, particularly in contexts where prolonged skin-toskin contact may be challenging due to maternal health status, cultural barriers, or limited staff support.
Another critical point concerns the use of fixation mechanisms.
Fixation on extremities enhances physiological positioning and reduces uncontrolled movement, promoting flexed sleep postures, oxygen stability, and sleep quality (Tane et al.
, 2019.
Vadakkan & Prabakaran, 2.
While the device aims to minimize uncontrolled movement and promote flexed postures that benefit oxygen stability and neurodevelopment, caution must be exercised.
Over-restriction of movement has been associated with delayed motor milestones if improperly applied (Ibrahim.
Chavez.
Smith.
Craig, & Pineda, 2024.
Ko & Lim, 2.
This underscores the need for training protocols to ensure that fixation is supportive rather than restrictive, and that long-term developmental monitoring accompanies the use of such devices.
In terms of workflow implications, the Instant Nesting Bed may reduce nursing workload by simplifying the nesting process, a benefit aligned with reports that standardized neonatal care tools improve efficiency and consistency in NICU settings (Hallowell.
Rogowski, & Lake, 2.
However, unless paired with structured training and parental involvement, variability in application may persist (Upadhyay et al.
, 2.
Moreover, the deviceAos warming feature, which relies on gel packs, presents limitations in duration and thermal consistency.
This aspect may pose challenges in resource-limited settings where incubator access is already constrained, necessitating further refinement of the warming mechanism to ensure sustained thermal support (Dubner et al.
Proceedings homepage: https://conferenceproceedings.
id/pshms/issue/view/47 ISSN: 2808-1021 Methodologically, this study demonstrates feasibility but remains limited by its small sample size and non-randomized design.
While expert and nurse validations provide useful initial evidence, they cannot substitute for clinical trials involving infants themselves.
Contemporary neonatal device research emphasizes the importance of randomized controlled trials and multicenter studies to establish clinical efficacy, safety, and scalability (Lyu et al.
, 2024.
Thabet & Sayed, 2.
Additionally, this study excluded infants with medical aids such as CPAP, oxygen therapy, or IV lines, yet these represent a substantial proportion of LBW infants in NICU care.
Future trials should incorporate this subgroup to assess compatibility and safety in more complex clinical scenarios.
Finally, the broader implications of innovation in neonatal care should be considered.
Beyond immediate physiological benefits, developmental care interventions should be assessed for their impact on neurodevelopmental outcomes, parental stress, and length of hospital stay.
Integration of family-centered care approaches, as recommended by the American Academy of Pediatrics, will be crucial to ensure that devices like the Instant Nesting Bed complement rather than fragment holistic neonatal care (Dubner et al.
, 2.
Additionally, cost-effectiveness and ease of large-scale implementation warrant evaluation, particularly for adoption in low- and middle-income countries where LBW prevalence is high.
In summary, the Instant Nesting Bed represents a feasible and innovative contribution to neonatal care, addressing specific weaknesses of conventional nesting.
However, its long-term effectiveness, safety across diverse clinical conditions, and role within broader neonatal care strategies require further investigation.
Robust multicenter randomized trials, integration with family-centered care models, and technical refinements to its warming function are critical next steps before large-scale implementation can be recommended.
CONCLUSION
Based on the research findings and discussion, the following conclusions can be drawn:
The development of the Instant Nesting Bed has been proven highly feasible according to expert validation and field testing by nurses.
This innovation significantly addresses the limitations of conventional nesting and offers an efficient, safe, and physiologically appropriate solution for LBW The product demonstrates potential to improve sleep quality and thermal stability, contributing to better neonatal care.
Beyond its potential clinical benefits, it may reduce nursing workload and enhance consistency in care .
Further research is needed to evaluate the direct clinical impact of the Instant Nesting Bed, including its applicability for infants receiving medical interventions.
Additionally, future product development should focus on enhancing the durability of warming components and ensuring compatibility with other supportive devices.
REFERENCES