A Buyer’s Guide to Stillborn Cooling and the CuddleCot

At Flexmort, we are specialists in cooling and storing the deceased. We have been asked by a number of families and groups for advice on cooling systems.

We appreciate families have a difficult task in deciding what system to buy, particularly if those offering these systems are not experts in cooling the deceased. Therefore, we have provided some background to the development of the CuddleCot cooling cot, as well as some questions to consider when making purchasing decisions.

We advise families to closely examine any system and company before making any purchases as we all want hospitals to have a reliable cooling system which will help as many bereaved families over many years.

Stillborn Cooling

“Refrigerated” baby cooling systems work in the same way as your refrigerator at home. Refrigerated systems share 5 basic components: fluid refrigerant; a compressor, which controls the flow of refrigerant; condenser coils (on the outside of the chilled area); evaporator coils (on the inside of the chilled area); and something called an expansion device. They are very heavy.

There are many reasons why UK hospitals replaced these “refrigerated” systems and 97% of UK hospitals now use CuddleCots. Very occasionally, we see a “new” refrigerated stillborn cooling unit appear in a UK hospital but these are very rare and hospitals still continue to prefer CuddleCots. We know a lot about this area because many years ago, we initially manufactured “refrigerated” cots but after hospital trials and feedback, we stopped manufacture and developed the CuddleCot.

There are some basic questions (as well as cost) that should be considered when buying cooling systems: How long has the company supplying them been in existence? What is their experience in providing cooling systems for the deceased? Do they supply a range of deceased cooling systems or just one product? What service and repair teams do they have? How big is the company? Is the product certified for hospital use (ask for evidence)? What long term hospital trials have been undertaken (ask for evidence)? Does the company have product insurance (ask to see a copy)?

Furthermore, it is imperative that any cooling system has undergone medium to long term clinical trials at a hospital before being offered for sale to assess product reliability and effectiveness. We would advise families clarify exactly what trials have been undertaken with these systems before making any purchases. Trials are absolutely crucial and we have conducted numerous clinical trials over the years at medical schools, universities and hospitals.

The History of the CuddleCot

Flexmort started through Warwick University Science Park in England and we manufacture a wide range of flexible deceased cooling systems used around the world. Our customers include hospitals, funeral directors, hospices, governments and the police.

In 2009, we started looking at a system to cool stillborn babies so that families could spend more time with their baby. Our research revealed there were already a few different types of cooling systems for babies but they had not become widespread and only approximately 20 to 30 hospitals were using them. The systems all used “refrigeration technology” cooling systems. Some of these units looked very clinical as they were fixed to a trolley and were on wheels.

We initially developed a system which used the same “refrigerated” technology but we tried to make it look less clinical by using a Moses basket and covering the refrigerated system with a satin cloth. However, as it was very heavy (over 58lbs!), it all had to be fixed onto a trolley with wheels.

During the trial, it became clear “refrigerated” systems had significant limitations. Hospitals, stillbirth charities, families and us wanted to improve on this and come up with something better. The areas requiring improvement were:

  1. Less clinical look and more of a “home feel”
  2. Flexibility of cooling as a lighter unit was needed (refrigerated units weighed over 58lbs/ 26kgs) – a heavy system could not be loaned to other hospitals or to families to take baby home
  3. Improvement in cooling efficiency: Eradicate the requirement for lids and eradicate the “hum” of traditional refrigeration which sounded like baby was inside a household refrigerator
  4. Reduce breakdowns and develop service support for hospital engineers

Therefore, Flexmort worked with the internationally recognised stillbirth support group SANDS as well as numerous hospitals to develop the CuddleCot. Refrigeration is not the ideal technology for cooling stillborn babies so we developed a new baby cooling system which did not require refrigerant gas (now used in a number of our systems). The clinical trials were successful and as a result, within a few years, the CuddleCot replaced virtually all of the refrigerated units that were in use and hundreds more hospitals began to use CuddleCots.

So why is the CuddleCot preferred over traditional refrigerated units?

Benefits of the CuddleCot

Homely Look

The drawbacks of traditional refrigerated units are:

  • Refrigerated units use old technology. As a result, they are VERY heavy and have to be mounted on trolleys and wheels which makes the systems look very clinical. Hospital staff and families wanted something that would look more like a cot used at home.
  • Refrigerated units usually need to have the cooling system fixed to the trolley. It cannot be easily taken apart and is usually one complete unit so it makes cleaning more difficult as well as creates longer term servicing issues.
  • Refrigerated units do not cool efficiently and make a “humming” which sounds like a home refrigerator.
  • With refrigeration, there is no flexibility where the cooling occurs as it is one unit. Hospitals wanted a cooling unit that had a pad which could be used in any Moses basket or any small basket (particular as very premature babies looked tiny in a standard basket). Many hospitals had a variety of receptacles and wanted the choice particularly if mum struggled to move from the bed and could not see into a trolley.

Q: When looking at purchasing, closely examine the system. How heavy is it? Does it use “refrigeration” to cool? Does it look clinical i.e. on a trolley with wheels or like something that would be used at home? 

The CuddleCot does not use any refrigerant gas. The CuddleCot is a modular system so each part can be easily separated, comes with a Schnuggle Moses basket so it looks homely rather than clinical and the only noise is a fan so it does not sound like a fridge.

As the CuddleCot cooling unit is not fixed to the basket, it can cool in any receptacle. The CuddleCot has 2 different size pads (including one small for premature babies) and this allows the hospital to determine which receptacle to use for cooling.

Also, some mums struggle to move from the bed. With the CuddleCot, the baby can be cooled next to mum in the basket for many hours rather than baby having to go “into a cooling unit with wheels” placed next to her bed. Finally, the CuddleCot is very simple to clean which is important for infection control reasons.

Flexibility

There is a growing requirement for “loan” cooling units as well as a growing recognition in hospitals that some families want to take their baby home. Forward thinking hospitals wanted a “future proof” system that was much more portable and lightweight. Providing families with the option to take baby home is growing with a number of hospitals around the world adopting policies for this.

This is incredibly difficult to do with conventional refrigerated cooling partly because the units are so big and heavy and partly because refrigerated systems should be left to “settle” for 24 hours before being switched on, otherwise this can seriously damage the system. If you want your hospital to be able to offer families the choice to take baby home, then a refrigerated system is not suitable.

Q: How heavy is the cooling system? Is it portable? Can it be lifted easily by one person? Can it be easily sent by courier at a low cost? How long does it need to be left after being moved and before being switched on?

The CuddleCot cooling unit only weighs 8lbs/ 3.8kg and is highly portable and can be sent by courier. It can be used immediately after delivery.

Efficiency

Additional drawbacks of refrigerated baby cooling units are:

  • Refrigerated systems (like your home refrigerator) all work by cooling a plate which in turn cools the air. The problem with this type of convection cooling is that you need to keep it contained – that is why you have an air tight door on your fridge. Any company with experience of cooling therefore provides “lids” for refrigerated units to increase cooling efficiency and to reduce the strain on the system. When mum is awake, the lid is often left off the unit but is then replaced when they are asleep. A lid can be distressing for families.
  • For the best and most efficient cooling method, the baby really should be in direct contact with the cooling surface but this means the baby would have to be placed directly onto the cold plate and with refrigerated systems, this plate is too cold due to the physics of refrigeration technology (and also families do not like their baby lying on a metal plate). Therefore, mattresses are used. The problem is that when a mattress is placed in the refrigerated cot, this then insulates the cooling mechanism and reduces cooling so babies’ condition deteriorates more quickly. This is exacerbated if a lid is not used.

Q: Is the system cooled using refrigeration? What testing has been undertaken in hospitals? How many units are in use across hospitals? What is the hospital feedback? Is a lid required for longer term use? What is baby placed on? What is the longest amount of time a baby has been cooled on the system? What hospital evidence is there for this claim?

The CuddleCot is designed differently and uses direct contact through a pad to cool the baby. As a result, our cooling is incredibly effective and fast. The soft pad can be placed on top of a comfy mattress and under a sheet so it is in contact with baby. This means baby is cooled in the most efficient and effective way possible whilst keeping them as comfortable as possible on a thick mattress. The CuddleCot helps keep the baby in a better condition than through refrigerated systems.

Servicing

There are two types of service issues for hospitals: annual servicing and breakdowns.

Drawbacks of the traditional refrigerated units regarding servicing are:

  • Refrigerated machines contain refrigerated fluid and so annual inspections and preventative maintenance visits are often required by engineers to ensure the equipment is in working order.
  • All electrical machines can break down. Refrigerated machines are heavy as they have lots of moving parts which increases the risk of a breakdown.
  • Hospitals found that getting a refrigerated unit serviced was a big problem as the manufacture was often located hundreds of miles away. This means units were often unavailable to families as repairs often took weeks and weeks. The units were also too heavy to simply be returned to the manufacture as pallets were required in order to send them. The availability of parts was also an issue.

Q: What are hospital servicing requirements if refrigeration is used? How is service undertaken should a fault occur? If the unit is heavy and cannot easily be returned for servicing, then what local and trained engineers are available? What is the service response time? What are the timescales for availability of spare parts? Are spare parts held in stock?

The CuddleCot’s cooling technology means we have very few moving parts and so breakdowns are very rare, especially when compared to refrigerant based systems. It also means our cooling unit is very light – it only weighs 8lbs/ 3.8kg. Traditional refrigerated systems weigh over 58lbs/ 26kgs!

Therefore, in the unlikely event of a breakdown, we can provide simple instructions to fix the unit or the CuddleCot cooling system can simply be sent back for servicing (as it is so light and is modular) and we can turnaround a breakdown within a couple of days with our team of engineers.

Find out more about the CuddleCot Cooling Cot

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