Small Technologies, Big Questions
By Caroline Lieffers
Sharon Rogone was frustrated. She had been a nurse in a California neonatal intensive care unit (NICU) for years, and she was struggling yet again to keep a fragile newborn baby’s eyes protected while they slept and squirmed under blue lights, waiting for the azure glow to break down their excess bilirubin. Many eye masks were poorly designed or too big for premature babies, and Rogone had tried rigging together devices with cotton balls, black construction paper, and rubber bands. Finally, she hit on a solution. Using foam and some netting material that was typically used for making casts, she contrived a stretchy little bonnet that finally kept the baby’s eyes safely covered. This was not her only MacGyvered NICU invention. Over the years she had cut pieces out of pacifiers to give small babies more room to breathe, modified suction devices, and come up with all manner of positioning pillows to keep her tiny charges comfortable.
Rogone knew there was a market for these devices—especially the “bili-bonnet,” as she took to calling it—so she worked on refining the design, and went into partnership with a former medical sales representative. In the mid-1990s, Small Beginnings was officially incorporated, and it would soon sell a variety of items for premature infant care, including pillows, diapers, and pacifiers.[1]
The story of Small Beginnings—whose records can be found at the Archives Center at the Smithsonian Institution’s National Museum of American History—shines a light on nurses’ often unsung role as technological innovators. The company often emphasized the nurse’s identity as a problem-solver and even an inventor, and they based many of their products on nurses’ ideas. Rogone’s husband Phil, who also worked for Small Beginnings, walked a fine line between praising nurses’ innovation while also wanting to render it unnecessary in the first place: “For too long, nurses have had to resort to being on the spot inventors to care for their patients, and we’re making it our job to do something about it.”[2]
Another nurse-devised product was a sling made of mesh to help stabilize a broken collarbone—a clear improvement over what was sometimes used, a contrivance rigged from a tee-shirt and cloth diaper, held together with a safety pin.[3] And there was the “cozy cuddler,” too, a special wrap with heat packs built in to keep babies warm when they were taken out of their isolette for procedures. When the periodical NurseZone featured the “cozy cuddler,” the inventor similarly leaned into nurses’ pride as innovators, commenting that “Because we are on the front line of health care, we know what works and what doesn’t. If there is a better way to do something, we’ll figure it out.”[4] Small Beginnings wanted to legitimize nurses’ needs, as well as the creative solutions that they devised to meet them.
With Rogone’s decades of experience in the NICU, it’s not surprising that Small Beginnings was also highly sensitive to the emotional dynamics of this unique clinical space. Starting around the 1970s, neonatologists and other experts began to advocate for more explicit recognition of infants’ individual preferences and needs, and to incorporate the family in their care.[5] But this was not always easy. Learning to read premature infants’ cues could be challenging, and in the intimidating NICU context, parents often struggled to know how to help or even relate to their fragile babies, especially when their signals and even simply appearance could be very different from those of a full-term infant. Nurses like Rogone understood that the right technologies could mitigate infants’ distress, but they could also give nurses useful tools to coach struggling parents as they learned how to care for their tiny neonate. Having comfortable and confident parents could, in turn, further help keep babies relaxed and support their growth—a foundational priority in the NICU.
In a cost justification document for the company’s Cuddle Buns diaper, Phil Rogone argued that “The psycho-social aspects of how parents perceive their baby can be seen in not only if the infant is wearing a diaper versus lying naked on a warmer with IV lines and tubes all over the place, but also on whether the baby is in the diaper that is appropriate for the baby’s size.”[6] Premature babies are not necessarily “cute or cuddly,” he said, and often do not respond well to being held like a full-term baby.[7] As a recognizable form of infant clothing, a properly-fitting diaper encouraged parents to see a baby in the otherwise alienated, delicate creature in front of them. For nurses, the specially made diapers were also helpful for securing urine samples, avoiding unwanted hip abduction, and protecting babies’ skin from injury.
The preemie hospital gown served a similar purpose. It kept the baby warm, which reduced distress, and it allowed easy access for nurses, but the advertisements also noted that “parents will like their non-threatening look.”[8] As an aid for parent-infant bonding, the item could even be billed to patients and sent home with them as a “keepsake.”[9] Serving emotional and medical purposes alike, these technologies attended to all sides of the NICU’s unique nurse-parent-baby triad.
Glamorous, even miraculous-seeming medical technologies often get a lot of hype and media attention—from imaging tools to artificial hearts to the latest in AI. But to borrow a line from the late historian Charles Joyner, there is also much to learn from “asking large questions in small places.”[10] Small Beginnings reminds us that many valuable innovations in medical technology fly under the radar. In the day-to-day work of patient care, nurses are often the first to identify and resolve problems, and their unique role as clinicians and coaches in the NICU highlights how medical technologies are embedded in caring relationships and often complex emotions. If necessity is the mother of invention, clinicians and historians alike might continue to think about how to account for health care’s too-often overlooked necessities and unsung inventors, and how medical technologies at every scale engage with the intangible fact of feelings.
Caroline Lieffers is an Assistant Professor of History at MacEwan University. She is also the English-language editor of the Canadian Journal of Health History/Revue canadienne d'histoire de la santé.
[1] Smithsonian Lemelson Centre, “Prototype Online: Inventive Voices,” March 1, 2008, https://www.smithsonianmag.com/arts-culture/prototype-online-inventive-voices-22054192/
[2] Quoted in Laszlo Sandor, “Inventions: Once Upon a Time,” Neonatal Intensive Care 13, no 6 (2000): 32.
[3] Product Information booklet, page 4, in File “Products overview (booklets) undated,” Box 1, Collection 940, Records of Small Beginnings Inc., Archives Center, National Museum of American History, Smithsonian Institution (hereafter Collection 940).
[4] Barbara Mosley, quoted in Clare Brocato, “Nurses Impact Care with Product Innovations,” NurseZone.com, 21 February 2006.
[5] Alistair G.S. Philip, “The Evolution of Neonatology,” Pediatric Research 58, no. 4 (2005): 808.
[6] Philip N. Rogone, “Cuddle Buns™ Cost Justification,” page 1-2, File “Catalogs, 2001-2005,” Box 3, Collection 940.
[7] Phil Rogone, “Small Beginnings Oral Histories Interviews, Log for Podcast,” 4 February 2007, CD 2, 3:30, page 10 in file “Rogone, Mary S., RCD 940 3-5, 2007,” Box 1, Collection 940.
[8] Small Beginnings Catalog (n.d.), page 7, in File “Catalogs, 2001-2005,” Box 3, Collection 940.
[9] “Product Catalog,” page 12, in File “Products overview (booklets) undated,” Box 1, Collection 940.
[10] Charles Joyner, Shared Traditions: Southern History and Folk Culture (University of Illinois Press, 1999), 1.