Detailed Comparison of Kangaroo Care/ Skin to Skin Contact Devices. The Zaky ZAK® vs. NuRoo® Pocket

Facts and Features
Photo of product in use:
Created by:	In 2009 by Yamile Jackson, a native of Colombia, a Ph.D. in ergonomics and safety engineering and [kangaroo] mom of Zachary (former NICU micro-preemie now in college). She founded the Kangaroo Care Awareness Day (May 15th) in 2011, she is a parent and infant advocate, published author, certified Kangaroo Caregiver, certified Trauma-Informed-Care Professional. Engineered The Zaky® brand. CEO of Nurtured by Design®, working in NICUs since 2001.	In 2013 by Hope Parish and Daniela Jensen, moms of healthy, full-term babies, professionals, and entrepreneurs.
Created originally for:	Engineered unisex to provide safety and comfort while holding hospitalized infants in KC or clothed. Also to be back-up when incubators lose power, a need based in Zachary's experience when we was 3 weeks old in the NICU and a flood shut-down the hospital.	For healthy babies from full-term birth to 35 lbs., with a pocket to "insert" the baby, and support with a belt. The instructions indicated that the baby must be inside the pocket, hence it was not for skin-to-skin contact.
Sold by:	Nurtured by Design® (small business, fully owned and operated by the Jackson family from Texas). www.thezaky.com, orders@thezaky.com	Brownmed acquired the brand on December 2014. https://www.brownmed.com/
Current users:	Unisex. Anyone holding a baby weighing 1 to 15 lbs. in a hospital or home. Antepartum, delivery, c-section/OR, post-partum, NICU, PICU, Rehab. Wear over bare torso for Kangaroo Care (Skin to Skin contact) over clothes replacing swaddle holding.	Unisex. Hold baby inside the pocket to prevent sliding. The manufacturer now says the pocket is optional so that it can be used for skin-to-skin contact. Uses a belt to keep baby from sliding, potentially creating pressure points on the lower extremities. Used in hospitals and homes.
Material and layers of fabric over the baby:	Cotton (naturally breathable fabric), elastane, and YKK® zippers. One layer of material over the baby, thus no pressure points, and ability to easily access for parent (breastfeeding/pumping), healthcare interventions, and see the baby's body contour.	Polyester, two layers cross over the baby. There is fabric between baby/parent when using the pocket, so it is not skin-to-skin contact.
How many babies can be held simultaneously?	1, 2, or 3 "one at a time, and taking your time™".	1, 2 (very close together facing each other due to the V neck design). Safety depends on the integrity of the Velcro®.
Closing mechanism:	Adjustable zippers are quiet, strong, easy, durable, and evident when it doesn't work. Closes straight from to bottom, consistently, and reliably. Zipper auto-locks (prevents sliding up or down unless the pull tab is tensioned) to partially open it to access the baby quietly and minimize disruption. Supports standing/sitting transfer.	Velcro® on both sides of the baby. Noisy near the delicate ears and skin of the baby. Velcro® closes where it may not be intended, so it needs to open to reposition. Velcro® loses adhesion properties when washed, increasing the safety risk. Velcro® may scratch the baby and the parent's skin.
Sizing:	Perfect fit every time. Fabric is color-coded by size. No guess sizing: Four sizes are available, and each has three adjustable zippers spaced every 2". See sizing table. It may be partially open for interventions. Consistency is vital for a predictable experience for infants, parents, and staff. A predictable experience increases self-regulation and overall satisfaction.	Four sizes. Safety depends on each user and how the baby is accessed. Containment depends on how straight the Velcro® is closed from top to bottom and how it is closed during each session. There is no consistent level of containment session after session or after opening it for interventions.
Access the baby while being held for interventions:	Minimal disruption. Partially open the zipper or fold The Zaky ZAK® down to access the baby's top half, or fold it up to access the bottom half of the baby. Quiet access for transfers, interventions, breastfeeding, pumping, ultrasounds, allowing baby to move or explore while awake, etc.	Open both Velcro® (noisy and disruptive) and both layers of fabric. Uncover the baby for any intervention, and close when finished.
Evidence / Publications:	Yes, NICU, Healthy Baby, Congenital Heart Disease, studies determined prevention of unplanned extubations when used with other strategies. The Zaky ZAK® increased frequency, duration, and parent satisfaction. Declared hip safe by the IHDI. Click here for the publications and evidence	We cannot find any evidence or publications. Ask manufacturer.
Is the baby safely contained if the parent removes the hands and attention from the baby? Regardless of hospital policy, an effective KC device must provide safety in the event that the parent falls asleep during kangaroo care.	Meet these five conditions to hold hands-free, rest, or do other tasks with the hands while holding with The Zaky ZAK®: 1. Wear The Zaky ZAK® in the correct size. 2. The baby is in the proper KC position, with the top of the head by the parent's collarbone, and covered to the ear lobe with The Zaky ZAK®. 3. The parent is sitting (or reclined for resting). 4. The zipper of The Zaky ZAK® is fully closed. 5. A kangaroo care coach or other adult is supervising your session. Any adult may use it to keep babies warm if the incubators lose power.	We can't find the manufacturer's explicit statement if the NuRoo® keeps the baby from sliding, dislodging equipment, or from accidental falls if the parent falls asleep during KC. This manufacturer does not explicitly indicate that the device will keep the infant safe (and how) if the parent falls asleep (knowingly or unknowingly) and the NICU assumes a risk if it is used off-label.
Parent comfort:	Cotton keeps baby and parent comfortable. It is strapless to provide the option to wear alone or cover shoulders with a robe/shirt/sweater/shawl/hospital gown, etc. if the parent feels cold. Use it on top of a shirt that opens in the front and move it away from the chest under The Zaky ZAK®. Hold the baby clothed with The Zaky ZAK® and replace swaddle holding (safer and more positive sensory stimulation for the baby).	No option to uncover shoulders if the parent feels hot/warm. Changes to the design try to keep the adult cooler (i.e., shortened sleeves and added mesh under the arms and back), and instructions to hold the baby without using the pocket.
Laundry:	Follow the same laundry protocol of clothing the babies. Close zipper and wash/dry The Zaky ZAK® inside-out. Give it to parents at admission as a welcome gift so they may care for it and do skin-to-skin care at the NICU and home after proper training.	Yes, however, Velcro® loses strength and gripping power with each wash, accumulates lint, and may catch on other fabrics.
Use bare (kangaroo care) or clothed (instead of swaddling holding)?	Yes. Wear The Zaky ZAK® first (nude or clothed, depending on what you want), close the zipper, then transfer the baby. Doing one step at a time reduces human error and risks.	Not made to use over clothes as it covers the shoulders and has sleeves. Place the baby first, then close the Velcro tight enough to provide containment. Velcro® needs four hands to be closed straight (two to hold the "hook" side straight and two to hold the "loop" side and close it straight from top to bottom).
What are other products or services the manufacturer offers related to Kangaroo Care?	The Zaky® brand offers a holistic solution for kangaroo care, neuroprotective care, and family integrated care, based on love and scientific evidence: The Zaky HUG® (extends the weight, shape, scent, touch of the hands of the parents) is used as neck roll during KC also scenting and warming. Kangaroo Care Day (education and science www.kangaroo.care), and The Zaky® mobile app for KC (funded by Nurtured by Design® and the Bill and Melinda Gates Foundation.	None found. Ask the manufacturer.