What are the Zakys, Use, NICU Process Standard, Comparison

What are The Zakys?

The award-winning Zakys are only evidence-based developmental care devices for neonates and are ergonomically designed to simulate parental intervention (shape, soothing touch, weight, and warmth of the hand and forearm) helping the parents and professionals provide the most comprehensive and effective support to the physical, physiological, psychological and neurological development of the patient, regardless of size, medical condition, or developmental stage;, from birth and around the clock.

Click here to view our outcome proposition specifically for the baby, the family, the staff, and the hospital

The features of the Zaky are unmatched:

Results:

• The Zakys are the only evidence-based and ergonomic developmental support device in the world: They are the only devices with clinical evidence that suggests significant decrease apnea/bradycardia and significant improvement in self-regulation and stress behaviors. In fact, the babies using the Zakys Maternally Scented had ZERO apnea/bradycardia events in this randomized clinical research.

Design:

• The shape is familiar and therapeutic: hand/forearm that weighs 500 grams.
• Multipurpose design: for every developmental stage, medical condition, size, and position.
• Its universal size: equivalent to a woman's medium size hand and forearm, the same size is used for every baby, regardless of positioning, size, medical condition, age, and/or developmental stage. No need for small/medium/large or light/medium/heavy.
• Ergonomic design researched and developed for 3.5 years before releasing it to the market. Invented by a PhD in ergonomics engineering.
• Adjustable weight to use on the top of the baby: Displace all the filling and use only the weight of the fabric for micropreemies. 6-7 lb babies can take the full weight of the Zaky (500 grams).

Safety:

• Fully Washable: includes the washing bag - wash/dry without disassembly.
• Recyclable: wash and reuse.
• Scent of the parents by placing them directly on their skin (chest or behind the neck) for at least one hour.
• Warm and soft: place the Zakys in the towel warmer or dryer to get it warm.
• Infection Control: many hospitals that have zero incidents of infections use the Zakys as standard for developmental care.
• Soft and soothing material: antipilling microfleece immediately is soothing for the baby.
• Safe materials: the filling is made out of a special type of plastic in the shape of smooth plastic micro-spheres that are antimicrobial, antiallergenic, antifungal, washable, quiet, and do not get hot under a heating source.
• Quiet operation: filling is quiet when the Zaky is moved. This is important for the NICU baby's developmental support.

Usability:

• Comprehensive care: a pair of Zakys virtually replace all positioners, transitional items, nests, bonding items, and soothing devices. The Zakys are ergonomically designed to help provide comprehensive physical, physiological, psychological, neurological developmental and family-centered care to hospitalized neonates ensuring the best possible quality of life (for a lifetime) and an effective inclusion of the baby into his/her family. All without medication/stimulants, invasive procedures, or expensive equipment .
• Individualized, and constant level of care for every baby, regardless of size, age, medical condition, or developmental stage, including NAS and end-of-life/palliative care.
• Ideal for any position: the same Zakys help with prone, sidelying, supine position, and to use on top, bottom, around, or away from the baby.
• Bolster Support: place the Zaky vertically with the hand on the top, and fold the hand to make a firm but flexible roll

Versatility:

• The most effective transitional device: To help babies with the transition from hospital to the house, and to continue developmental care at home, the healthcare professionals must train the parents to correctly use the Zakys in the car seat, to continue providing developmental care during wake periods, and the "back-to-sleep program", as they teach any other intervention to be performed at home. Up to 6 months of age, the Zakys must be used under constant supervision.
• More effective transport: give the Zakys to the mom to scent (place on the chest or behind the neck) while the baby is being prepared for transport. Take the Zakys with the baby.

Family-Centered Features

• Family-centered device: Originally made for Zachary (hence the name), The Zaky was invented to help Yamile leave the hospital every night leaving something of her behind (the simulation of her hands and her scent). The baby feels the scent and love of the mother and father constantly (helping with strengthening attachment/bonding), even when they are not present and they, in turn, feel more confidence and secure to perceive it as an extension of them that contributes to the 24/7 development of the baby. Parents leave the scented Zakys with the baby at all times (scent it by placing it on the chest or behind the neck for at least one hour)
• Complement for Kangaroo Care: Place the Zaky behind the neck of the parent during kangaroo care to help support the head while scenting the Zakys to leave with the baby at the end of the session.

Our call for arms is to decrease or even eradicate bradycardia and apnea of prematurity. Current knowledge suggests that these events are common, often treated by prescribing caffeine/stimulants to keep the baby awake or by waking them up with tactile stimulation. With research about Kangaroo Care and The Zaky, we are shedding light to the fact that they are not caused by the immaturity of the brain, heart, and respiratory system but because of poor environmental conditions in the NICU.

Clinical research shows that Kangaroo Care and The Zakys significantly reduce life-threatening apnea and bradycardia and significantly improve self-regulation and organization, needed for brain development. All without expensive equipment, medication/stimulants or invasive procedures

While babies may "outgrow" apnea and bradycardia, the effects of sleep deprivation, especially neurological deficiencies, may never be outgrown."

-Yamile Jackson, PhD, PE ( Inventor of the Zakys)

For hospitals, each Zaky Package includes:
Left and Right hand Zakys of the same color Two washing bags Instructions/Information Click here to request hospital pricing and policies.

How do you use the Zakys?

Brochure The Zaky (PDF)

Photos

Videos

Warnings

Two Zakys are virtually all you need to provide effective and ergonomic developmental care to all NICU babies. The Zakys may be used in any number of ways to position and comfort, calm, console and reassure the neonate: The Zaky can be positioned around the agitated or restless neonate to provide containment, and promote hand-to-mouth activities. Containment will reduce overall energy expenditure and oxygen consumption, and encouraging hand-to-mouth activity will enhance development of the neurological system. The best results are achieved when the Zakys are scented by the mother, as she is the only known source of security, and the father, the new source of security. Scent them by placing them on the chest or behind the neck for at least one hour.

See the videos or pictures below to see some uses of the Zaky:

Photos The same Zakys are used in any position, providing nesting, boundaries, containment, the parents' scent. They virtually eliminates the need for swaddling, replaces all positioners, transitional items, bonding/attachment devices, and soothing/sleep aids. One universal size is used for every baby independent of size, medical condition, age, or developmental stage. They are the only clinically proven to significantly decrease apnea/bradycardia events and significantly improve self-regulation.

Warnings Adjust the weight to be placed on top of a baby: Displace the filling of the Zaky so that the weight on the baby is selected according to his/her size and medical condition. For example, babies weighing 500-600 grams need only the weight of the fabric (displace all the filling by holding it vertically by the hand; or displace the filling from the middle of the Zaky) Infants of 5-6 lbs can take the entire weight of the Zaky. Do not use The Zakys on the face. Wash/Dry the Zakys in the washing bag provided. Warm them in the dryer or towel warmer. Do not use The Zakys for any other purpose other than the ones recommended by the manufacturer. As with any other intervention to be performed at home, staff needs to ensure that the parent is proficient and knowledgeable about developmental care and the use of the Zakys. Do not leave baby unattended when using the Zakys at home. For babies younger than 6 months old, the Zakys will provide an environment so the baby falls asleep, however, the Zakys must be removed once the baby is asleep and/or if parents are not around, unless otherwise recommended by the pediatrician. Reasons some pediatricians may recommend the Zakys to stay with the baby include: the baby needs developmental care at home, s/he is not sleeping (thus not developing the brain), wakes up too much, has colic, experiences separation anxiety, is getting a flat head, must sleep on the side, etc.

Process Standard (sample)

 

NNICU/Level II Nursery
Process Standards – The Zaky®

Review responsibility: NNICU Director, Assistant Director, and Educator

Approved: NNICU Medical Director:

Effective date:

Last reviewed date:

Team members performing: RN (including transport RN)

Standard applicable to: NNICU/Level II Nursery

Physician Order required: no

 

PURPOSE	ASSESSMENT	TEACHING
POLICY	INTERVENTION	DOCUMENTATION
EXPOSURE TO MOTHER'S SCENT	REPORTABLE CONDITIONS	REFERENCES/ REGULATORY STANDARDS

PURPOSE
The Zaky is a patented device readily available in the market that mimics the shape, weight, warmth and keeps the scented odor of the infants' mother. It should be scented for a minimum of one hour with direct skin to skin contact free of perfumes, lotions or chemicals. It can be scented anywhere on the mother and should be placed flat with direct skin to skin contact. On the mother it may be placed between the breasts, against the back of the neck. It may be left on the infant and changed with infant bathing, isolette change or when soiled. Once removed it will be placed in MCCG the laundry in the white washing bag it was placed in prior to implementing therapy to prevent it from being harmed by other products in the wash. Clean Zakys will be stored in the unit near the clean bed covers, blankets and infant clothing.
To outline the results of our nursing research conducted in the Neonatal Intensive Care Unit 2009-2010 entitled Give Them a Hand to develop their brain: The Effect of a Maternal Simulated Intervention on Physiologic and Developmental Behaviors of 24-34 Week Gestation Infants In a Level III Neonatal Intensive Care Unit as it relates specifically to the use of The Zaky.
It is not the intention of this policy to outline all developmental strategies the support the growing preterm infant.

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POLICY
Neurodevelopmental care is a broad term used for nursing practices, physical environmental elements and family involvement philosophies that may favorably impact the neurodevelopment of the premature newborn. It includes promotion of positioning strategies, gentle touch, modulation of light and sound exposure, increased parental involvement as well as an emphasis on the need to preserve sleep. There has been a recognized need to systematically address these issues. The decision to implement these practices is base upon evidence derived from a rapidly evolving body of scientific knowledge. This is found not only in the medical and nursing literature but also in the fields of neuroscience, neurobiology, neurophysiology, developmental psychology and developmental psychobiology.
The somatesthetic (touch) system includes several types of sensory input including touch, pressure, and pain among others. The neural pathways for movement and position stimuli are intact as early as 23-24 weeks gestation. These systems have early endogenous stimuli for axon growth and targeting. They also set the patterns for the connections that ultimately lead to the cortex. The in- utero environment of the fetus provides somatesthetic, kinesthetic (movement) and proprioceptive position) feedback. Swaddling and containment of the infant with general flexion of the extremities and trunk use a general approximation of the effect. Swaddling has a long history basis in practice. ¹ It is a means to promote sleep with decreased awakenings during quiet sleep. ^{2, 3} and longer periods of REM sleep. ⁴ It also appears to improve self regulation, diminished stress response ⁵ and a decrease in arousal level, 6 including decreased crying, ^7-9 and may promote neuromuscular development in the preterm infant. ¹⁰
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EXPOSURE TO MOTHER'S SCENT
Four major anatomic areas are responsible for human smell: the olfactory system, the vomeronasal organ, the trigeminal nerve and the terminal nerve. They all interact to provide varying sensitivities to chemostimulants. The vomeronasal organ is designed to function primarily in late fetal life, and may lose function prior to birth, as it is not detected in adults. The olfactory system is clearly functional by 28 weeks gestation, with the trigeminal nerve and vomeronasal organ effective prior to 24 to 25 weeks. ¹¹
The newborn infant has an inherent preference for amniotic fluid odors, breast milk and their own mothers' odor signature.^{12, 13}, ^{14, 15, 16, 17, 18, 19, 20, 21, 22, 23}    Within days after birth, olfactory preferences seem to be reinforced by exogenous cues associated with the mother's unique body odor and breast milk characteristics,^{22, 23, 24, 25, 26, 27} which may be translated into improved non-nutritive sucking.^{28, 29}
These familiar odors also seem to have an adjunctive calming or soothing effect compared to non-familiar odors or no odors during venipuncture or heel lancing procedures,^{30, 31} with the stress of maternal separation or as a soothing tool.^{29, 32}
The ultimate goal of intervention strategies in the NICU is to facilitate and promote infant growth and development. In the NICU caregivers achieve this goal by altering the environmental and care giving stressors that interfere with physiologic stability; promoting individual neurobehavioral organization and maturation by identifying and facilitating stable behaviors and reducing stressful behaviors, conserving energy, teaching parents to interpret infant behavior, and promoting infant-parent interaction and care giving. Establishing biorhythmic balance and physiologic homeostasis is necessary for survival and is enhanced by a sensitive, responsive NICU environment. An unresponsive environment may be so stressful to the preterm infant that apnea, bradycardia, and other physiologic instabilities may severely compromise and prolong recovery.
Hospitalized infants, especially those with prolonged stays, may exhibit classic signs of institutionalized infants or infants suffering from maternal deprivation. Our goal is to prevent this maladaptive behavior by altering the NICU to be more developmentally appropriate and responsive for infants. Normalizing the environment begins with an assessment of the stimulation to which the individual infant is exposed.
The goal of minimal stimulation is to deliver quality therapeutic and supportive care in the least stressful manner. This will reduce the neonate’s energy expenditure, preventing the breakdown of the neonate’s natural defenses to achieve as normal a neurological outcome as possible.
The results of our research “Give Them a Hand” are promising in that use of the maternal simulated intervention (Zaky) demonstrated a positive outcome in the population studied. Organized physiologic indicators were improved in the scented Zaky group as evidenced by cardiorespiratory stability, color, less apnea and bradycardia and feeding tolerance. Organized behavior indicators were smooth, synchronous movements, good tone, flexed extremities, well defined sleep and wake states, exhibiting self quieting behaviors, and attentive behaviors. Additionally, the finding of no apnea and bradycardia in our maternally scented experimental group has the potential to augment current care. Using the maternally scented Zaky for positioning may be a low cost intervention that can be easily implemented as a standard part of care for the premature infant in the NICU. Findings from this study support the need for additional research.
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ASSESSMENT
Assessments related to the use of The Zaky include: correct infant positioning, visibility of the temperature probe, inspection of the product for soiling or need for replacement, availability of the mother for maternal scenting and attention to infant behaviors.
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INTERVENTION
There are many available strategies for the NICU nurse to evaluate when selecting interventions and devices to augment and support the growing preterm infant. The optimal environment for the developing fetal brain is the womb and the NICU environment is less favorable and often hostile. Use of The Zaky when weighing potential risk against benefit has some additional justification for use from our research. It is our responsibility to ensure that our existing environment is at the least non disruptive, and optimally supportive for normal brain development. It is in this context that our unit provides this intervention as a general recommendation.

REPORTABLE CONDITIONS

Notify physician if stress signals are not relieved by interventions.

Discuss need for developmental team evaluation and support of the plan of care.

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TEACHING
1. Provide the parent(s) with an explanation of:

• Developmental care based on the infants gestational age
• Positioning and maternal scenting of Zakys and NNICU process

2. Explain the effects of stimulation and NNICU stress on the infant.

3. Assist parents in the recognition of behavior cues.

4. Assure parents that their participation in the infant’s care is very important and beneficial to their infant.

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DOCUMENTATION
Document in the progress record of the nurse’s notes the:
a. Parental education
b. Zaky use and maternal scenting
c. Infants response or behavioral cues

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REFERENCES/ REGULATORY STANDARDS
1. Lipton EL, Steinschneider A, Richmond JB. Swaddling a child care practice: historical, cultural, and experimental observations. Pediatrics 1965; 35: 519–567.
2. Franco P, Seret N, Van Hees J, Scaillet S, Groswasser J, Kahn A. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 2005; 115: 1307–1311. 
3. Caglayan S, Yaprak I, Sackin E, Kansoy S, Aydinlioglu H. A differenct approach to sleep problems of infancy: swaddling above the waist. Turk J Pediatr 1991; 33: 117–120. 
4. Claudia M, Gerard C, Harris K, Bradley T, Thach B. Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics 2002; 110: e70 (Available at:
5. Neu M, Brown JV. Infant physiologic and behavioral organization during swaddled versus unswaddled weighing. J Perinatol 1997; 17: 193–198 (PMID: 9210073). 
6. Brackbill Y. Continuous stimulation reduces arousal level: stability of effect over time. Child Dev 1973; 44: 43–46. 
7. Van Sleuwen BE, L'Hoir MP, Engelberts A, Busschers W, Westers P, Blom M et al. Comparison of behavior modification with and without swaddling as interventions for excessive crying. J Pediatr 2006; 149: 512–517. 
8. Ohgi S, Akiyama T, Ansawa K, Shigemori K. Randomised controlled trial of swaddling versus massage in the management of excessive crying in infants with cerebral injuries. Arch Dis Child 2004; 89: 212–216. 
9. Giacoman S. Hunger and motor restraint on arousal and visual attention in the infant. Child Dev 1971; 42: 605–614. 
10. Short MA, Brooks-Brunn JA, Reeve DS, Yeager J, Thorpe JA. The effects of swaddling versus standard positioning on neuromuscular development in very low birth weight infants. Neonatal Netw 1996; 15: 25–31. 
11. Fearon I, Kisilevsky BS, Hains SM, Muir DW, Trammer J. Swaddling after heel lance: age-specific effects on behavioral recovery in preterm infants. J Dev Behav Pediatr 1997; 18: 222-232.
12. Schaal B, Hummel T, Soussignan R. Olfaction in the fetal and premature infant: functional status and clinical implications. Clin Perinatol 2004; 31: 261–285. 
13. Schaal B, Marlier L, Soussignan R. Olfactory function in the human fetus: evidence from selective neonatal responsiveness to the odor of amniotic fluid. Behav Neurosci 1998; 112: 1438–1449. 
14. Lecanuet J, Schaal B. Fetal sensory competencies. Eur J Obstet Gynecol Reprod Biol 1996; 68: 1–23. 
15. Marlier L, Schaal B, Soussignan R. Bottle-fed neonates prefer an odor experienced in utero to an odor experienced postnatally in the feeding context. Dev Psychobiol 1998; 33: 133–145. 
16. Marlier L, Schaal B, Soussignan R. Neonatal responsiveness to the odor of amniotic and lacteal fluids: a test of perinatal chemosensory continuity. Child Dev 1998; 69: 611–623. 
17. Varendi H, Porter RH, Winberg J. Attractiveness of amniotic fluid odor: evidence of prenatal olfactory learning? Acta Paediatr 1996; 85: 1223–1227. 
18. Varendi H, Porter RH, Winberg J. Does the newborn baby find the nipple by smell? Lancet 1994; 344: 989–990. 
19. Cernoch JM, Porter RH. Recognition of maternal axillary odors by infants. Child Dev 1985; 56: 1593–1598. 
20. Makin JW, Porter RH. Attractiveness of lactating females' breast odors to neonates. Child Dev 1989; 60: 803–810. 
21. Marlier L, Schaal B. Human newborns prefer human milk: conspecific milk odor is attractive without postnatal exposure. Child Dev 2005; 76: 155–168. 
22. Porter RH, Makin JW, Davis LB, Christensen KM. An assessment of the salient olfactory environment of formula-fed infants. Physiol Behav 1991; 50: 907–911. 
23. Mizuno K, Ueda A. Antenatal olfactory learning influences infant feeding. Early Hum Dev 2004; 76: 83–90. 
24. Sullivan RM, Taborsky-Barba S, Mendoza R, Itano A, Leon M, Cotman CW et al. Olfactory classical conditioning in neonates. Pediatrics 1991; 87: 511–518. 
25. Macfarlane A. Olfaction in the development of social preferences in the human neonate. Ciba Found Symp 1975; 33: 103–117. |
26. Porter RH. Olfaction and human kin recognition. Genetica 1998-99; 104: 259–263.
27. Schaal B, Marlier L, Soussignan R. Human foetuses learn odours from their pregnant mother's diet. Chem Senses 2000; 25: 729–737. 
28. Varendi H, Porter RH, Winberg J. Natural odour preferences of newborn infants change over time. Acta Paediatr 1997; 86: 985–990. 
29. Bingham PM, Abassi S, Sivieri E. A pilot study of milk odor effect on nonnutritive sucking by premature newborns. Arch Peidatr Adolesc med 2003; 157: 72–75.
30. Sullivan R, Toubas P. Clinical usefulness of maternal odor in newborns: soothing and feeding preparatory responses. Biol Neonate 1998; 74: 402–408. 
31. Rattaz C, Goubet N, Bullinger A. The calming effect of a familiar odor on full-term newborns. J Dev Behav Pediatr 2005; 26: 86–92. 
31. Goubet N, Rattaz C, Pierrat V, Bullinger A, Lequien P. Olfactory experience mediates response to pain in preterm newborns. Dev Psychobiol 2003; 42: 171–180. 
32. Varendi H, Christensson K, Porter RH, Winberg J. Soothing effect of amniotic fluid smell in newborn infants. Early Human Dev 1998; 51: 47–55. 

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Difference Between the Zakys and Other Devices

The Zakys virtually replace all developmentally supportive devices.

All these devices (*) are made to provide support when the baby is on the bed/incubator. For support when the baby is out of the bed in Kangaroo Care, visit the Kangaroo Zak

Manufacturer (*)	Nurtured by Design®	Philips®					Dandle-lion™				Sundance®
Product Name (*)	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
# of item Codes per Product	1	23	1	9	12	1	5	11	3	1	16
Purpose	comprehensive, multifunctional, developmentally supportive and family-centered care	positioiner-Sidelying	positioner-  boundaires & containment	positioner - prone	nesting	scent of parent only	positioner, includes base support, Gel pad/cover, roll, &  Brim	positioner similar to Dandle ROO but disposable	adjustable swaddler	positioner-  boundaires & containment	matress, positioner-  boundaires & containment
When is it used?	At all times, in all NICU incubator and beds	At the discretion of caregiver	At the discretion of caregiver	At the discretion of caregiver	At the discretion of caregiver	At the discretion of caregiver	At the discretion of caregiver	At the discretion of caregiver	At the discretion of caregiver	At the discretion of caregiver	At all times up to a certain developmental stage
Positioner
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Full Body Support	✔	✔			✔				✔		✔
Positioner For Prone	✔	✔	✔	✔	✔					✔
Positioner For Supine	✔	✔	✔		✔		✔	✔	✔	✔	✔
Positioner For Sidelying	✔	✔	✔		✔					✔	✔
Positioner For Nesting	✔	✔	✔		✔		✔	✔		✔	✔
Positioner For Under The Baby	✔		✔	✔	✔						✔
Positioner For Over The Baby	✔		✔		✔		✔	✔	✔	✔	✔
Positioner For Side of The Baby	✔	✔	✔		✔					✔	✔
Positioner For Away from The Baby (i.e., Help Holding Equipment, etc)	✔	✔	✔	✔						✔
Evidence-Based Device for Developmental Care
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Any Clinical Evidence?	✔
Clinical Evidence That Suggests Significant Decrease Of Apnea / Bradycardia (28-34 Weekers)	✔ (view)
Clinical Evidence That Suggests Significant Increase Of Self-Regulation In NICU (28-34 Weekers)	✔ (view)
Ergonomic Design
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Designed by a PhD in Ergonomics Engineering	✔
3+ Years Of Ergonomics Engineering Research And Development Before Introducing to Market	✔
Provides Constant Level Of Care	✔
Same Universal Size Provides Individualized Care From Birth To 12 Months and beyond (no need S/M/L/XL or Light/Medium/Heavy, etc.)	✔
One Universal Weight That Can Be Adjusted Depending Of The Size Or Condition Of The Baby	✔		✔							✔
May Be Used With Other Developmental Care Devices	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔
Continuity and Constant Level of Care: Same and Only Device Needed To Support Every Developmental Stage and Medical Condition, Eliminating Margin of Error Due to Product Selection/Availability	✔
Containment Without Restraining Movement	✔	✔	✔		✔		✔	✔	✔	✔
Containment Without Excessive Baby Manipulation	✔	✔	✔							✔
Instant View Of The Baby's Entire Body (From Head To Toes)	✔	✔	✔	✔						✔
Immediate Access To The Baby With Minimal Disruption	✔	✔	✔	✔		✔				✔
Converts To A Pediatric Bolster (Firm Yet Flexible Roll for Back Support)	✔
Familiar Shape and Design For The Parents	✔
Extra Pair Of Hands for Parents and Staff	✔
No Metal Rods, Straps or Wings That May Create Pressure Points	✔		✔	✔		✔				✔
Adjust The Firmness Of The Device To Provide Extra Support	✔
Made To Be Warmed In Dryer Or Towel Warmer	✔
Quiet Handling (No Velcro Or Noisy)	✔	✔		✔	✔					✔
Support and Containment Without Restraining Movement	✔
Designed To Work Standalone	✔
Effective Quality Control for Positioning	✔
Constant Level Of Care - Individualized Developmental Care
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Everyday Use Regardless Of The Caregiver in Shift	✔				✔						✔
Same Device to Support Individualized and Comprehensive Developmental Care Regardless Of Baby's Size, Medical Condition, and Developmental Stage	✔
NIDCAP friendly (Recommended by International NIDCAP Trainers to Provide Individualized Care)	✔
Family-Centered Care
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Parental Involvement - Made For Parents To Easily Learn How To Use	✔
Made To Encourage Parental Learning and Intervention	✔
Made To Simulate Parental Intervention	✔
Made To Help Calm The Baby And Mother During Transport And Admission	✔
Helps Reduce Parents' Separation Anxiety and Stress	✔					✔
Made to Keep the Scent Of Both Parents	✔					✔
Bonding Aid	✔					✔
Made To Be An Extension Of The Parent That Stays With The Baby	✔
Attachment Aid	✔
Provides Neck Support For The Parent during Kangaroo Care (While Scenting Them)	✔
Designed To Comfort Parents During Baby's End-Of-Life / Palliative Care	✔					✔
Made So Parents Continue Effective Developmental Care After Hospital Discharge	✔
Multi-Functional, Multi-Purpose
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Transitional Item	✔	✔	✔		✔	✔	✔	✔	✔	✔	✔
Effective with Narcotic-Dependent Infants	✔
Assists Baby's Upright Position in Car Seats, Bouncy Seats, Strollers, Etc.	✔
Comforting and Non-Pharmacological Pain Management Device	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔
Made For Home And Hospital Use
Soothing/Therapeutic Item	✔		✔			✔				✔
Effective Staff and Parent Training
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Intuitive - Very Short Learning Curve By Professionals	✔					✔
Intuitive - Very Easy for Professionals to Teach Parents How To Use	✔					✔
Parents Continue Developmental Care With The Same Product At Home After Proper Training	✔
Training Concentrated On Developmental Stage Of The Baby Not On How To Use What Combination Of Tools	✔
Infection Control
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Washable Full or Parts	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔
Includes Washing Bag	✔
No Disassembly Required	✔		✔	✔	✔				✔
Management and Supply Chain
Product Name:	The Zakys™	Bendy Bumper™	Frederick T. Frog™	Prone Plus™	Snuggle Up™	Snoedl™	Dandle ROO™	Dandle ROO Lite™	Dandle WRAP™	Dandle PAL™	Z flo®
Reduced and Minimized Inventory	✔
Reduced and Minimized Overall Storage Space	✔
Always the right device is available	✔
Simplified Ordering Management	✔
Simplified Supply Chain	✔
Simplified Training and Quality Control	✔
More Accurate Forecasting and Planning	✔
Simplified Logistics	✔
Simplified Procurement	✔
Multifunctional, Multipurpose Device Used By Every Patient in the NICU To Provide Comprehensive, Evidence-Based Family-Centered Developmental Care.	✔

(*)=Company and product names are Registered Marks of each individual company. Nurtured by Design is independent from any other company listed in this comparison. This comparison is for information only.