Neonatal Airway Management Simulator


Approximately 1 million neonates are born in Japan every year. On the other hand, 16% of neonates do not start spontaneous breathing immediately after birth, and some kind of treatments are required. As a guideline against such cases, which called neonatal cardio-pulmonary resuscitation (NCPR) is established. That includes invasive procedures such as laryngoscopy and tracheal intubation, so doctors are required to have sufficient experience.

However, for residents who need training, it is difficult to experience NCPR up to a sufficient number of cases only with clinical training. Although simulation training is also spreading, the usual manikin simulator did not have a feedback function to the trainees, so it is not enough to acquire the correct technique.

Therefore, we aim to develop a NCPR training system that can simulate various scenarios along with the guidelines and have advisory presentation function based on quantitative evaluation of the procedure. In 2016, we focused on an airway management procedure, which is particularly dangerous in the NCPR, and developed a neonatal airway management simulator WAKABA-1(WAseda Kyotokagaku Airway BAby-No.1) equipped with various sensors for quantitative evaluation.

Fig.1 The major complications of airway management and the measurement items of WAKABA-1

Fig.2 WAKABA-1 body

WAKABA-1 simulates the average physique of neonates, and it looks like a neonate using soft materials for the face and limbs. In addition, the airway from the mouth to the lung uses flexible materials, and the tongue, epiglottis, branching to the esophagus, etc. are also reproduced. These flexible parts were produced by Kyoto Science Co., Ltd. which conducts joint research.

WAKABA-1 can detect the danger motions causing some complications in airway management with the 6 types of 25 embedded sensors. The data measured by these sensors is sent to the computer wirelessly and used for the advice generation to the trainee during the trial and after the trial.

In this research, physician's measurement is actually carried by using WAKABA-1. Comparing the measurement results, the skilled physician knows that the time required for laryngeal deployment is short, and the pressure on the upper jaw and epiglottis is also small.

In the future, we will implement actuators to imitate some vital signs such as breath and heart beat for the scenario training along NCPR. Additionally, we will collect more data and consider the quantitative evaluation of NCPR. Finally, we plan to construct the interactive tutorial system which gives advices to trainees automatically.


Fig.3 Embedded sensors in WAKABA-1

IMU in head and abdomen

IMU (inertial measurement unit) measures the angle of the neonate's neck flexed backward in sniffing position. Overextension and insufficient flexion of the neck cause damage to the cervical vertebrae or the incorrect esophageal intubation.

Oral camera

Oral camera shoots images around epiglottis, then the position of laryngoscope is evaluated. The incorrect position of laryngoscope makes the visibility of vocal cords lower and causes the ventilation delay and the esophageal intubation.

Larynx pressure sensor

Larynx pressure sensor measures the pressure distribution on larynx lifted by laryngoscope. Overpressure on larynx cause the dislocation of cricoid cartilage, which is near by vocal cords. On the other hand, laryngoscopy with too small pressure makes the visibility lower and cause the ventilation delay and the esophageal intubation.

Upper jaw pressure sensor

Upper jaw pressure sensor measures the pressure on the upper jaw touched by laryngoscope. In the airway management to adults, the front teeth are often broken by laryngoscope. Of course, neonates have no teeth, but the overpressure on gum stops the teeth eruption or make the teeth alignment worse in future.

Tube position sensor and esophageal intubation sensor

Tube position sensor measures the depth of tube in trachea at the endotracheal intubation. Esophageal intubation sensor detects the tube invasion into esophagus. If the tube is not intubated deeply, air pressure doesn't reach to lungs. However, if the tube is intubated too deeply and reaches to the right (left) bronchus, only one side of lungs is ventilated and the efficiency becomes very low. Additionally, the esophageal intubation is dangerous situation. It makes the gastric juice flow backward to lungs and cause the aspiration pneumonitis, which leads to death.

Ventilation pressure sensor

Ventilation pressure sensor in both lungs and esophagus evaluates the ventilation as outcome of the airway management. WAKABA-1 has both lungs in the chest so that the trainee can check the ventilation with eyes.



武部康隆, 椎名恵, 菅宮友莉奈, 中江悠介, 片山保, 石井裕之, 高西淳夫: "新生児蘇生法トレーニング・システムの開発―新生児に近い外見と多数のセンサを有する気道管理シミュレータの設計・製作―", 第35回日本ロボット学会学術講演会予稿集, 2J1-04, 2017. (Awarded: "日本ロボット学会第33回研究奨励賞受賞")

武部康隆, 椎名恵, 石井裕之, 高西淳夫: "新生児蘇生法トレーニング・システムの開発―気管挿管手技において上顎損傷につながる危険操作の定量的評価―", 日本咀嚼学会第28回学術大会予稿集, P-21, 2017.

日本経済新聞: "患者ロボ使い介護・医療磨く", 2017年10月16日朝刊. 電子版速報