#394 - The Pxxs: Pampers Creates the World's Smallest Diaper for 22-Week Preemies

Hello friends 👋

What if the smallest patients finally had a diaper designed just for them? For years, NICUs have struggled to find appropriately sized diapers for extremely premature infants, often resorting to makeshift solutions that compromised skin integrity and care quality. That changes now. In this breaking news episode, Ben sits down with Harry McCusker, Director of Research and Development for North America Pampers Diapers, to discuss the groundbreaking launch of the Pxxs diaper—the world's smallest commercially available diaper, specifically engineered for micropreemies born as early as 21-23 weeks gestation. Weighing less than a nickel and designed with input from NICU professionals worldwide, the Pxxs addresses critical challenges in skin protection, fluid management, and developmental care for our most vulnerable patients. Join us as we explore how this innovation represents more than just a smaller diaper—it's Pampers' commitment that every preemie deserves products designed with their unique needs in mind.

Link to episode on youtube: https://youtu.be/f6QM7QOD6w8

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Short Bio: Harry McCusker is the Director of Research & Development for North America Pampers Diapers, bringing over 26 years of experience in developing innovative ingredients, formulations, and processes for baby products, including diapers and wipes. With a global perspective, he has designed diapers to meet the needs of babies and parents everywhere, with a special focus on creating solutions for newborns in hospitals and the NICU. A passionate advocate for infant care, Harry draws from his personal experience as a proud parent of two children who grew up using Pampers.

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First Look at the Pxxs:

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The transcript of today's episode can be found below 👇

[00:00.894] Ben Courchia, MD Hello everybody. Welcome back to the Incubator Podcast. We're back today for a conversation and we have the pleasure of having on with us in the studio, Harry McCusker. Harry, welcome to the podcast.

[00:13.104] Harry McCusker Thank you very much. It's great to be here.

[00:15.900] Ben Courchia, MD It's great to have you, Harry. If people who are not familiar with who you are, you're the director of research and development for North America Pampers Diapers, bringing over 26 years of experience in developing innovative ingredients, formulation and processes for baby products, including diapers and wipes. With global perspective, you have designed diapers to meet the needs of babies and parents everywhere with a special focus on creating solutions for newborns in hospitals and the habitat that we all favor the most on this podcast, NICU. You're a passionate advocate for infant care. You draw from your personal experiences as a proud parent of two children who grow up on using Pampers. So we're very excited to have you on to talk a brand new innovation being released by Pampers.

[01:04.260] Harry McCusker I'm excited to be here and very happy to talk about it.

[01:08.126] Ben Courchia, MD So the reason that we're very excited about this episode is because Pampers is announcing the release of a brand new addition to the lineup of diapers that are currently available. And the reason we're mentioning this on the podcast is because it is extremely relevant to our patient population. We are talking about the Pampers XXS, Pampers Extra Extra Small, which is designed for babies at 21 to 23 weeks of gestation. This is a phenomenal innovation. We've been, I think, waiting for that for some time. So I think there's a lot of excitement. And I wanted to maybe start off by talking to you about how really Pampers has played a meaningful role in neonatal care for decades. And before we start talking about the intricacies of this new product, can you frame for us a little bit? How do you guys think about your mission in the NICU and what role do you see yourselves playing for the tiniest babies and their families.

[02:09.476] Harry McCusker Yeah, mean, our mission at Pampers is simple, right? It's to create high quality diapers for kids that are two to three years old or for kids that are born two to three months premature. We want to offer all of them high quality diapers that are great for caring for skin, have extraordinary fit, outstanding leakage protection. This is something that we've been doing for a lot of years. We invented the diaper category over 60 years ago. And so there's a lot of legacy there. It's also personal for me in terms of my mission at Pampers. You I mentioned or you mentioned that I have two kids. They're all well, well out of diapers now, but all of us have friends and colleagues and neighbors that have babies. so babies are central to so many people's lives. And so trying to offer great products to our own family members, our own kids or to our neighbors is an important thing that we do. You can see this for yourself. We just started this advertising campaign. We call it Behind Every Baby. It showcases what Pampers is all about and showcases our commitment to serving the premature babies. So this is a mission that I've been doing now for, I think, guess, 26 years now, one that I take quite seriously and one that I still really enjoy.

[03:25.607] Ben Courchia, MD Yeah, I mean, we definitely see that and this commitment to our NICU patients is really something remarkable. When we're looking specifically at the population that we're talking about today, we're talking about babies really on the edges of viability between about 21 to 23 weeks. And they are obviously very small, but we see though that this population has been subject to a striking relative increase in their NICU presence over the past decades. I think some of the statistics that I was reading said that more than 300% rise in admissions for babies born at 22 weeks. So when you look at both the percentages and also the real numbers behind them, at what point do you decide that it is the right moment to act and really to proceed with the creation of a product specifically designed for this very narrow segment of our NICU population?

[04:23.856] Harry McCusker Yeah, so we've been talking about this for years. We have a history of innovating in the NICU and providing new products. We introduced the first preemie diaper for kids that are less than 2000 grams in the early 2000s. And then a few years ago, we introduced a product that was for babies less than 800 grams. that was a few years ago. even at the time of the creation of that product, we began asking ourselves, do you think after this one, we'll need to make one that's even smaller? And so we focused on getting that first one for babies less than 800 grams out the door with high quality. And as we saw this in the marketplace play out, most caregivers were very pleased with us having done this. It was a great fitting diaper for those babies. But then as this trend has continued with even lower gestational ages of babies being born, the need for these smaller diapers has just continued to grow. And fortunately, we have a lot of contact with people who work in the NICU through various channels, whether it's personal relationships, advisors that we have, nurses and doctors that we co-create with, the voices of people saying that we need a better diaper for this small population that is still not being served by the size of diapers that are in the marketplace today. That's when we began to activate. I'm having to create this new Pampers extra extra small diaper.

[05:53.908] Ben Courchia, MD Yeah, and the question of whether you might need a smaller one is still on the table. We don't know. If years down the road, you might need to do a triple X. Who knows where the way our field is going with innovation and creating opportunities for smaller and smaller babies to survive their prematurity. It might be a question you might have to revisit down the road. So talking a little bit about the feedback that you were just mentioning, I'm just wondering when this feedback reaches your team, what does that actually look like? Can you walk us through the early stages on how do you determine whether this is simply a matter of shrinking an originally existing product, kind of like you would do on a mobile device, or whether obviously there's a lot of rethinking that has to go into it because smaller does not mean necessarily that it's the same as the bigger model. So can you tell us a little bit about what does that look like?

[06:50.032] Harry McCusker Yeah, absolutely. you know, the feedback that we got was, this diaper that we had in the marketplace, and it's still there now, that's designed for babies less than 800 grams. It's fantastic. But for this small population of these 21 to 23 weekers, or less than 500 grams, even that diaper is still too big. And so, you know, your audience probably knows this, but You know, like a mobile phone, like the one that I carry in my pocket every day, this weighs, mine weighs 220 grams. So these kids that are being born weigh just a little bit more than the phone that some people may have in their hands. And yet, despite these babies being so tiny, they would say to us that for those little babies, our P3 size that we call it, they were swimming in that diaper. And, you know, I have a lot of admiration for the nurses that care for these kids. They're amazing in how they often will fold them. They're origami experts, we joke, or some crafts wizards, they cut them down to size. But these nurses should be focusing on other ways of caring for these kids, not about compensating or compromising a product that we're offering them. And so we're just hearing that even that one that existed was just too big. And a diaper that's too big does have some negative consequences, right? It may be covering an area of the body that that these nurses don't want to be covered, or if a diaper is too big, it can leak. And you would well know that changing a diaper by itself is already a disrupting event for a baby that should be resting and trying to develop. As if you have to do a diaper change when the diaper is too big and it leaks, that means even more activity inside of the isolette, right? Which is not what we're aiming for. And so we're hearing all this feedback about for these little, this small population, these diapers being too big, we knew we needed to take action. And so for us, if I think about how we designed it, you ask about like, could we just shrink it? Well, in some ways that is what we did, but in other ways it's not. So when we design products like this, we get the input from the medical community. We actually have a nurse on staff. She's a former NICU nurse. She had been a NICU nurse for 10 years. And so she's fantastic about speaking the language and getting in and understanding with the NICU community about how we can do a better job and how to design these products. And we have the benefit, as you probably know, that nurse feedback especially is very candid, direct, and that makes it very useful. And so we'll often try to pick from what are known platform technologies from a menu that we have around the world of things that will well serve these little kids. And what are some areas that are unique and we need to have a unique technology for these little kids? And maybe one example of that that we faced when we were doing this is the engineering contradiction about being very absorbent and preventing skin over hydration and being very absorbent, preventing leaks, but also being thin and flexible so that they help support the development of these little kids. And so when you make a diaper, you know, that's this small, right? You wanna pack as much technology in as possible. And so fortunately for us, as the biggest diaper manufacturer in the world, we have a number of different ways that we can construct these diapers. And so in this case, we used our thin gel absorbent technology so that it can still be like very absorbent and yet at the same time, allow the positioning of these baby legs to be in line with where they should be so that it can help, so they can develop in a healthy way. And so that overcoming that, engineering contradiction was key to towards scaling it down. So in some ways we did scale some things down, but we introduced other layers that tend to be more on the thin and flexible side to help best meet the needs of these kids.

[10:46.725] Ben Courchia, MD Yeah, the feedback from nurses, it's one of the reasons why I love working with our NICU nurses is that they don't mince words, right? They tell you things the way they are and it's the best feedback that you can receive. I'm just wondering when you're looking at this particular diaper, the PXXS, what is one of the elements of its design or performance that you've already alluded to, but which one is the one that you feel you're the most proud of? The one where you're like, man, we've done something pretty neat here.

[11:23.428] Harry McCusker Yeah, mean, part of what I already talked about about that overcoming that absorbency piece of it is definitely one of them. And maybe to kind of talk about that just a little bit more, know, part of the difficulty with this little real estate of these little diapers, of course, is that you want to put as much absorbency in there as you can. But not all these babies are the same size and shape, right? Every baby is going to be a little bit different. And so, you know, how we make it fit around them properly is a challenge because some of these kids when they're born, they can be of a certain shape and then quickly it can change. Their bellies can become distended. The breathing support that they're on can change that. And so you need to be fitting the smaller ones and still fitting as they begin to grow or the difference in hydration, right? You want a diaper that could absorb as much as 30 milliliters or a little bit more for those babies that are being very highly hydrated, but you don't want to over-design it. So for those kids that are only urinating several milliliters, that it's not overly bulky for them. And so those kind of challenges are quite difficult to overcome. But I think one of the other features that makes it very unique is what we call our flexible fasteners. I know some of your listeners may be only on audio, but a traditional diaper tends to have the fasteners attached to the back of the diaper and they're permanently attached. And then you wrap the fasteners around the side such that that Velcro can land in the front or the middle of the diaper to fasten it up. Well, as we were designing our diapers, we recognized that there were so many things you have to accommodate for in different situations for these little kids. And so we wanted to offer the maximum versatility and adaptability on these products. And so not only do we design it such that these fasteners can be attached anywhere on the front of the diaper to move around a lead or a line or a surgical procedure location to provide that kind of adaptability. But in fact, even the where it's attached on the back of the diaper is a Velcro piece such that that can actually be removed. In doing so, you can actually fully remove the entire stretchy side of these diapers. And in having and in doing so, you then have the versatility to be able to apply this little piece anywhere on the back and anywhere on the front. And you can do so in almost any of the positions that the babies are in, whether it's like prone supine sideline and it kind of provides just extra ability to adapt this diaper to best meet the needs of these little kids.

[14:02.643] Ben Courchia, MD That's super cool. And like you said earlier, these infants are small, but some of their inherent physiology is that they could have a significant urine output. And that presents, obviously, an engineering challenge, as obviously they have a very dynamic physiology and growth patterns, for sure. Have you guys been able to provide some of these brand new PXXS diapers to some NICUs and have you already gotten some beta testing and feedback from the community? And I'm curious to hear what that has looked like.

[14:39.640] Harry McCusker Yeah, absolutely. We've gotten very good feedback from the beta testing, as you call it, already. We're quite happy about that. But actually, that testing is maybe one of the last steps in the journey, right? Because for us, the way that we innovate at Pampers is all about ensuring that there are no compromises, and especially for these little kids, right? So the beta testing part of it happens after a long series of different activities which would involve all of our laboratory testing, consulting with our experts from around the world. We have the benefit of having different divisions that PAMPERS is part of Procter & Gamble. So we have a skincare division, we have other divisions that are into absorbent technologies like Bounty paper towels and Charmin. So we're able to consult with different groups and check our ideas and peer review what we're doing. We've got great modeling and simulation capabilities so that we can virtually design these diapers before we actually even make one. We have great 3D printing and prototyping facilities so that we can then make a few of these, test them out in our labs, run them through our models, and then co-create with our, not just our peers in the company, but our advisory board to make sure that we're on track. So once that's done, that's when we really begin the clinical, the beta testing and the clinical testing.

[16:01.265] Ben Courchia, MD Yeah, so by the time it gets to the clinical settings, you guys have a lot of certainty towards the validity of the product and how it's going to perform. this is not a trial and error process by no means.

[16:12.206] Harry McCusker Well said, yeah. And so once we get to that testing, the results of that have been quite encouraging. And we have made some small design adjustments to make it even better. But the feedback from the community that has used this has been extraordinary. They've been great partners in giving us great feedback. And they've been really pleased with the products. That also makes us quite proud of Pampers.

[16:35.027] Ben Courchia, MD That's phenomenal. So for the people who are listening and who are like us, quite excited about this new addition to the Pampers lineup, they must be wondering the same thing we're all wondering now, which is when can they expect to be able to put their hands on the PXXS and provide that new solution for their patients?

[16:54.382] Harry McCusker Yeah, so we're just now introducing it and we'll be expanding that introduction over the course of the coming year. The good news is that all hospitals there, procurement or purchasing departments have a dedicated Pampers rep that they'd be able to contact and that person will work with the hospital to figure out what the needs are and get them the products that they need.

[17:15.303] Ben Courchia, MD Very cool. So I just maybe want to take a bit of a step back as we are getting close to the end of our conversation. And in the beginning, circling back to what you said where a few years back around 2020, when you guys were wondering whether you might have to innovate further on the smallest diapers you had created, you find yourself today really revisiting that and having created a product for a population that really was not part of the NICU landscape a couple of years back, when you and your team are looking at the direction in which neonatal care is heading, how do you guys at Pampers think about the future and what do you think long-term innovation will look like for you specifically in the space of the neonatal ICU?

[18:01.168] Harry McCusker Yeah, you know, like I said in the beginning, this latest campaign that we have, we talk about it as being behind every baby. So we are carefully tracking what's happening and we will continue to try to meet the needs of these little kids as the medical technology evolves. And we have a track record of introducing new products into the NICU that help meet the need over the years. And we're carefully tracking the changes, not only in practices and the birth ages of these little kids, but also the treatments and the care and how our products can complement that. We wanna make sure that we're offering great products every day, but in terms of innovation, we're often looking multiple years or times even a decade into the future. So we're looking very closely at how things are evolving and trying to forecast and working with thought leaders who can try to help us to forecast what will be different in three to five years from now. And so we're working on different diapers and wipes technologies that will help to meet that need. And that's something that we have been doing and will continue to do.

[19:08.071] Ben Courchia, MD That's very exciting. That's very exciting. I really enjoy talking to people such as yourself, Harry, because when we meet with individuals behind innovation, even from industry, I think that one of the themes and the threads that I see that is consistent across you and the other individuals that we speak to is a real care for caring for the patients and for their families. And I think that the way you've spoken about this new diaper really is eloquent and speaks to this dedication. What do you hope that the introduction really of a new diaper designed specifically for a very vulnerable population, a population that is not representing of the majority of NICU babies, what do you hope this product really communicates about your commitment and Pamper's commitment to this community of neonates? And maybe that will be our final answer.

[20:03.812] Harry McCusker Yeah, I think as most of your listeners know, there are only a few thousand of these babies that need these kinds of products. And yet we still find it to be very important to serve this very, very small population on top of the 25 million babies that wear our diapers every day. And so we want to make sure that everybody knows that Pampers is here to serve the babies, the nurses and the doctors that are providing the care and that we are a trusted brand that wants to sustain the trust that many of your listeners have given to us and continue to earn that both from the medical community and from the parents. We get to talk to lot of the parents as well of these premature infants. And they also are often quite touched that we go to the trouble to make such a tiny little diaper for such an infrequent experience. And it says a lot to them about what we're trying to do. And I'd say those stories and getting to hear from them or even talk to some of those families is one of the things that keeps me very motivated, my team very motivated, because we can see the human effect that our products have on these little kids and their families.

[21:18.451] Ben Courchia, MD Yeah, I'm so happy you said that because in the neonatology field, we've seen a lot of times where because certain maybe products or certain medications affect such a narrow spectrum of the overall medical patient population, they're discontinued and they're abandoned. And what you're presenting today is the exact opposite of that is really a commitment to innovation and to the development of solutions for a population that is often forgotten. So I think that this speaks volume to your commitment and we're very thankful to be able to discuss and announce the release of this brand new diaper on the incubator podcast, the PXXS. Harry McCusker, thank you. You're the Director of Research and Development for North America Pampers Diapers. It was a pleasure talking to you and congratulations again on this new release.

[22:03.864] Harry McCusker I really enjoyed it. Thank you for having me.

[22:06.462] Ben Courchia, MD Thank you.