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Incubator care

New born babies take time to accustom to the external environment specially if they one
premature and low birth weight. As they are on risk to develop hypoxia, hypothermia and other
many associated adverse conditions, need special care and attention.
The term incubation has derived from a latin word ‘Incubare’ that means “lie on”. Incubation
is the process of providing an environment to keep them worm and suitable for their
development as birds sit on their egg to hatch them.
Similarly, Incubator is an apparatus used to care the premature, low birth weight and very
sick babies in thermo neutral environment.
Application of oil or liqud paraffins to the skin of the babies either inside the incubator or
outside reduces the heat loss by 50%. If is very essential for baby to obtain an ideal environment
for growth and development, basically survival itself.
Thus about one third of nursery beds schedule comprises of incubators.

Indications: Indication of incubation care depends on ability of neonates to sustain and
adopt in external environment. But generally all premature babies, babies with low birth weight
(<1000g) may be stable, hypothermic child (<32˚c), Sick children need luenbotor and its care.
Frequently incubator is used to transport babies from one place to another, like referral to
another hospital, within the hospital for various investigations e.g. CT scan & MRI. Neonates
who need close observation are also kept in the incubators.

Purpose: Main purpose of keeping and caring a neonate in incubator are
1. Maintenance of thermoneutral ambient temperature
2. Provision of desired humidity and oxygenation
3. Observation of very sick neonates

4. Isolation newborn babies from infections, unfavorable external environment and
stimulations.
Types:
Incubation can be of various types
1. Portable and non portable– Portable incubation can be used to shift the patient to
another area of hospital as needed.
2. Open box type- It is also known as Armstrong, here neonate is keep on the Plexiglas
bassinet to keep unstable babies or newly born babies. A radiant warmer can be attached
if child needs. The main disadvantage of this type of incubator is it can not maintain
thermoneutral environment if lids are open frequently. Despite it can not filter the air
and neonate is directly in the contact with external environment. It has only advantage
that neonate in this incubator can be observed well and can be handled easily.
3. Close type- Close type of incubator has special function to concentrate fresh air after
filtration. It prevents water loss from radiation. As neonate remain inside the box the
risk f infection is minimum.
4. Double walled- The incubator has two walls. As air is not good conductor of heat the
incubator prevents heat and fluid loss.
5. Servo control incubator- It is best type of incubator and most frequently desired. It is
automatically operated and set the parameters as per need of neonate. Skin sensor or
thermo capsule is affixed with the abdominal wall of neonate midway between
umbilicus and xiphisternum, and incubator is set to maintain desired temperature at
360c. The skin sensor feeds the information regarding skin temperature to the thermostat
which automatically regulates the output of heat to maintain the desired temperature of
neonate. It is also provided with inbuilt audio visual alarm for set temperature with
upper and lower desired temperature, air flow and probe failure. Inbuilt heat monitor
provides information regarding the amount of heat generated by incubator to keep the
neonate warm. When the heater output reading is minimal or nil it suggests that neonate
is capable of generating enough metabolic rate of heat to keep himself warm and
neonate can be taken out of incubator or nursed in open cot .Recent models of incubator
have arming systems which even suggests the actions to be performed.
Ideal settings of incubator-
Setting of incubator depends upon various parameters of neonate as well as environment e.g.
gestational age, maturity, body temperature and presence or absence of disease.
Recommended Nursery temperature is 28-300c. The incubator temperature should be such as
it will maintain the temperature of neonate between 35-370c.

Neutral range of Environmental temperature
Birth weight in grams
Age
<1200 1201- 1500 1501-2500 >2500
1st day 35.0 ± 0.5 34.3 ± 0.5 33.4 ± 1.0 33.0 ± 1.0
2nd Day 34.5 ± 0.5 33.7 ± 0.5 32.7 ± 1.0 32.0 ± 1.0
3rd Day 34.5 ± 0.5 33.5 ± 0.5 33.0 ± 1.0 32.0 ± 1.0
4th Day and later 33.5 ± 0.5 32.8 ± 0.5 32.2 ± 1.0 31.5 ± 1.0

A humidity of 60-70% is sufficient under most circumstances.
Oxygen delivery inside the incubator depends on wellbeing and ability of neonate to adapt in
external environment but 7-10 lit/min of Oxygen provides adequate oxygen to the neonate
unless neonate has some pathology.

Procedure-
 Warm and oxygenate the incubator as you receive the message of expected arrival of
neonate, generally 10-15 minutes earlier.
 Check the physician’s order.
 Explain the needs of incubator care to the parents of neonate.
 Adjust the incubation parameters and maintain, follow the chart.
 Remove the cloths of the neonate and place inside the incubator.
 Provide meticulous care as long neonate remains in side.
 Continue care through port hole.
 Report to the doctor if baby is not maintaining the temperature, generally after two
abnormal readings.
 Do not bring the neonate out without justifiable cause.
 Document time and condition of the neonate.
 In open care system, cover the baby with warm cloths or to minimize heat loss.

Cleaning and sterilization-
When the incubator is occupied, it should be cleaned daily with mild detergent. Humidifier
chamber must be emptied and cleaned daily, fill with fresh distilled water.
After seven days neonate should be sifted to another incubator and used incubator should be
cleaned with antiseptic solution.1-2 ml of Glacial acetic acid or vinegar can be added to water in
the humidifier to prevent bacterial growth.

Special considerations-
1. It is important that the incubator should not interfere with observation of the neonate and
quality of care.
2. Sensory stimuli like light and pain should be kept to the minimal.
3. When neonate develops fever, the incubator modes have to be changed in normal modes.
4. When the neonate is nursed in prone position, skin sensor is placed over the flank and it
should not touch the bed.
5. The neonate in the incubator should not be bathed.
6. The daily linens should be kept within the Nursery to keep warm.
7. No alarm should be ignored.
Conclusion-
Almost all preterm and low birth babies need incubator care. Unless baby is extremely small or
sick open care system I preferable upon closed system because of easy access to the babies.
References:-
1. Singh Meharwan, Care of Newborn, 6th edition, 2004, published by Narinder K Singh,
new Delhi-01.
2. Clinical Nursing Protocol, Nursing Service, Christian Medical College, Vellore.
3. Prajapati Badev, Essential procedures in Pediatrics, 1st edition, 2003, Jaypee brother’s
medical publication, New Delhi.
4. Gupte Suraj, The text book of Pediatrics, 7th edition, 1996, Jaypee brother’s medical
publication, New Delhi.