Care of child with incubator

1. Care of child with incubator

2. Introduction Incubator is   an apparatus for maintaining an infant,especially a premature infant, in an environment of controlled temperature, humidity, and oxygen concentration .(Online medical dictionary).

3. Incubators have simple alarm system to alert the clinical staffs if there is any danger of overheating of the device.In some cases power is reduced automatically to prevent overheating

4. Principle of Incubator Infant incubator is in the form of trolley normally with mattress on the top covered by plastic cover. This chamber provides a clean environment and helps to protect the baby noise, infection, and excessive handling.

5. Principle of Incubator A temperature sensor is tapped into the baby’s skin and the incubator heater adjusts to maintain the baby at a constant temperature or the temperature is controlled by thermostat in the heated air stream.

6. Purpose of Incubator An infant may require an incubator for the following reasons: When they are not maintaining their own temperature with clothing and wrapping. When they are acutely unwell and close observation is required. When they are at risk of abnormal heat loss. They have a known infection/ or the potential to develop sepsis.

7. Purpose of Incubator 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

8. Main functions of infant incubators are: 1.Temperature control 2.O2 Concentration 3.Humidity control 4.Breathing gas filtration

9. Indications of incubator 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.

10. 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.

11. 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.

12. 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 of 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.

13. STEP 1.Prepare the incubator Pre-warmed to a temperature appropriate to the infant’s age, size and condition. Use in Air mode and must always be switched on with the motor running if in use for a baby. Check and record the incubator temperature hourly. Position away from draughts or direct sunlight.

14. NURSING CARE OF CHILD IN INCUBATOR

15. Note : Ensure alarms self-test has been completed (automatic). If the unit fails the self test, the alarm sounds, and one or more messages are displayed in the trend/alarm window.

16. STEP2:Care of Baby Maintain axilla temperature between 36.5°C and 37.2°C Access baby by using the portholes, limit opening of large door as this interferes with air temperature. Ensure baby is nursed naked apart from a nappy. Position baby utilizing rolled towels/cloth nappies to provide boundaries that support ‘nesting’ and flexion of limbs but keeping face clear

17. Explain to parents/caregivers the purpose of an incubator for their baby Ensure they are familiar with how to access baby as it is optimal for parents to continue to touch and provide comfort. Maintain a quiet environment There is no tapping on the canopy. No equipment is placed on top of the canopy. Careful opening and closing of doors.

18. STEP 3:Adjusting incubator temperature Default incubator temperature in NICU is 35 degrees Adjust the incubator temperature by no more or less than 0.5 of a degree at a time. Re-check the temperature within half an hour of making any adjustment.

19. STEP 4: Monitoring Axilla temperature is taken on admission into the incubator and rechecked in the first hour. Temperature is documented 4-6 hourly as per the condition.

20. STEP 5: Use of Humidification Is utilized for incubator care of preterm babies only – NOT required for babies >32weeks.

21. 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.

22. 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.

23. 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.