Optimization of the incubator air temperature during LED phototherapy treatment for the preterm infant.

Light-emitting diode phototherapy treatment for jaundice of the preterm infant presents adverse effects, such as discomfort, changes in metabolism, and overheating. This study quantified the body heat exchanges between the environment and a simulated preterm infant requiring phototherapy treatment in a closed incubator. Phototherapy treatment increased the mean incubator roof temperature by 2.9 °C (p < 0.001) and the incubator air temperature by 1 °C (p < 0.001). Analytical calorimetry was used to calculate the additional energy received during phototherapy and thus deduce the optimal incubator air temperature for ensuring thermoneutrality and preventing hyperthermia. The optimal air temperature settings inside the incubator during phototherapy were - 0.51 to - 1.25 °C lower than references, for preterm infant weighing 500 to 2000 g.Conclusion: Phototherapy treatment for jaundice of the preterm infant increased the incubator air temperature. To prevent overheating in the preterm during phototherapy, new curves for optimal air temperature settings inside the incubator were calculated with analytic calorimetry. What is Known •Phototherapy treatment is the first-line treatment for jaundice in the preterm infant. •Phototherapy treatment increases the risk of overheating. What is New •The heat transfers and risk of overheating were quantified using a thermal manikin during phototherapy treatment. •Phototherapy treatment increased the incubator roof temperature and heat transfers. •New incubator's air temperature settings during phototherapy treatment were calculated with analytical calorimetry for preterm infant weighing 500-2000 g.

Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa.

Background: Inadequate neonatal facilities in rural areas is one of the challenges affecting the management of preterm infants. In low income countries with limited resources, over 90% of preterm babies die within few days of life. Purpose: The purpose of this study was to describe the challenges encountered by midwives when providing care to preterm infants at resource limited health facilities in Limpopo Province, South Africa. Methods: Qualitative research approach, using exploratory and descriptive design was used. Non-probability purposive sampling was used to select twenty three midwives who had an experience of two or more years in maternity. Data was collected using unstructured individual interviews, which were voice recorded and transcribed and data analysed qualitatively through the open-coding method. Findings: Revealed one theme, preterm condition and expected care; with sub-themes namely; perceived causes of preterm complications and deaths, preterm babies experience several difficulties which need specialised care, the need for constant individualised care and monitoring of preterm infants by midwives, functional relevant equipment needed for care of preterm infants, a need for constant training for midwives regarding care of preterm infants, and importance for a proper structure to house preterm infants which will lead to quality care provision. Conclusion: Preterm babies need simple essential care such as warmth, feeding support, safe oxygen use and prevention of infection. Lack of adequate resources and limited skills from midwives could contribute to morbidity and mortality. Health facility managers need to create opportunities for basic and advanced preterm care to equip the skills of midwives by sending them to special trainings such as Limpopo Initiative Neonatal Care (LINC), Helping Baby Breath (HHB) and Neonatal Intensive Care Unit (NICU). Operational managers should be involved in the identification, procurement and supply of required equipment. Continuous health education should be provided on the mothers about kangaroo mother care (KMC) and measures to prevent infections in the neonatal unit.

A multi-function neonatal incubator for low-income countries: Implementation and ab initio social impact.

The World health Organization estimates that about 8 million babies die prematurely worldwide. Most of these cases are found in low-income countries (LICs). The use of neonatal incubators has proven to be very useful in the reduction of infant mortality. However, access to this important medical device is not always easy in LICs. This article presents the implementation of a multi-function neonatal incubator with remote monitoring, fingerprint scanner, phototherapy, and heart rate monitoring. In this view, proportional integral (PI) control algorithm and an Android application were developed. Furthermore, an initial social impact of the implemented neonatal incubator usage was performed in some hospitals in Cameroon.

Effect of environmental music on autonomic function in infants in intensive and growing care units.

BACKGROUND: The aim of this study is (1) to observe the effect of the background music (BGM) in the incubator on heart rate variability (HRV) during the first few weeks of life in preterm infants in the neonatal intensive (NICU) and growing care units (GCU) and (2) to investigate the effect of environmental music on autonomic function in the infants. METHODS: Thirty infants, including premature (26 3/7 - 38 4/7 weeks) and low-birth weight (LBW) (946-2,440 g) infants, admitted to the NICU or GCU were involved. The heart rate, low- (LF, 0.05-0.15 Hz) and high- (HF, 0.15-0.4 Hz) frequency HRV components, and LF/HF ratio were measured. The BGM, lullabies for a baby, was delivered through a speaker in the incubator, and the HRV components were compared among before, during, and after intervention with BGM. RESULTS: The mean HR did not change among the experimental conditions. The LF and HF values decreased during the BGM condition, but not LF/HF, compared with the condition before BGM. CONCLUSIONS: The present results showed that an auditory environment affected the autonomic function of infants with a range of BGM in the NICU/GCU. The present study also suggested that BGM, a non-invasive and non-pharmacological intervention, could be an evaluation tool for autonomic function in infants in NICU/GCU.

Additional double-wall roof in single-wall, closed, convective incubators: Impact on body heat loss from premature infants and optimal adjustment of the incubator air temperature.

Radiant heat loss is high in low-birth-weight (LBW) neonates. Double-wall or single-wall incubators with an additional double-wall roof panel that can be removed during phototherapy are used to reduce Radiant heat loss. There are no data on how the incubators should be used when this second roof panel is removed. The aim of the study was to assess the heat exchanges in LBW neonates in a single-wall incubator with and without an additional roof panel. To determine the optimal thermoneutral incubator air temperature. Influence of the additional double-wall roof was assessed by using a thermal mannequin simulating a LBW neonate. Then, we calculated the optimal incubator air temperature from a cohort of human LBW neonate in the absence of the additional roof panel. Twenty-three LBW neonates (birth weight: 750-1800g; gestational age: 28-32 weeks) were included. With the additional roof panel, R was lower but convective and evaporative skin heat losses were greater. This difference can be overcome by increasing the incubator air temperature by 0.15-0.20°C. The benefit of an additional roof panel was cancelled out by greater body heat losses through other routes. Understanding the heat transfers between the neonate and the environment is essential for optimizing incubators.

The history of neonatology in Korea

Neonatology in pediatrics became a part of medical school curricula in Korea in 1954-1959. Specific treatments and procedures in the neonatal field were adopted around this period, for example, antibiotics, oxygen therapy, and the exchange transfusion procedure were established in 1950-1960. Usage of an infant incubator was implemented along with the establishment in 1960. The trend of separation between a premature infant care unit and newborn nursery room enabled the specialized treatment of high-risk infants in the 1970s. Assisted ventilation with continuous positive airway pressure and phototherapy was initiated in 1978. The recent concept of a neonatal intensive care unit was established in 1980, and it made so-called neonatal intensive care such as mechanical ventilation and intensive monitoring available. The Korean Society of Neonatology was founded in 1993. The usage of pulmonary surfactant in the 1990s, accelerated the improvement of respiratory distress syndrome survival, and it resulted in the nationwide opening of neonatal intensive care unit in hospitals. The high frequency ventilator and inhaled nitric oxide were introduced in the 2000s. The Korean Neonatal Network was commenced as a nationwide systemic database for very low birth weight infant registry in 2010. Accordingly, the history of Korean neonatology can be summarized as 50 years in total, and 35 years in a narrow sense. During this era, neonatal care in Korea has improved remarkably and has achieved a great survival rate for high-risk neonates, preterm infants, and micro-premies. In this review, we intend to provide an overview of the history, efforts, and outcomes of Korean neonatology activity that have led to these achievements.

[Perioperative thermal management in children]. / Kinderanästhesie--Perioperatives Wärmemanagement bei Kindern.

Perioperative temperature monitoring is a pre-requisite for successful prevention of inadvertent hypothermia in children. To achieve this goal, besides of pre-warming, active warming measures have to be intensified the younger and immature infants are. Intraoperatively incubators can be used. Forced-air warming in combination with fluid warming has been proven effective in children. Postoperative shivering should be treated, e.g. with pethidin or clonidine.

Transferring preterm infants from incubators to open cots at 1600 g: a multicentre randomised controlled trial.

OBJECTIVES: To determine the effects on weight gain and temperature control of transferring preterm infants from incubators to open cots at a weight of 1600 g versus a weight of 1800 g. DESIGN: Randomised controlled trial. SETTING: One tertiary and two regional neonatal units in public hospitals in Queensland, Australia. PARTICIPANTS: 182 preterm infants born with a birth weight less than 1600 g, who were at least 48 h old; had not required ventilation or continuous positive airways pressure within the last 48 h; were medically stable with no oxygen requirement, or significant apnoea or bradycardia; did not require phototherapy; and were enterally fed with an intake (breast milk/formula) of at least 60 ml/kg/day. INTERVENTIONS: Transfer into an open cot at 1600 or 1800 g. MAIN OUTCOME MEASURES: The primary outcomes were temperature stability and average daily weight gain over the first 14 days following transfer to an open cot. RESULTS: 90 infants in the 1600 g group and 92 infants in the 1800 g group were included in the analysis. Over the first 72 h, more infants in the 1800 g group had temperatures <36.4°C than the 1600 g group (p=0.03). From post-transfer to discharge, the 1600 g group had more temperatures >37.1°C (p=0.02). Average daily weight gain in the 1600 g group was 17.07 (SD±4.5) g/kg/day and in the 1800 g group, 13.97 (SD±4.7) g/kg/day (p=<0.001). CONCLUSIONS: Medically stable, preterm infants can be transferred to open cots at a birth weight of 1600 g without any significant adverse effects on temperature stability or weight gain. TRIAL REGISTRATION: ACTRN12606000518561 (http://www.anzctr.org.au).

Mist and water condensation inside incubators reduce the efficacy of phototherapy.

OBJECTIVE: To measure the irradiance in humidified incubator under three different overhead phototherapy devices. DESIGN/METHODS: The effective irradiance of three phototherapy devices was assessed by taking a series of irradiance measurements in the illuminated field. Measurements were made with a fixed bandwidth broadband radiometer (380-530 nm). The distance between the light source and the radiometer was 35 cm for the daylight fluorescent lamp, 40 cm for the light emitting diode (LED) and 50 cm for the halogen phototherapy. A double-wall incubator was kept at 36°C and set at three different levels of humidity (60-70%, 80% and equal or above 90%). RESULTS: The irradiance under the overhead daylight fluorescent lamp phototherapy did not change with the increasing humidity. However, above 90% humidity, when water vapour inside the incubator was so saturated to the point of totally condensing in the incubator walls, the measured irradiance decreased 15% of the initial values with the blue LED phototherapy and 45% with the halogen spotlight phototherapy. CONCLUSIONS: Highly humidified incubators are frequently used to treat very low birthweight infants. Health professionals should be aware that mist and water condensation inside an incubator may significantly reduce the efficacy of treatment.

A new device (cicogna) for transferring the neonate in the delivery room setting: a randomised, controlled trial.

OBJECTIVE: We developed a new system ('cicogna') for transferring the neonates into the delivery room setting. Our aim was to compare the 'cicogna' system and the conventional method (plastic basin) with regard to the time needed to transfer the neonate from the operating table to the radiant warmer; and to evaluate the degree of approval for the 'cicogna' expressed by the midwives. STUDY DESIGN: In a prospective, randomised, controlled trial including 100 infants (gestational age > or =34 weeks), we measured the time elapsed from the umbilical cord clamping to the positioning of the neonate under the radiant warmer using the 'cicogna' system or the conventional method. Midwives involved in the study were asked to fill out a final, written evaluation regarding the feasibility and the safety of the devices. RESULTS: The time elapsed from the cord clamping to the positioning of the infant under the radiant warmer was significantly shorter for infants who were managed with the 'cicogna' system compared with infants who received standard care: 18.7 +/- 5.6 s vs. 24.5 +/- 9.0 s (p < 0.001). In the evaluation forms, 19 out of 20 midwives (95%) evaluated the 'cicogna' as good or excellent. CONCLUSIONS: In comparison with the conventional method, 'cicogna' decreased the time needed to transfer the neonate into delivery room setting and received a high degree of approval by personnel involved in neonatal care. It appears to be a feasible and safe method for transferring the neonate in the setting of the delivery room.

Fluid and electrolyte management in the premature infant.

Caring for the premature infant in the NICU requires knowledge and understanding of the physiologic adaptation to extrauterine life and how prematurity affects that transition. Nurses play an integral role in managing fluid and electrolyte balance in these infants. This article addresses postnatal adaptation and all aspects of fluid and electrolyte management of the preterm infant.

Developmental care: does it make a difference?

The term "Developmental Care" has been applied to a wide range of interventions. These may be centred on the nursing management of the infant, their environment or family-based interventions. The short-term targets of reducing infant stress and promoting stability have led to hopes that long-term neurodevelopmental outcomes may be improved by some or all of these practices. Thus far the paucity of large clinical trials consistently demonstrating positive outcomes has resulted in cynicism among many clinicians. However, the generally positive experiences of those units which have adopted many of these practices have contributed to the spread of these interventions in neonatal units. The emergence of large well-conducted clinical trials may provide the evidence to support or refute the outcome-based assumptions of developmental care.

[Assessment of hydration on the stratum corneum and the influencing factors in neonates].

PURPOSE: The study was conducted to investigate the skin hydration level in various body sites and identify the influencing factors in neonates. METHODS: An exploratory comparison study was designed to measure the stratum corneum hydration, using a National DM-R2 on the forehead, abdomen, buttocks, and the back of the hands and feet of 198 neonates including 92 premature infants. RESULTS: The results showed 32.7%-36.5% of stratum corneum hydration for all sites. Premature infants revealed a higher hydration level on the peripheral sites (dorsal hand and feet) than those of the full-term infants, possibly resulting from therapeutic regimens including an incubator or radiant warmer. Infants in an incubator showed a higher hydration level than those in radiant warmers, suggesting more attention to fluid management for infants in the open environment. In addition, all stratum corneum hydration measurements except one, from the forehead, showed a positive correlation with postnatal age in full-term infants while showing no relation to any measurements in premature infants. CONCLUSION: The study demonstrated the very low skin hydration levels in hospitalized neonates, particularly in premature neonates with more susceptible skin hydration instability despite therapeutic interventions for fluid balance. More vigilant fluid management is imperative in neonates, particularly those in the open environment.

Assessment of Hydration on the Stratum Corneum and the Influencing Factors in Neonates / 간호학회지

PURPOSE: The study was conducted to investigate the skin hydration level in various body sites and identify the influencing factors in neonates. METHODS: An exploratory comparison study was designed to measure the stratum corneum hydration, using a National DM-R2 on the forehead, abdomen, buttocks, and the back of the hands and feet of 198 neonates including 92 premature infants. RESULTS: The results showed 32.7%-36.5% of stratum corneum hydration for all sites. Premature infants revealed a higher hydration level on the peripheral sites (dorsal hand and feet) than those of the full-term infants, possibly resulting from therapeutic regimens including an incubator or radiant warmer. Infants in an incubator showed a higher hydration level than those in radiant warmers, suggesting more attention to fluid management for infants in the open environment. In addition, all stratum corneum hydration measurements except one, from the forehead, showed a positive correlation with postnatal age in full-term infants while showing no relation to any measurements in premature infants. CONCLUSION: The study demonstrated the very low skin hydration levels in hospitalized neonates, particularly in premature neonates with more susceptible skin hydration instability despite therapeutic interventions for fluid balance. More vigilant fluid management is imperative in neonates, particularly those in the open environment.

Major full thickness skin burn injuries in premature neonate twins.

Burns in neonates have been reported following the use of pulse oximeters, various electrodes, chemical disinfecting agents and phototherapy blankets. Burn injuries in premature neonates are very rare and there have been no reports on major full skin thickness injuries. This case reports on preterm neonate male twins delivered at a Community Hospital. After the delivery they were placed on water warmers for 15-20 min and then transported into incubators. Burn injuries were noticed 1h after the delivery. Infant One, weight 1500 g, had an injury of 20% TBSA on his dorsum, waist and buttocks. The other infant, weight 1835 g, had an injury of 14% TBSA on the same areas. The infants were transported to the University Hospital. At the seventh day after the injury they recovered from respiratory distress and surgical procedures started. The eschar was excised deep to fascia and wounds were grafted with 0.1mm thickness skin grafts harvested from the thigh and cut into islets. Autografts were protected by overlay with fresh allograft harvested from the twins' father. Surgery procedures were performed in two steps, each second day, not exceeding 10% of total body area during excision. Donor sites healed at the eighth day after the surgery. Burn wounds healed gradually by way of spontaneous replacement of allograft and wound closure by spontaneous epithelization from the autograft islets. Eighteen days after the surgery all the grafted wounds were found epithelized. We conclude that in premature neonates relatively low temperatures may cause deep burn injuries. We recommend the delivery of preterm childbirths at well equipped facilities with staff qualified in nursing of premature neonates.