Care of the baby in an Incubator

Compiled by Victoria Barnao & Dale Garton

December 2010

Overview	Indications	Nursing Care
Weaning from Incubator to Cot	Phototherapy	Transport of Baby in Incubator
Care of Incubator	Related Documents	References

Overview

Infants should be nursed in the neutral thermal environment and have a core body temperature between 36.5 – 37.2 degrees Celsius.

The neutral thermal environment is the temperature range where heat production is at the minimum needed to maintain normal body temperature. It depends on
Birthweight, postnatal age, and whether the infant is clothed or naked.

Because heat production requires oxygen consumption and glucose use, persistent hypothermia may deplete these stores, leading to metabolic acidosis, hypoglycaemia, decreased surfactant production, increased caloric requirements, and if chronic, impaired weight gain.

Infants lose heat through conduction, convection, radiation and evaporation.

Nursing care is critical in supporting thermoregulation through ongoing assessments and environmental interventions to decrease heat loss for the infant being cared for in an incubator.

Indications

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.

There are nutritional concerns (given that infants use a large proportion of their calorific intake for maintaining their temperature

They are small for gestational age.

They have a large wound site.

New stoma (not always indicated) or exposed bowel.

Nursing Care

Step	Action
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. Do not routinely use on the humidity function while in use for babies in Starship hospital– this function is generally required for premature infants only. For use in Starship – phone 24920 and arrange an orderly to pick up from NICU, 9th Floor, ACH. (SSH owns 3 incubators however these are stored and cared for in the NICU). 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.
2	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 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.
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.
4	Monitoring Axilla temperature is taken on admission into the incubator and rechecked in the first hour. Temperature is documented 4-6 hourly as condition dictates.
5	Use of Humidification Is utilized for incubator care of preterm babies only – NOT required for babies >32weeks. (Link to humidification clinical guideline) Remember: A stressed baby is less able to maintain thermoneutrality Surgical babies are prone to stress both before, during and after surgery.

Weaning Incubator Temperature in Preparation for Cot Care

Step

Action

When the decision is made to remove the infant from the incubator the incubator temperature should be weaned by 0.5 degree’s until 30 degree’s is achieved.
For term infants being cared for in an incubator in Starship wards for observation purposes -Weaning is NOT required. As long as baby is clothed and wrapped adequately he/she may be transferred to a cot when clinically safe to do so. Check temperature within 1 hour of transfer.

Phototherapy

Step	Action
1	Decrease incubator temperature when phototherapy is commenced.
2	Re-check axilla temperature within half hour of making adjustment

Transporting Baby in Incubator

Step	Action
1	Consider covering during transport to promote warmth and provide privacy.
2	Always use two people when moving the incubator and baby together.

Care of the Incubator

Step	Action
1	Wipe down daily using minimal soap/water. Do not use alcohol.
2	Incubator is changed every 7 days Incubators are cleaned with hot soapy water; all inserts are removed and thoroughly washed and dried. Filters are changed every three months (Label to indicate the due date).
3	Incubators required for SSH are kept in NICU, they are returned there for cleaning and maintenance.

References

1	Lissauer T, Fanaroff A, A, Rodriguez R, J, Weindling M. (2006) Neonatology at a Glance. Blackwell publishing Ltd. Chapter 29, Temperature control.

Step	Action
Starship Children’s Health	Oxygen Therapy
Newborn service clinical guidelines	Phototherapy http://www.adhb.govt.nz/newborn/Guidelines/GI/Phototherapy.htm Humidification http://www.adhb.govt.nz/newborn/Guidelines/Admission/Humidification.htm
Equipment manual	Instructions for Use Airshields Isolette, Dragermedical
Infection Control	Decontamination
Textbooks	Merenstein G,B, Gardner, S, L (2002) Handbook of Neonatal Intensive Care, 5th Ed, Mosby, St Louis Missouri. Chapter 6, Heat balance (pg 108-109). Whaley,L.F. Wong,D.L. (1997) Nursing Care of Infants and Children 5th Ed., Mosby