Care of the baby in an Incubator

 

 

Compiled by Victoria Barnao & Dale Garton
December 2010
Clinical Guidelines Back Newborn Services Home Page
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

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

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

1
  • 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.


Related Documents

The table below indicates other documents and sources associated with this recommended best practice.

Step

Action

Starship Children’s Health
  • Oxygen Therapy
Newborn service clinical guidelines
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

 

References

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