Choosing the Right Neonatal Incubator

TSE Medical neonatal incubator on wheels

The main functions of a neonatal incubator are oxygenation, observation, and cold protection.

• Oxygenation: Respiratory distress syndrome is one of the main causes of death in premature babies. Some infants are also born with apnea. Oxygenation is therefore essential for newborns and premature babies. Incubators are connected to a ventilator, which allows the child to breathe optimally with the help of nasal cannulas, a face mask, or an oxygen hood. Infants can be given mechanical ventilation, such as through continuous positive airway pressure (CPAP).
• Observation: Neonatal incubators are used to monitor and measure vital parameters such as temperature, respiration, cardiac function, oxygenation, and brain activity.
• Protection from the cold: Incubators keep newborns or premature babies in a perfect atmosphere in terms of temperature and humidity. They protect the baby from cold and drafts as well as infection and noise (with closed incubators).
  

  TSE Medical neonatal incubator

With a neonatal incubator, it is possible to monitor a whole range of essential parameters, such as heart rate, respiratory rate, and blood pressure. Here is a list of the main parameters:

• Heart rate/cardiovascular system: Neonatal incubators enable us to monitor an infant’s heart rate and detect any abnormalities (tachycardia, bradycardia, etc.). The normal heart rate for a newborn is between 120 and 160 bpm.
• Respiratory rate: The respiratory rate of newborns or premature babies is also a fundamental parameter that can be monitored with a neonatal incubator to treat respiratory distress syndrome or apnea at birth.
• Blood pressure: Blood pressure is another vital parameter controlled by a monitor connected to the incubator. As with heart rate and respiratory rate monitoring, an audible signal (the level of which is attenuated to the maximum) is triggered when one of the pressure measurements becomes abnormal. The signal is also sent to a central station monitored by the nursing staff.
• Temperature: Hypothermia in newborns and premature babies can affect their health, exacerbate pulmonary problems, affect growth, or increase their risk of kernicterus. For babies with a very low birth weight, the consequences are even more serious. In closed incubators, temperature is monitored using a thermal probe placed on the infant’s stomach or back. Heat is transferred mainly by convection. Air is distributed in the incubator either by a curtain of warm air or warm air circulation that travels from head to toe. External heat sources can also increase temperature (phototherapy, direct sunlight, outdoor temperature). Open incubators, also known as infant radiant warmers, feature a warmer above the equivalent of a changing table. These are not used for premature babies.
  

  Ningbo David neonatal incubator on wheels

• Blood oxygen saturation: An SpO2 sensor placed on the infant’s hand or foot measures the level of oxygen carried by red blood cells, removing the need for blood sampling. Blood oxygen concentration should be determined to achieve a PaO2 of 50 to 70 mmHg in premature infants and 50 to 80 mmHg in full-term infants—i.e., an oxygen saturation of 90 to 94% in premature infants and 92 to 96% in full-term infants.
• Brain activity: A newborn’s brain is fragile. Premature babies are also at risk of brain damage. Brain development and activity can be assessed in a neonatal incubator. The recent development of MRI incubators has made it possible to carry out neuroimaging examinations on unstable or very premature infants, safely and in a thermoregulated environment with cardio-respiratory monitoring.

Neonatal incubators are fitted with various equipment, including a blood pressure monitor and an apnea monitor.

• Blood pressure/cardiopulmonary monitor: An essential piece of incubator equipment is the blood pressure monitor. It is non-invasive and provides continuous measurement of the infant’s blood pressure.
• Apnea monitor: An incubator’s apnea monitor detects the cessation of breathing in infants at risk of respiratory failure and alerts the parent or caregiver. Prolonged pauses in breathing result in low oxygen concentrations in the body, which can lead to irreversible brain damage and, if prolonged, death. The apnea monitor gives an audible or visual warning to the caregiver if the infant stops breathing for longer than the selected apnea interval.
• Phototherapy lamp: At birth, newborn babies need phototherapy to treat jaundice, because their bilirubin levels rise too fast. Phototherapy involves projecting strong blue or white light onto the infant’s body so that it is absorbed by the skin. This slows the progression of jaundice and reduces bilirubin levels. A newborn can receive phototherapy via a phototherapy lamp integrated into the incubator or via a phototherapy blanket.
  

  Heal Force neonatal incubator on wheels

• Radiant heater: A radiant heater (such as an infant warmer) equipped with a temperature control system with several modes (pre-heat mode, manual mode, etc.) helps to protect the infant from the cold and keep them at the perfect temperature. Radiant heaters must provide fast heating speed, short heat-up time, and low-temperature fluctuations to create a stable, warm environment for the infant.
• Syringe pump and infusion pump: A syringe pump is used to administer small quantities of fluids to the baby via an infusion pump and syringe.
• Specific consumables:
  • Central venous lines: Central venous lines are medical catheters designed for large veins. They can be used to inject medication into newborns and premature babies, and in some cases to measure central venous pressure.
  • Neonatal endotracheal tubes: Endotracheal intubation is a frequent procedure in neonates in respiratory distress. Clinicians use different methods to estimate the depth of intubation insertion.
  • Gastrostomy tubes: Premature babies can be fed by infusion (parenteral nutrition) or via gastrostomy tubes (enteral nutrition). Gastrostomy tubes require an opening in the abdomen to be made to give direct access to the stomach for nutrition. This requires an incision in the abdominal wall. The gastrostomy tube fitted to the incubator is then inserted, allowing food to be introduced directly into the baby’s stomach.

Incubators can be either closed or open.

• Closed incubators: Closed incubators consist of a rigid box (housing) in which the infant is kept in a controlled environment to receive medical care. Parents and caregivers have access to the child through front doors or portholes. Parameters inside the incubator such as temperature and humidity are set manually via a control screen, or automatically using skin sensors attached to the baby’s skin. Other features include a mattress, integrated scale, and X-ray cassette. An incubator includes an AC heater, an electric motor-driven fan to circulate heated air, a water tank to add moisture, a mechanical filter through which oxygen flows, and a nursing access port. Closed incubators are ideal for babies who need extra germ protection, reduced light and sound, and humidity control. Some closed incubators have two walls to prevent heat and air loss (double-walled incubators). New-generation closed incubators enable caregivers to interact more closely with babies.
• Open (or radiant) incubators: Open incubators, also known as neonatal resuscitation tables, consist of an uncovered table/mattress topped with a radiant lamp for heat diffusion. These models give medical staff easier access to newborns for certain treatments. Open incubators are ideal for infants who mainly need to be temporarily warmed and have their vital functions measured. The inability to control humidity and protect the infant from airborne germs means that open incubators are not ideal for premature babies or those requiring a more controlled environment.

There are also transport incubators used to transport premature infants short distances. Some models offer a complete out-of-hospital transport system, either by land or air. A transport incubator typically includes a mini-ventilator, cardiorespiratory monitor, infusion pump, pulse oximeter, and integrated oxygen supply.

Ningbo David neonatal incubator on wheels

When purchasing a neonatal incubator, there are several criteria to take into account, such as price, size, and the risks involved.

These criteria are listed below:

• Price
• Dimensions (portable models are smaller than ordinary open and closed incubators)
• The range of devices included
• Incubator maintenance and operating costs
• Take into account the fact that this may pose a barrier between the infant and its family (closed incubators)
• Risks for newborns (burns, hyperthermia, falls, electrical hazards)

A neonatal incubator is either line- or battery-powered (transport incubators).

Solar-powered models are also available, especially in some countries where power failures can be frequent, putting neonatal incubators out of action. Solar energy as an emergency power source is one of the innovations used in Africa, particularly in the fight against premature infant mortality.