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PubMed2003

Heart period variability of intubated very-low-birth-weight infants during incubator care and maternal holding.

BACKGROUND: Heart rate has been used to measure infants' physiological stability during skin-to-skin holding. Variability in heart period (interbeat interval), a more sensitive measure of autonomic nervous system tone, has not. OBJECTIVE: To describe heart period variability in intubated very-low-birth-weight infants during incubator care and during maternal skin-to-skin holding. DESIGN/METHODS: An experimental, interrupted time series, crossover design was used; infants served as their own controls. Infants were randomly assigned to treatment order: 2 hours of intermittent skin-to-skin holding for 2 consecutive days followed by 2 days of incubator care or vice versa. The analog signal representing heart period was sampled and quantized at 5 Hz via a dedicated computer system in multiple 300-second epochs each day. RESULTS: Fourteen infants with similar characteristics completed the protocol. The mean interbeat interval was 332 ms during skin-to-skin care and 368 ms during incubator care. Power within the low- and high-frequency regions of heart period was not significantly different between skin-to-skin holding and incubator care. Mean low-frequency power was 124.6 ms2 during skin-to-skin holding and ranged from 51.9 ms2 to 71.4 ms2 during all periods of incubator care. Mean high-frequency power was similar during skin-to-skin holding and incubator care (8.8 ms2 and 6.1 ms2). Infants of 32 to 34 weeks' corrected gestational age had increased power in the low- and high-frequency regions. CONCLUSIONS: Heart period variability did not improve during skin-to-skin holding. Gestationally older infants had increased power in the low- and high-frequency regions, suggesting a maturing autonomic nervous system.

Analysis of Variance↗
PubMedDate not supplied

Comparison of kangaroo and traditional methods of removing preterm infants from incubators.

OBJECTIVE: To compare the kangaroo and traditional methods of removing an infant from an incubator in terms of four physiologic parameters, mother's satisfaction, and mother's preference. DESIGN: Time-series design (quasi-experimental), with infant-mother dyads subjected to both methods. SETTING: Intermediate neonatal care unit in a tertiary hospital in Canada. PARTICIPANTS: A convenience sample of 71 infant-mother dyads. INTERVENTION AND MEASURES: The intervention was use of the kangaroo or traditional method of maintaining body temperature of preterm infants. The dependent variables were physiologic parameters (skin temperature, heart rate, respiratory rate, and oxygen saturation) measured five times with each method. Mother's satisfaction was measured at the end of each testing period and mother's preference at the end of the experiment. RESULTS: The kangaroo method produced less variation in oxygen saturation and longer duration of testing, and it was preferred by most of the mothers. CONCLUSIONS: The kangaroo method is safe for the preterm infant and allows for early contact between parents and infants.

Adolescent↗
PubMedDate not supplied

Co-bedding versus single-bedding premature multiple-gestation infants in incubators.

OBJECTIVE: To compare the physiological stability and behavioral effects of co-bedding with those of single-bedding premature multiple-gestation infants in incubators as well as the psychological effects on their parents. DESIGN: Prospective, randomized, repeated measure. PARTICIPANTS: Convenience sample of 16 infants and 8 parents in the co-bedded group, and 21 infants and 11 parents in the control group. INTERVENTIONS: Infants in the study group were co-bedded in incubators. MAIN OUTCOME MEASURES: Baseline and posttesting for parental state anxiety, maternal attachment, and parental satisfaction measures; infant sleep-wake synchronicity; physiological measures; and stress cue measures during baseline and activity. MAIN RESULTS: Repeated measures 5 (time) x 2 (group) analysis of variance found significant differences in infant daily weight, feeding amount, and high-activity heart rate. There was no difference in parental state anxiety, maternal attachment, and parental satisfaction scores by group, except for higher baseline parental satisfaction scores in the co-bedded group. CONCLUSIONS: This research demonstrated the safety of co-bedding multiple-gestation infants in incubators but did not find any significant clinical improvement in infant or parental outcomes with co-bedding. Neonatal intensive-care unit providers should educate staff and parents about the potential benefits of co-bedding and consider developing policies and procedures for co-bedding in both incubators and cribs. Co-bedding of multiple-gestation infants may be provided as an adjunctive developmental care strategy if parents desire this intervention.

Female↗
PubMed1982

Effects of forced convection of heated air on insensible water loss and heat loss in preterm infants in incubators.

To assess the effect of forced convection of heated air exchange in preterm infants in conventional incubators, we measured insensible water loss and total heat loss in preterm infants in a conventional forced convection incubator (air velocity 15 to 25 cm/second) and in a specially constructed still-air incubator (air velocity 0 to 2 cm/second) at equal operative temperature and humidity. Under the forced conditions, insensible water loss in the preterm infants increased by a mean 52% from 1.04 +/- 0.24 (mean +/- SD) to 1.58 +/- 0.51 ml/kg/hour (P less than 0.001). The ensuing increase in evaporative heat loss was partly reflected in the small but significant increase in total heat loss from 1.65 +/- 0.47 to 1.80 +/- 0.44 kcal/kg/hour (P less than 0.02). In the forced convection incubator, the increased evaporative heat loss in preterm infants was apparently partly compensated by a decreased nonevaporative heat loss. If reduction of insensible water loss is required, preterm infants should not be subjected to forced convection in incubators.

Air↗
PubMed2004

Transfer of preterm infants from incubator to open cot at lower versus higher body weight.

BACKGROUND: The use of incubators in helping to maintain a thermoneutral environment for preterm infants has become routine practice in neonatal nurseries. As one of the key criteria for discharging preterm infants from nurseries is their ability to maintain temperature, the infant will need to make the transition from incubator to open cot at some time before discharge. The timing of this transition is important because when an infant is challenged by cold, the infant attempts to increase its heat production to maintain body temperature. The increase in energy expenditure may affect weight gain. The practice of transferring infants from incubators to open cots usually occurs once a weight of around 1700-1800 g has been reached; however, this practice varies widely between neonatal units. This preferred weight mark appears to be largely based on tradition or the personal experience of clinicians, with little consideration of the infant's weight or gestational age at birth. OBJECTIVES: The main objective was to assess the effects on weight gain and temperature control of a policy of transferring preterm infants from incubator to open cot at lower versus higher body weight. SEARCH STRATEGY: Searches were undertaken of MEDLINE from June 2003 back to 1966, CINAHL from June 2003 back to 1987 and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2003). The title and abstract of each retrieved study were examined to assess eligibility. If there was uncertainty, the full paper was examined. SELECTION CRITERIA: Trials in which preterm infants were randomly allocated to a policy of transfer from incubators to open cots at a lower body weight versus at a higher body weight. DATA COLLECTION AND ANALYSIS: Quality assessments and data extraction for included trials were conducted independently by the reviewers. Data for individual trial results were analysed using relative risk (RR) and mean difference (MD). Results are presented with 95% confidence intervals (CI). Due to insufficient data, meta-analysis could not be undertaken. MAIN RESULTS: Four studies were identified as potentially eligible for inclusion in this review. Two studies were excluded as random allocation to the exposure was not employed. One study is pending, awaiting additional information from the authors. Therefore, one study involving 60 preterm infants, employing a matched-pairs design, which compared the transfer of infants to open cots at 1700 g versus 1800 g, is included in this review. Only two outcomes could be included from this study; return to incubator and daily weight gain. No statistically significant difference was shown for either return to incubator (RR 2.00, 95% CI 0.40 to 10.11) or daily weight gain [MD 4.00 g/day (95% CI -5.23, 13.23)]. Due to small numbers, effects on clinically important outcomes could not be adequately assessed. REVIEWERS' CONCLUSIONS: There is currently little evidence from randomised trials to inform practice on the preferred weight for transferring preterm infants from incubators to open cots. There is a need for larger randomised controlled trials to address this deficiency.

Body Temperature Regulation↗
PubMed1990

Neonatal exposure to methyl chloroform in tape remover.

Methyl chloroform (MC) is commonly used solvent found in some adhesive tape remover products used in intensive care nurseries. Since volatile substances can accumulate inside an infant incubator, we measured levels of MC following simulated use of 2 commercially available adhesive tape remover pads. Readily detectable levels of MC could be found in incubator air for several minutes. Although adult occupational neurotoxic thresholds are higher, increased toxic susceptibility of the neonate CNS indicates caution should be observed.

Air↗
PubMed2005

Feasibility and safety of early transfer of premature infants from incubators to cots: a pilot study.

OBJECTIVES: To document whether medically stable infants can be transferred safely from incubators to unheated, open cots at 1500 g. METHODS: Four cohorts were recruited in a stepwise observational trial of transfer from incubators to unheated, open cots. We aimed to transfer the first 15 infants into cots on reaching a weight of 1800 g, the second at 1700 g, the third at 1600 g and the fourth at 1500 g. Nursery temperatures were set at 25 degrees C. The primary outcome measure was failure of transfer defined as the inability to maintain body temperatures in a cot despite additional coverings, with two consecutive axillary temperatures below 36.6 degrees C 1 h apart. Secondary aims were to determine temperature stability, growth, medical complications and time to discharge for these infants. Weight and corrected gestation at discharge were recorded. RESULTS: A total of 61 infants were recruited and transferred into cots. Cohorts were similar in gestation and sex. Infants recruited to the 1500 g cohort had higher birthweights than the other cohorts. There was no difference in the rate of infants failing transfer into cots between cohorts. Rate of weight gain before and after transfer and the number of high and low temperatures per infant after transfer was not different between cohorts. There were no differences between cohorts for discharge weight or corrected gestation. CONCLUSIONS: The results of this pilot study indicate the potential to transfer very low birthweight infants to an open unheated cot at a bodyweight of 1500 g. This study provides information for the design of future randomized controlled trials that are required to confirm the findings of this study before routine adoption of this intervention into clinical practice.

Body Temperature Regulation↗
PubMedDate not supplied

[Measuring vibrations of transport stress in premature and newborn infants during incubator transport].

BACKGROUND: Despite increasing numbers of centers for perinatology, transportation of newborns and premature infants can not totally be avoided for several obvious reasons. The following investigations were carried out as part of our quality control measures of the established neonatal transportation system, and were aimed on the optimization of a new neonatal transportation equipment resulting in reduction of transportation stress caused by acceleration forces. METHOD: The new system investigated consisted of a Volkswagen type T4 equipped with a Dräger incubator type 5400, which was mounted on a pneumatic patient lift. We measured acceleration forces in three axes (expressed as K-Wert) as well as over a spectrum of frequencies (1-80 Hz). Measurements were taken at different points of the transportation unit during simulated transports driving a predetermined route. After obtaining informed consent of the parents, one actual transport of a newborn was used for an additional point measurement at the newborn's head. RESULTS: The mean K-Wert was decreased by about 50% in the vertical axis between the chassis of the car and the incubator by activating the pneumatic patient lift. Without activating the lift the K-Wert increased by about 20% between the car's chassis and the incubator. The frequency analysis showed resonance effects between the different components of the system. However, by activating the patient lift, effective accelerations in the incubator were decreased to less than 0.1 m/s2 across the whole frequency spectrum evaluated. The single measurement at a newborn's head revealed similar acceleration forces at the head of the baby and under its head. CONCLUSIONS: Utilization of a pneumatic patient lift can reduce acceleration forces. However, our results show that each system (car, incubator, and its base) has to be investigated and optimized for this purpose as a unit. Optimization of the complete system is necessary not only before its primary use but also in regular intervals over the years. Sometimes, further improvements can be reached with minor modifications such as the exchange of worn out rubber buffers.

Acceleration↗
PubMed1998

[Measuring lateral skin temperature profile of premature infants in incubators with thermography].

Thermography enables the measurement of patients skin temperature profiles without stress caused by direct contact of probes to the skin. In previous incubator studies, frontal recordings were made through a hole in the top wall of the incubator hood. Using this method it is not possible to record the lateral temperature gradient from the back to the abdomen of the infant (in supine position), which is due to very limited heat loss near the incubator mattress. In this study temperature recordings were made from a lateral position. For this purpose a new front door of the incubator (Draeger 8000) was designed, which replaced the standard front door during measurements. In a clinical study thermography was compared to temperature measurements by standard thermistors. The mean difference between thermography and thermistors was 0.16 degree C. These results verify the use of thermography for measuring skin temperature of preterm infants in incubators.

Equipment Design↗
PubMed2006

Diet- and colonization-dependent intestinal dysfunction predisposes to necrotizing enterocolitis in preterm pigs.

BACKGROUND & AIMS: Preterm birth and formula feeding are key risk factors associated with necrotizing enterocolitis (NEC) in infants, but little is known about intestinal conditions that predispose to disease. Thus, structural, functional, and microbiologic indices were used to investigate the etiology of spontaneous NEC development in preterm pigs. METHODS: Piglets were delivered by cesarean section at 92% gestation, reared in infant incubators, and fed infant formula or colostrum every 3 hours (n = 120) until tissue collection at 1-2 days of age. RESULTS: Clinical and histopathologic signs of NEC were observed in 57% of pigs fed FORMULA (26/46) and in 5% of pigs fed COLOSTRUM (2/38) (P < .05). Relative to COLOSTRUM, both healthy and sick FORMULA pigs had reduced intestinal villous heights, enzyme activities, nutrient absorption, and antioxidant levels and higher inducible nitric oxide synthetase activity (P < .05). In healthy pigs, mucosal microbial diversity remained low and diet independent. NEC pigs showed bacterial overgrowth, and a high mucosal density of Clostridium perfringens was detected in some but not all pigs. Germ-free conditions and antiserum against Clostridium perfringens toxin prevented intestinal dysfunction and NEC in formula-fed pigs, whereas the gut trophic factors, epidermal growth factor, and glucagon-like peptide 2 had limited effects. CONCLUSIONS: A subclinical, formula-induced mucosal atrophy and dysfunction predispose to NEC and bacterial overgrowth. The adverse feeding effects are colonization dependent and may be reduced by factors in colostrum that include antibodies against aggressive toxins such as those of Clostridium perfringens.

Animals↗
PubMedDate not supplied

["Fetal memory" in the "care" of preterm newborn infants in the incubator].

Prenatal ultrasound evaluation of non-identical twins, with a postnatal follow-up up to the age of two allowed the Author to identify a specific "fetal personality". This features is revealed by the relationships between the fetus and its environment. A review of the prenatal ultrasound videotapes at follow-up has allowed the identification of behavioral patterns clearly related to a well structured function of "fetal memory". The Author discusses several implications of the fetal memory in close relationship with clinical practice in the Neonatal Intensive Care Units.

Embryonic and Fetal Development↗
PubMed1985

[Mechanical stress of newborn infants caused by incubator transport].

Newborn babies transported in an incubator are obviously exposed to considerable mechanical vibrations. We measured these vibrations with the aim to improve these conditions. The vibrations measured on transportation by R.T.W. ambulance (Daimler-Benz 508 with an "anti-vibration platform") are almost tolerable; however on the K.T.W. ambulance (Volkswagen Type 2) the registered vertical accelerations were much greater and gave an unacceptable level of gravitational forces. Small constructive corrections to the stretcher and the connection between stretcher and incubator lead to a marked decrease in peak acceleration and the value of effective acceleration. We also found that it is of great importance to drive smoothly and that the vibrations are more pronounced with hasty driving. The influence of these vibrations as a possible co-factor in the pathogenesis of intracranial haemorrhage is discussed.

Acceleration↗