Double wall versus single wall incubator for reducing heat loss in very low birth weight infants in incubators (Review)
Newborn infants maintained in the appropriate temperature range have a better chance of surviving. When newborn infants are within the appropriate temperature range, they burn less energy and have improved growth. The concept of an incubator with additional insulation, namely a double wall of plexiglass, is appealing as it may help very low birth weight infants maintain this appropriate temperature environment. We assessed the effects of double wall incubators compared to single wall incubators on the energy needs and water balance of very low birth weight infants. In addition, we looked at important clinical outcomes such as growth, length of hospital stay and survival. Three studies were found that met our criteria. The double wall incubators had advantages as far as decreasing heat loss and decreasing heat production. These infants seemed to be in the best temperature range, as their need to burn energy was less. However, these effects were small and did not provide any evidence of any long-term improvement regarding duration of hospitalization or survival. Although it appears that caring for extremely small infants in double wall incubators may result in certain metabolic advantages, this review was unable to find any data in the literature to support or refute this theory. Available data is insufficient to directly guide clinical practice.
Available from: Nelson Driban
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ABSTRACT: Since the 19th century, devices termed incubators were developed to maintain thermal stability in low birth weight (LBW) and sick newborns, thus improving their chances of survival. Remarkable progress has been made in the production of infant incubators, which are currently highly technological devices. However, they still need to be improved in many aspects. Regarding the temperature and humidity control, future incubators should minimize heat loss from the neonate and eddies around him/her. An unresolved issue is exposure to high noise levels in the Neonatal Intensive Care Unit (NICU). Strategies aimed at modifying the behavior of NICU personnel, along with structural improvements in incubator design, are required to reduce noise exposure. Light environment should be taken into consideration in designing new models of incubators. In fact, ambient NICU illumination may cause visual pathway sequelae or possibly retinopathy of prematurity (ROP), while premature exposure to continuous lighting may adversely affect the rest-activity patterns of the newborn. Accordingly, both the use of incubator covers and circadian lighting in the NICU might attenuate these effects. The impact of electromagnetic fields (EMFs) on infant health is still unclear. However, future incubators should be designed to minimize the EMF exposure of the newborn.
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ABSTRACT: Very-low-birth-weight (VLBW) neonates require regular nursing procedures with frequent opening of the incubator resulting in a decrease in incubator air temperature. This study was designed to assess changes in the thermal status of VLBW neonates according to the type of nursing care and incubator openings.
Thirty-one VLBW neonates (mean gestational age: 28.7 ± 0.3 weeks of gestation) were included. Over a 10-day period, each opening of the incubator was recorded together with details about caregiving. Body temperature was recorded continuously, and door opening and closing events were recorded by a video camera.
This study analysed 1,798 caregiving procedures with mean durations ranging from 6.2 ± 2.1 to 88.5 ± 33.4 min. Abdominal skin temperature decreased by up to 1.08°C/h for procedures such as tracheal intubation (p < 0.01). The temperature decrease was strongly correlated with the type of procedure (p < 0.01), incubator opening (p < 0.01) and procedure duration (p < 0.01). The procedure duration accounted for only 10% of the abdominal skin temperature change (p < 0.01).
For VLBW neonates nursed in skin temperature servo-control incubators, the decrease in abdominal skin temperature during caregiving was correlated with the type of procedure, incubator opening modalities and procedure duration. These parameters should be considered to optimize the thermal management of VLBW neonates.
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