When babies are born prematurely or are ill, they may need additional care to help them survive outside a mother’s womb. Depending on how early they are born and how developed their system is, they may be placed in a medical apparatus or device known as an incubator in a neonatal intensive care unit (NICU).
You may have numerous questions about incubators’ use and functions. Read this post to know more about the role of incubators for babies in an NICU.
What Does An Incubator Do?
An incubator is an integral part of the NICU. The biomedical device appears like a box or a clear glass bassinet and helps in providing medical care to the newborn by providing an environment similiar to the mothers womb, keeping them warm and protecting them from allergens or environmental pathogens. Incubators are equipped with devices that provide the baby with a controlled environment by regulating the temperature, humidity, and oxygen. They also have hand-access ports with doors to meet the baby’s nursing or other medical requirements (1) (2).
Incubators also tune out excess noise, which may cause sleep disruptions, unnecessary stress, or a rise in the baby’s blood pressure. Thus, an incubator helps eliminate extraneous stressors, such as temperature fluctuations and noise, and allows physicians to provide better healthcare to a baby.
Different Types Of Incubators
- Open incubator: It is also known as a radiant warmer or open-box incubator and is open from the top. The baby is usually placed on a flat surface with a heating element placed below or above the baby. The incubator is equipped with other devices, too. The infant warmer is generally used to maintain the temperature of the just born baby for a few hours. Since the incubator is open, the humidity control is not as good as in the closed incubator, nor is there protection from pathogens in the environment. Although this incubator allows more physical contact with the baby, it is not ideal for babies who require germ protection.
- Closed incubator: It keeps the baby completely enclosed within the incubator. The closed or closed-box incubator has hand-access ports that allow the caretakers to administer medicines and IVs when required. It provides better heat circulation and temperature control than an open incubator. Oxygen can be given easily through prongs or an oxygen hood. In a closed incubator, the humidity and temperature can be controlled manually or through skin-based sensors. Minimal contact with the medical personnel and environment provides a sterile environment.
- Double-walled incubator: Some closed incubators feature dual walls to maximize heat and humidity retention. Like a closed incubator, a double-walled incubator also creates a more controlled and protected microenvironment for the baby.
- Servo-controlled incubator: It is a type of closed incubator that works on an electronic feedback system. It automatically controls the temperature and humidity based on the readings of the sensors attached to the baby’s skin. It is much more beneficial in providing a controlled environment to the baby.
- Portable incubator: This incubator is used to shift babies from one area, location, or hospital to another when needed. Portable incubators are usually smaller and equipped with a cardio-respiratory monitor, pulse oximeter, mini ventilator, additional oxygen supply, and an IV pump. They are useful in cases of transporting babies in remote areas to a hospital or from a basic health unit to a tertiary care hospital.
Why Do Some Babies Need An Incubator?
An incubator is used in conjunction with other equipment to ensure babies are in an ideal environment and continually monitored in an NICU. A baby may need an incubator for various reasons, such as those mentioned below (2) (5) (6).
- Premature birth: Infants born before 37 weeks of gestation period are called premature babies or preemies. Premature babies need incubation since they have trouble regulating their body temperature, usually due to the following reasons.
- Inadequate keratinization: Preemies lack skin integrity, which results in high permeability of water. Usually, permeability drops in seven to ten days after birth. Therefore, it is important to maintain humidity to avoid heat loss and water loss through the baby’s skin.
- Low body fat: Preemies have no protective fat and feel cold even at room temperature.
- Breathing issues: Some newborns may have breathing difficulty due to underdeveloped lungs. As a result, their premature organs may not receive enough oxygen supply. There is deficiency of surfactant important for maturation of lungs. The premature baby may go into respiratory depression. Such babies may need breathing support through a ventilator. Therefore, they may require cardio-respiratory monitoring within an incubator.
- Infection: Premature babies and babies with congenital problems usually have an underdeveloped immune system, making them more prone to infection. Thus, the use of an incubator could protect the baby from infectious agents until their immune function improves. A protected environment is provided to the baby. Babies can also be administered IV fluids and medicines through hand-access ports, helping them fight any existing infection.
- Effects of gestational diabetes: Babies born to mothers with gestational diabetes may be placed under incubators right after birth for a short period of time. This is done to keep a check on their blood sugar levels while they are being kept warm and comfortable.
- Jaundice: Newborn jaundice is quite common and occurs due to high levels of bilirubin in the blood. A few incubators are equipped with special phototherapy/fluorescent lights that can help in the treatment of jaundice.
- Long or traumatic delivery: Birth-related trauma could cause injury and impaira baby’s bodily functions. Prolonged labor also results in birth hypoxia. Such babies could be placed in an incubator for monitoring and medical support that can help in their recovery.
- Low birth weight: Babies weighing less than 5.5pounds or 2500 grams at birth fall in the low birth weight category. These babies look smaller, have very less body fat, and may have similar problems, such as respiratory issues and infection, as a preemie. They are, therefore, unable to regulate their body temperature. Placing them in an incubator keeps them warm and supports their optimal development in a controlled environment.
- Recovery from surgery: Some newborns may require a life-saving surgery shortly after birth. Such procedures can put the baby under stress. Therefore, to monitor their progress and help them recover in a regulated environment, they can be placed in an incubator.
How Does An Incubator Work In NICU?
Every healthcare facility has certain guidelines and checklists for the appropriate use of incubators for infants. Usually, parents are made aware of the purpose and expected outcomes before a baby is placed in an incubator.
- The incubator is positioned away from direct sunlight and draft.
- The incubator is pre-warmed to a temperature according to the baby’s age, size, and health condition.
- In an NICU, the default incubator temperature is 35℃, and the incubator temperature is adjusted no more or less than 0.5℃ at a time.
- The temperature is maintained and monitored hourly.
- The baby’s temperature is recorded routinely using skin sensors or rectal thermometers.
- The axilla temperature is usually maintained between 36.5℃ to 37.2℃.
- Access to the baby is allowed through hand-access ports. It minimizes the need to open the incubator’s doors repeatedly and disturb the temperature and humidity equilibrium.
- The baby is usually positioned using rolled towels or cloth nappies to make boundaries that support nesting and movement of limbs. It is ensured that the face is kept clear to avoid suffocation.
- The standard operating procedure, checklists, and other guidelines to use an incubator may vary depending on the medical institution, the purpose of incubation, the type of incubator, and the health of the baby. Monitoring of vitals is done. Therefore, discuss the specific expected outcomes of incubator use for your baby with your baby’s healthcare provider.
While an incubator may look disturbing to many, this medical device ensures a baby’s survival through many health conditions. The incubators are equipped with devices that support the baby’s recovery and optimal growth by controlling temperature, humidity, and oxygen levels. Comfortable, safe, and warm like a mother’s womb, incubators help in providing a protected environment to the newborns.
2. Incubator, Infant; World Health Organization
3. Edward F. Bell;Servocontrol: Incubator and radiant warmer; University of Iowa Stead Family Children’s Hospital
4. Edward F. Bell;When and how to move babies from radiant warmer to incubator and from incubator to open bed; University of Iowa Stead Family Children’s Hospital
5. Caring for a Premature Baby: What Parents Need to Know; HealthyChildren; AAP
6. Low birth weight; University of Rochester Medical Center
7. When and how to move babies from radiant warmer to incubator, and from incubator to open bed; University Of Lowa Stead Family Children’s Hospital.