Infant Incubators

Strengthening Specialised Clinical Services in the Pacific. User Care of Medical Equipment: A first line maintenance guide for end users. (2015).
 Summary
• Quiz • Commercial Examples
• Clinical Use • Preventive Maintenance
• History • Common Problems
• Specifications • Test Procedures
• Principles of Operation
• Block Diagram
 Quiz
1. What are the 4 kinds of body heat lost?

2. Which parameters can one control in a infant incubator?

3. Draw a block diagram from an incubator AIR circuit

4. Besides temperature, what are other danger for

incubators without preventive maintenance?
 Neonatal Monitoring

The Premature Infant needs care for:

• Life-support systems
• Nutrition
• Fluid and electrolyte therapy
• Pulmonary support
• Elimination of products of metabolism
 Neonatal Monitoring

Primary Health Problems of the Premature:

• Hyperbilirubinemia
• Apnea
• Anemia
• Low Blood Pressure
• Infection
 Neonatal Monitoring

Life-support systems:
• Pulse rate (100 - 160 beats per minute )
• Blood pressure
• Respiration rate (60/minute)
• Temperature

Shannonpatrick14 (2009), “Phototherapy” [image]. Retrieved from https://www.flickr.com/photos/shannonpatrick17/3907957458

 Body Surface
Heat Transfer Rate

Factors:

• The skin thickness

• Skin characteristics
• Subcutaneous fat
• Blood flow
Don Bliss, National Institutes of Health (2009), “Anatomy of the Skin”, [drawing].
Retrieved from https://commons.wikimedia.org/wiki/File:Anatomy_The_Skin_-_NCI_Visuals_Online.jpg
 Difference between
Newborns and Adults
• Geometric view: Ratio between the body
surface and the weight in one newborn is 4
times bigger than the adult
 Difference between
Newborns and Mature Babies
• Physiologic view:
– Less fat tissue
– Higher energy consumption
– Fewer energy reserve
 Reactions to the
Cold Sensation

• Vasoconstriction
• Changes body position (to reduce the area of
heat change)
• Increases the metabolic rate, producing more
heat
 Results of energy lost in Sick
Premature Newborns
• Worsen the disease condition
• Change blood’s pH value
• Hypoglycaemia

Jaap Vermeulen (1979), “Neonatal Intensive Care Unit” [photograph]. Retrieved

from
https://en.wikipedia.org/wiki/Neonatal_intensive_care_unit#/media/File:Neonatal_Jac
oplane.jpg
 Results of energy lost in Sick
Premature Newborns
• Loss of activities from the central nervous system
• Coma
• Death

• Effect of Air Temperature on Survival Rate:

– 70% 36-37 degrees
– 10% 32-33 degrees
 Possible Heat Lost

1. Conduction
2. Convection
3. Irradiation
4. Evaporation
 Evaporation Heat Loss

He = K(partial pressure skin - partial pressure air)(area)

 Radiation Heat Loss

Ar - area of the walls surrounding the

infant
Es - emissivity of the infant’s skin
Er - emissivity of the walls
Tr – wall temperature
Ts – skin temperature
 History

• 1835 by Johann Georg von Ruehl in Russia: double-

walled cradle that was kept warm by filling the space
between the walls with warm water

• 1880 by Odile Martin von Ruehl in Paris Maternity

Hospital
 Clinical Use

• Neonatal ICUs

Robert Malkin (2006), Infant Incubator: Use and Operation

[photograph]. Retrieved from: library.ewh.org
 Incubators
Controls Parameters
• Temperature: 33.5 C and 37.5 C
– Improve growth rates
– Higher resistance to disease
• Humidity
• Light
• Air flow
• O2
Analog Incubator Selectors and
Controls
Indicator lights
High Temp
Oil Cups
Heat
Power

INCUBATOR

Power Switch

Fuse

Temperature Access Hole High Temp Alarm

Selector Adjust
Virginia Reid (2015), “Incubator” [diagram]
 Principles of Operation

• Isolation chamber that helps

regulate the temperature of
an infant and can provide air
which is enriched in
humidity or oxygen

Robert Malkin (2006), Infant Incubator: Use and Operation

[photograph]. Retrieved from: library.ewh.org
 Temperature Controls

World Health Organization (1996), Infant Incubators: Basic Principles. [diagram]. Retrieved from library.ewh.org
 Hot Air Circuit

Strengthening Specialised Clinical Services in the Pacific. User Care of Medical Equipment: A first line maintenance guide for end users. (2015).
 Alarms

• Air flow blockage

• High and low temperature

• Power failure

• Probe signal lost

 Wiring Diagram

Bolliger, Peter. “Design for A Simple Effective Baby Incubator.” Practical Action, 1977. Retrieved from: http://practicalaction.org/media/preview/27000
Commercial Examples- Common in
Developing World

Nkansah Rexford (2014), “Baby incubator” [photograph]. Retrieved from

https://commons.wikimedia.org/wiki/File:Baby_Incubator_cape_medical_museum.JPG
 Commercial Examples

Andre Engels (2004), “Premature baby in an incubator” [photograph]. Retrieved from https://commons.wikimedia.org/wiki/File:Incubator-tahrir.jpg
 Preventive Maintenance

• The humidification chamber should be

rinsed out with diluted bleach and dried
after every use

• One should check and replace air filters

 Patient’s Safety

• Incubator temperature is critical for infant

survival!

WHO. “Incubator, Infant.” From the publication: Core Medical Equipment. Geneva, Switzerland, 2011
 Patient’s Safety

• If not cleaned properly the incubator

may expose the babies to bacterium
• Temperature alarms, stability and fan
noise are important safety factor
 Incubators Preventive
Maintenance
- Cleaning of Cover, Bed and Air flow
chamber
- Fan Motor Lubrication
- Calibration of Alarms and Temperature
(Display and control)
- Check/Replacement of filter(s)
- Fan Noise
- Battery/Batteries
 Common Problems

• Dirty humidification chamber

• Heating element - nicrome wire

– Replace for another with same
power and resistance
 Common Problems

• Dirty or clogged/restricted fan filters

• Leaks
• Overheating due to external sources (.."I would
add reduced airflow due to fan/filter problems.

• Overheating due external light sources (sun

light, phototherapy (bili) lights, etc…)

• Disposable skin temperature sensors

 Common Problems

• Inner walls displacement

• Noisy fan
– lubricating the motor or tightening any loose
bolt
- Lubricate Fan Motor
- Check for broken fan blades
- Check motor mounts; Loose or
cracked/sagged
 Test Procedures

• Humidity in the incubator should be between

60% and 90%

• Chamber carbon dioxide should be kept below

500 ppm

• Check alarms level(s)/operation

 Test Procedures
Temperature between approx 33-38C. (Exact
temperature range determined by manufacturer
& model)
- Must be stable and accurate to +/-0.5C of
set point
- Alarms must be accurate to +/-0.5C

Fan noise must be < 65dB. Newer Incubators

have a limit of 58dB. Note; very low fan noise
indicates a slow moving fan due to restriction or
motor binding
 Troubleshooting

Cooper, Justin and Alex Dahinten for EWH. “Infant Incubator Troubleshooting Flowchart.”
From the publication: Medical Equipment Troubleshooting Flowchart Handbook. Durham, NC: Engineering World Health, 2013.
Questions