Search

BACKGROUND Previously, we recorded periods of time with foot higher than abdominal temperatures in association with infection in preterm infants. Monitoring dual temperatures may be an important tool to assess infant instability. Currently, incubators cannot measure and display dual temperatures in servo-control mode. PURPOSE To examine the usability of GE Healthcare's Giraffe OmniBed with research software to measure, display, and record dual temperatures, and their differences while in servo-control. In addition, nurses' perceptions of the use and display of dual temperatures and differences were evaluated. METHODS A multiple-case, mixed-methods design. Abdominal and foot temperatures were measured, displayed, and stored for 28 days for 14 preterm infants. Nurses were surveyed for satisfaction and preferences with the dual temperature display. Nurses noted abnormal temperature differences and infant condition in bedside journals. RESULTS Study infants were 26 to 31 weeks of gestational age and 670 to 1410 g. Abdominal, foot, and the abdominal-foot temperature difference was measured, recorded, and downloaded successfully in all infants over all days. Nurses liked using dual temperature display with the abdominal-foot temperature difference. Surveys indicated preferences for larger displays and alarms for abnormal values. Thermal instability, stimulation, and thermistor detachment were associated with abnormal thermal gradients. Two exemplar cases are presented. IMPLICATIONS FOR PRACTICE Monitoring dual temperatures adds information to the clinical assessment. IMPLICATIONS FOR RESEARCH Studies are needed to examine relationships between abnormal thermal gradients and infections, infant stability, and nursing care along with the underlying physiologic mechanisms. Studies are needed for wireless dual temperature monitoring.

BACKGROUND In neonatal intensive care units (NICUs), hygiene and disinfection measures are pivotal to protect neonates from nosocomial infections. This study aimed to evaluate the efficacy of the classical incubators disinfection procedure and to follow-up neonates housed in the incubators for the development of late-onset sepsis (LOS). METHODS In a tertiary NICU, 20 incubators were monitored for bacterial contamination at three times: before disinfection, after disinfection, and 24 h after turning on and housing a new neonate. Clinical data of neonates housed in these incubators were retrieved from the medical records. RESULTS All 20 incubators were contaminated at the 3 times of the study, mainly on mattresses and balances. Coagulase-negative Staphylococci, Enterococcus, and Bacillus-resisted disinfection while enterobacteria and Staphylococcus aureus were eradicated. After 24 h, the bacterial colonisation was similar to the one observed before disinfection. The bacteria isolated on incubators were also found on the caregivers' hands. During the study, two preterm neonates developed a LOS involving a bacterial species that has been previously isolated in their incubator. CONCLUSION Pathogenic contaminants persist on incubators despite disinfection and represent a risk for subsequent infection in preterm neonates. Improvements are needed concerning both the disinfection process and incubator design. IMPACT Procedures of disinfection that are usually recommended in NICUs do not allow for totally eradicating bacteria from incubators. Preterm neonates are housed in incubators colonised with potentially pathogenic bacteria. The control of nosocomial infections in NICUs requires further researches concerning mechanisms of bacterial persistence and ways to fight against environmental colonisation.

Introduction\ud Neonates often require imaging within incubators however limited evidence exists as to the optimal method and acquisition parameters to achieve these examinations. This study aims to standardise and optimise neonatal chest radiography within incubators.\ud \ud Methods\ud A neonatal anthropomorphic phantom was imaged on two different incubators under controlled conditions using a DR system. Exposure factors, SID and placement of image receptor (direct v tray) were explored whilst keeping all other parameters consistent. Image quality was evaluated using absolute visual grading analysis (VGA) with contrast-to-noise ratio (CNR) also calculated for comparison. Effective dose was established using Monte Carlo simulation using entrance surface dose within its calculations.\ud \ud Results\ud VGA and CNR reduced significantly (p < 0.05) whilst effective dose increased significantly (p < 0.05) for images acquired using the incubator tray. The optimal combinations of parameters for incubator imaging were: image receptor directly behind neonate, 0.5 mAs, 60 kV at 100 cm SID, however, if tray needs to be used then these need to be adapted to: 1 mAs at maximum achievable SID. Effective dose was highest for images acquired using both incubator tray and 100 cm SID owing to a decrease in focus to skin distance. There is significant increase (p < 0.01) in VGA between using 0.5 mAs and 1 mAs but an apparent lack of increase between 1 and 1.5 mAs.\ud \ud Conclusion\ud Using the incubator tray has an adverse effect on both image quality and radiation dose for incubator imaging. Direct exposure is optimal for this type of examination but if tray needs to be used, both mAs and SID need to be increased slightly to compensate.\ud \ud Implications for practice\ud This study can help inform practice in order to both standardise and optimise chest imaging for neonates in incubators.

Background Numerous scholars have reported that inconsistent levels of incubator humidity in the neonatal intensive care unit (NICU) require attention. Evidence synthesis was needed to identify optimal incubator humidity levels and duration to decrease transepidermal water loss (TEWL) and the potential for infection. Purpose The purpose of this systematic review was to appraise and synthesize the evidence of preterm outcomes related to incubator humidity. The primary aim of this study was to determine how patient outcomes were impacted by incubator humidity levels and duration in premature infants born before 320/7 weeks cared for in the NICU. Methods/search strategy The foundation of this systematic review was the Joanna Briggs Institute method for systematic reviews. Mefford's theory of health promotion for the preterm infant was used to address the wholeness of the preterm infant's body system. Evidence was classified using the Johns Hopkins evidence-based practice levels and quality of evidence. Findings Twelve studies met inclusion criteria. The evidence demonstrated that the practice of incubator humidity is warranted; however, it does not come without risks. Microbial growth was increased in high levels of incubator humidity. Unnecessary TEWL was prevented by lowering high levels of incubator humidity after the first week of life, improving skin barrier formation. Implications for practice Incubator humidity of 60% to 70% in the first week of life was effective in preventing TEWL in infants born 26 weeks or more. Implications for research Future incubator humidity research is needed for infants born before 26 weeks.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=39.

BACKGROUND: The aim of this study is (1) to observe the effect of the background music (BGM) in the incubator on heart rate variability (HRV) during the first few weeks of life in preterm infants in the neonatal intensive (NICU) and growing care units (GCU) and (2) to investigate the effect of environmental music on autonomic function in the infants. METHODS: Thirty infants, including premature (26 3/7 – 38 4/7 weeks) and low-birth weight (LBW) (946–2,440 g) infants, admitted to the NICU or GCU were involved. The heart rate, low- (LF, 0.05–0.15 Hz) and high- (HF, 0.15–0.4 Hz) frequency HRV components, and LF/HF ratio were measured. The BGM, lullabies for a baby, was delivered through a speaker in the incubator, and the HRV components were compared among before, during, and after intervention with BGM. RESULTS: The mean HR did not change among the experimental conditions. The LF and HF values decreased during the BGM condition, but not LF/HF, compared with the condition before BGM. CONCLUSIONS: The present results showed that an auditory environment affected the autonomic function of infants with a range of BGM in the NICU/GCU. The present study also suggested that BGM, a non-invasive and non-pharmacological intervention, could be an evaluation tool for autonomic function in infants in NICU/GCU.

Light-emitting diode phototherapy treatment for jaundice of the preterm infant presents adverse effects, such as discomfort, changes in metabolism, and overheating. This study quantified the body heat exchanges between the environment and a simulated preterm infant requiring phototherapy treatment in a closed incubator. Phototherapy treatment increased the mean incubator roof temperature by 2.9 °C (p 0.001) and the incubator air temperature by 1 °C (p 0.001). Analytical calorimetry was used to calculate the additional energy received during phototherapy and thus deduce the optimal incubator air temperature for ensuring thermoneutrality and preventing hyperthermia. The optimal air temperature settings inside the incubator during phototherapy were - 0.51 to - 1.25 °C lower than references, for preterm infant weighing 500 to 2000 g.Conclusion: Phototherapy treatment for jaundice of the preterm infant increased the incubator air temperature. To prevent overheating in the preterm during phototherapy, new curves for optimal air temperature settings inside the incubator were calculated with analytic calorimetry. What is Known •Phototherapy treatment is the first-line treatment for jaundice in the preterm infant. •Phototherapy treatment increases the risk of overheating. What is New •The heat transfers and risk of overheating were quantified using a thermal manikin during phototherapy treatment. •Phototherapy treatment increased the incubator roof temperature and heat transfers. •New incubator's air temperature settings during phototherapy treatment were calculated with analytical calorimetry for preterm infant weighing 500-2000 g.

To assess the sound reducing characteristics of modern incubators in the neonatal intensive care unit (NICU) and to better characterize auditory and language exposures for NICU infants.Sound frequency spectral analysis was conducted on language and noise audio acquired simultaneously inside and outside incubators located in the NICU.Sound transmission into the incubators was nonuniform. Very low-frequency sounds (100 Hz) were unattenuated or even slightly amplified inside the incubators. Maximal reduction was observed for low-to-mid frequencies (300-600 Hz) and high frequencies (2000 Hz), which convey important language information.Sound reductions observed across NICU incubator walls are more severe than those reported for sound transmission into the intrauterine environment, particularly for midrange frequencies that are important for language. Although incubator walls may serve as a protection against noxious noise levels, these findings reveal a potentially detrimental effect on language exposure for infants inside a NICU incubator.

Introduction There is limited and confusing evidence within the literature regarding the optimal techniques when imaging neonates within incubators; in particular, whether to place the image receptor directly behind the neonate or in the incubator tray. For this reason, radiology departments across Wales and North West England were surveyed to explore existing working practice with regards to incubator imaging. Method A self-designed survey was developed using a systematic approach. The survey was sent to 31 radiology departments across Wales and North West England whom had a neonatal unit in order to assess existing techniques used when imaging neonates within the incubator. The survey was split into three main domains: 1) general/demographics, 2) exposure factors and technique, and 3) incubator design. Results Nineteen departments responded (64%) demonstrating a wide variation in practice for incubator imaging. The minimum and maximum exposure factors used for neonatal chest x-ray imaging varied from 55 kV to 65 kV and 0.5 mAs–2 mAs. Fifty-eight percent of departments used the incubator tray as standard practice with the remaining forty two percent not using the tray for various reasons including, image quality, artefacts and misalignment. Sixty-three percent of departments use the maximum achievable SID for incubator imaging which demonstrates wide variability as the SID would be dependent upon: incubator design, portable machine and radiographer height. Conclusion The survey demonstrates a wide variation in existing practice for neonatal incubator imaging. Implications for practice This study supports the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.

Objective: To compare incubator and thermal blanket for thermoregulation in preterm and low birth weight neonates. Method: The pilot study was conducted from January to March 2018 at the emergency department of the National Institute of Child Health, Karachi, and comprised preterm and low birth weight neonates without any co-morbidity who were randomised to control and interventional groups. Data was collected using a proforma about demographics, weight, gestational age and brief clinical history. Temperature, blood pressure and pulse were monitored along with other routine care after every 15 minutes in the incubator, and the same procedure was adopted for thermal blankets. Data was analysed using Statistical Package for Social Sciences (SPSS) Version 23. Results: Of the 38 subjects, 19(50%) each were cases and controls. The mean gestational age between the groups was not significantly different (p>0.05). Temperature for the first 60 minutes remained similar in the two groups, but at 75 minutes and onwards, the incubator showed a significantly better results (p

ObjectivesTo compare situation awareness (SA), visual attention (VA) and protocol adherence in simulated neonatal resuscitations using two different monitor positions.DesignRandomised controlled simulation study.SettingsSimulation lab at the Royal Alexandra Hospital, Edmonton, Canada.ParticipantsHealthcare providers (HCPs) with Neonatal Resuscitation Program (NRP) certification within the last 2 years and trained in neonatal endotracheal intubations.InterventionHCPs were randomised to either central (eye-level on the radiant warmer) or peripheral (above eye-level, wall-mounted) monitor positions. Each led a complex resuscitation with a high-fidelity mannequin and a standardised assistant. To measure SA, situation awareness global assessment tool (SAGAT) was used, where simulations were paused at three predetermined points, with five questions asked each pause. Videos were analysed for SAGAT and adherence to a NRP checklist. Eye-tracking glasses recorded participants’ VA.Main outcome measureThe main outcome was SA as measured by composite SAGAT score. Secondary outcomes included VA and adherence to NRP checklist.ResultsThirty simulations were performed; 29 were completed per protocol and analysed. Twenty-two eye-tracking recordings were of sufficient quality and analysed. Median composite SAGAT was 11.5/15 central versus 11/15 peripheral, p=0.56. Checklist scores 46/50 central versus 46/50 peripheral, p=0.75. Most VA was directed at the mannequin (30.6% central vs 34.1% peripheral, p=0.76), and the monitor (28.7% central vs 20.5% peripheral, p=0.06).ConclusionsSimulation, SAGAT and eye-tracking can be used to evaluate human factors of neonatal resuscitation. During simulated neonatal resuscitation, monitor position did not affect SA, VA or protocol adherence.

EXTEND (EXTra-uterine Environment for Neonatal Development) is a novel system for supporting extremely premature infants that replicates in utero conditions by maintaining a sterile fluid environment and providing gas exchange via a pumpless arteriovenous oxygenator circuit connected to the umbilical vessels. Target gestational age (GA) for EXTEND support in human infants is 23-27 weeks, when immature lungs are most susceptible to injury in the setting of air ventilation. We previously demonstrated physiologic support of premature lambs cannulated at 105-117 days GA (lungs developmentally analogous to the 23-27 week GA human infant) for up to 28 days on EXTEND. In the present study, we sought to determine the technical feasibility of umbilical vessel cannulation in 85-96 days GA lambs delivered to EXTEND at weights equivalent to the 23-27 week GA human infant (500-850 g). Five preterm lambs were cannulated at 85-96 days GA (term 145 days) and supported on EXTEND for 4-7 days. All lambs underwent umbilical artery and umbilical vein cannulation. Circuit flows and pressures were monitored continuously, and blood gases were obtained at regular intervals for assessment of oxygen parameters. Systemic pH and lactate were measured at least once daily. Mean body weight at cannulation was 641 ± 71 g (range 480-850 g). All lambs were cannulated successfully (cannula size varied from 8 to 12 Fr), and mean survival on EXTEND was 140 ± 7 hours. Mean circuit flow was 213 ± 15 mL/kg*min, mean pH was 7.37 ± 0.01, and mean lactate was 1.6 ± 0.2 mmol/L. During the initial 120 hours after EXTEND cannulation, there were no significant differences between 85-96 days GA lambs and 105-117 days GA lambs in weight-adjusted circuit flows, oxygen delivery, pH, or lactate levels. This study demonstrates successful umbilical cord cannulation and adequate circuit flows and oxygen delivery in midgestation lambs size-matched to the 23-27 week GA human fetus, which represents an important step in the translation of EXTEND to clinical practice.

To investigate the risk of adverse events in the clinical use of infant incubators of three kinds of national medical devices in Zhejiang Province.Semi-quantitative matrix analysis was used to analyze the risk of adverse events related to incubator products in Zhejiang province from August 2018 to August 2019.Through the risk analysis of 213 cases of adverse events of infant incubator product, the risk point and degree of the product in practical clinical application were evaluated.Through the evaluation results of the production enterprises, medical institutions put forward relevant recommendations to reduce the risk of product use to prevent the recurrence of serious adverse events in the use of the product and spread.

BACKGROUND "Kangaroo mother care," a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (

BackgroundThe thermal servo-controlled systems are routinely used in neonatal intensive care units (NICUs) to accurately manage patient temperature, but their role during the immediate postnatal phase has not been previously assessed.ObjectiveTo compare two modalities of thermal management (with and without the use of a servo-controlled system) immediately after birth.Study design and settingMulticentre, unblinded, randomised trial conducted 15 Italian tertiary hospitals.ParticipantsInfants with estimated birth weight +6weeks.InterventionThermal management with or without a thermal servo-controlled system during stabilisation in the delivery room.Primary outcomeProportion of normothermia at NICU admission (axillary temperature 36.5°C–37.5°C).ResultsAt NICU admission, normothermia was achieved in 89/225 neonates (39.6%) with the thermal servo-controlled system and 95/225 neonates (42.2%) without the thermal servo-controlled system (risk ratio 0.94, 95% CI 0.75 to 1.17). Thermal servo-controlled system was associated with increased mild hypothermia (36°C–36.4°C) (risk ratio 1.48, 95% CI 1.09 to 2.01).ConclusionsIn very low birthweight infants, thermal management with the servo-controlled system conferred no advantage in maintaining normothermia at NICU admission, while it was associated with increased mild hypothermia. Thermal management of preterm infants immediately after birth remains a challenge.Trial registration numberNCT03844204

Introduction Growth monitoring of preterm infants is essential for assessing the nutritional effects on their growth. The current growth monitoring techniques are too stressful, however, for the smallest preterm infants. We performed a systematic review to summarize studies on stress-free techniques for measuring the body size of preterm infants inside incubators other than the traditional calliper and tape measure-based instruments. Methods We searched four online literature databases: Embase, Medline, Web of Science Core Collection, and Cochrane, using search terms related to patients (neonates, infants, children) and body size measuring techniques. By means of expert judgement we assessed the techniques’ suitability for stress-free body size measurement of an infant lying in an incubator. As a criterion for suitability, we used an imaginary ideal technique. Results Twenty-six studies were included in this review. In 24 studies, the technique for body size measurement was related to 3D technology, and the majority of these studies acknowledged clinical superiority of 3D over 2D data. Two 3D techniques were assessed as suitable for stress-free measurement of preterm infants inside incubators. The first technique used a commercially available 3D handheld scanner which needed 3D postprocessing to derive measurement data. The second technique used a self-developed stereoscopic vision system. Conclusions 3D volumetric parameters have higher clinical value for growth monitoring than 2D. In addition, contactless 3D measurements enable stress-free growth monitoring of even the smallest preterm infants. However, the time-consuming 3D postprocessing challenges the usability of 3D techniques. Regrettably, none of the identified suitable 3D techniques met all our requirements of an ideal all-in-one body size measuring technique for extreme preterm infants. Handheld 3D scanning might have the best properties for developing this ideal technique.

OBJECTIVE: To study the safety and efficacy of magnetic resonance imaging (MRI)-compatible incubator in cranial MRI examination for neonates. METHODS: A total of 120 neonates who were hospitalized in three hospitals and needed to undergo MRI examination were randomly divided into a control group and an experimental group, with 60 neonates in each group. The neonates in the experimental group were transferred with MRI-compatible incubator and underwent cranial MRI examination inside the MRI-compatible incubator, and those in the control group were transferred using a conventional neonatal transfer incubator and then underwent MRI examination outside the incubator. The two groups were compared in terms of the primary efficacy index (total examination time), secondary efficacy indices (times of examination, MRI completion rate on the first day of use), and safety indices (incidence rate of adverse events and vital signs). RESULTS: There were no significant differences in total examination time, times of examination, and MRI completion rate on the first day of use between the two groups (P > 0.05). There were also no significant differences between the two groups in the incidence rate of adverse events and vital signs such as respiratory rate, heart rate, blood pressure, and blood oxygen saturation rate at different time points before and after examination (P > 0.05). CONCLUSIONS: The use of MRI-compatible incubator does not significantly shorten the examination time of cranial MRI, but it does provide a relatively stable environment for examination with acceptable safety. There is a need for further studies with a larger population.

The COVID‐19 pandemic is affecting all age and patient groups, including pregnant women and neonates. There is no evidence at the moment to show vertical transmission and intrauterine virus infections in fetuses when women develop COVID‐19 pneumonia in late pregnancy. However infections in neonates are higher than in older children, according to the largest population‐based study to date, and this means that infants may also face a higher risk of severe respiratory failure (1). Dong et al’s national study of 2143 paediatric cases in China from 16 January to 8 February 2020 showed that 10.6% of the severe and critical cases were under one year of age. The incidence rates for the other paediatric age groups studied were: 1‐5 years (7.3%), 6‐10 years (4.2%), 11‐15 years (4.1%) and 16 years plus (3.0%).

Incubator is a medical device that provide a climatic environment for a newborn and a preterm infant. In the incubator environment, especially, the temperature significantly increases the survival rate of infants. In this study, the incubator air temperature, temperature uniformity and infant skin temperature were measured and controlled with conventional methods and FBG based temperature sensors, and their results and related literature results were compared among them. To this end, in addition to classical sensors, six FBG sensors were used during the measurements, and very close results were obtained between them (R-2 = 0.9989). In addition, since real time monitoring of the FBG bands were ensured with a user-friendly interface, measurement processes have been made more ergonomic. In this way, the insulation required for the measurements is also provided perfectly. Measurement errors caused by conventional sensors' properties, which are different for each of them, change over/with time, and also change with different values, have been minimized by using this method. Moreover, in case of increasing the number of sensors for multi-point, continuous and real time temperature measurement in conventional methods, some of the problems such as monitoring of these sensors, obstructing or changing the air flow due to the confusions of these sensors and their cables in the incubator cabinet, and following these, control errors caused by these reasons, and difficulties that may be happened during the infant care and resuscitation procedures have been eliminated. Thus, thermoneutrality in closed incubators were also able to validated and assessed fast and more accurately for preterm and neonates.

The standard terms of infant incubators with high clinical risk and high incidence of adverse events has been tested through the introduction of YY/T 0841-2011 standard, an on-site inspection scheme for using infant incubators has been proposed, the problems existing in the inspection are analyzed and reasonable suggestions are put forward, this paper provides a certain technical reference for the whole life cycle management of the infant incubator.

In this project, a fully functional incubator with precise control with respect to temperature, humidity, and airflow was developed and assessed. In parallel with the development of the incubator, a heuristic simulation was created to test and tune the Mamdani fuzzy logic controller. The controller was then applied to the incubator prototype.

Preterm infants are born with immature organs, thus affecting the immune system. Electromagnetic fields influence melatonin production with low exposure levels. These infants require medical equipment 24/7 to recover, so they are constantly exposed to magnetic fields during their stay in the Intensive Care Unit. Our objective was to measure magnetic field levels generated around each incubator using a gauss meter and compare our results to the 2010 recommendations by the International Commission on Non-Ionizing Radiation Protection and the IEC 60601-1-2:2004 standard by the International Electrotechnical Commission (IEC). Among 11 hospitalized newborn infants, radiation was found within the recommended limits, but there was electromagnetic interference resulting from medical equipment layout problems in the unit.Los neonatos pretérminos nacen con inmadurez en los órganos, lo que lleva al compromiso del sistema inmunológico. Los campos electromagnéticos afectan la producción de melatonina a niveles bajos de exposición. Estos niños necesitan equipamiento médico las 24 horas del día para su recuperación, por lo que están expuestos a los campos magnéticos durante todo el tiempo que se encuentren en la Unidad de Terapia Intensiva. El objetivo fue medir los niveles de campo magnético que se generan alrededor de cada una de las incubadoras utilizando un gaussímetro y comparar los resultados con las recomendaciones de la Comisión Internacional para la Protección contra las Radiaciones No Ionizantes de 2010 y la norma de la International Electrotechnical Commission (IEC) IEC 60601-1-2:2004. En 11 neonatos internados, los valores de radiación se encontraban dentro de los recomendados, pero existía interferencia electromagnética por problemas de disposición de los equipos en el área.

Objectives\ud \ud This systematic review aimed to explore the impact of incubator design (canopy, mattress, and mattress support) on neonatal imaging in terms of imaging technique, radiation dose and image quality.\ud \ud Key Findings\ud \ud A systematic literature review was performed by searching multiple healthcare databases. Following study selection and extraction, 7 articles were deemed eligible and included within the study. Of these 7 studies, six were experimental phantom based with the remaining one being a retrospective analysis. Four studies reported a percentage reduction in beam attenuation for incubator components ranging from 12% to 72% with one other study reporting a reduction but with no numerical data. This wide variation in radiation beam attenuation from the incubator components was correlated with image quality within five studies, two suggesting reduced image quality when using the incubator tray under the mattress support whilst the other three found no significant difference. Although the seven studies reported that incubator components reduced X-ray beam intensity, there was limited evidence on whether this required an increase in exposure factors. Only one study suggested increasing exposure parameters to accommodate for the increase in beam attenuation when using an incubator tray.\ud \ud Conclusion\ud \ud The literature clearly demonstrates that with existing incubator designs, there is considerable beam attenuation between placing the image receptor directly behind the neonate as oppose to the incubator tray. However, this radiation beam attenuation is not well correlated to neonatal radiation dose or image quality effects and therefore is very confusing when considering clinical implementation.\ud \ud Implications for practice\ud \ud This review highlights the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.

BACKGROUND: The 2020 novel coronavirus (SARS-Cov-2) pandemic necessitates tailored recommendations addressing specific procedures for neonatal and paediatric transport of suspected or positive COVID-19 patients. The aim of this consensus statement is to define guidelines for safe clinical care for children needing inter-facility transport while making sure that the clinical teams involved are sufficiently protected from SARS-CoV-2. METHODS: A taskforce, composed of members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Transport section and the European Society for Paediatric Research (ESPR), reviewed the published literature and used a rapid, two-step modified Delphi process to formulate recommendations regarding safety and clinical management during transport of COVID-19 patients. RESULTS: The joint taskforce consisted of a panel of 12 experts who reached an agreement on a set of 17 recommendations specifying pertinent aspects on neonatal and paediatric COVID-19 patient transport. These included: case definition, personal protective equipment, airway management, equipment and strategies for invasive and non-invasive ventilation, special considerations for incubator and open stretcher transports, parents on transport and decontamination of transport vehicles. CONCLUSIONS: Our consensus recommendations aim to define current best-practice and should help guide transport teams dealing with infants and children with COVID-19 to work safely and effectively. IMPACT: We present European consensus recommendations on pertinent measures for transporting infants and children in times of the coronavirus (SARS-Cov-2 /COVID-19) pandemic. A panel of experts reviewed the evidence around transporting infants and children with proven or suspected COVID-19. Specific guidance on aspects of personal protective equipment, airway management and considerations for incubator and open stretcher transports is presented. Based on scant evidence, best-practice recommendations for neonatal and paediatric transport teams are presented, aiming for the protection of teams and patients. We highlight gaps in knowledge and areas of future research.

Interfacility transport to tertiary care for high-risk neonates has become an integral part of equitable access to optimal perinatal healthcare. Excellence in clinical care requires expertise in transport medicine and the coordination of safe transport processes. However, concerns remain regarding environmental stressors involved in the transportation of sick high-risk neonates, including noise and vibration. In order to mitigate the potential deleterious effects of these physical stressors during transport, further knowledge of the burden of exposure, injury mechanisms and engineering interventions/modifications as adjuncts during transport would be beneficial. We reviewed the current literature with a focus on the contribution of new and emerging technologies in the transport environment with particular reference to whole-body vibration. This review intends to highlight what is known about vibration as a physical stressor in neonates and areas for further research; with the goal to making recommendations for minimizing these stressors during transport.

ObjectivesMR compatible incubators (MRcI) offer the examination of preterm and critically ill infants in controlled environment. The aim of the study was to compare objective and subjective image quality as well as diagnostic value of MRI brain examinations with and without using the MRcI. Thus, predictive value of brain MRI at expected delivery date in general was investigated.MethodsThis retrospective study included MRI brain examinations conducted at patients’ corrected age ≤6 months and presence of four standard sequences (PD TSE transversal, T2 TSE transversal, T2 TSE sagittal and T1 SE transversal). Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) was calculated. Subjective image quality was estimated using a 5-point Likert scale. Findings of MRI were compared with those of previous transfontanellar ultrasound because of additional diagnostic information. Severe brain abnormality scaled by score of Kidokoro was related to results of Munich Functional Developmental Diagnostics (MFDD) within first year.ResultsOne hundred MRI brain examinations (76 with MRcI, 24 without MRcI) were performed in 79 patients. Using the MRcI SNR and CNR were significantly higher in PD- and in T2-weighted sequences (pConclusionsThe MRcI increased objective image quality and revealed additional diagnostic information to transfontanellar ultrasound. Nevertheless, prediction of infants' future development remains limited.

Background: The role of environmental cleaning as an effective measure to contain the diffusion of Healthcare Associated Infections (HAIs) has already been demonstrated. Among medical devices, neonatal incubators have been recognized as a source of pathogens involved in the spread of HAIs. Aim of the study was to assess the efficacy of a disinfection protocol for neonatal incubators. Methods: The cross sectional study took place in the “Neonatal Pediatric Unit” of the Teaching Hospital of Siena: twenty incubators, used for critical newborns, were swabbed in 13 sampling points before and after the implementation of the disinfection protocol. Sanitation procedures were performed by trained staff, implementing the product Umonium38® Neutralis as disinfectant. Different culture media for the identification of the microbial contamination were adopted: plates were incubated for the proper time and the results were referred to Colony Forming Units (CFUs)/swab per point. Descriptive statistical analysis was performed. It was also evaluated the 95% confidence interval (C.I.) of the mean and the percentage of CFUs reduction by the bootstrap bias corrected and accelerated resampling method. Results: Matched points analyzed were 313. The average CFUs percentage of reduction was 93.5% [C.I. 90.6–95.9%]: it was higher, 97.0% [C.I. 94.1–99.1%], in points placed inside the incubators structure compared to the 88.4% [C.I. 83.6–93.0%] obtained outside. Conclusion: The disinfection protocol achieved good results. Routine surveillance and supervision of the various aspects of the disinfection processes (procedures, staff and disinfectants) could guarantee a safe environment during the first days of babies’ life, avoiding harmful conditions for the newborns’ health. Keywords: Healthcare Associated Infections, Disinfection, Neonatal incubators, Italy

Context Understanding the biological rhythms and stress response in sick newborns is important to minimize the negative effects of intensive care. Salivary cortisol has been used as a noninvasive surrogate marker of adrenal function; however, understanding of its control variables is insufficient. Objective To investigate the presence of feeding-induced cortisol response and its control variables in newborns. Design, Setting, and Patients Fifty-three newborn infants, who were between 30 and 40 weeks’ corrected age and were on 3-hourly regular oral/enteral feeding, were recruited between January 2013 and June 2014. Main Outcome Measure Saliva samples were collected before and 1 hour after regular feeding. Dependence of cortisol levels (adjusted for postnatal age) and their feeding-related elevation on clinical variables was assessed by using generalized estimating equations. Results Higher cortisol levels were associated with corrected age ≥37 weeks and saliva samples collected after feeding (both P < 0.001). Oral feeding was associated with a greater feeding-induced cortisol response compared with exclusive enteral feeding (P = 0.034), whereas a prolonged feeding duration (≥30 minutes) was associated with a reduced cortisol response compared with brief feeding ( Conclusions Feeding-induced cortisol response was observed in newborns. The cortisol response was more prominent following oral feeding and was reduced with prolonged feeding. Future studies may investigate whether feeding-induced cortisol response plays a role in the acquisition of adrenal ultradian and diurnal rhythms.

Background Preterm infants usually have to spend a long time in an incubator, excessive noise in which can have adverse physiological and psychological effects on neonates. In fact, incubator noise levels typically range from 45 to 70 dB but differences in this respect depend largely on the noise measuring method used. The primary aim of this work was to assess the extent to which noise in an incubator comes from its own fan and how efficiently the incubator can isolate external noise. Methods Three different incubator models were characterized for acoustic performance by measuring their internal noise levels in an anechoic chamber, and also for noise isolation efficiency by using a pink noise source in combination with an internal and an external microphone that were connected to an SVAN958 noise analyzer. Results The incubators studied produced continuous equivalent noise levels of 53.5–58 dB and reduced external noise by 5.2–10.4 dB. Conclusions A preterm infant in an incubator is exposed to noise levels clearly exceeding international recommendations even though such levels usually comply with the limit set in the standard IEC60601-2-19: 2009 (60 dBA) under normal conditions of use.

Aim To describe cerebral oxygenation during gavage feeding of preterm infants during incubator and skin-to-skin care. Methods Further analysis of data from two crossover studies comparing cerebral oxygenation, heart rate and oxygen saturation during skin-to-skin care with incubator care. Data were analysed in three epochs; 10 minutes prefeed, during-feed and 10 minutes postfeed. Measurements from infants fed during incubator care were compared with those obtained during skin-to-skin care. Results In 39 infants [median (IQR) 27.8 (26.1-30.0) weeks' gestation], there was no difference in cerebral oxygenation between pre-, during- and postfeed. Heart rate increased by three beats per minute postfeed compared with during-feed. Twenty infants received two gavage feeds, one feed in the incubator and another during skin-to-skin care. There was no difference in cerebral oxygenation and heart rate; peripheral oxygen saturation decreased by 3% during feeding whilst skin-to-skin care compared with feeding in the incubator. Conclusion Cerebral oxygenation remained stable before, during and after gavage feeding in an incubator and during skin-to-skin care. The small decrease in oxygen saturation whilst receiving gavage feeding during skin-to-skin care is unlikely to be clinically important, providing reassurance that preterm infants maintain physiological stability during skin-to-skin care.

Premature infants tend to lose heat quickly. This loss can be aggravated when they have received an invasive procedure involving a venous puncture. This research uses crossover design by conducting 2 intervention tests to compare 2 different treatments on the same sample. This research involved 2 groups with 18 premature infants in each. The process of data analysis used a statistical independent t test. Interventions conducted in an open incubator showed a p value of .001 which statistically related to heat loss in premature infants. In contrast, the radiant warmer p value of .001 statistically referred to a different range of heat gain before and after the venous puncture was given. The radiant warmer saved the premature infant from hypothermia during the invasive procedure. However, it is inadvisable for routine care of newborn infants since it can increase insensible water loss.

Non-electric infant incubators are needed in remote areas that have no access to electricity to reduce infant mortality nationwide. In previous studies, non-electric infant incubators have been developed using phase change material of beeswax as the heating element. This study aims to improve the performance of beeswax non-electric infant incubator to obtain a more reliable and practical one. The design of the original beeswax cartridge in the form of copper boxes was modified into tubes of stainless steel. The geometry and location of the air holes were also modified. Wood that was previously used as the body material was replaced with polyurethane to reduce the weight of the incubator. The beeswax cartridges were heated using boiling water until the beeswax melted. For temperature measurement, five 0.5 mm k-type thermocouples were placed inside of the incubator according to the National Industrial Standard of SNI 16-4221. The beeswax cartridge arrangement was varied to obtain the best performance. The results showed that polyurethane provides infant incubator lighter and more practical to use. The new design of non-electric infant incubator was capable of providing a temperature of 32-36 °C for 2 h.

Aim Frequent nursing procedures can modify a newborn infant's thermal environment when their incubator is opened. This study evaluated the impact of relative humidity on preterm infants in closed incubators and calculated their heat loss and additional metabolic cost. Methods We studied 45 preterm infants born before 32+0 weeks, nursed at the neonatal intensive care unit at Amiens University Hospital, France from January 2009 to November 2011. Their body, skin and air temperatures and the incubator's relative humidity were continuously recorded from days 1-8 of life and the differences between the measured and target relative humidity were calculated. Body heat loss was also calculated. Results On day one, the measured relative humidity (68.7 ±1.0%) was significantly lower than the target relative humidity (75%, p

Although technological advances have improved devices used to maintain the temperatures of 500- to 1500-g infants, managing the thermal environment remains challenging.To evaluate the effects of 2 methods of thermal support provided by a hybrid incubator during routine care in the first week of life.This descriptive, comparative study evaluates changes in temperature, humidity, heart rate, and oxygen saturation in the incubator versus radiant warmer (canopy) modes of hybrid warmers using data downloaded from the incubator and the monitor. The impact of the Boost Curtain on temperature when opening the portholes during the incubator mode was also examined. Mixed-effects linear models and the log-rank test were used to analyze patient data to determine the effect of thermal support on temperature and humidity changes during care, as well as during the postcare period.Entering the incubator through the portholes improved temperature control compared with using the canopy mode. The Boost Curtain resulted in an overall temperature stability and heat gain.Nurses caring for premature infants in hybrid incubators should minimize incubator openings and utilize portholes rather than the canopy whenever practical. The Boost Curtain should be used when opening the portholes during the incubator mode.Comparing time, accuracy, and tolerance of procedures in the canopy versus incubator modes would improve nurses' ability to determine the best approach for different clinical scenarios.