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

2. Summary Quiz Clinical Use History Specifications
Principles of Operation
Block Diagram
Commercial Examples
Preventive Maintenance
Common Problems
Test Procedures

3. Quiz What are the 4 kinds of body heat lost?
Which parameters can one control in a infant incubator?
Draw a block diagram from an incubator AIR circuit
Besides temperature, what are other danger for incubators without preventive maintenance?

4. Neonatal Monitoring The Premature Infant needs care for:
Life-support systems
Nutrition
Fluid and electrolyte therapy
Pulmonary support
Elimination of products of metabolism

5. Neonatal Monitoring Primary Health Problems of the Premature:
Hyperbilirubinemia
Apnea
Anemia
Low Blood Pressure
Infection

6. Neonatal Monitoring Life-support systems:
Pulse rate ( beats per minute )
Blood pressure
Respiration rate (60/minute)
Temperature
Shannonpatrick14 (2009), “Phototherapy” [image]. Retrieved from

7. 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

8. 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

9. Newborns and Mature Babies
Difference between
Newborns and Mature Babies
Physiologic view:
Less fat tissue
Higher energy consumption
Fewer energy reserve

10. Reactions to the Cold Sensation Vasoconstriction
Changes body position (to reduce the area of heat change)
Increases the metabolic rate, producing more heat

11. 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

12. 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% degrees
10% degrees

13. Possible Heat Lost
Conduction
Convection
Irradiation
Evaporation

14. Evaporation Heat Loss
He = K(partial pressure skin - partial pressure air)(area)

15. 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

16. 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

17. Clinical Use Neonatal ICUs
Robert Malkin (2006),  Infant Incubator: Use and Operation [photograph]. Retrieved from: library.ewh.org

18. Incubators Controls Parameters Temperature: 33.5 C and 37.5 C
Improve growth rates
Higher resistance to disease
Humidity
Light
Air flow O2

19. Analog Incubator Selectors and Controls
Indicator lights
High Temp
Oil Cups
Heat
Power
INCUBATOR
Power Switch
Fuse
Temperature Selector
Access Hole High Temp Alarm Adjust
Virginia Reid (2015), “Incubator” [diagram]

20. 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

21. Temperature Controls
World Health Organization (1996),  Infant Incubators: Basic Principles. [diagram]. Retrieved from library.ewh.org

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

23. Alarms Air flow blockage High and low temperature Power failure
Probe signal lost

24. Wiring Diagram
Bolliger, Peter. “Design for A Simple Effective Baby Incubator.” Practical Action, Retrieved from:

25. Commercial Examples- Common in Developing World
Nkansah Rexford (2014), “Baby incubator” [photograph]. Retrieved from

26. Commercial Examples
Andre Engels (2004), “Premature baby in an incubator” [photograph]. Retrieved from

27. Preventive Maintenance
The humidification chamber should be rinsed out with diluted bleach and dried after every use
One should check and replace air filters

28. Patient’s Safety
Incubator temperature is critical for infant survival!
WHO. “Incubator, Infant.” From the publication: Core Medical Equipment. Geneva, Switzerland, 2011

29. 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

30. 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

31. Common Problems Dirty humidification chamber
Heating element - nicrome wire
Replace for another with same power and resistance

32. 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

33. 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

34. 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

35. 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

36. 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.

37. Questions ?