Preterm Infant Incubator Humidity Levels

Abstract

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 at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=39.

The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach

“…Avoid excessive fluid intake − In the first postnatal day: 80-100 mL/kg/day − After the first postnatal week: 135-150 mL/kg/day [32][33][34] Provide adequate incubator humidity − In the first postnatal week: 60-70% [37] Maintain adequate temperature − Abdominal skin: 36.0-36.5 • C − Inspired air temperature (hood, CPAP, or ventilator): 34.0-41.0 • C, relative humidity of 100% [38,39] Optimize early parenteral energy intake − In the first postnatal week: 80-100 kcal/kg/day − After the first postnatal week: 120-150 kcal/kg/day [44,78] Optimize early parenteral amino acid intake − Start with 1.5-2 g/kg/day after birth − Increase to 3.5 g/kg/day from the first 48-72 postnatal hours [79] Optimize early parenteral fat intake − Start with 1.0-2.0 g/kg/day within the first postnatal day − Increase by 0.5-1.0 g/kg/day up to a maximum of 4.0 g/kg/day at 72-96 postnatal hours [80] Provide adequate intravenous glucose − Limit the rate to 12 mg/kg/min (ideal limit: 8.3 mg/kg/min) [33] Optimize early parenteral calcium and phosphorus intake − In the first postnatal week: parenteral Ca 32-80 mg/kg/day and P 31-62 mg/kg/day − After the first postnatal week: parenteral Ca 100-140 mg/kg/day and P 77-108 mg/kg/day − Parenteral Ca/P ratio: 1.3 (mass) or 1 (molar) [86] Provide adequate intravenous lipid soluble vitamins − Vitamin A (retinol) 227-455 µg/kg/day or 700-1500 IU/kg/day − Vitamin E (α-tocopherol) 2.8-3.5 IU/kg/day [90] Provide adequate intravenous trace elements − Particularly zinc 400-500 µg/kg/day [91] Initiate early enteral feeding − Initiate minimal enteral feeding (12-24 mL/kg/day) prior to 3rd postnatal day − Use preferably mother's own milk or donor human milk as second choice [101,106,125] 7.2.4. Feeding Methods Tube feeding for a long period of time may be required in very preterm infants with DBP [27].…”

“…Body temperature and environmental humidity influence the fluids policy [ 35 , 36 , 37 , 38 , 39 ]. The temperature of the abdominal skin should be kept between 36.0 °C and 36.5 °C, and the inspired air temperature (hood, CPAP, or ventilator) between 34.0 °C and 41.0 °C at the Y-piece, with a relative humidity of 100% [ 35 , 36 , 37 , 38 , 39 ].…”

“…Body temperature and environmental humidity influence the fluids policy [ 35 , 36 , 37 , 38 , 39 ]. The temperature of the abdominal skin should be kept between 36.0 °C and 36.5 °C, and the inspired air temperature (hood, CPAP, or ventilator) between 34.0 °C and 41.0 °C at the Y-piece, with a relative humidity of 100% [ 35 , 36 , 37 , 38 , 39 ]. A survey on incubator humidity practices in the management of preterm infants found a wide variation in humidification practices, but the majority of the surveyed centers used a starting humidity higher than 80% [ 38 ].…”

“…A survey on incubator humidity practices in the management of preterm infants found a wide variation in humidification practices, but the majority of the surveyed centers used a starting humidity higher than 80% [ 38 ]. A systematic review including 12 studies assessing preterm infants’ outcomes related to incubator humidity concluded that 60–70% humidity in the first postnatal week was enough to reduce the transepidermal water loss in infants born at 26 weeks or older; however, more research is needed regarding more immature infants [ 37 ].…”

Video_1.MP4

“…He was intubated in the operation room with a 2-mm endotracheal tube and transferred to the NICU in an incubator. The admission temperature at the axilla was 35.8 • C. The humidity in the incubator was set at 90% on day 0 in order to reduce insensible water loss, and it was lowered by 5% daily to 60% (23). His Apgar score was 2 at 1 min after birth, 6 at 5 min, and 6 at 10 min.…”