2 incubator medical equipment

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Lecture-2: Infant Incubator
Sherif H. El-Gohary , Phd
Assistant Professor,Biomedical Engineering
Sh.ElGohary@eng1.cu.edu.eg
Medical
Instrumentation
SBE 310

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Outlines
• What is Incubator ?
• Why we need the incubator?
• Parameters ?
• Types of Heat Transfer?
• Modes of Temperature control
• Types of Incubators.
• Calibration of Baby incubator.

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Infant Health
• Deaths from hypothermia is often
masked under other causes
P: 212.854.6196 F: 212.854.8725
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Annual estimated proportions of death by
cause for neonates
Worldwide
• 38% of all under-5-year-old
deaths occurred in the
neonatal period (2001) [1]
– 99% occurred in the
developing countries
–¾of neonatal deaths
occurred during the 1st week
of life
– 24-45% of neonatal deaths
occur during the 1st 24 hrs.
1. World Health Organization. Estimates. In: State of the world's
newborns. Washington: Saving Newborn Lives, Save the
Children/USA; 2001: PN1–49.
2. Source: World Health Organization. The Global Burden of
Disease: 2004 update. WHO, Geneva, 2008

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Incubator
“Incubare” latin = to lie on
A microenvironment to place newborns who are at
high risk, for maintenance of temperature and
humidity.
Infant incubator is a Bio Medical Device which
provides Warmth, Humidity and Oxygen all in a
controlled environment as required by the New born

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Purposes
 Maintenance of thermo neutral ambient
temperature.
 Provision of desired humidity and
oxygenation.
 Observation of very sick neonates.
 Isolation of newborn babies from infection,
unfavorable external environment and
stimulations.

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Indication
 Premature babies
 Babies with low birth weight (<1500gm)
 Hypothermic child (<320C)
 Sick children
 Also used in case of transportation of babies from one hospital to
another.
 Also used to shift babies within the hospital for various investigations.
E.g, CT Scan and MRI.

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Functional Requirements and Constraints
http://
Constraints:
– Affordable
– Durable
– Easy to maintain and repair
– Portable
– Biocompatible and comfortable
– Intuitive and easy to use
– Useable in a variety of incubators and
cribs
– Low powered
– Easy to sterilize and clean
– Allow for high infant visibility
Functional Requirements:
– Maintain a temperature range
– Monitor infant temperature
– Ventilation
– Humidification
• 40-80% relative humidity

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Parameters
• Temperature.
• Humidity.
• Air velocity.
• Sound.
• Oxygen.

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Anatomy of Skin
 Skin is often considered the largest
organ system of the human body.
 The average adult male has 18 square
feetof skin weighing over 6 pounds.
 Skin is comprised of three layers, the
Epidermis, Dermis and Subcutaneous
tissue.

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Skin - Function
 Provides a physical barrier to the outside environment.
 Assists in the development of the immune system
 Conserves body fluid by preventing evaporative loss.
 Maintains body temperature.
 Produces vitamin D in the presenceof sunlight.
 Provides sensations of temperature and touch.

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Normal range
Cold stress
Moderate hypothermia
Severe hypothermia Outlook grave, skilled
care urgently needed
Danger, warm baby
Cause for concern
37.5o
36.5o
36.0o
32.0o
Axillary temperature in the newborn ( 0C)

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Body Temperatures
 Hypothermia
Low body temperature
 Hyperthermia
High body temperature

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Hypothermia: Definition and Causes
• Those that survive often face [6]:
– Diabetes
– Heart disease
– Low IQ
– Other complications
• Normal temperature of newborn 36.5-37.5 °C
• Temperatures < 35 °C is “under temperature” 
hypothermic
– Indicates either surrounding is too cold or
infection
• Infant body acts as a heat sink [5]:
– Poor thermal insulation
– Large SA:V
– Small mass
– Heat loss via conduction, radiation, convection,
and evaporation
– Preterm infants are at highest risk of
hypothermia
5. Kawaji, Q. An alternative infant incubator: incubators for third
world countries. Johns Hopkins University.
https://jscholarship.library.jhu.edu.
6. Why embrace. Embrace. http://www.embraceglobal.org.

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Hypothermia
Remedy
 Skin-to-skin contact with the mother
 Use a heated water-filled mattress
 Use radiant heater
 Use Incubator

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Hyperthermia
Hyperthermia can be defined as a core
temperature greater than 98.6° F (37.0° C)
In adults it may lead to Fever, Heat
syndromes like collapse, cramps, stroke
etc.

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Thermoregulation
Thermo regulation is the ability of the body to
balance the heat produced in the body with the
heat lost by the body, thereby maintaining the body
temperature in the normal range.

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 The temperature of the body is regulated by
hypothalamus
 Sweating begins almost precisely at a skin
temperature of 37°C
 If the skin temperature drops below 37°C, a
variety of responses are initiated to conserve the
heat in the body and to increase heatproduction
Thermoregulation

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Thermoregulation
Heat Production
 Due to metabolic activities
Heat Loss
 Evaporation
 Conduction
 Convection
 Radiation

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19
Convection and Radiation
Convection
Occurs when air flow
carries heat to or
away from the body
Radiation
Radiant energy
exchange occurs
between two objects
that are not in direct
contact with
each other.

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Conduction and Evaporation
Conduction
Heat exchange that
occurs between
objects that are in
direct contact
with one
another
Evaporation
Occurs when liquid
is turned to vapor,
as with
amniotic
fluid on a
newly delivered
infant.

21. 21
Possible Sources
of Heat Loss

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Four ways a newborn may lose
heat to the environment
Thermal balance
Conduction
Radiation
Convection
Evaporation

23. 23Cold Items on Bed
Cold Walls
Cold Room Temp.
Radiation
Cold Blankets
Cold X-ray plates
Cold Scale
Conduction
Passing Traffic
Oxygen left on
Bed Near Air Vent
Convection
Tachypnea
Bath
Wet Diaper
Evaporation
Baby

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24
Strategies to prevent heat loss:
• CONVECTIVE HEAT LOSS can be prevented
by:
– Providing warm ambient air temperature
• Placing infants less than 1500 grams in incubators
• Keeping portholes of the incubator closed
• Warming all inspired oxygen
• On open warmers keeping sides up and covering infant if
possible
• Using Infant Servo Temperature Control

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Strategies to prevent heat loss:
• RADIANT HEAT LOSS can be prevented by:
– Avoiding placement of incubators, warming tables
and bassinets near cold windows, walls, air
conditioners, etc..
– Placing a knit hat on the infant’s head
– Wrapping tiny babies in saran or “bubble” wrap
–  environmental temperature

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Strategies to prevent heat loss:
• CONDUCTIVE HEAT LOSS can be prevented
by:
– Placing a warm diaper or blanket between the neonate and
cold surfaces
– Placing infant on pre-warmed table at time of delivery
– Warming all objects that come in contact with the neonate
– Admitting infant to a pre-warmed
– Skin to skin contact

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Strategies to prevent heat loss:
• EVAPORATIVE HEAT LOSS can be prevented
by:
– Keeping the neonate and his/her environment dry.
– Drying the baby immediately after delivery.
– Placing preterm infant in occlusive wrap/bag at
delivery
– Delay bath until temperature is stable

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BIRTHWEIGHT AND TEMPERATURE RANGE
J.W and Ahmed, I. (1966) Range of critical
temperatures in sick and premature newborn babies
Archives of Diseases in Childhood 41: 417

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A- Baby incubator.
B-Transport baby incubator :
C-Radiant warmer

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Infant warming
devices
Closed careOpen Care
Radiant Warmer
Stand alone
Wall mounted
Incubator
Transport
Incubator
NICU
Incubator
others
Warming
blankets, etc
Infant Warming Devices

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Embrace Warmer
• An infant warmer designed for
neonatal transport in the developing
world
• Uses a phase change material to
warm the child
Pros:
– Cheap
– Portable
Cons:
– Warming only
– No temperature monitoring
– Low infant visibility
– Need to refresh phase change material
every 4 hoursEmbrace. http://embraceglobal.org/

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VAN HEMEL Baby
Incubator
• Built specifically for the developing
world
• Uses light bulbs and the chimney
principle to heat and humidify
• Has an on/off switch for lights, a
thermometer, and a hydrometer
Pros:
– Cheap (~$500)
– Made with highly available materials
– High infant visibility
Cons:
– Not portable
– Bulky
– Does not have fine temperature
control
– Only monitors ambient temperature
– Must be shipped from Amsterdam
HEBI Hemel Baby Incubator.
http://www.hebi-incubator.org/templates/heb/global/index.php?lngid=2&sqlmode=1&fid=144

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Caleo Neonatal
Incubator
• Provides a controlled warm, humid,
and oxygen-enriched environment
• Monitors and controls air
temperature, skin temperature,
humidity, oxygen concentration, and
weight
Pros:
– Intuitive and easy to use
– High infant visibility
– Monitors and alarms
– Rechargeable battery
Cons:
– Bulky and expensive
– Requires trained technician to repair
– Parts not widely available
P: 212.854.6196 F: 212.854.8725
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Caleo Neonatal Incubator, Drager Medical.
http://clinicalengineering.duhs.duke.edu/wysiwyg/downloads/caleo.pdf

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Incubator
• Closed care
• Convection principle
• Humidity Adjustment
• Less disturbances
• Oxygen control available
Radiant warmer
• Open care
• Radiation Principle
• No Hy.Adjust
• External Disturbances more
• No O2 control
Differences

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Transport
Incubator
• Battery powered
• Air (Manual) Mode only
• Resuscitation apparatus
attached
• Compactable in size
NICU
Incubator
• Mains operated
• Both Air & Patient mode of
operation
• Not attached
• Bigger
Differences

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Parts of an incubator
 Hood / canopy
 Cabinet
 Access panel
 Mattress
 Arm port holes
 Bassinet
 Latch release
 Control panel
 Oxygen inlet
 Thermostat
 Air inlet filter
 Access port
 Caster lock
 Levers

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http://
Jones T, Belsinger H, Mackin M, inventors; 1996 Jul.23.Heat controlled
humidifier for infant incubator. United States patent US 5,539,854.

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Block diagram

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Hardware Parts
Fan
The fan takes the filtered room air and blows it over or through the
heating element and the humidifier.
Without the fan the incubator would overheat.
Filter
• Simple incubators are equipped with washable foam filters. After
washing and drying they can be reused.
• Modern incubators however usually have disposable bacterial
filters. They can not be cleaned and have to be renewed.

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Heater
• A heating element made from coiled resistance wire as
known from hair dryers or the tube type (flat or coiled)
as seen in autoclaves are used to heat up the air. But
unlike in autoclaves, the heater has much less power and
thus does not get so hot.
• The power rating is between 100 W and 300 W.
• The heater is controlled by an electronic temperature
control unit via a relay or simply by a thermostat.
Hardware Parts

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 Fan types- Blower , Impeller
 Heater types- ceramic, Quartz tube
Hardware Parts

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Impeller –fan’s type

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Blower –fan’s type

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FRONT PANEL

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 Air temperature
 Patient temperature
 Control temperature
FRONT PANEL

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Modes of Temperature control:
A.The Air Controlled mode.
B.The Skin Controlled mode.

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A. Controlled the Air :
• In air control mode, the air temperature is sensed and
used to provide the feed back to the system to turn on or
off according to the set value.
• Under the air control, the hot air flow is turned on
whenever the incubator air temperature goes below the
set temperature; maximum flow of hot air is allowed
from the heater into the incubator. This causes rapid rise
in the incubator air temperature.

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A. Controlled the Air (Cont)
• When the air temperature reaches the desired
value, the flow of hot air is turned off. With this
on-off control, there is an overshoot and
undershoot in the air temperature

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B. Skin control mode:
• In skin control mode, the skin temperature is sensed
and used to provide the feed back to the system to
turn on or off according to the set value.
• Under the skin control, the hot air flow is turned on
whenever the skin temperature goes below the set
temperature, and maximum flow of hot air takes
place into the incubator. This causes a rise in air
temperature.

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B. Skin control mode (cont)
• Skin temperature also goes up through
convection of heat from air to skin. When the
skin temperature reaches the desired value the
flow of hot air is turned off.
• Under this on-off control while skin
temperature is maintained constant there are
high fluctuations in air temperature

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Block diagram show On-Off
Control
Heater

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Noise
 Premature babies are fragile. One of their special
needs is quiet environment.
 However, in the neonatal intensive care unit (NICU),
high noise levels and frequent handling leave the
babies sleep deprived and may disrupt their normal
growth and development.

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Noise
Noise effects on the infant are,
• Hearing Impairment
• Sleep disturbance
• Somatic Effects
• Auditory Perception and Emotional Development

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Avoiding Noise
• No tapping or writing on top of the Incubator or hood.
• Careful and soft closure of the Incubator pot hole
doors.
• Neonatal Noise mufflers can be used.
• Medical staff should be advised to wear soft shoe.
• To identify noisy areas and to isolate them.
• Check existing machines for noise level
• Check all incoming new machines for their noise
• level before being put to use

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Noise Levels

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Controlled humidity in incubator:
• The humidity control system of the newborn incubator can
be presented under two aspects:
1. Passive humidity control system
This system consists of a reservoir with water.
This humidity of air occurs for the passive diffusion of the water for
the air that passes for the reservoir, not existing.
2. Active humidity control system
This system consists of a reservoir with water and the vapor is
controlled.

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Controlled humidity in incubator:
• I. Without water in reservoir:
That the relative humidity of the air inside newborn incubator,
without water in humidity reservoir, go out from the band of
comfort established by Standard (40% - 60%).
• II. With water in reservoir and without
control of humidity:
The relative humidity of the air inside of the newborn incubator
that used water in humidity reservoir, without control of
humidity, go out from the band of standard.

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Controlled humidity in incubator:
• III. With water in reservoir and controlled
humidity:
The relative humidity of the air inside of the newborn incubator
that used water in humidity reservoir, with control of humidity,
if it kept inside of a band preset.

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Alarms
• Low Temp – check Alarm limits, sensor&
calibrate if required
• High Temp-checkAlarm limits,sensor&calibrate
if required
• Probe Fail – check probe for any damage &
calibrate if required

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Hardware Alarms
• Power fail- check mains present, power cord, fuse,
power supply PCB
• Fan fail- check Fan, Fan voltage, Fan control circuit.
• HeaterFail- check Heater resistance, heater voltage,
heater control circuit.
• Air probe- Patient probe, safety probe-respective
sensors, calibrate if necessary.

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Head hood
• Single piece, Round Shape, made of autoclavable
Polycarbonate material.
• Trauma free Silicone neck adjustment flap.
• Bilateral oxygen nozzle ( prevents direct flow of cold
oxygen on patient’s head.
• Height : 7.5”.
• Width : 8.5”.

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X-ray tray:
An X-ray tray may be fitted beneath the bassinet to
enable X-rays to be taken without disturbing the infant.
This may be done with the canopy up or down.
• X-rays taken using the tray may result in a higher dose to
the patient because of the bedding, the mattress and
other plastics.

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Schematic
of Baby
inside the
Incubator
with all
connections

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Idea #1
• Lines the perimeter of
incubator
• Makes use of a heater,
bubble humidifier, and a
fan to accommodate
functional requirements
PROS:
– May be used in a crib with dome covering
– Comfortable
– High infant visibility
CONS:
– Shape may need to be adjusted for each incubator unit
– Safety concern of location of heater and humidification
system

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Idea #2
• Portable box that is inserted into incubator
• Makes use of a heater, bubble humidifier, and a fan to
accommodate function requirements
PROS:
– Comfortable
– High infant visibility
– Portable
CONS:
– Safety concern of location of heater and humidification
system
– May reduce space available for infant

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Idea #3
• Mat that can be inserted into
incubator
• Makes use of phase change
material and a fan.
PROS:
– Eliminates the need for a separate humidification system
– Portable
– Prevents infant skin burns
CONS:
– May limit infant visibility
– May require large quantities of power

73. P: 555.123.4568 F: 555.123.4567
123 West Main Street, New York,
NY 10001
www.rightcare.com|

74. P: 555.123.4568 F: 555.123.4567
123 West Main Street, New York,
NY 10001
www.rightcare.com|