Neonatal incubator

Neonatal incubator. The term incubator is usually applied to devices used to keep premature or weak children warm. The newborn loses temperature in four different ways, radiation , evaporation , condensation, and conduction . This medical equipment is designed to avoid temperature losses in these children, for which it consists of a motor that circulates air stream inside it at a pre-established temperature, so that it is maintained between 36 and 37 ° C, and also provides different levels. moisture.

Summary

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  • 1 History
    • 1 Origins
    • 2 Introduction in other countries
  • 2 Features
  • 3 Exhibition fairs
  • 4 Scientific emphasis
  • 5 Sources

History

Before the 19th century, care for a premature newborn presenting problems at birth and requiring some care was nil, they were left to their spontaneous evolution and therefore many of them died.

The first to make technological discoveries for better care in the field of neonatology were French midwives and obstetricians.

origins

When investigating the origins of the incubator, it was known that the first publication on the subject in the western world dates from 1857 and was made by Jean Louis Paul Denucé .

In 1878, the obstetrician Stéphane. Tarnier of Parisian origin, modified a chamber with a heater, based on the incubator for raising chickens and proposed to Odile Martin to develop a team for premature newborns that managed to decrease neonatal mortality among children weighing less than 2000 grams. at birth.

In the bibliographic reviews carried out, there are differences since in some WC Deming is postulated as manufacturer of the first incubator in 1888, others place the appearance of the incubator for the first time in the period from the 1850s to 1859.

According to what was published in the press of the time, everything seems to indicate that one of those who contributed important technological elements was Alexander Lyons, who in 1891 developed his “couveuse” or incubator.

In the journalistic reports of the time it is stated: “In his establishment in Paris there are a dozen of these incubators and each one is occupied with a baby. The bright incubators are set up against the wall in a neat row. ”

These establishments called them a charity because incubators were made available to the poor and distributed in different parts of the country.

Introduction in other countries

This team first developed in France was introduced in England in 1987 , The Lancet of London of the 29 May of that year refers to this. Incubator childcare is discussed in this publication and refers to the first public incubators in England. In 1898 Dr. Joseph B. DeLee established the first incubator station for premature infants in Illinois , Chicago , United States .

In Cuba before 1959, there were only 4 centers for newborn care, which had a total of 10 to 20 beds distributed between cribs and incubators, which were very few and were introduced in the early 1950s. Between the late 1970s and the early 1980s saw an accelerated development of the country’s Neonatological Units in terms of this and other technological resources. In 2005, various equipment with advanced technology was acquired, including more than 350 incubators for different uses in addition to those already existing in the Services.

characteristics

Generally the cover is made of single or double acrylic that prevents radiation losses and facilitates continuous observation of the patient. It has different holes that allow the manipulation of the newborn and the entrance of ventilation, monitoring and venous equipment for the administration of medications and parenteral feeding. Modern neonatal incubators have electronic sensors and light displays that allow continuous knowledge of temperature and humidity ranges. They may also have included scales that prevent excessive patient manipulation and filters to purify the air. Cribs with radiant heat sources are also used in heavier children.

Exhibition fairs

The survival of such young children motivated curiosity so much that it promoted the occurrence of showing them at fairs as an exhibition, for this reason an exhibition of children in an incubator was held at the Gewerbeausstellung in Berlin , Germany in 1896 that excited many imitators and encouraged the exhibitions held at the Trans-Mississippi Exposition , in Chicago the Progress Exhibition, the New York World’s Fair and the Coney Island Fair among others, which were for profit.

Between 1901 and 1904, incubators for premature infants were the sensational attractions of world exhibitions in Buffalo , New York, and St. Louis , Missouri .

At the 1904 World’s Fair, “incubator babies” were one of the main attractions, but after an epidemic of diarrhea among infants, some action began. This incident may perhaps be considered the first outbreak of nosocomial infection in a “Neonatal Service”.

Among the measures that were proposed was the need to place a glass between the incubators of the babies and the visitors to the exhibitions because they were only separated by a metal bar and so it could also be that the first ideas about the hospitalization cubicles of the current neonatology services, separated by crystals.

On September 18, 1897, The Lancet strongly criticized the commercialization in fairs of newborns who remain in incubators and strongly judging this fact published

“… the directors of the shows will not be made victims, using inexperienced or irresponsible people who seek to trade with the established reputation of an invention that has been recognized by both the medical and secular press …”

This same publication, the following year, referring to the Exhibition Fairs and the incubators of Barnum & Bailey, exposes in an article

“What connection exists between the serious subject of human survival, and the bearded woman, the dog man, the elephants, the representation of horses and pigs, and the clowns and acrobats who are the main attraction of Olympia.”

The exhibition fairs were one of the first bioethical disputes of the time and, regardless of their profit, forced the development of increasingly sophisticated equipment that would achieve a greater survival of these premature children.

Scientific emphasis

In 1907 in his book Le Nourrisson, Pierre Budín, considered by some to be the father of neonatology, pointed out that it was necessary to control the temperature to achieve the survival of preterm children, this was an affirmation in neonatal care that caused it to be stimulated the improvement and development of incubators of the time.

In 1938 Dr. Charles Chapple designed a modern infant incubator that allowed high levels of oxygen therapy but this invention unfortunately led to a retrolental fibroplasia (Retinopathy of Prematurity) “epidemic” in the 1940s and 1950s.

Incubators were discussed in many journalistic publications of the time and referred to survival in children with low birth weight and those born prematurely, but the attention of the newborn entered the academic scene through the work of Julius Hess , Chief of Pediatrics at Michael Reese Hospital in Chicago who established research concepts in the newborn and developed the Hess Incubator becoming the leading American expert on prematurity. This doctor gave the incubator another connotation with the development of the oxygen box , in 1934, what this gas could offer for the treatment of respiratory distress .

The Hess Incubator was first used in the United States for specialized neonatal transportation in Chicago. The incubator dried with a kind of plates in the form of rolls containing hot water.

While few scientific efforts were concentrated before 1950 to save the lives of preterm infants, some other scientific and technological advances occurred around this year.

Reference centers for premature infants were created in the United States in the 1950s and 1960s, and thus the need also arose to improve the transfer incubator technologically.

In 1963 Patrick Bouvier Kennedy , son of President Kennedy died shortly after birth, from a respiratory distress syndrome, who was born at 32 weeks of gestational age and his death, unfortunately, caused an event of political connotation with a more comprehensive and scientific approach to the care of the newborn child and it was declared that such high figures of neonatal mortality could not be accepted, for this reason Congress approved a significant increase in the national fund for scientific research aimed at the development of neonatal aspects. This impacted on vital issues such as mechanical ventilation , fluid therapy, thermal control and other investigations that led to a better understanding of the diseases characteristic of these patients.

In this way, neonatology also emerged as a specialty and Schaeffer, with his textbook “Diseases of the Newborn”, marked a milestone in the scientific knowledge of the newborn.

These “premature baby nurseries”, with primitive incubators, gradually developed until they became the current Neonatal Intensive Care Units with their sophisticated incubators that include specific air flows inside, servo control, digital bed-weights, different angles for fowler or trendelemburg position of electronic and continuous change, height change by pedal , batteries for power failure, cardiomonitors non-invasively coupled, in short, a wide range of computerized technological advances that would be the admiration and surprise of Stéphane Tarnier, Odile Martin, Alexander Lyons, Hess and Pierre Budín among others to whom history and newborn children will be eternally grateful for to be the promoters of these advances in the specialty.

 

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