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Incubator to Cot Transfer

Introduction

Evaluating when is the right time to transfer a preterm infant from a closed incubator into an open cot is an essential skill for staff in the Special Care Nursery (SCN).

Incubators are designed to minimise heat loss and provide a thermo-neutral environment requiring minimal metabolic effort by the baby to maintain a normal temperature.

Incubators are not required for the entire length of the baby's SCN stay. Recognising when an infant is capable of maintaining it's temperature in an open cot is an important step in planning for discharge.

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The premature infant and temperature maintenance

Achieving temperature stability is important in optimising body growth and development in the premature infant.

Both premature and low birth weight infants have

  • sparse brown fat available for heat production
  • small liver with limited glycogen stores for energy and heat production
  • large surface area to body mass posing a huge potential for heat loss
  • immature response of the central nervous system to cold stress

Cold stress can lead to

  • feeding intolerance
  • respiratory and metabolic acidosis
  • hypoglycaemia 
  • hypoxia 

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Nursing Assessment

  • infant weight
    • infants weighing 1500 grams or more are candidates
    • for extremely preterm infants consistent weight gain is an additional indicator

  • incubator settings
    • the incubator should be in manual mode
    • stable body temperature (36.5 - 37.0•C per axilla) with the incubator set in the lower range of the neutral thermal range (NTE)

  • physiologically stable
    • the infant must be systemically well and physiologically stable

  • feeding
    • the infant should be tolerating feeds 

  • monitoring
    • on transfer from incubator to open cot check axillary temperature
      • hourly for 4 hours
      • then 3-6 hourly before feeds

  • parent education

The ambient room temperature in most nurseries is frequently slighter warmer than the home and will influence the amount of clothing and blankets the baby requires on transfer to an open cot compared to at home.

Perhaps the most important role is to educate the parents about actions to reduce the risk of SIDS including

  • putting the baby's feet to the foot of the cot
  • placing the baby on his/her back to sleep
  • prevention of overheating
  • maintaining a non-smoking environment

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References

Open and Closed Care, Ducker. T and Todd. R, Journal of Neonatal Nursing Vol 6 No 6, 2000.

Transition from incubator to waterbed: a care study approach, Harvey. M, Journal of Neonatal Nursing Vol 6 No 6, 2000, p 185 - 188.

Kenner. C, Rockwern Amlung. S and Applewhite Flandemeyer. A (1998), Protocols in Neonatal Nursing, W.B Saunders Company Philadelphia.

Merenstein. G and Gardner. S (1998), Handbook of Neonatal Intensive Care 4th ed., Mosby St Louis.

Transition of pre-term infant to an open crib, Meier. P, Bliss-Holtz. J, Lund. C., AWHONN Voice Vol 1 No 10 1993 pg 10.

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