Humidity In The Newborn Infant Less Than 30 Weeks Gestation - Standard Operating Procedure For The Use Of

Publication: 13/10/2014  --
Last review: 09/07/2018  
Next review: 09/07/2021  
Standard Operating Procedure
CURRENT 
ID: 3977 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Standard Operating Procedure For The Use Of Humidity In The Newborn Infant Less Than 30 Weeks Gestation

Aims

  • To standardise and optimise the care of a very low birthweight neonate receiving incubator humidity via Giraffe incubators.

Background and indications for standard operating procedure/protocol

The neonates susceptibility to temperature instability needs to be recognized and understood in order to manage and limit the effects of cold or heat stress of an already comprised patient. Very low birth weight (LBW), less than 1500g and neonates 23-26 wks gestational age have very immature skin1. The epidermis is very thin approximately 2-3 cells thick and the stratus corneum development is less rapid than for a more mature neonate. Therefore these infants are more at risk of transepidermal water loss (TEWL) compared to the more mature and bigger infant. It has been demonstrated that TEWL is correlated with gestational age2. Ambient humidity is vital because it reduces evaporation and prevents cold stress which impacts on oxygenation and metabolism3, but if set too high it can delay the formation and maturation of the stratus corneum. It also decreases the need to administer increased volumes of fluids that have been shown to have potential complications to an already compromised neonate.
The optimum level of humidity is set by gestational age, days of life, skin maturity and underlying condition.

  1. At delivery the baby less than 30 weeks or estimated less than 1500g should be placed into a plastic bag
  2. The neonate should continue to be kept in plastic bag until all lines and admission procedures are complete. The plastic bag should only be removed then.
  3. Admit into pre-warmed Giraffe incubator as this is to aid in reduction of evaporation, convection, radiation, and conduction. It also allows a clear view of the neonate
  4. Record the neonates axilla temperature on admission before humidity commences and then an hour from humidity starting.
  5. Place temperature probe on skin. Check probe regularly as probe may become wet due to humidity.
    1. Skin temperature must be documented hourly
    2. Axillary temperature must be recorded four hourly.
  6. Skin swabs for MRSA screening should be taken on admission.
  7. Assess and record skin condition as per Braden Q score assessment sheet during admission.
  8. Insert venous +/- arterial access, secure and X-ray. Attach infusions when line placement confirmed as acceptable, then commence humidity.
  9. Use sterile water to fill water reservoir / humidity chamber. Keep humidity chamber topped up with sterile water. Check every hour. FILL ONLY BEFORE USE. Chamber should be emptied and refilled every 24hours.
  10. Giraffe incubator should be changed every 7 days, also assess baby’s individual condition prior to changing incubator. Inform nurse in charge if you feel baby’s condition dictates otherwise. Complete incident form if equipment (new incubator) not available.
  11. Nurse the neonate in a nappy only and use appropriate positioning aids to promote developmental care.
  12. <26 weeks do baby may not need ECG leads on as they do not stick and may damage the skin. Please get recorded in medical notes. Heart rate can be monitored using the saturation probe. Check baby’s condition on individual basis, some may still require ECG monitoring.
  13. On incubator control panel select humidity symbol (raindrops symbol on giraffes) and set as per humidity guideline (see below)
  14. Only access incubator through portholes to maintain relative humidity.
  15. Wear gloves when handling neonate as skin is moist and so more at risk of trauma and infection.
  16. Assess and record skin condition once per shift (day/night). Maceration can occur in the neck, groin, axilla or trauma can occur from removal of tape. Document, photograph and report any such abnormality to nurse in charge as may need referral to tissue viability. Humidity may need altering.
  17. After the first week humidity should begin to be weaned for <28 weeks or on day 2 for>28 weeks as below. Date and times on days of weaning humidity to be documented. When weaning humidity temperature increase incubator /giraffe omnibed by increments of 0.5 of a degree. Axilla temperature must continue to be recorded and documented to ensure maintenance of temperature control. If temperature becomes unstable when humidity is lowered discuss rate of humidity decrease with nurse in charge or consultant.
  18. When humidity discontinued ensure the humidity/ water chamber is cleaned and dried.

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Algorithms - Humidity settings for Giraffe incubators

Neonate 23-28 weeks gestation

Day of Life

Incubator Humidity

1 -6

80%

7

75%

8

70%

9

65%

10

60%

11

55%

12

50%

13

45%

14

40% Discontinue after 12hours


Neonate 28+1 - 30 weeks gestation or less than 1500grammes

Day of Life

Incubator Humidity

1

80%

2

75%

3

70%

4

65%

5

60%

6

55%

7

50%

8

45%

9

40% Discontinue after 12 hours

Provenance

Record: 3977
Objective:
Clinical condition:

Preterm

Target patient group: Newborn infant less than 30weeks gestation and under 1kg
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

  1. Meza T (2013)
    Should we use olive oil or sunflower oil on a preterm infants skin?
    Infant 9, 5 170-172
  1. Allwood M (2013).
    Skin Care Guidelines for Infants aged 23-30 Weeks Gestation; A Review of the Literature.
    Neonatal, paediatric and child health nursing
    14, 1, 20-27
  1. Rutter N (2003)
    Applied physiology; the newborn skin.
    Current paediatrics
    13,226-230

Evidence levels:
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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