An unstable premature newborn is best observed naked. Behaviour, colour and type of breathing can give information about the illness of the child. This is imperative in the unstable phase. Dosed oxygen supply, antibiotics and gastric tube feeding are possible in most cases. But when nursing a naked child, the temperature regulation of its environment is extremely important. In this respect it is relevant to know that heat is easily lost through radiation. Perspex all around - like in professional incubators - introduces serious dangers. Therefore we construct our incubator of insulating wood and only two of the six sides are transparent.
Cross-infection forms an additional danger for premature children with a poorly developed immune system. Therefore the air supply should contain fewer bacteries than room air. In industrial incubators this is achieved through a bacterial filter at the air inlet of the suction motor. The heated air is almost always re-used in this type of incubator. Because the Van Hemel Incubators do not have a motor no bacterial filter is applied, but the air is not re-used either. Huysman-Evers has tested the Van Hemel Incubator in the dispersion laboratory with three species of bacteries (staphylococcus aureus, pseudomonas, sarcinella). A very well-known professional incubator was installed for verification purposes. The growth of colonies in the Petri dishes put in the Van Hemel Incubator turned out to be significantly lower than in the professional one. This is probably the result of not recycling the air, short pasteurization, dehumidification and the subsequent humidification of the air.
Mother and child
Note: in professional incubators the newborn is continuously exposed to sound of the electromotor. The HEBI incubator does not use a motor.
The disadvantage of nursing newborns in incubators is the lack of body contact with the mother. So, as early as the condition of the child permits, the methodology of the Kangaroo method should be applied. But even while in the incubator, sufficient occasion for contact with the mother should be offered. This is imperative in developing countries. The armholes of the Van Hemel Incubator have sleeves to allow umlimited contact with the child. The sleeves decrease heat loss by preventing draughts. The mother herself is quite capable to feed by gastric tube with diluted mother's milk following example instructions.
The HEBI Incubator is kept as simple as possible. This results in a low cost and ease of maintenance.
In 1983 an extensive scientific study resulted in a list of physical properties which an incubator should satisfy. The HEBI incubator was reviewed against these requirements and only minor modifications were advised (like some energy saving recommendations).
In 1988 an inspection was made of 20 hospitals in Uganda and Kenya. This inspection revealed that many incubators with more than 15 years of service were still functioning, even in hospitals where no maintenance whatsoever was applied. A similar review in 2002 showed the same.
900 to 950 grams was repeatedly mentioned as the lowest birth weight for children who were saved. Recorded growth curves for six small prematures in Uganda show the same weight. The growth speed has been compared with six small incubator children from Amsterdam. In the first 14 days, the weight drop is congruent with the children from Amsterdam.
Aspects of adapted new born
In october 2005 Social and Tropical Paediatrics Henk W.A. Voorhoeve, MD, PhD, DTM&H wrote an article named ' Aspects of adapted new born care in rural hospitals'. You can download this article as a pdf file here.