1. INCUBATORS Lumanto, Rosalia Dewi – 564996 Doan Huynh, Anh Vu – 562887
HTW Berlin - University of Applied Sciences
Technical English 2 for Health Services Information Computing
Summer Semester 2018
INCUBATORS
Lumanto, Rosalia Dewi –
Doan Huynh, Anh Vu –
Tran, Van Nam –

2. CONTENTS History of incubators Premature babies
Incubators and their functions

3. HISTORY OF INCUBATORS

4. 19th Century Premature birth – slim chance of surviving
There are no special interventions
Ca. 36% all infants deaths
Johann Georg von Ruehl
Stephane Tarnier
Martin Couney
An infant who was born before term or usually called premature birth would get no special attention from a doctor, and was often neglected by the family. They were died in the first days of life from hypothermia, infection or weight loss. At this stage in the game around 36% of all infant deaths were due to premature birth.
There are 3 inventor and developer of the incubator in late 19th century. The similar thing of their incubator is to adjust the infant body temperature and to keep the body’s temperature stable.

5. Johann Georg von Ruehl A former Russian physician
In 1835 Ruehl’s Cradle
The first “warming tubs (Wärmewannen)”
The mortality rate was high
In 1835 a former Russian physician Johann Georg von Ruehl got the ball rolling. He developed a double-walled metal incubator.
However, the adaption of the surrounding temperature and the baby’s body temperature were difficult compatible with each other, therefore the mortality rate was high.

6. Ruehl’s Cradle Constructed with an opened system. Glass
A double-walled metal incubator to keep the warm
Opening
The Ruehl’s cradle is looked like a baby cot. It is constructed with an opened system
Both sides of the cradle are made of glass.
an opening, which is filled with the heated water.
There is provided with a faucet for draining.
In the middle part of the Ruehl's cradle is the lying surface with a mattress for padding, where the preemie is placed.
Faucet
Bed / Mattress

7. Stephane Tarnier A French obstetrician
In 1880 built a closed system incubator
Inspired from chicken incubator
For about 45 years later, the French obstetrician Stephane Tarnier built in 1880 a closed system device for the care of infants. The chicken incubator in the Paris zoo inspired him to build a similar device. The incubator is better with the closed system than the opened system, because it is more effective and efficent to stop the energy from leaving the system and could keep the warm longer.

8. A hot-water reservoir attached to an external heating source (W)
Simplified : hot-water bottles replaced manually, every 3 hours
It has a glass cover
Double-walled incubator to keep the warm
Ventilation relied on simple convection
Th = Thermo Syphon
W = reservoir / water container
d = glass cover
k = double-walled incubator
P = door
a = drainpipe
Z = Opening to filled water
L = vent
Tarnier’s first incubator housed several infants who were warmed over a hot-water reservoir attached to an external heating source. He quickly simplified the apparatus to a single infant model heated by hot-water bottles replaced manually by the nurse every 3 hours. It’s a closed system, so there is a glass on the top to cover. Ventilation relied on simple convection, with air entering at the base and circulating upward around the infant.

9. Martin Couney German doctor the first “oven like” incubator
Exhibition in Berlin
Before the exhibitions, medical professionals didn’t believe his project would work and banks were unwilling to finance production of his incubators, believing that no hospital would want the devices. Then after the exhibitions he hit the homerun as more hospitals began to develop methods for treating premature infants and as the field of neonatology became more accepted.
Exhibition in Berlin in 1896

10. Exhibition in Coney Island, New York in 1990
Pay 25 cents to enter the exhibition
25 incubators showed in the exhibitions
Around preemies life
He presented the incubator exhibition and it attracted people’s attention and media. Even though he was also criticized often by his “Live Baby” exhibition, he still gave his best shot. it was also one controversial project, where the people, who want to enter the exhibition, have to pay for 25 cents. The exhibition showed 25 incubators with premature babies, that were cared all day by a group of professional nurses and two doctors.
a ballpark figure of 6,500 preemies lived and improved their chances of survival.

11. Worked very accurate and strict
Strict with hygienic measures in workplace
No Smoking and eating in the exhibition
Treatment to premature infants  no inhibitions
Encourages the parents and nurses to make body contacts with the babies
The Attractions were also showed at a number of the World’s Fair, such as New York City’s World Fair, the Omaha Trans Mississippi Exposition, the Buffalo Exposition and the Chicago World’s Fair
He is always on the ball. He demanded strict compliance with hygienic measures in the workplace. There was an extra chef who was responsible for making the food for the premature babies, there was also someone who washed the baby clothes and the uniform of the workers. They had all hands on the deck to keep the environment hygienic and comfortable for the babies.

12. Now : many incubators with modern technologies
To adjust baby’s body temperature
To control humidity
X-ray
The survival rates will rise more in coming years

13. PROBLEM !!! 15 million babies are born preterm
Approximately 1 million deaths in 2015
Across 184 countries
According to WHO :
Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.
Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015.
Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born.

14. PRETERM BIRTH (PREMATURE BIRTH)

15. Definition Babies born alive before 37 weeks of pregnancy
Based on gestational age:
extremely preterm (less than 28 weeks)
very preterm (28 to 32 weeks)
moderate to late preterm (32 to 37 weeks)

16. Why does Preterm birth happen ?
Having a previous premature birth
Pregnancy with twins, triplets or other multiples

17. Why does Preterm birth happen ?
Problems with the uterus, cervix or placenta
Smoking cigarettes or using illicit drugs

18. Why does Preterm birth happen ?
Some infections, particularly of the amniotic fluid and lower genital tract
Multiple miscarriages or abortions
Physical injury or trauma

19. Temparature control problems
Complications
Temparature control problems
Premature babies:
can lose body heat rapidly
can not generate enough heat to counteract what's lost through the surface of their bodies
While not all premature babies experience complications, being born too early can cause short-term and long-term health problems. Generally, the earlier a baby is born, the higher the risk of complications.
Some of the premature birth complications that can be listed are:
Temperature control problems. Premature babies can lose body heat rapidly. They don't have the stored body fat of a full-term infant, and they can't generate enough heat to counteract what's lost through the surface of their bodies. If body temperature dips too low, an abnormally low core body temperature (hypothermia) can result.

20. Complications Brain problems
intraventricular hemorrhage
larger brain bleeding that causes permanent brain injury
Brain problems. The earlier a baby is born, the greater the risk of bleeding in the brain, known as an intraventricular hemorrhage. Most hemorrhages are mild and resolve with little short-term impact. But some babies may have larger brain bleeding that causes permanent brain injury.

21. Complications Immune system problems
underdeveloped immune system
 infection
Immune system problems. An underdeveloped immune system, common in premature babies, can lead to a higher risk of infection. Infection in a premature baby can quickly spread to the bloodstream, causing sepsis, an infection that spreads to the bloodstream

22. Complications Heart problems
The most common heart problems premature babies experience are low blood pressure (hypotension) and patent ductus arteriosus (PDA)
low blood pressure
patent ductus arteriosus

23. Complications Breathing problems
A premature baby may have a trouble breathing due to an immature respiratory system. He or she may develop respiratory distress syndrome because the lungs can't expand and contract normal
immature respiratory system
respiratory distress syndrome

24. Complications Blood problems
Anemia
Newborn jaundice
Premature babies are at risk of blood problems such as anemia and newborn jaundice. Anemia is a common condition in which the body doesn't have enough red blood cells. While all newborns experience a slow drop in red blood cell count during the first months of life, the decrease may be greater in premature babies.

25. Complications
 Incubators are necessary!!!

26. INCUBATORS AND THEIR FUNCTIONS

27. What is an incubator? Bassinets: are the little plastic tubs
are padded down with blankets
to keep babies in for a few hours or days.
A lot of people hear about babies being put in incubators and don’t actually have a solid image of what an incubator actually is. An incubator is not the same thing as a bassinet. Bassinets are the little plastic tubs that are padded down with blankets in the hospital’s nursery to keep babies in for a few hours or days.

28. What is an incubator? Incubators
are glass container-like constructions
are equipped to create a microclimate
can be customized to fit that particular infant’s need
Incubators are glass container-like constructions that are equipped to create a microclimate.
What we mean by microclimate is a small environment. Incubators are used to store infants while they receive food and monitoring because the temperature, humidity, and light can all be adjusted to control those things inside the incubator.
The infant is existing in a little box where everything is a customized way to fit that particular infant’s needs and promote better recovery.

29. What is an incubator? Knobs that control each different function
Often incubators have knobs that control each different function on the outside of the incubator for the nurses to manage.
Monitoring and observation equipment is often built into the infant incubator unit. These instruments can include cardiac monitors, brain-scan equipment, blood-monitoring equipment, thermometers and other instruments for observing vital signs. The consolidation of this equipment in one place minimizes the need to move and handle infants excessively. Also, because of the small, enclosed environment, some data such as temperature and heart rate can be accurately measured without the need for invasive instruments.
Knobs that control each different function
Monitoring and observation equipments
 Minimize the need to move and handle infants excessively

30. What is an incubator? Incubators are accessible
These incubators might be glass boxes that have an assortment of wires and tubes hooked up to them, but they are accessible. They have to be, after all.
While infants are kept in incubators and receive a good deal of treatment and food there, they will sometimes need to be taken out and examined.
For this reason, there will be ports in the incubator where nurses can open the incubator and remove the baby for exams or just to check up.
Normally the head nurse will be the one checking the baby and removing them from the incubator.
Visitors are often not allowed, though mothers sometimes are, and only certain nurses and some doctors are allowed to come into contact with the baby. This is because those professionals know how to safely and hygienically come into contact with a sick infant without contaminating the infant or themselves.
Incubators
are accessible
can be opened  the babies can be taken out for exams or check up

31. Who needs incubators? Babies
that have been declared in a critical condition.
cannot sustain themselves for any number of reasons outside of the incubator.
Incubators are for storing babies and keeping them in a stable environment while they receive treatment.
The babies kept in incubators are babies that have been declared in a critical condition of some sort and that cannot sustain themselves for any number of reasons outside of the incubator.

32. Who needs incubators? Premature babies Abnormally small babies
Babies born from diabetic mothers
Babies, who have a very difficult or prolonged delivery
The most common reason why a baby will go into an incubator is because of premature birth. Babies that are born up to 13 weeks early can survive in an incubator after being kept there for a certain amount of time. Some infants born with special needs or birth defects might also need an incubator to keep themselves stable.
For examples:
A baby born right on time might be abnormally small and need to be put in an incubator for many of the same reasons as a premature baby.
Babies born from diabetic mothers will also be put in an incubator. This is so that they can be monitored while tested for the disease and also because other complications will arise. If the baby has jaundice, they will go into the incubator.
In addition, they might go into the incubators if they have a very difficult or prolonged delivery because these can be traumatic for the infant.

33. Factors to be controlled Warmness
Premature babies
have a difficult time keeping their body temperature up
can freeze in perfectly normal temperatures
As have been said in the last part of the presentation: One thing that many infants struggle with is keeping warm. In a healthy infant, warmth can be preserved by swaddling them and then putting a little cap on their head to keep their head heat in. In a newborn that needs to go to an incubator, though, this is not the case.
Premature babies namely have a difficult time keeping their body temperature up. This is because mammals sustain their own body temperature but outside factors can override that.
Because infants are so small and their ratio of skin to muscle is a little off for a while when born premature, it’s impossible for them to stay warm. In fact, they can freeze in perfectly normal temperatures that an adult would consider tepid at most.

34. Factors to be controlled Warmness
Exact temperature can be controlled and maintained in an incubator
In an incubator, nurses can control the exact temperature and maintain a steady heat.
This way the infant’s body won’t have to work as hard at keeping warm and can focus that energy on other important things.

35. Factors to be controlled Oxygenation
The oxygenation in the incubator can be lowered or heightened depending on what that specific child needs.
One of the things that an incubator can control--well, a nurse can control inside of the incubator--is oxygenation. Often a premature baby will require changes to be made in their oxygen intake. This can be because of lung malfunctions or deflations. Inside an incubator, the oxygenation of the tank can be lowered or heightened depending on what that specific child needs.
This is, to understate it, an incredible feat in modern medicine. To be able to control the oxygen levels in a specific confined area is entirely revolutionary and saves the lives of many premature babies and babies with other complications every day.
With the proper level of oxygen, babies are able to not have to work so hard to breathe and their bodies can start doing other things to promote their own quicker, easier recovery.

36. Factors to be controlled Humidity
A factor that many people consider abhorrent in the climates where they live, humidity is a surprisingly huge factor in the health of an infant in the incubator. Infants require water to survive, as do all humans and most living things. Because of this, it’s important that they lose as little water as possible. In many premature babies, water will be lost rapidly through the skin.
The best way to keep water from being lost through the skin is to keep the incubator humid. This way, water won’t leave the skin so quickly. We all experience the feeling of sweat sticking to the body--when it’s humid, sweat doesn’t evaporate and cool the way that it’s supposed to.
Babies experience a similar effect with retaining water that tries to leave their skin. It stays moisturizing and keeps them from getting dehydrated, which can be a very serious concern 
Infants require water
to survive.
In many premature babies, water will be lost rapidly through the skin.

37. Protection from the incubators
Incubators block out most hazardous chemicals and things that might be bad for baby’s tiny system
 The incubator has a huge impact on infant mortality rates
The incubator serves as a microclimate, yes, but it also serves as a nearly impenetrable fortress. The point of an incubator is to keep a baby safe, after all, so this only makes sense.
Incubators are essentially the perfect place for a baby to be because they block out most hazardous chemicals and things that might be bad for that baby’s tiny system. Cold air, bright light, and even some germs can’t penetrate the incubator.
It’s for this reason alone that the incubator has had such a profoundly huge impact on infant mortality rates. Infant mortality rates have dropped dramatically since the invention of the incubator. This is because small things that used to be the death of infants are now unable to get to infants, and have to find something else to go ruin.
Infants are safe as long as they’re in the incubator where nothing can get them.

38. How babies are fed during incubation?
through a tube
with the required nutrients as well as medication
breast milk from mother
Babies, like any other person, require food to live. This is especially true in the early hours, days, and weeks of their lives, incubator or no. Babies that are placed in an incubator will often be fed through a tube. Formulas are the norm in this situation. These formulas will have the required nutrients as well as whatever medication the baby needs if the baby needs medication.
Sometimes, though, mothers will be pumped for their breast milk and they will administer that to a baby. This helps babies immensely and will help mothers to feel like part of the process.
In addition, mothers will feel their breasts starting to hurt after giving birth because the body will want to breastfeed usually. Giving breast milk through a tube is not always the case, but it’s one of the possible ways that a baby can be fed in a situation in which that baby has been placed in an incubator.

39. Transition period The period of time:
the baby is prepared to get out of the incubator and into the regular world
mothers will be enlisted to help
Some babies are in incubation for many, many weeks. However, most of the time, babies are only in the incubator for about a week, or a few days. In these cases, mothers will get to be around during the transition period.
This is the period of time in which the baby is prepared to get out of the incubator and into the regular world. It requires a lot of work and training, but it’s all worth it in the end.
During this period of time, mothers will be enlisted to help. They will learn how to handle their baby under the supervision of nurses and will be allowed to interact with their child much more than before.
In fact, sometimes mothers will be changing diapers and breastfeeding. During the transition period, it’s been established that the baby is going to leave, so it’s much less stressful for the mother and for the baby.

40. Sources
Jeffrey P. Baker, MD, PhD. "Historical Perspective, The Incubator and the Medical Discovery of the Premature Infant." Journal of Perinatology, 2000: 5:
Rebovich, Kelsey.“Martin Couney and Incubator Exhibits from 1896 to 1943”. it was accesed:

41. Sources
World Heath Organization, “Preterm birth “, 19/2/
Mayo Clinic, “Premature birth”.
Sarah Brown, “Premature babies care study launched by Sarah Brown”, 16/11/
Andrea Mullenmeister, “Gearing Up for RSV Season (7 Ways You Can Help)”, Nov 6,
Pediatric Cardiothoracic Surgery , “Patent Ductus Arteriosus”,
David F. Kramer , “Anemia in Dogs – Causes, Symptoms, and Treatment”,

42. Thank you for your attention!!!