Iowa Neonatology Handbook: Temperature

When and How to Move Babies from Radiant Warmer to Incubator, and from Incubator to Open Bed

Edward F. Bell, MD
Peer Review Status: Internally Peer Reviewed

1. Radiant Warmer to Incubator:
   
   Most newly-admitted infants are cared for on radiant warmer beds in order to provide accessibility for resuscitation or procedures without jeopardizing thermal stability. As long as an infant remains critically ill and is likely to require resuscitation or frequent procedures, he should be kept on a warmer bed. Most very small infants (<1000 grams) can be kept warm more easily on a radiant warmer than in an incubator, since incubator air temperature drops rapidly when the door is opened. If a very small infant has difficulty maintaining normal body temperature on a radiant warmer, plastic food wrap can be stretched across the bed (from side to side). This reduces the movement of cool air over the baby's body surface.
   
   When the condition has stabilized so that frequent procedures are not likely to be needed, an infant can be moved to a preheated incubator, on skin temperature servocontrol. Axillary temperature should be checked 30 minutes after moving the baby to the incubator, and every hour thereafter for four hours. The very small infant is at greatest risk of heat loss through an open incubator door. Whenever possible, procedures performed on a baby in an incubator should be performed through the ports (diaper change, vital signs, phlebotomy, etc.). Any infant who weighs less than 1000 grams should be cared for on a radiant warmer or in a servocontrolled double-walled incubator. If an infant consistently requires an air temperature above 37° C, it may be necessary to operate the incubator in the air temperature control mode to avoid periodic increases in air temperature to above 38° C, which may cause the heater to stop completely. Some infants who require a radiant warmer for temperature support may not need routine vital signs as often as other infants under radiant warmers. The frequency of vital signs may be reduced at the discretion of the infant's nurse and physician.
   
2. Incubator to Bassinet:
   
   1. If an infant has been maintained in an incubator operated by skin temperature servocontrol, the incubator should be changed to air temperature servocontrol in the following manner, before attempting the move the infant to a bassinet.
      1. Change to air temperature servocontrol setting the control temperature to equal the average incubator air temperature during the previous 24 hours (from the nursing notes).
      2. Check the baby's axillary temperature in 30 minutes and each hour for four hours.
      3. If the axillary temperature remains normal (36.5 to 37.4°C), disconnect and remove the skin probe if desired.
   2. When an infant reaches 1700 to 1800 grams, has no respiratory distress and only occasional apnea, and has been stable in an incubator operated in the air temperature control mode with air temperature 32°C or less, an attempt can be made to move him to a bassinet as follows:
      1. Dress the infant in shirt and diaper and wrap him in a single blanket. Turn the air temperature control to 28°C.
      2. Check the baby's temperature in 30 minutes and each hour for four hours.
      3. If the baby's axillary or rectal temperature drops to below 36.5°C, reheat him in the skin temperature servocontrol mode until his skin temperature is 36.0°C and return to manual or air servocontrol mode as described above (try again in two or three days).
      4. If the baby's temperature is stable for eight hours, bundle him in extra blankets and move him to a bassinet.
      5. Check body temperature in 30 minutes and each hour for four hours; if the axillary or rectal temperature drops to below 36.5°C, return infant to incubator, reheat on skin temperature servocontrol as described above, then revert to air temperature control; try again in two or three days.

Reference:

Bell EF. Infant incubators and radiant warmers. Early Hum Dev 1983;8:351-375.

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