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Humidification for neonates

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Incubator management

To manage humidity for infants born <30 weeks gestation (if an infant >30 weeks is assessed to have immature skin and thermoregulation difficulties, use of incubator humidity is not contraindicated)

  1. If baby is admitted on to a heat table, transfer to humidified incubator as soon as possible. 
  2. Babies ≤28+6 weeks gestation
    - Commence humidity of at least 80% 
    - Maintain humidification at 70-80% for first 7 days 
    - If temperature stable after 7 days, wean gradually to 50% 
    - Discontinue after 21 days or 32 weeks gestation (whichever is reached first). 
  3. Babies 29-30+6 weeks gestation
    - Commence humidification at 70-80% 
    - If temperature stable after 3 days, consider weaning humidification 
    - Discontinue when baby reaches 32 weeks gestation or when a level of 40% has been reached and has been demonstrated to be compatible with thermal stability 
  4. Ensure hypotonic sterile water for injection is used for humidity (1000ml bag) to avoid corrosive damage in the incubator system 
  5. Clothing should not be used in the presence of humidity. 
  6. Check bed linen to ensure it is not damp.

Circuit management

To manage gas humidity for infants on respiratory support (at flows >300 ml)

  1. All babies requiring respiratory support at flows over 300ml (ventilated infants, those on CPAP, Humidified High-Flow or Humidified Low-flow) to receive humidified gas using the MR850 humidification system.
  2. Slide the warmer plate (Conventional Ventilator RT235, CPAP BC151, Humidified High-Flow/Low-flow RT329, HFOV MR290) onto the humidifier base.
  3. Connect 1 litre bag sterile hypotonic water to auto feed drip line.
  4. Push the on/off button. (The humidifier will automatically default to the intubated mode).
  5. Change circuits weekly.
    It is suggested by Fisher and Paykel to always have the humidifier plate below the infant to allow for proper drainage of rain out - this is not always possible when the infant is out for a Kangaroo cuddle so care needs to be taken to remove condensate

Associated Documents

  • Fisher and Paykel recommendations on circuit management
  • Drager / Airshields product recommendations

References

  1. Agren (1998). Transepidermal water loss in infants born at 24 and 25 weeks gestation. Acta Paediatrica 1998;87:1185-90.
  2. Agren (2006). Ambient humidity influences the rate of skin barrier maturation in extremely preterm infants. Journal of Pediatrics 2006;148;613-17.
  3. Sinclair, Crisp & Sinn (2009). Variability in incubator humidity in the management of preterm infants. Journal of Paediatrics and Child Health 2009; 45; 535-540

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Document Control

  • Date last published: 31 July 2010
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years