The Role of Humidity in the Management of Premature Neonates in a Rural Incubator

Abstract

Background While growing inside the uterus, the human fetus floats in amniotic fluid, and the mother maintains a stable temperature of 37 °C and a humidity of 100%. In most neonatal incubators, a stable temperature is maintained but not the humidity. We hypothesised that maintaining a humidity of 70% and a temperature of 32 °C in incubator rooms might improve the outcomes related to low birth weight (LBW) neonates. Methods In this interventional study, 30 preterm LBW neonates delivered at different gestational ages were studied. Instead of an incubator box, we converted one entire room (14'/9'/10') into an incubator. Three 200-watt bulbs were fixed to the wall at a height of 1 meter from babies. The room thermometer was mounted on the wall close to babies. The room temperature was maintained at 32 °C by turning the lights on or off as required. Wet cotton sheets (4' × 6') were spread on the opposite wall with the support of a stand. A hygrometer was fixed to the wall near to babies, and the humidity of the room was maintained at 70-80%. The hydration and nutrition needs of the babies were met with IV fluids/nasogastric (NG) tube feeding. Antenatal steroids were given to all mothers before the completion of 38 weeks. Babies were discharged when they were stable, and further care was given at home with similar arrangements of maintaining temperature and humidity. Birth weights, the number of babies that developed neonatal respiratory distress syndrome (NRDS), hypothermia, septicaemia, neonatal intensive care unit (NICU) admission days, home incubator days, and neonatal deaths were recorded and compared with the findings in the existing literature. Results Among the 30 neonates studied, birth weights ranged from 1.00 to 1.95 kg. Twenty-three babies developed NRDS, and four babies developed septicaemia; NICU days ranged from five to 28 days, and at-home incubator days ranged from 15 to 60 days. One baby succumbed to the illness. Conclusion Open nursing care of functionally premature neonates at room temperature of 32 °C and humidity of 70% is a cost-effective method that can lead to excellent outcomes.

Keywords: cost-effective neonatal care; humidity in a rural incubator; open premature care; rural incubator.

Figure 1. Rural incubator images

(a and b): three 200-watt bulbs, a room thermometer, and a hygrometer are fixed on the wall. Three babies wearing sweaters are seen; (c) chart showing room temperature, babys' temperature, humidity, feed volume, and aspiration fluid volume from the stomach

Figure 2. Humidifying system in the incubator room

(a) drip system fixed on the wall; (b) dribbling water drops from drip pipe; (c) drip system connected to the tap; (d) wet cotton sheets hanging on drip pipe

Figure 3. Original image of an incubator at home

(a) the house of a below-poverty line mother; (b) three 200-watt bulbs can be seen hanging, and room thermometer is fixed on the wall; (c) the baby wearing a sweater on the cot; (d) wet cotton sheets can be seen hanging on the wall

Figure 4. A sample of the consent form obtained from the participants in the study