Historical background to maternal-neonate separation and neonatal care.

Maternal-neonate separation after birth is standard practice in the modern obstetric care. This is however a relatively new phenomenon, and its origins are described. Around 1890, two obstetricians in France expanded on a newly invented egg hatchery as a method of caring for preterm newborns. Mothers provided basic care, until incubators became part of commercial exhibitions that excluded them. After some 40 years hospitals accepted incubators, and adopted the strict separation of mothers from babies observed at the exhibitions. The introduction of artificial infant formula made the separation practical, and this also became normal practice rather than breastfeeding. Incubators and formula were unquestioned standard practices before randomized controlled trials were introduced, and therefore never subjected to such trials. The introduction of Kangaroo Care began 40 years ago in Colombia, now as a novel intervention. Recent trials do in fact show that maternal-neonate separation is detrimental to mothers and babies. Recent scientific discoveries such as the microbiome, epigenetics, and neuroimaging provide the scientific explanations that have not been available before, suggesting that skin-to-skin contact and breastfeeding are defining for the basic reproductive biology of human beings.

Healthful environments for hospitalized infants.

PURPOSE: Medical and technological advances dominate the design of infant incubators because of their essential role in the survival of critically ill neonates. Yet other important design considerations, such as caregiver interaction, discomfort at bedside, and harmful materials, often are overlooked. The purpose of this paper is to consider the effects of existing incubator designs and to suggest criteria for the next generation of infant incubators. BACKGROUND: Incubators of the mid-1940s established an industry standard that exists to this day: portholes in an infant chamber positioned over a mechanical system, resting on top of storage cabinets or drawers. This design is unresponsive to many of the infants' needs and significantly influences parent/infant interaction. The physical effects and social barriers that the incubator presents to the health and well-being of infants are compounded by the use of unhealthful substances and materials such as formaldehyde. Collectively, these conditions call for an incubator that not only ameliorates physical and social obstacles, but also uses benign materials. CONCLUSIONS: Simple alterations to existing incubator design, such as introducing color and pattern, providing arm rests, and freeing space beneath the infant chamber to accommodate seated caregivers, would encourage more prolonged periods of contact with the infant occupants, thereby improving their behavioral organization and recovery. Replacing harmful materials with alternatives such as formaldehyde-free substrates in the cabinetry also will improve the developmental outcomes of the infant occupants. These types of recommended changes embrace the intent of the incubator to provide a controlled, secure environment while acknowledging that incubators are not merely medical equipment, but the living spaces of their infant occupants.

The infant incubator in the neonatal intensive care unit: unresolved issues and future developments.

Since the 19th century, devices termed incubators were developed to maintain thermal stability in low birth weight (LBW) and sick newborns, thus improving their chances of survival. Remarkable progress has been made in the production of infant incubators, which are currently highly technological devices. However, they still need to be improved in many aspects. Regarding the temperature and humidity control, future incubators should minimize heat loss from the neonate and eddies around him/her. An unresolved issue is exposure to high noise levels in the Neonatal Intensive Care Unit (NICU). Strategies aimed at modifying the behavior of NICU personnel, along with structural improvements in incubator design, are required to reduce noise exposure. Light environment should be taken into consideration in designing new models of incubators. In fact, ambient NICU illumination may cause visual pathway sequelae or possibly retinopathy of prematurity (ROP), while premature exposure to continuous lighting may adversely affect the rest-activity patterns of the newborn. Accordingly, both the use of incubator covers and circadian lighting in the NICU might attenuate these effects. The impact of electromagnetic fields (EMFs) on infant health is still unclear. However, future incubators should be designed to minimize the EMF exposure of the newborn.

Optimizing the neonatal thermal environment.

Devices used to maintain thermal stability in preterm infants have advanced over time from the first incubator reported by Jean-Louis-Paul Denuce in 1857 to the latest Versalet Incuwarmer and Giraffe Omnibed devices today. Optimizing the thermal environment has proven significant for improving the chances of survival for small infants. Understanding the basic physiologic principles and current methodology of thermoregulation is important in the clinical care of these tiny infants. This article highlights principles of thermoregulation and the technologic advances that provide thermal support to our vulnerable