Improved thermal stability by using a novel hybrid microenvironment device (Omnibed) for resuscitation in the delivery room and for transfer to the NICU in critically ill Neonates and VLBWI

Background: In many hospitals, transferof sick newborns from delivery room to NICU requires transfer from the overhead warmer in the delivery room to the NICU by using a transport incubator resulting in significant thermal stress, respiratory and hemodynamic instability. We have developed a novel device to improve thermoneutral environment during this early critical phase, which incorporates an overhead warmer and an incubator. The purpose of this study was to compare the impact of using this device on admission thermal stability.

Methods: 35 newborns were included in this cohort study. Fourteen infants with birth weights of less then 1500g (n=21, range 540–1490g) and 11 sick children (CDH, n=14, CCAM n=2) were transported in a Giraffe OmniBed from delivery room to the NICU. This hybrid device was upgraded for this study with a cardiorespiratory monitor (GE Dash 4000), a mechanical ventilator (Stephan), a suction source and gas supply. After delivery, the babies were resuscitated in the labor and delivery area using the device in the open bed, radiant warmer mode and then transported in closed bed, incubator mode to the NICU (a distance of approximately 500 m).

Results: All initial resuscitation procedures including catheterization of the umbilical vessels, were performed without any problems using the overhead mode. The average rectal temperature measured immediately upon admission to the NICU for all babies was 36,7°C (median, range 36,2–37,2°C). The average temperature was 0,4°C higher than in the historical control group of 30 babies transported with a conventional transport incubator (p=0,045).

Discussion: Using this novel hybrid device for resuscitation in the delivery room and for transfer to the NICU resulted in improved thermal stability. This device allows to initiate and maintain mechanical ventilation without any disruption and may help to maintain continuing life support to result in admission of more stable infants to the NICU.