Modern Technologies and NICU s Pre-term

Modern Technologies and NICU’s

• Pre-term (anatomic and physiological immaturity) – no capability to response extra-uterine environment Result: STRESS • by cold, noise, light and MANIPULATION • by an environment not propitious and to facilitate the organization reciprocal • this environment of NICU’s is stressing and not contribute to the development of the pre-term babies • the physiologic homeostasys it’s a necessary condition to activity regulation and organization • and with immaturity of the Central Nervous System (CNS) can cause inconsistent breath, high risk apnoea. . . resulting in a low systemic blood pressure AND Consequences: Perinatal Hypoxic, Arterial Channel Persist (ACP), and Sepsis

• Therefore the NB reacts to STRESS in a global way with alterations: – Immunologic – Cardiovascular – Endocrine-metabolic • there are some papers show the VLBW is manipulated from 82 to 132 times/day (Consent. & Malerba Scochi, 1980) • in the uterine life the fetus sleep around 80% of time… (Marrese by Scochi, 1998) • contrary occurs minutes after they born – They’re submitted by a large quantity of MANIPULATION • since the studies about the NICU’s environment showed it born a new broach of MINIMAL MANIPULATION

§ The MINIMAL MANIPULATION allow: § Brain care § Positive influence of pré-term neurodevelopment § Clinical parameters improvement § STRESS reduction! § Thinking in this advantages some incubators are developing with high technology platform and gives to VLBW a therapeutic environment and guarantee the physiologic homeostasis with minimal manipulation.

WHICH ARE THESE BENEFITS? § HUMIDITY SERVOCONTROLLED - Allow the servo control by % of humidity (with a humidity sensor) - for VLBW it’s recommended high humidity (70 – 90%) to avoid the transepidermal water loss. - prevent the electrolytic loss and therefore decrease the water infusion needs - avoiding the problem of ACC (Arterial Channel Closing) - generally 80 -85% (1 st week), 70 -75% (2 nd/3 rd week) and 65% (4 th week or if >1500 g)

§ OXYGEN SERVOCONTROLLED - Allow the servo control by % of oxygen (with 2 oxygen sensors) - control with better precision and without use of helmets (another accessory and manipulation)

§ TEMPERATURE SERVOCONTROLLED - Can be controlled by air or skin temperatures Thermoregulation pre-term babies: • Huge thermodispersion • No brown adipose tissue, no shivering • Atmosphere 35°C, reduced to 31°C at 6 weeks of extrauterine life thus: Priority: avoidance of thermal stresses § SKIN SENSOR - Allow to monitoring or control the skin temperature - constant and without any manipulation

§ SCALE - Allow to control the weight evolution day by day - without much manipulation - against disconnect intubated patients (brain hypoxia and stress) § X-RAY BED - Allow to insert the film/ecran without any manipulation - less risk of infections

§ ANOTHER ADVANTAGES There is another important accessories that make the differences: - Double Wall Allow to maintain the stability of the temperature without interferences of external temperature

- Head Fixer w/ Auricular Protection Allow the security of intubation patients and the reduction of perception noise. - Goose Neck Allow the security of intubation patients. Protection against glottis edema.

- Light Small light by white LED’s allow a nice illumination without broken the Circadian Cycle.

- Non Invasive Ventilation After the introduction of MINIMAL MANIPULATION (1986) reduces the intracranial hemorrhages from 49% (1985) to 25% (1987) for the NB with gestational age >28 weeks It contributed to spontaneous breath and reduced the treatment with mechanical ventilation from 82% to 54% (in the same period above) (Jacobson, Gronvall, Petersen, Andersen) Invasive Ventilation cause oxygen and blood pressure variations and can induce brain damages. In major times It was used the Nasal CPAP less aggressive than invasive ventilation.

ü New Launch: Babypap - CPAP FANEM ü Models 1150 S (Bubble CPAP) and 1150 (Electronic)

ü Advantages: ü pulmonary stimulation – liquid redistribution ü with surfactant use reduce the mechanical ventilation ü the CPAP used in the delivery rooms reduce the mechanical ventilation therapy ü the costs are lower than traditional ventilation ü FANEM developed a special kit with different sizes containing nasal canula, tubes, connections and a cap band that allow use it with phototherapy together

- Super LED’s Phototherapy ü The first phototherapy with reduced and microprocessed dimensions ü it uses only 5 Super LED’s

ü it uses Super LED irradiant source of blue light ü the radiation transmitted by this source is focused on the blue spectrum of interest for the treatment (460 nm)

ü the radiation is higher then another phototherapy kinds ü the emission of radiation in the infrared and ultraviolet ranges is extremely attenuated

ü work temperature low ü dimensions extremely reduced ü low power consumption

ü microprocessor controlled: enables a greater amount of resources never before explored in phototherapy until today (with clock/calendar, contol % of radiance, terapy time, Super Led life and RS 232) ü double equipment: the first phototherapy equipment that embodies a radiometer ü and pattented with trademark from FANEM We need to work with good conditions thinking in the pre-term future The technology today allow us to do it!

Márcio R. M. Serra, CE International Technical Support Engineer FANEM LTDA. Tel: + 55 11 6972 5700 - Ext. 240 Fax: + 55 11 6979 1575 serra@fanem. com. br Skype: serra_fanem www. fanem. com. br