Atom Infant Incubator V-850

Date
Circa 1980s
Description
This is a standard baby incubator (aka "Humidicrib") in general use from the 1980s. Staff often referred to it as an "Isolette", but that is the brand name of the predecessor of this incubator used in the 70s and 80s, manufactured by Air-Shields.

It was used for a wide variety of infants, ranging from babies with mild problems requiring observation only, down to tiny babies and those with abnormalities but not usually those requiring intensive care; in the 1980s and 90s babies requiring intensive care, especially respiratory support, were managed in open beds with overhead radiant warmers; this set-up gave greater access for procedures and better visibility for observation of vital signs, but had the disadvantage of increasing fluid loss and difficulty with fluid and electrolyte balance.

In more recent years there has been a return to management of intensive care babies in closed-wall incubators, but they are more sophisticated than the V-850. Nevertheless as nasal CPAP and high- and low-flow intranasal oxygen delivery has become increasingly utilised this is often managed in incubators such as the V-850. Having the baby wrapped in an incubator gives good temperature control and discourages interference with the baby, while modern monitoring techniques make the need for direct observation less essential.

There is a long history of infant incubators going back to Dr. Tarnier in France in the late 19th century.

The temperature in the incubator could be pre-set and then adjusted according to the baby’s temperature, or it could operate on a microprocessor feedback system that was continuously measuring the baby’s abdominal skin temperature via a temperature sensor, so that the incubator air temperature self-adjusted according to the direction in which the baby’s abdominal skin temperature was trending. This feedback loop system (or ‘Servo’ control) was used in the most critically ill and smallest premature babies because it reduced handling to measure temperature as well as being more accurate. However it was sometimes difficult to apply the sensor adequately, so in the bigger and more stable babies the incubator air temperature was adjusted directly.

Later models of the V-850 had double walls, which stabilised the incubator air temperature and also reduced radiant heat loss from the baby.

There were alarms for high and low incubator temperature, high and low baby temperature in Servo mode, sensor malfunction and for power failure.

The display showed the incubator temperature and, when in Servo mode, the baby’s skin temperature.

Oxygen levels in the incubator were adjusted by altering the flow rate of oxygen administration, and higher concentrations could be obtained by using the air inlet closure device 'the red plastic ‘flag’. Concentrations of up to 40% could thus be achieved. Higher concentrations generally required the use of a headbox surrounding the baby’s head with direct administration of oxygen by tube into it. Monitoring of required oxygen levels was achieved either by blood gas analysis, transcutaneous p02 measurement or in later years by pulse oximetry.

These incubators were designed to provide humidity which is known to provide greater temperature stability. The air/oxygen mix is circulated over water warmed in the humidity reservoir (missing on this incubator). Unfortunately it was shown that humidity compartments such as this were shown to be a source of infection, and humidity in incubators ceased to be used in the 1980s.

In the 1980s and 90s the babies typically were nursed naked (with nappies) for greater ease of observation. However by 2000 most babies were clothed to give better temperature control, with more reliance on electronic and pulse oximetry monitoring.

By 2005 the combined benefits of open radiant heat incubation and closed-wall technology were built into a single unit which could be used in either mode or in combination. An early example of this was the ‘Giraffe’ incubator.