In this section
Infants born at
<30 weeks gestation have an immature epidermis and stratum corneum and are at an increased risk of transepidermal water loss (TEWL). The use of environmental humidity assists to reduce TEWL and in turn supports temperature regulation, fluid and electrolyte management and skin integrity.
The aim of this guideline is to provide all clinical staff with the criteria, settings and weaning regime required for the provision of environmental humidity for preterm infants. Correct management of environmental humidity assists to improve skin integrity, thermoregulation and fluid and electrolyte balance.
All neonates <30 weeks gestation AND <2 weeks of age should be nursed in an incubator with environmental humidity and servo control thermoregulation functions.
Environmental humidity should be delivered via an incubator, and commenced as soon as practical following admission. The water reservoir within the incubator should be filled with sterile water to prevent bacterial colonisation, and regularly checked and refilled as required. Gradual weaning should occur with staged reductions in the humidity percentage after 7 days of life as long as this is clinically appropriate.
A water bag needs to be attached to the humidification system with the connection kit via the leur lock on the rear sensor wall. On the babyLeo, humidity therapy control should be set manually in the therapy bar (see table below).
While it is possible to provide a degree of humidification while nursed on a radiant warmer, there is a significant increase in TEWL. Furthermore, this method poses potential problems regarding an accumulation of carbon dioxide for non-ventilated infants. If patient requires surgery, the humidity can be turned off and the hood in the hybrid warmer can be lifted up.
How to set up humidity in an incubator
How to set up humidity on Babyleo
The impact of TEWL and serum sodium levels should be regularly assessed, by testing for hypernatraemia as an indicator of excessive TEWL or water deficit, this signifies a necessity for higher humidification percentages in the incubator.
After successful staged reductions, environmental humidity can then be ceased after 2 weeks of life, as the epidermis will then have matured to act as an effective barrier. The table below demonstrates the commencing and weaning process for humidification.
It is important to note that the duration and percentage of environmental humidity may vary and depends on the neonate’s gestational age, serum sodium levels, fluid balance and skin condition – all of which should be discussed and assessed during the medical ward round. Weaning humidity should only continue when clinically indicated as appropriate.
Within the flowsheets of EMR, within the observation section, the following should be documented:
Environmental humidity for premature neonates evidence table
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The development of this nursing guideline was coordinated by Emily Dam, RN/RM, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated May 2020.