In this section
Note: This guideline is currently under review.
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.
Environmental humidity: The percentage of ambient humidity surrounding the baby
Transepidermal water loss (TEWL): The evaporative loss of water from the immature epidermal layer of the skin
All infants <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 possible. 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.
The impact of TEWL and serum sodium levels should be regularly assessed, with hypernatraemia an indicator of excessive TEWL, or a water deficit, that signifies a requirement for greater humidification percentages. After successful staged reductions, environmental humidity should 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 depend 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.
Humidification via a Radiant Warmer
Skin-to-Skin Care for the Newborn
Thermoregulation in the Preterm Infant
Environmental humidity for premature neonates evidence table
Please remember to
read the disclaimer
The development of this nursing guideline was coordinated by Tara Doyle, CNS, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2016.