The Giraffe bed provides the most self-contained environment for the micropremie by converting from open bed warmer to isolette. The Giraffe is designed to provide better thermal stability and less evaporative fluid loss in the early days of life of an extremely low birth weight infant. Therefore, every effort should be made to admit infants less than 1000g into Giraffe beds. If supply permits, Giraffe beds also offer benefits for larger premies in the 1000-1500g weight range as well.

To prepare the bed for any admission:

Turn on the bed and clear the patient history.

Raise the canopy.

(You will receive the "Warm Up" mode prompt. Don’t do anything.)

After 10 minutes, heater power will automatically cut back to "Pre-Heat" zone.

(Do not use the control buttons to increase or decrease heater power at this point or the bed will alarm every 12 minutes)

Leave the Giraffe in open bed, manual mode.

When you admit a baby to the bed, change to "Baby" mode and adjust the skin temperature setting.

If humidity will be used, add water, (but don’t turn on just yet.)

Skin temp and axillary temp should be stable at least 1 hour prior to initially

closing the bed down into incubator mode.

When you first close down the bed, briefly activate "Air" mode.

(It will read 33.0°C.)

Change this temperature using the "Comfort Zone" recommendation.

(Go to "Comfort Zone" icon. Based on a baby’s EGA, postnatal age, and weight, there will be a recommended temp.  If <1200g- use upper temp of range.  If >1200g- use lower-mid temp of range)

Adjust air temp up or down.

Return to "Baby" mode and adjust skin temp setting.

Turn on humidity.

If you are anticipating an admission of known gestational age or weight, the Giraffe bed may be prepared slightly differently.

Turn on the bed and clear the patient history.

Leave the canopy closed in air control mode.

("33.0°C" will be flashing.)

Change this temperature to efficiently warm the bed using the Comfort Zone recommendation-(see above.)

Adjust the air temp up or down.

Leave the bed in closed position until admission.

(This practice warms the mattress, walls, etc.)

Open the canopy to admit the baby.

Change to "Baby" (servo) mode and set skin temp.

Again, if humidity will be used, add water, (but don’t turn on just yet.)

Skin temp and axillary temp should be stable at least 1 hour prior to initially

closing the bed down into incubator mode.

When the canopy is closed down, leave the bed in "Baby" mode, and

Turn on humidity.

Place the skin temp probe in the right axilla.

The baby’s axillary skin temp should be in the normal range before closing the canopy.

Aim for a skin temp of approximately 36.5°C, but tolerate baby’s temp within a range of normal (36.5 – 37.5°C.) Giraffe’s computer software uses a cascade algorithm to titrate the temp gradually. In "Baby" mode, the ambient temp in the bed should increase or decrease by 0.1°C every 15 minutes to regulate baby’s temperature. If the baby’s temperature continues to trend outside the limits of normal, you may need to change the set (control) temp.

By placing more immature babies in an isolette environment earlier in life, air temperatures in the Giraffe may be higher than you’d expect. 39°C air temp in the Giraffe incubator is equivalent to 100% power on a radiant warmer heat bar.

Be sure to use the Comfort Zone information rather than old temp charts to set the bed temp range.

To perform cares or procedures on an infant in the Giraffe incubator, use the "Air Boost" to create a warm air barrier to minimize disruption of the thermal environment. Air Boost will last for 20 minutes unless reset. The baby can be made more accessible for complicated procedures within the isolette by turning the infant on the "baby susan." However, if multiple procedures or major interventions need to be performed, open the canopy and use the bed as a radiant warmer on manual mode to maintain thermal stability. Remember that all humidity is lost when you convert to radiant heat and evaporative losses increase.

Furthermore, going from open to closed and vice versa creates an air shift over the baby. Covering the infant with a blanket for 1-2 minutes before the change may help.

Increasing ambient humidity decreases evaporative water losses which are particularly high in VLBW (<1500g) infants and extremely high in ELBW (<1000g) micropremies. In this population, use humidity for at least two weeks. You may use humidity for 3-4 weeks if necessary. Using humidity enables the baby to be maintained in a thermoneutral environment at a lower ambient temperature.

The Giraffe bed provides humidity via a vaporizing system designed to prohibit the growth of gram-negative organisms (especially Pseudomonas.)

Use humidity at 60 – 70%.

After 2 - 4 weeks, wean humidity over 12- 24 hours. If the baby’s temperature becomes unstable during the wean, wait for several days before resuming the weaning process. When humidity is decreased to 40%, it may be discontinued.

Discussed at the Nursery Policy & Procedure Meeting 2/21/01.

References:

Sinclair J. Servo-control of abdominal skin temperature at 36ْC in low birth weight infants. Cochrane Systematic Reviews. http://www.nichd.nih.gov/cochraneneonatal/SINCLAIR/SINCLAIR.HTM