Temperature control is far from the only concern when tending to infant incubators

Incubators: Leading the Way in Infant Care
In an 1880 visit to the Paris World’s Fair, Stéphane Tarnier saw bird eggs warming in glass incubators. He was struck with inspiration. Tarnier, an obstetrician, had witnessed many premature babies faltering in the cold maternity wards. Eventually, he persuaded the show’s director to create a similar machine for the hospital.

“It was overall a pretty simple device, basically consisting of an externally heated hot water reservoir underneath a chamber containing the infant. Yet, it had dramatic results,” says Jeffrey Baker, MD, PhD, a physician and medical historian at Duke University, Durham, NC. “Premature infant mortality fell by nearly half. There were few medical interventions in 1880 that could claim such dramatic results.”

First Paris, Then the World
At the turn of the century, a World’s Fair could be counted on to feature the latest in science and technology. Early incubators were often showcased at these events to help increase public awareness and to popularize the idea that premature babies could be treated successfully with technology.

“It’s important to remember that in the early 1900s, babies, in general, were born at home. Parents were often afraid to trust infant hospitals, which routinely had mortality rates of as much as 50%,” says Baker, noting that most children’s hospitals were charitable institutions dedicated to the poor, and they were unable to afford either technology or expert nursing required to take care of preemies. “Because of this, parents would only bring their children to the hospital as a last resort.”

After 20 years of use in France, incubators remained a rarity outside the city of their origin, Paris. At this point, their promoters embarked upon a radically different strategy to win recognition. They began to display infants in world’s fairs and exhibitions. Interestingly, the incubator itself changed in the process.

In Paris hospitals, the role of mothers in caring for their infants was believed to be key in reducing infant mortality, so incubators were kept simple. Soon, the dominant form of French incubators were simple glass boxes powered by hot water bottles.

Americans took a different approach.
“In the US, there was a great deal of ambivalence about saving lives of premature babies, which were called ‘weaklings,’ ” says Baker, who notes that many physicians believed babies were born premature because something was wrong with them. “So Americans focused on very fancy, very complex incubators employing ventilation systems and thermostats.”

This focus on technology produced a much higher-quality incubator—that no one used.

“They were definitely superior for premature babies, but were so expensive hospitals could not afford them,” says Baker. “So they did not make an impact on overall infant mortality.”

A Technology Born Too Soon
A lack of funding combined with reluctant parents delayed any widespread implementation of incubators in infant care for almost 2 decades. During that time, hospitals became a more accepted place to have children, and by 1920, most births took place there.

At roughly the same time, treatment of these tiny patients was championed by Julius Hess, who is regarded by many as the father of premature infant care in the United States.

One of Hess’ most significant contributions was funding. As an active member of Chicago’s Jewish community, he was able to raise significant amounts of money to support research to help develop a premature baby nursery.

“Under his leadership emerged the expert premature baby nurse, who was essential for the technology to succeed,” Baker says. “Before this, advances in the technology alone didn’t matter, because they were countered by poor nursing or inadequate hospital care.”

As acceptance and qualified professionals increased, new innovations were added, primarily thermostats and the provision of high oxygen, both of which came about in the late 1930s and ‘40s.

Unfortunately, not all developments helped infants. For example, early on it was observed that a preemie’s breathing was less labored with pure oxygen.

“High oxygen did, in fact, dramatically lower the mortality of premature babies; however, it led to an epidemic of blindness,” Baker says. “Infants do not tolerate high oxygen concentration, and in the late 1940s and ‘50s, some 10,000 were blinded worldwide by high oxygen in incubators.”

Learning Through Trial and Error
Though these results are tragic, they did prompt physicians to push for continuous improvements to the early incubators that have evolved into today’s complex life-support systems. And just like those clinicians faced 60 years ago, the challenges are sure to lead to even better innovations.

“Now the great challenge,” Baker says, “is trying to not only improve survival, but to improve outcomes and decrease complications of a premature birth.” —DH