key: cord-0742082-nwr5jvdc
authors: Kumar, Abhyuday; Kumar, Neeraj; Kumar, Amarjeet; Chowdhry, Bhabesh Kant; Sinha, Amit Kumar
title: How a portable negative pressure incubator for COVID‐19 was created with minor modifications
date: 2020-08-16
journal: Acta Paediatr
DOI: 10.1111/apa.15521
sha: 1fc3c99847dd27a5dfeebec33824cacfb5d62968
doc_id: 742082
cord_uid: nwr5jvdc

The COVID‐19 pandemic is affecting all age and patient groups, including pregnant women and neonates. There is no evidence at the moment to show vertical transmission and intrauterine virus infections in fetuses when women develop COVID‐19 pneumonia in late pregnancy. However infections in neonates are higher than in older children, according to the largest population‐based study to date, and this means that infants may also face a higher risk of severe respiratory failure (1). Dong et al’s national study of 2143 paediatric cases in China from 16 January to 8 February 2020 showed that 10.6% of the severe and critical cases were under one year of age. The incidence rates for the other paediatric age groups studied were: 1‐5 years (7.3%), 6‐10 years (4.2%), 11‐15 years (4.1%) and 16 years plus (3.0%).

The COVID-19 pandemic is affecting all age and patient groups, including pregnant women and neonates. There is no evidence at the moment to show vertical transmission and intrauterine virus infections in fetuses when women develop COVID-19 pneumonia in late pregnancy.

However infections in neonates are higher than in older children, according to the largest population-based study to date, and this means that infants may also face a higher risk of severe respiratory failure (1). Dong et al's national study of 2143 paediatric cases in China from 16 January to 8 February 2020 showed that 10.6% of the severe and critical cases were under one year of age. The incidence rates for the other paediatric age groups studied were: 1-5 years (7.3%), 6-10 years (4.2%), 11-15 years (4.1%) and 16 years plus (3.0%).

Aerosol generating procedures carry the highest risk of transmitting infection and this has particular relevance in neonatal settings, where continuous positive airway pressure (CPAP) and high-flow oxygen therapy are commonly used. Guidance for units treating neonates with COVID-19 recommend full personal protective equipment protection for CPAP and high-flow therapies of at least two litres per minute. They also suggest keeping the expiratory limb of the CPAP in the incubator whenever possible (2) . The American Academy of Pediatrics recommends that COVID-19 patients should be placed in negative pressure rooms or in incubators (3).

With the rise in COVID-19 patients across the globe, many hospitals are facing an unprecedented crisis with regard to equipment and infrastructure. A negative pressure room is necessary to

This article is protected by copyright. All rights reserved contain this new virulent killer and hospitals are racing against time, budget and infrastructure to create them.

We recognised the need for negative pressure incubators for neonatal patients with COVID-19. To address this, we created a negative pressure incubator using readily available and affordable materials. We used a Neo Shield, Model Neo 1001 incubator (Neokraft Medical Pvt Ltd, Karnataka, India) and drilled numerous small holes in the last 40cm of the suction tubing. This tube was then fixed over the end wall, where the infant's head is placed, and the roof of the incubator (Figure 1, Panel A) . The suction tube was then passed through the underwater seal drain system, which contained 100ml of 1% sodium hypochlorite, to disinfect the exhaust air before attaching it to the wall suction unit (Figure1, Panel B) . The inlet for the surrounding airflow was This assembly has a number of advantages. It can be easily constructed using readily available and affordable materials and this also make it useful in low-resource settings. The unit is portable, which means that it can be used in different locations like neonatal intensive care units and labour rooms. It provides an effective physical barrier that creates an enclosed continuous negative airflow and it allows oxygen therapy and aerosol generating procedures in patients with COVID-19 patients, while preventing aerosol dispersion.

The unit could also be used in the post COVID-19 era for containing other respiratory infectious diseases, like tuberculosis.

This article is protected by copyright. All rights reserved We realise that further research and testing are necessary to quantify the effectiveness of this modified unit in reducing the exposure of healthcare workers to aerosol generating procedures.

However, we believe that this is an ingenious device and that a better design based on these principles can be developed in the future.

CPAP, continuous positive airway pressure.

This study did not receive any specific funding.

The authors have no conflicts of interest to declare.

Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China epidemiology of COVID-19 among children in China

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FAQS: Management of infants born to infants born to mothers with suspected or confirmed COVID-19

COVID-19. Information for Health Care Professionals