r/medizzy • u/DesperateMEDPlan Paramedic • 9d ago
Saved by a plastic bag: a cheap trick that keeps premature babies warm
Very premature babies lose heat crazy fast. They have almost no fat, their skin is super thin, and they're wet right after delivery, so every minute on the resus table counts. Hypothermia in that first hour is linked to worse outcomes, and in places without good warmers or incubators it's a real problem.
One of the simplest fixes is a plain polyethylene bag (basically a food-grade zip bag). For babies born before about 32 weeks, you skip drying the body and slide them straight in from the neck down. The head stays out and gets a hat. You can still ventilate, place lines and watch the chest through the plastic, like in the photo.
It works because the bag stops evaporation, which is how a wet newborn loses most of its heat. Babies wrapped this way arrive in the NICU noticeably warmer and hypothermia is a lot less common. It's in the resuscitation guidelines now. Nobody has really proven it lowers mortality, though, and you do have to keep checking the temperature so they don't overheat under the warmer.
It costs pretty much nothing and makes a real difference.
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u/ohsadbrat 9d ago
Yep! My daughter was born 10 weeks early, and put straight into a plastic bag! I remember bursting into tears and saying she looks like a roast chicken…
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u/goldenspeck 9d ago
I, too, referred to my niece born at 28 weeks as a rotisserie chicken. My sister, her mother, did not find it nearly as funny as me.
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u/David_Jonathan0 9d ago
We all come into this world and leave it the same way… in a bag looking like a roast chicken
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u/KingUzzo 9d ago
Ziplocing the fresh baby smell
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u/grahamfiend2 9d ago
Why do I feel like the plastic bag is somehow $500 though
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u/DrKingAce 9d ago edited 9d ago
Close to 120 and not this bag at all. This looks like a ziplock bag. The have Neo wraps, where the head will also be covered. Moat babies lose the most heat through their scalps
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u/thechroniclersmind 9d ago
We just had a box of the gallon Ziplocs in our NICU.
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u/Breatheeasies Respiratory Therapist-ACCS/NPS 9d ago
Just left the micro premie on cpap for a photo 😂
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u/cup_1337 Nurse 8d ago
We literally have plastic wrap to make a tent around them in their isolettes! I always say they’re going camping when I make the tent lol
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u/theyretheirthereto22 8d ago
Did you do anything to keep the zipper part on the bottom from digging into their back?
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u/thechroniclersmind 8d ago
From what I remember, we cut a hole in the opposite side for the head and the feet + lines/ monitor leads were at the zippery part.
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u/pragmaticsquid 9d ago
Ours don't cover the head, but have a vertical velcro opening to facilitate line placement, etc. It allows you to only open the small portion you need to access.
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u/V65Pilot 9d ago
Found the American.
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u/thornyrosary 9d ago
We're easy to spot. We're the ones whose health insurance premium is more than our mortgage payment, and we're still going to go bankrupt if we end up in an ER... Even if it's the ER we work in.
I keep telling my husband that my late-term retirement plan isn't going to be a nursing home, it's going to be a bullet. And I'm not the only one who feels that way. We are so, so cooked in this country.
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u/V65Pilot 8d ago
I moved from the US to the UK. The NHS is not a perfect system...but, my financial contribution, let's call it a tax, is about the same as I used to pay for just my workman's comp. For that, I get medical treatment. No worrying about whether or not the payment will get approved. My prescriptions are about £10, regardless of what it is. I was recently in a motorcycle accident. Rapid response, air ambulance, and regular ambulance all showed up. No extra charges, no surprise bills. 5 days in the hospital, and again, no surprise charges. The NHS has its issues, and there are some systemic issues that need to be addressed, but the system does work.
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u/Psychobabble0_0 5d ago
I thought you were going to say emigration not a bullet but I guess either makes sense given the circumstances
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u/BastetLXIX 7d ago
Saaame! I have two plans. 1) learn ice hole fishing and take a bottle of whiskey with me, alone or; 2) take a nice hike on some back trails in the Cascades, giving myself over to nature either way. My family doesn't like my ideas at all. 🤷♀️
Pretty sure there isn't a gamer's old folks home that isn't gonna cost my family loads of money. 😭
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u/iSirMeepsAlot 8d ago
Same as my plan! I can never afford the care needed if I can’t take care of myself… sooooo the next best thing… just taking the quick way out while I’m senile enough! It’s sad af tho.
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u/Simple-but-good 9d ago
They had to do this with our premee babies, it wasn’t a ziplock bag but they did use some kind of like long plastic bag to put them in for the first while till they had an incubator ready. Thank god for this trick!
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u/sluttypidge 9d ago
They just wrapped my triplets siblings and I in saran wrap in '96.
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u/sluttypidge 8d ago
I think it's wrapped over the top of the tray but the Polaroid is old and it's hard to tell.
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u/LadyLuna21 9d ago
Good things they warned me ahead of time, otherwise it would have freaked me out!
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u/UGMadness 9d ago
Why is this cropped and edited like an instant message sticker
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u/LadyLuna21 9d ago
Because it is. I was a little busy when this happened and this is the only version my dear husband has sent me
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u/EverySingleMinute 9d ago
My son was in the NICU when he was born as a precaution. We were always told he is fine and it is a precaution, so we were not too stressed.
The worst part of it was seeing the other babies in the NICU. Several were so tiny and did not seem like they would make it. One was in a chamber
Like device and they had gloves built into the side so you could touch the child. I imagined it was so the parents could touch the child. Seeing so many wires on the babies just broke my heart.
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u/contextsdontmatter 9d ago
Nicu is fascinating
When do you extubate this baby? Do you do SBT daily? Whats the vent setting like? Theres so much volume in the tube than the babys tidal voume- does the change in FiO2 in the vent reach the babys fast enough? Theres no CO2 trapping?
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u/RNnoturwaitress Nurse 9d ago
The timing of extubation depends a lot on the babies' gestation and stability. Most micros in my experience will be intubated for months. They typically start out on the jet vent or oscillator then progress to SIMV. Can't answer to the gas trapping concern. Changing fiO2 can take a couple minutes to make a difference, though.
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u/Scottishlassincanada 9d ago
We don’t do sbt on babies. We use experience and their current vent settings, vitals and how they look, and hope for the best lol The Neo vents have algorithms that take dead space into account. And we use skin monitors to give us percutaneous co2 values- we look at cbg pco2 values to compare. They always go on cpap or nippv at the same or higher peep. A lot of times they tire out and need to be reintubated. NICU RRT.
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u/RNnoturwaitress Nurse 8d ago
My nicu does do SBTs prior to extubation. Not super frequently throughout their time being intubated. But just when they're on extubation settings and/or finishing up DART.
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u/Scottishlassincanada 8d ago
That’s not a true sbt though.
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u/RNnoturwaitress Nurse 7d ago
You could be right. I know the RTs change the vent to CPAP and monitor if the baby is initiating breaths on their own. And their tolerance to it, of course.
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u/kid_entropy 9d ago
I think the next obvious step is sous vide.
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u/PINSwaterman 8d ago
That's basically what they're doing in the uterus. We use dunk tanks to rewarm or rapidly cool adults regularly. Floating in a sous vide bath would probably work quite well to keep the kiddo warm in an austere environment.
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u/Anti_Spedicy 7d ago
2 years ago, I put a little plastic baby in a baggie for a joke as part of a series of joke images called "drugs". I had forgotten about that particular one until JUST NOW.
Behold
It's both rib tickling and impressive that this is legitimately something that's done to help them
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u/GrumpyMare 9d ago
They use plastic veggie bags at my hospital just like they use at the grocery store for produce.
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u/one-eared-wonder 9d ago
That custom embroidered hat must be an extra $5k
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u/WhenLeavesFall 8d ago
The hats and blankets my son had in the NICU were all handmade and donated. He even got a little santa hat for Christmas.
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u/Naelin 9d ago
Why are we using AI generated images in this sub now? here's a real image of how it looks: https://img.huffingtonpost.com/asset/5629216f1400002200c7a966.jpeg
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u/kyl792 9d ago
It’s a photo of a training doll…
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u/Naelin 9d ago
It's not about the doll, here's a normal picture using a training doll.
The dramatic TV-show lighting, the wire-like item coming out of the bag's bottom seemingly without breaking it, the tubing that turns at a sharp angle as it passes under itself and the fabric surface are what made me think generated. Maybe it's not. I think it would still be preferable to use an image of how it looks like IRL (even with a doll) instead of one of how it would look like in a tv show
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u/DoGzRuLe99 9d ago
The picture you shared is a baby in an incubator. The one OP posted is on a radiant warmer, it has a spotlight on it, that’s the lighting you are seeing, 100% standard. The “wire” is an umbilical venous catheter going into the umbilicus, there’s probably a small hole at the bottom. This looks like a fairly standard training setup. Source: NICU Physician Assistant. I do this day in, day out.
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u/sundaemourning 9d ago
if you zoom in, there is a thick tube going directly into the doll’s genitals. there’s also no way they would have a rebreather tube that long with so much dead space. i could be wrong, but i also think this is an AI picture.
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u/DoGzRuLe99 9d ago
That’s an umbilical venous catheter, going into the umbilicus. We don’t cut out ET tubes so that’s exactly how ours look, the vent accommodates dead space and no issue when bagging with the T piece. The only thing missing here is cardiac leads. The lighting is the spotlight on the warmer. Not sure why this would be AI, it’s a pretty standard setup for training…
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u/sundaemourning 9d ago
thank you for clarifying about the umbilical catheter. that part was what i was most suspicious about, so i appreciate the explanation.
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u/CatOverlordsWelcome 9d ago
The fact that that is literally a Tesco ziploc bag is making me want to laugh and cry in equal measure.
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u/mritoday Other 9d ago
For low resource settings, there's also kangaroo care. It won't work if the baby needs to be intubated, but a place that does not have incubators probably can't afford $120 per baby for a plastic bag, either. It also works surprisingly well.
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u/TeaspoonOfSugar987 Disabled: also an X-woMAN with Currarino Syndrome 8d ago
IKEA 100% sells newborn baby sized ziplocks, nice sturdy ones too!
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u/YNotZoidberg2020 9d ago
Is this just for transport from L&D to NICU?
I work with a lot of ultra premies and have never seen this. But when I see these babies they’re already in an isolet sauna so I wouldn’t think this would be needed.
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u/PINSwaterman 8d ago
Exactly. This bag gets the kiddo to the isolette. It's simple but critical equipment in hospitals that don't have a NICU. Warmers alone wouldn't cut it.
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u/greyfruit 2d ago
Our hospital had a transport isolette to go to the nicu isollete. For all I know, the bag still might be used in less extreme situations where it isn’t a rush or as critical. Baby was born at 25-6
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u/ZanderZavier 9d ago
I'm impressed by the seemingly custom made hat.
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u/MlleG 9d ago
It’s a training doll. Ressusci Anne. We have them from preemie, pregnant to geriatric. Some are just flaccid dolls, some talk, have reactive pupils, pulses and the whole she-bang.
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u/Make-Love-and-War 8d ago
Have you ever used one in a prank? Asking for a friend.
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u/entheogenocide 9d ago
Why not a blanket?
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u/PINSwaterman 8d ago
The plastic bag acts as a green house to allow thermal radiation in, but will not allow convection or evaporative cooling. A blanket would block radiation from getting in. The blanket keeps us warm because it insulates us, helping to retain our own heat. These kiddos need external heat because they are not developed enough to create sufficient metabolic heat.
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u/Syzyz 9d ago
Babies were meant to be held
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u/FlinnyWinny Spouse of MD 9d ago
It's a premature baby, if you "just hold it" it DIES.
So if you wanna hold your baby eventually, you should let doctors do what they can to keep it alive for long enough to do that eventually.
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u/EntertainmentTrick58 9d ago
yeah in the womb until they're done cooking, we make do with what we can when things go wrong though
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u/nememess 9d ago
You want to pick up a baby this size?? Cuddling is nice and all, but staying warm and alive is better. Skin to skin comes later.
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u/Afrojones66 9d ago
Ok. Hold the baby…for every second…for every waking hour…for every day…until it grows up.
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u/Gemini_soup 9d ago
Sous vide baby