Neonatus installs the Neonatal Ventilator at each intensive-care cot. This turbine-driven, time-cycled, pressure-limited ventilator delivers tidal volumes as low as 2 mL with a volume accuracy of plus or minus (0.1 mL + 5% of reading) using a hot-wire anemometer flow sensor positioned at the airway. Modes include synchronised intermittent mandatory ventilation SIMV with pressure support, pressure-controlled ventilation PCV, and volume-targeted ventilation VTV. For the extremely low birthweight infant less than 1000 g, VTV is recommended to maintain a tidal volume of 4–6 mL/kg while minimising volutrauma.

The ventilator’s lung-mechanics monitoring panel displays dynamic compliance Cdyn, airway resistance, and the pressure-volume PV loop in real time. A decremental PEEP trial algorithm helps the clinician identify the optimal PEEP — the lowest pressure that maintains SpO2 in the 90–95% range while delivering the smallest FiO2. The ventilator is equipped with a heated-wire circuit double-limb for invasively ventilated patients, single-limb with leak compensation for nasal CPAP and an active servo-humidifier maintaining airway humidity at 37 °C and 100% relative humidity. An integrated pulse oximetry module Masimo SET technology is preferred, providing reliable SpO2 readings with a 2–4 second averaging time.

Technical Note: The flow sensor must be calibrated at least once per shift, and always after reconnection of the circuit, by running a 10 mL calibration syringe through the sensor at 60 cycles per minute. The heated-wire circuit’s water trap must be emptied every 2 hours; a full trap causes auto-triggering and delivers an unintended breath that increases the risk of pneumothorax in a surfactant-deficient lung.

For infants requiring supplemental oxygen without positive-pressure support, Neonatus supplies the Oxygen Hood, a transparent, double-walled polycarbonate dome with a soft neck collar and an integrated gas-inlet that accepts a blended air-oxygen mixture. The hood’s internal volume is 12 L, allowing a 50% oxygen concentration to be reached within 90 seconds at a gas flow of 8 L/min. An internal oxygen analyser continuously samples the concentration through a side-port, with an alarm set at plus or minus 5% of the prescribed FiO2. The hood is placed over the infant’s head while the infant lies supine inside the Incubator, eliminating the need for nasal prongs that can cause mucosal injury in the extremely preterm.

The hood’s gas flow is warmed and humidified by the Incubator’s integrated servo-humidifier, maintaining the internal atmosphere at 34 to 36 °C and 80 to 90% relative humidity. The infant’s SpO2 is monitored via the ventilator’s pulse oximeter, and a weaning protocol, reducing FiO2 by 2% every 15 minutes as SpO2 permits, is displayed on the cot-side chart. For infants transitioning from CPAP, the hood offers a comfortable, non-invasive alternative during the final stage of oxygen weaning.

Technical Note: The hood’s polycarbonate dome must be inspected weekly for micro-crazing; residual ethylene oxide from sterilisation can produce surface cracks that shatter under thermal stress. The oxygen analyser’s galvanic cell has a lifespan of 12 months and is replaced on a pre-programmed replacement schedule; a failing cell produces a falsely low reading, leading to unintentional hyperoxia.

Neonatus deploys the Infant Incubator as the controlled thermal and humidity environment for the ventilated infant. The incubator is a double-walled, forced-convection design with a servo-controlled air temperature maintained at 34–37 °C, depending on the infant’s weight and gestational age. The air circulation is filtered through a high-efficiency particulate air HEPA filter 99.97% efficiency at 0.3 μm, producing a laminar downflow over the infant’s mattress. The incubator’s integrated servo-humidifier injects sterile water vapour into the circulating air, maintaining a relative humidity of 80–90% for preterm infants less than 30 weeks to minimise transepidermal water loss.

The incubator’s controller uses a dual-sensor algorithm: an air-temperature sensor and a skin-temperature probe placed on the infant’s abdomen. In skin-servo mode, the incubator adjusts the air temperature to maintain the infant’s skin at 36.5 °C, automatically compensating for the radiant heat loss through the portholes when the side door is opened. The hood of the incubator has four iris-ported access doors that allow the respiratory therapist to adjust ventilator settings without fully opening the hood, preserving the internal atmosphere.

Technical Note: The skin temperature probe must be covered with a foam-backed reflective disk; exposing it to the radiant warming of the incubator’s heating element will produce a spurious reading 1.0–1.5 °C above the infant’s true core temperature. The incubator’s HEPA filter is replaced every 3 months; a clogged filter reduces airflow by 30% and compromises temperature uniformity.

Neonatus links the Ventilator, the Oxygen Hood’s analyser, and the Incubator’s temperature/humidity controller via a real-time data bus. A 19-inch touchscreen monitor at the cot-side displays the infant’s SpO2, heart rate, respiratory rate, FiO2, tidal volume, minute ventilation, and the incubator’s air temperature and humidity. A colour-coded “Stability Index”, a weighted composite of SpO2 variability, desaturation frequency, and ventilation efficiency, is displayed as a trend bar, giving the nursing staff an at-a-glance assessment of the infant’s respiratory status.

An integrated alarm system escalates alerts in three tiers: yellow for example SpO2 less than 88% for 15 seconds triggers a visual alert on the monitor; orange SpO2 less than 85% for 30 seconds, or EtCO2 greater than 60 mmHg sends a notification to the nurse’s mobile device; red bradycardia less than 80 bpm with SpO2 less than 80% for more than 60 seconds sounds a loud audible alarm at the cot and pages the on-call neonatal fellow. All alarm events are logged with a 30-second pre-trigger waveform capture, enabling retrospective analysis of the physiological cascade leading to the event.

Technical Note: The data bus must be isolated from the hospital’s general Ethernet network via a dedicated VLAN with guaranteed 10 Mbps bandwidth. Latency exceeding 100 ms can cause the alarm to sound after the infant has already self-recovered, increasing alarm fatigue. The stability index algorithm must be recalibrated every 6 months using a sample of 500 infants to adjust for unit-specific case mix.

Neonatus configures the ventilator’s software with a structured weaning protocol. When the infant meets pre-set criteria – FiO2 <0.30, PIP < 18 cmH2O, frequency < 20 bpm, and a stable PV loop for>6 hours – the display presents a “Weaning Readiness” flag. The respiratory therapist performs a spontaneous breathing trial (SBT) by switching to CPAP mode with pressure support of 5 cmH2O for 30 minutes. If the infant maintains SpO2 > 88%, respiratory rate < 60, and no bradycardia, the extubation checklist is activated. After extubation, the infant is placed in the Oxygen Hood inside the Incubator, and the transition success rate (no reintubation within 48 hours) is tracked.

For intra-hospital transport, a transport-configured ventilator and a transport incubator are used. The transport ventilator operates on a 2-hour battery, delivering the identical mode and settings as the bedside ventilator; the transfer is seamless with a single “transport” hot-key that swaps the circuit to the transport unit while maintaining the same parameters. A handoff checklist is completed at the destination (e.g., MRI suite, operating theatre), signed by both the transferring and receiving teams.

Technical Note: The spontaneous breathing trial must be conducted with the infant in the prone position if tolerated; prone positioning improves thoracoabdominal synchrony and increases SpO2 by 2-3% in preterm infants, potentially preventing a false-negative SBT. The transport ventilator’s battery must be load-tested weekly by running it at the highest setting (PIP 30, rate 60) for 15 minutes; a battery that cannot sustain the 2-hour rated runtime is replaced immediately.