This PPT belongs to organization and setup of neonatal intensive care unit services, levels, transport and management. it includes the role of the nurse. and images used in intensive care services.

1. SEMINAR ON
By,
Mr. Abhijit Bhoyar
M Sc. Nursing
ORGANIZATION OF NEONATAL
INTENSIVE CARE SERVICES, LEVELS,
TRANSPORTED, AND MANAGEMENT.

2. GENERAL OBJECTIVES:-
• At the end of the seminar students will be able
to gain the depth knowledge regarding
organization of neonatal intensive care
services, transported, levels, and management
and organization of NICU and developed a
positive attitude and apply a skill in clinical
and teaching practice.

3. SPECIFIC OBJECTIVES:-
At the end of the seminar students will be able to,
• Define the neonatal intensive care unit.
• Explain the importance of neonatal intensive care services.
• Explain the criteria for admission in NICU.
• Discuss the aim/goals of neonatal NICU.

4. • Describe the physical facilities of neonatal care services.
• Discuss the preparation of NICU.
• Describe the admission procedure in NICU
• List down the life threatening condition in NICU.
• Discuss the point that how to make rounds with doctor in
NICU.
• Describe the aspect of NICU.

5. • Describe the equipment and setup of NICU care services.
• Discuss the preventive maintenance, emergency & repair.
• Explain the personnel of intensive care unit.
• Describe the equipment and setup of NICU care services.

6. • Explain the cot –side laboratory facilities in NICU services.
• Describe the transported of sick infants of NICU services.
• Explain the levels of neonatal care services.
• Describe the role of nursing care and management of NICU.
• Explain management of services in NICU.

7. INTRODUCTION:-
• The organization of a good quality special care neonatal unit
(SCNU) is essential for reducing the neonatal mortality and
improving the quality of life among the survivors. During the
past three decades, improvements in the diagnostic and
therapeutic approaches in the care of high – risk infants have
influenced their prognosis favorably.

8. NEONATAL INTENSIVE CARE UNIT

9. DEFINITION:-
The term neonatal comes from neo, "new", and natal,
"pertaining to birth or origin" An intensive care unit (ICU),
also known as a critical care unit (CCU), intensive therapy
unit or intensive treatment unit (ITU) is a special department
of a hospital or health care facility that provides intensive care
medicine.

10. IMPORTANCE OF NEONATAL
INTENSIVE CARE UNITS:-

11. IMPORTANCE OF NEONATAL
INTENSIVE CARE UNITS:-
1. Intensive Care Units cater to
patient with the most severe and
life –threatening illnesses and
injuries; that require constant,
close monitoring and support
from specialist equipment and
medication in order to maintain
normal bodily functions.

12. 2. They are staffed by highly
trained doctors and
critical care nurses who
specialize in caring for
seriously ill patients.
Common conditions that
are treated within ICU's
include those such as
trauma, multiple organ
failure and sepsis.

13. 3. Patients may be transferred directly to an Intensive Care Unit
from an emergency department if required, or from a ward if
they rapidly deteriorate; or immediately after surgery if the
surgery is majorly invasive and the patient is at high risk of
complications , Not only careful nursing, but also new
techniques and instruments now played a major role.

14. 4. As in adult intensive-care units,
the use of monitoring and life-
support systems became routine.
5. These needed special
modification for small
babies, whose bodies were
tiny and often immature.
6. Adult ventilators, for example,
could damage babies' lungs
and gentler techniques with
smaller pressure changes
were devised.

15. 7. The many tubes and sensors used for monitoring the baby's
condition, blood sampling and artificial feeding made some
babies scarcely visible beneath the technology.
8. Furthermore, by 1975, over 18% of newborn babies in Britain
were being admitted to NICUs.

16. CRITERIA FOR ADMISSION IN NICU:-
INDICATION …….
• Low birth weight. (200 gm).
• Large babies (more than or equal to 4kg).
• Birth asphyxia.
• Severe jaundice
• Infant of a diabetic mother.

17. • Neonatal sepsis /meningitis.
• Neonatal convulsion.
• Sever congenital malformation /o2 therapy.
• Injured neonate.
• Exchange blood transfusion.
• Mother of hepatitis B carrier.

18. AIMS/GOAL OF NEONATAL INTENSIVE
CARE UNIT:-
• To improve the condition of the critically ill neonates keeping
in mind the survival of neonate so as to reduce the neonatal
morbidity and mortality.
• To provide in service continuing in-service training education
to medicine and nursing personal in the care of new born.
• To maintain the function of cardio –vascular, pulmonary,
renal, and nervous system.

19. • To monitor the vital sign, central venous pressure, and blood
by non –invasive technique.
• To measure the oxygen concentration of blood is by oxygen
analyzers’.
• To administer precise amounts of fluids and minute quantities
of drugs through I.V. infusion pump.

23. PHYSICAL FACILITIES:-
• The size of the unit is related to the expected population
intended to be served.
• In India, about 15 to 20 percent of newborn babies need special
care, depending upon the criteria for antenatal booking for
confinement.
• In addition, if the center is to serve as a referral unit for the
infants born outside the hospital (extramural babies) allowance
should be made for additional physical facilities and space.

24. • In a maternity unit having 2,000 deliveries per year, facilities
for special care of 6-8 high- risk infants should be available.
• Each infant should be provided with a minimum area of 100
sq. ft. or 10 M2 .
• Additional space would be needed to provide for special
facilities as outlined below in the floor plan, for promotion of
breast feeding, expression of breast milk and its storage.

25. LOCATION:
• The neonatal unit should be located as close as possible to the
labor rooms and obstetric operation theatre, to facilitate
prompt transfer of sick and high – risk infants.
• The presence of an elevator in close proximity is desirable for
transport of out born infants.
• In tropical countries, the nursery should not be located on the
top floor of the hospital but there should not be feasibility for
the sunlight to peep in to the nursery to enhance brightness
and provide ultraviolet rays to augment asepsis.

27. NURSERY DESIGN:-
• The unit design may be in a
square space or a single corridor
based rectangular unit.
• A split unit that is on either side
of the hospital corridor should be
avoided for ease of mobility and
for prevention of infections.

28. • A unit design occupying one side of the corridor
with a nurses control room in the centre, from where
all the babies can be viewed, is preferred.
• Apart from constant surveillance of all babies, the
design should ensure minimal walking distance for
the staff.

29. BABY CARE AREA:-
• The unit should be provided
with areas and rooms for inborn
or intramural babies step down
nursery, out born or intramural
babies, examination area,
mother’s area for breast feeding
and expression of breast milk,
nurses’ station and charting area.

30. • The floor and walls should be made washable glazed or
vitrified tiles and windows should have two layers of glass
panes to ensure some measure of heat and sound insulation.

31. • The obviously infected infants with open sepsis (especially
those with diarrhea and abscesses) should be isolated in a
septic nursery, which should be located away from the SCNU
and manned by different nursing and resident staff.
• A large number of ancillary services are needed and should be
designed and earmarked during the planning stage.

32. HAND WASHING AND GOWNING
ROOM:-
• Hand washing and gowning facility should be located at the
entranced.
• It should be provided with abundant space with self closing
doors.
• A positive air pressure should be maintained in the SCNU so
that corridor air does not enter the SCNU.

34. • Street shoes are changed with nursery slippers, followed by
hand washing and gowning. The use of mask is controversial
and is best avoided.
• Hand –free elbow-operated hand washing sink with liquid
soap dispenser is recommended. Sink should be made of
porcelain or stainless steel.

35. • Pictorial hand washing instructions should be provided on the
wall next to the sink.
• Hands should be dried with single use or disposable napkins
or hot air dryer.
• Walls adjacent to the sink should be made of non- porous or
non-absorbent material to prevent growth of moulds.

36. • Sinks should not be
provided with slabs or
counter tops which are
potent sources of infection.
• The unit should be provided
with 24-hour uninterrupted
water supply by having
dedicated over head tank
with a capacity of 1000-
2000 liters.

37. EXAMINATION AREA:-
• A small comfortable room with
examination table, comfortable
seating, sufficient light, and
warmth is needed for assessment of
baby before admission to the
nursery.
• The baby is cleaned and provided
with nursery.
• The baby is cleaned and provided
with nursery garments in this room.

38. MOTHER AREA:-
• The room should provide with
comfortable seating and privacy
to the mother to breast feed and
express the breast milk with the
help of a location nurse.

39. HAND WASHING STATIONS
• Hand washing sinks should be provided within 20 feet (6
meters) of every newborn bed.
• The sink should be large and deep (24” wide X 16” front –
back and 10” deep) and made of porcelain or stainless steel
and without any counter or shelf.

40. • Single use cotton or disposable
paper napkins should be available
for drying the hands.
• Alternatively, antiseptic sanitizing
solution (sterillium) can be used
for disinfection of hands in
between the babies.

41. PREPARATION OF INTRAVENOUS
FLUIDS:-
• A separate area should be earmarked and provided with a
laminar flow system for preparations of intravenous fluids,
parenteral nutritional formulations, enteral feeds and
medications.
• Boiling and autoclaving facilities should be available next to
this area.

42. NURSES STATION:-
• Nursing station and charting
area for nurses and residents
should be located in a central
area from where all the
babies can be observed.
• Newborn charts, hospitals
forms, computer terminals,
telephone lines should be
located in this area.

43. CLEAN UTILITY AND SOILDE UTILITY
HOLDING ROOMS:-
• There should be enough space for stocking clean utility items
and sterile disposables, and for disposal of dirty linen and
contaminated disposables.
• Built-in wall wooden cabinets with foldable covers are useful
for stacking purposes.

44. • The ventilation system in the soiled utility or holding room
should be engineered to have negative air pressure with all air
being exhausted to the outside.
• The soiled utility room should be so located that it enables
removal of soiled material without passing through the baby
care area.

45. STAFF ROOMS:-
• Space should be provided within
the unit to meet the professional,
personal and administrative needs
of resident staff on duty.
• A comfortable room with
intercom, telephone and computer
terminal and WC facilities is
mandatory.
• Nurse’s change room is required
for changing from formal street
clothes to a smart shirt and trouser
dress stipulated by the NICU.

46. GROWING NURSERY:-
• A separate bay in the lying –in ward should be earmarked for
transitional care of high-risk babies by their mothers before
they are discharged from the hospital.
• The entery of visitors to this area should be restricted and it
should be kept adequately warm.

47. • Facilities for monitoring
asepsis and weighing the
babies should be available in
the transitional care room
(TCR) or growing nursery
(GN).
• The growing nursery is used
with advantage for educating
the mothers in child craft
activities and promoting the
practice of exclusive breast
feeding.

48. VENTILATION:-
• Effective air ventilation of nursery is essential to reduce
nosocomial infections.
• The most satisfactory ventilation is achieved with laminar air
flow system which is rather expensive.
• When centralized air – conditioning is used, minimum of 12
changes of room air per hour are recommended.

49. • There should be no draughts of air on and near the newborn
beds. The air-conditioning ducts must be provided with
Millipore filters (0.5u) to restrict the passage of microbes.
• A simple method to achieve satisfactory ventilation consists
of provision of exhaust fan in the conventional manner near
the floor for air exit.

50. • A constant positive air pressure should be maintained in the
nursery so that contaminated air from the corridors does not
gain access into the nursery.
• The use of chemical air disinfection and ultraviolet lamps are
no more recommended.

51. LIGHTING:-
• The nursery must be well illuminated and painted white or
slightly off white to permit prompt and early detection of
jaundice and cyanosis.
• It is best achieved by cool white fluorescent tubes or LED
(light –emitting diodes) to provide at least 100 foot candle,
shadow-free illumination at the infant’s level. The number and
exact location of fixtures can be worked out taking into
account size of the nursery, height of the ceiling, and
availability or otherwise of sunlight.

52. • Spot illumination for various procedures can
be provided by a portable angle-poise lamp
having two 15 watt fluorescent bulbs
which when held at a distance of about one
foot from the infant, produce about 100 foot
candle intensity of light.
• Most open care systems are equipped with
in built source of overhead spot light.
• In places where electrical failure is frequent
and prolong, the electrical system of the
nursery complex must be attached to a
generator.

53. ENVIRONMENTAL TEMPERATURE AND
HUMIDITY:-
• The temperature of the nursery
complex must be maintained
between 26-28oc (78.8-82.4oF) in
order to minimize effects of thermal
stress on the babies.
• This is best achieved by centralized
air conditioning having temperature
control knobs in the nursery.

54. • The air movement should be so
designed that draught is minimized.
• In places where air conditioning is not
feasible, room temperature can be
reasonable well maintained in winter
by use of radiant heaters and hot air
blowers.
• Portable radiant heater, infra red lamp
or bakery bulb can be used to provide
additional source of heat to an
individual infant.

55. • The external windows of nursery should be glazed to
minimize heat gain and heat loss and baby beds should be
located at least 2 feet (0.6 meters) away from the wall or
window.
• In most parts of India relative humidity averages above 50
percent, this is quite satisfactory for routine need of newborn
babies.

56. • Humidity level can be raised
for preterm babies nursed in
an incubator.
• High and effective humidity
level is useful to reduce
insensible water loss but is
associated with increased
risk of nosocomial infection.

58. PREPERATION OF NICU
• Warm (33-36oc) incubator.
• Adequate light source.
• Resuscitation and treatment trolley stocked.
• History, continuation sheet, treatment and diet sheet, problem
list and flow charts.

59. • Oxygen air and suction
apparatus.
• Oxygen line connected to
oxygen and air flow meter.
• Suction –various size of
suction tube are available.
• Ventilation bag and mask of
appropriate size.
• Vital sign monitors
• Specific equipment as indicate
by diagnosis.

60. ADMISSION PROCEDURE IN NICU
• All babies admitted to the neonatal unit should have the
following data recorded carefully within 24 hours of
admission.

61. History and examination
• Maternal history
• Paternal history
• Previous obstetric history
• Details of present pregnancy
• Labour
• Delivery
• Apgar score

62. On admission
 Notify the doctor and the nurse
incharge.
 Resuscitate infant as necessary
and maintain warmth.
 Check infant identification
label
 Quickly examine the infant
from head to tie for obvious
abnormalities if the condition
permits.

63.  Record weight, length and head circumference as soon as
possible.
 Transfer to warm environment as soon as possible.
 Commonest observation are:-
(a)Temperature – infant normal temperature range 36 0c to 37 0c

64. • Environment –see natural thermal environment charts.
(b) Heart rate.
(C) Respiration
(d) Colour
(e) Activity.
• Explain to parents
• Hand over from transferring unit staff.

65. Record keeping
• Birth history: - done in labour ward.
• History
(a) Ward history contains:-
• Apgar score and examination of new born infant sheet.
• Neonatal weight and feed sheet, progress chart.
(b) Compiled history contains
• Patient registration from.
• Progress sheet
• Intra uterine growth chart.
• O2 flow sheet fluid balance sheet etc.

66. Life threatening condition which require
NICU
The following are the life threatening conditions in neonates:-
• Apnea
• Baby with respiratory distress
• Birth asphyxia.
• Convulsions.
• Low birth weight babies (less than 1500 gm requiring
intensive care.)
• Neonatal jaundice requiring exchange blood transfusion.
• Sepsis and meningitis

67. How to make the round with the
consultant in nicu
• While round with consultant the nurse should maintain
recording and reporting.
• Examine and evaluate assigned patient each day.
• Recording keeping
• Progress notes –It should reflect present status of
infant and new or ongoing problem.

68. • Problem list: - A complete programmed list is kept at the front
of the progress notes.
• This must be kept current, new problem listed and resolve
problem also noted, the number of problem in the progress
chart should be consistent with the problem list.
• Only active problem need to be discussion.

69. • GENERAL STATUS
• Better? Worse? No change?
• Pertinent physical finding.
• NUTRITION :-
• Weight, change appropriate?
Inappropriate.
• Caloric status, source.
• Plan of nutrition.
• Respiratory problem: - Present
status, laboratory finding
• Infection: - If suspected or
present, culture result.
• Apnea: - Number and severity
of apnea, about treatment.
• Cardio vascular: - Physical
finding, blood pressure, results of
test such as echo, treatment.
• Fluid and electrolyte: - Intake
and output, electrolyte, problems
and plan.

70. • Metabolic: - Glucose, calcium, phosphorus, balance or any
problems .assessment and plan.
• Neurological: - Problems, changes, medication, plans,
seizures, blood levels, ECG results.
• Hematological: - Anemia, coagulopathy, neutropenia etc .
• Hepatic.
• Renal problem.
• Eyes discharge.

71. Physical
set up
Administra
tive set up
Aspects of
NICU:
Two main
aspects

72. PHYSICAL SET UP:
• Space between the patient :
• For the patient care, 100 square
feet is required for each baby as
it true for any adult bed.
• 6 feet gap between two
incubator for adequate
circulation and keep the
essential life saving equipment,
space need about 120 sq feet.

73. • Each patient station should
have 12-16 central voltage
stabilized electrical outlets.
• 2 to 3 oxygen outlets.
• 2 to 3 suction outlets & extra
plug for other devices.

74. water :-
• Hand washing :
• Each unit must have an uninterrupted clean water supply and each
patient care area must also have a wash basin with foot or elbow
operated tapes.
• Neat washbasin, placing paper, towel.

75. Colour:-
• Walls of the whole unit should be washable and have or
slightly off white colour for better colour appreciation of the
neonates.
• Lighting:
• The lighting arrangement should be provide uniform, shadow
free illumination of 100 foot any procedure.

76. Sounds:-
• The intensity of noise is kept below 75 decibels.
• The unit should have intercom and outside telephone for
contact with parent and with doctor at a time of emergency.
• Ventilation:-
• Minimum of 6 air changes, 2 air changes should be outside for
filtering the inner air.
• Effective air ventilation of nursery is essential to reduce
nosocomial infection.

77. Rooms:-
• A room for keeping the x-rays and ultra sound machines.
• 1 or 2 room each would be needed for doctor and nurses on
day and night duties.
• Additional space will be required for educational activities and
storage data.
• Mother room, a side laboratory room ,a room for scrubbing
and grooming near entrance.

78. Ventilated air :-
• A simple method to achieve satisfactory ventilation consist of
provision of exhaust fan in a reverse direction near the ceiling
for input of fresh in contaminated air fixation of other exhaust
fan in the conditional manner near the floor for air exist.

80. ADMINISTRATIVE SET UP:-
• MEDICAL STAFF:-In unit a full time neonatologist with
special qualification and special is training in neonatal
medicine.
• He should be responsible for maintenance of standard of
patient care.
• Development of the operating budget.

81. • Equipment, evaluation and purchase
• Planning and development of education programme.
• Evaluation of effectiveness of perinatal care in the area
• He should devote time to patient care service , research and
teaching as well as co-ordinate with level 1 and level 2 in
hospital .area

82. STAFF REQUIREMENTS:
• Neonatal physician 6-12 patient in continuing care, inter
mediated care and NICU.
• He should be available on 24 hours bases for consultation.
• A ratio of 1 physician in training in 4-5 patients who
reacquires intensive care ideal round the clock.

83. • Services of other specialists like
Microbiologist,
Hematologist,
Radiologist, and
Cardiologist should be available on call.
• An anesthetist, pediatrics, surgeon pediatrics pathologist also
be available.

84. NURSES RATIO:-
 Nurses patient ratio of 1:1 maintain throughout day and night.
 A ratio of 1 nurse for 2 sick babies not requiring ventilator
support may be adequate.
 For an ideal nurse’s patient ratio, four trained nurses per intensive
care bed are needed.
 Additional head nurse who is over all incharge.
 For level 2 a dedicated, committed and train staff of highest
quality.

85. EXPERIENCE:-
• A staff nurse must have minimum 3 year work experience in
special neonatal care unit in addition to having 3 month hands
on training in a nicu.
• OTHER STAFF
• 1 sweeper should be available around the clock
• Laboratory technique. ,
• PHN /social worker s,
• Respiratory therapist,
• Biomedical engineer,
• Ward clerk

86. EQUIPMENTS FOR NICU:-
• During the last 2-3 decades, a large number of monitoring
devices for diagnostic and therapeutic use for the high risk
newborn infants have been developed
Resuscitation set -6
Open care system -4.
Incubator -2
Infusion pump- 12
+ve pressure ventilators -6
O2 hoods ,02 analyzer -6
Heart rate apnea monitor without
scope -6
Phototherapy unit -6
Electronic weighing scale -12
Pulse oxygmeters -6
Transcutaneous po2 and bpco2 ,monitor
2-3
BP monitor -2
E.C.G. monitor without defibrillator -1
Intracranial pressure monitor -1

87. Disposable article required for NICU
• I .V CATHETER
• I.V SET ,
• BACTERIAL FILTERS,
• FEEDING TUBE ,
• ENDOTRACHEAL TUBES ,
• SUCTION CATHETER ,
• 3 WAY CANULA,
• SYRINGES ,
• NEEDLES ,
• VENTILATOR TUBES.

88. PREVENTIVE MAINTENANCE AND
EMERGENCY REPAIRS:-
The objectives of preventive maintenance includes.
• The equipment should be functional most of the time and
should operate with accuracy, efficiency and safety.
• The maintenance engineer should undertake at least two
technical visits per year to check the wear and tear, and
performance of the device as per manufacturers technical
check list.

89. • The equipment should be cleaned and defective components replaced
by spare parts.
• He should interact with in –house technician and end –users to
provide necessary guidance for correct use of the equipment to ensure
effective preventive maintenance and upkeep.
• Despite careful use of the equipment, the average lifetime of most
electronic equipment is about 7years.

90. • In the event of break down, when contacted
the service engineer should report to the NICU
without delay to ensure that the downtime of
the equipment is minimum.

91. PERSONNEL:-
• It is important, that while
allocating nursing, medical and
paramedical staff to the
hospital, the needs of the
neonatal unit are not ignored.
• It is unfortunate that newborn
babies are not counted as
patients requiring nursing and
medical care while expressing
the bed strength is hospital.

92. • The census of the hospital bed is administratively based on
dieted beds.
• The survival of newborn babies depends upon the availability
of specially trained nurses.
• The nursing council of India has not outline any special
guidelines for this purpose.

93. • It has been recommended by the Americans academy of
pediatrics that one nurse is needed to offer special or
intermediate nursing care to 3babies or intensive care to one
infant.
• In countries where monitoring devices are not routinely
available, relatively larger numbers of nurses are necessary for
undertaking manual monitoring.

94. • It is generally not appreciated by the hospital administrators
that a considerable time of the nurse is spent in rigorous
housekeeping rituals to maintain asepsis in the nursery.
• The National Neonatology Forum of India has recommended
that at least one trained nurse should be allocated to provide
coverage to four babies in the special care neonatal unit.

95. • The allowance should be kept for additional 25 percent staff to
provide for the exigencies of day off and leave.
• Therefore, for an 8- bedded SCNU, eight nurses should be
sanctioned to ensure availability of two nurses in each shift
along with one additional sister incharge in the morning shift.

96. • The continuity of services can be maintained if at least 50
percent of the nurses are rather permanent and not transferred
frequently as is the usual practice in general hospitals.
• There must be equal distribution of nurses in the three duty
shifts during 24 hours.

97. EQUIPMENT:-
• During the last 2-3 decades, a large number of monitoring
devices for diagnostic and therapeutic use for the high risk
newborn infants have been developed.

98. RESUSCITATION EQUIPMENT:-
• The equipment needed for resuscitations of asphyxiated baby
at birth,
• Emergency tray should be available in each infant care room
of SCNU containing
• AMBU bag and mask,
• Infant laryngoscope,
• Tracheal tubes of different sizes,
• Sterile suction catheters,
• Oral mucus suction traps and
• Emergency drugs.

100. BAG AND MASK
RESUSCITATOR:-
• Self –inflating bag of 250-
500ml capacity is ideal for
resuscitation of a newborn
baby.
• It should be provided with a
pop off valve or with a facility
to attach a pressure gauge.

101. • An oxygen reservoir in the form of a corrugated tube or
rubber bladder helps to increase the oxygen concentration to
90 to 100 percent.
• When self –inflating bag is used without an oxygen reservoir,
it delivery 40-60 percent oxygen because room air enters the
bag with each inflation.
• A one- way valve allows delivery of oxygen at the outlet when
bag is squeezed but closes as soon as the bag is released so
that the exhaled air cannot re-enter the bag.

102. OXYGEN AND SUCTION FACILITIES:-
• A centralized source of oxygen,
compressed air and suction outlet
consoles (50 psi) affixed on the
walls is ideal.
• By mixing variable quantities of
compressed air and oxygen
concentrations ranging between 25
percent to 100 percent. De lee trap
for a single use by self oral suction
with 12 Fr.

103. • Catheter is affordable and
ideal for use at birth.
• A soft plastic catheter or
nozzle with a suction bulb is
a good alternative but
difficult to clean.
• Suction machines using
recoil springs are bulky and
complex to operate and
difficult to clean.

104. CATHETERS, SYRINGES AND NEEDLES:-
• Nasogastric polyethylene feeding tubes (fr.5,6 and 8), suction
catheters (fr 10 and 12), umbilical vein catheters, small –vein
infusion sets (G23), medicates (neoflon), and exchange
transfusion sets are now freely available in India at a
reasonable cost.
• They are repacked sterile by a process of gamma-irradiation.
These should not be reused after boiling.

105. FEEDING EQUIPMENT
Glass or stainless steel
bowls of adequate size (120
ml capacity) should be
available in the nursery for
collection of expressed breast
milk, mixing and preparing
the formula.

106. LAMINAR FLOW SYSTEM:-
• The laminar flow system is
useful for safe and aseptic
formulation and mixing of
drugs, parenteral fluids and
nutrients.
• High efficiency particulate
aggregate (HEPA) filter is used
to filter out bacteria.

107. • Two types of systems are available. In a vertical type system,
the air flows from above downwards and it is recommended
for use in the NICU.
• The horizontal flow type system is used for tissue culture and
microbiologic techniques.

109. WEIGHING MACHINE:-

110. BASSINETS:-

111. INCUBATORS:-

112. RADIANT HEAT WARMER/OPEN CARE
SYSTEM:-

113. THERMOMETERS:-

114. OXYGEN CONCENTRATOR:-

115. OXYGEN CONCENTRATOR:-
• Portable oxygen cylinders are expensive and not
readily available in a district hospital or community
health center.
• Oxygen concentrators are being indigenously
manufactured and they work both on a battery and
mains.
• The atmospheric air is passed through a chemical
which absorbs all gases except oxygen.

116. OXYGEN HEAD BOX (OXIHOOD)

117. OXYGEN ANALYZER:-

118. PERSPEX HEAT SHIELD:-

119. PHOTOTHERAPY UNIT:-

120. HEART RATE MONITOR:-

121. RESPIRATORY RATE AND APNEA
MONITOR:-

122. BLOOD PRESSURE MONITOR:-

123. MULTI-CHANNEL VITAL SIGN
MONITOR:-

124. INFUSION PUMP:-

125. NEONATAL VENTILATORS:-

126. COT – SIDE LABORATORY FACILITIES:-
• A side laboratory for routine analysis blood,
urine, amniotic fluid, gastric aspirate for shake
test and cytology, glucose, bilirubin,
hematocrite and blood gases and acid – base
parameters etc.

127. TRANSPORT OF SICK NEONATES:-
• Neonates are usually transported from labor
room to nursery with level II or III facilities or
NICU.
• Neonatal transport may required from home to
level I centers, level I to level II centers or
level II to level III centers.

128. INDICATIONS FOR NEONATAL
TRANSPORT:-
• Preterm infants with a birth weight < 1500 g or
gestation < 32 weeks.
• Respiratory distress requiring CPAP or assisted
ventilation.
• Severe hypoxic – ischemic encephalopathy.
• Life – threatening sepsis.
• Intractable seizures.

129. • Bleeding neonate.
• Congenital anomalies or surgical neonate.
• Inborn errors of metabolism.
• Severe hyperbilirubinemia.
• Procedures or diagnostic facilities
unavailable at the parent hospital.

130. PRINCIPLES FOR TRANSPORTING
NEONATES:-
• Correct assessment of the baby should be done to
justify the indication of transports and referral.
• Explain the condition of the baby and reasons for
referral.
• Baby’s condition to be stabilized and hypothermia
should be corrected before transporting.

131. • Record case history, need for referral and
treatment given in the referral card or sheet.
• Mother should accompany the baby at the time
of transport or at the earliest time.
• A doctor or nurse or health worker or Dai
should accompany the neonate to provide
necessary care on the way to referral center.

132. (1) LEVEL I NURSERIES:-
a) > 1500 g.
b) Intermittent enteral feeds having
demonstrated a positive Growth trend.
c) Temperature stable in an isolate or open crib.
d) Apnea/Bradycardia controlled

133. (2) LEVEL II NURSERIES:-
a) Stable nutritional and fluid status.
b) Non-acute respiratory status (i.e. conditions
that require low- Flow oxygen therapy only).
c) Infection free: may be nearing completion of
antibiotic Therapy.

134. • (d) Therapeutic level of drugs administered for
chronic disease
• Condition (i.e. caffeine, Phenobarbital, etc.).
• (e) Temperature stable in an isolate or open
crib.
• (f) Free of disease processes requiring
specialized consultation

135. (3) LEVEL III NURSERIES:-
• (a) Stable on supportive therapy.
• (b) Able to tolerate transport procedure.

136. LABORATORY FOR NICU:-
• A micro chemistry laboratory attached to unit.
• House x-ray machine and u .s. g machine
should be mandatory for modern day neonatal
units.

137. • Equipment for measure of specific gravity of
urine and calcium should be available.
• Facilities for T.LC and microscopic
examination of peripheral blood films are for
evidence of infection.

138. DOCUMANTIONS IN NICU:-
• The unit should have printed problem oriented
stationary for maintaining records, admission
and discharge slip etc

139. • Records of all admission should be maintained
in a register or on a computer.
• The information should discuss at least 1 time
in a month to improve the effectiveness of the
NICU in providing the services.

140. ROLE OF NURSE IN NICU:-
• Neonatal nurse is one of the important members of the
NICU team, monitoring the baby continuously using
clinical and electronic monitoring.
• Neonatal nursing is considered to be a highly
specialized area of knowledge and practice that
requires lengthy supervision experience to reach to a
level of competence that permits independent
functioning.

141. RESCENT RESERCH FINDINGS
• CAN I DO EVERYTHING? TIME MANAGEMENT IN
NICU
• This paper presentation finding of a study which explored
the lives experience of managed time for new graduate
nurses working in NICU unit in the public health system
in australia.information was collected through conducting
in depth focused interviews with six nurses’ .

142. Conclusion:-

143. 143