PHYSICAL INFRASTRUCTURE OF NICU

2. ORGANIZATION OF
NEONATALINTENSIVE CARE
UNIT

3. INTRODUCTION

4. WhatisaNICU?
NICU means….

5. DEFINITION
•Newborn or neonatal intensive
care unit,an intensive care unit
designed for premature and ill
newborn babies.
Andria Santiago

6. •A neonatal intensive care unit,is an
intensive care unit specializing in the
care of ill or premature newborn
infants.
wikipedia

7. AIMOFTHEORGANIZATION
OF ANICU
•Reducing the neonatal
mortality and improving the
quality of life among the
survivors

8. OBJECTIVES
•To save the life of the
sick new born
•To prevent damage in infants with
problems at birth and also reduce
morbidity in later life

9. •To monitor high risk
newborns so as to reduce
mortality and morbidity in
these babies

10. BASIC REQUIREMENTS
•Adequate space
•Availability of running water round
the clock
•Centralized oxygen and suction
facilities

11. •Maintenance of thermo neutral
environment
•Availability of plenty of linen
and disposables
•Facilities for availability to treat
common neonatal problems

12. MAIN COMPONENTS TO BE
CONSIDERWHILE
ORGANIZING ANICU
1. PHYSICAL FACILITIES
2. PERSONNEL
3. EQUIPMENTS
4. LABORATORY
FACILITIES

13. 5. PROCEDURE MANUAL
6. TRANSPORT OF SICK INFANTS
7. COOPERATION BETWEEN
THE OBSTETRICIAN AND
NEONATOLOGIST

14. 1.Physicalfacilities
•Location
•Space
•Floorplan
•Ventillation

15. •Lighting
•Environmentaltemperature
andhumidity
•Acousticcharacteristics

16. •Handling andsocial contacts
•Communicationsystem
•Electricaloutlets

17. location
 located as close possible to the labor rooms and
obstetric operation theatre
 should not be located on the top floor
 brightness and provide ultra violate rays to
augment asepsis.

18. space
500-600 Gross square feet per bed.
Space includes patient care area,
storage area, space for doctors,
nurses, other staff, office area,
seminar room area, laboratory area
and space for families
6 Feet gap between two incubators
for adequate circulation and
keeping the essential lifesaving
equipment

19. FLOOR PLAN
Open encumbered space
The walls should be made of washable glazed tiles and
windows should have two layers of glass panes.
Wash basins with elbow or floor operated taps facility
having constant round-the- clock water supply should
be provided.
The doors should be provided with automatic door
closers.
Isolation room

20. BabyCareArea
 Areas and rooms for inborn or
intramural babies,
 Examination area
 Mother’s area for breast feeding and
expression of breast milk
 Nurses station and charting area.

21. HandWashing AndGowningRoom
 Should be located at the entrance.
 self closing doors.

22. ExaminationArea

23. MotherArea

24. NursesStations
 Central area
 Newborn charts,
hospital forms,
computer
terminals,
telephone lines
should be
located in this
area.

25. CleanUtilityandSoiled UtilityHoldingRooms
 Stocking clean utility items and
sterile disposables, and for
disposal of dirty linen and
contaminated disposables.

26. StaffRooms

27. LIGHTING
 Well illuminated and
painted while or slightly off
 Cool white fluorescent tubes
 The number and exact
location of fixtures can be
worked out taking into
account size of the nursery,
height of ceiling, and
availability or otherwise of
sunlight.

28. ventilation
 Effective air ventilation of nursery
 Provision of exhaust fan
 Do not use chemical air disinfection and ultraviolet
lamps

29. ENVIRONMENTALTEMPERATURE AND
HUMIDITY
 26-28°C in order to minimize effect of
thermal stress on the babies.
 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 away from the wall and windows.

30. 2.Personnel•Skillednurses
•Neonatologists
•Labtechnician
•Biomedicaltechnician
•Respiratorytherapists
•pathologists

31. STAFF
• A direct who is a full time neonatologist
• One neonatal physician is required for every
6-10 patients
 One resident doctor should be present in the unit
round-the-clock.
• Anesthetist - pediatric surgeon and pediatric
pathologist are essential persons in establishment of
a good quality NICU

32. NURSES
 A nurse : patient ratio of 1:1 maintained thought out day and
night is absolutely essential for babies on multi system support
including ventilatory therapy.
 For special care neonatal unit and intermediate care, nurse to
patient ratio of 1:3 is ideal but 1:5 per shift is manageable.
• Head nurse is the overall in-charge
 In addition to basic nursing training for level-II care, tertiary care
requires, staff nurse need to be trained in handling equipment, use
of ventilators and initiation of life-support like use of bag and
mask resuscitation, endotracheal intubations, arterial sampling and
so-on.
 The staff must have a minimum of 3 years work experience in
special care neonatal unit in addition to having 3 months hand-on-
training in an intensive care neonatal unit.

33. 3.Equipments
•Resuscitationequipment
•Bag andmaskresuscitator
•Oxygenand suction facilities
•Catheter,syringes andneedles

34. •Feedingequipment
•Laminar flowsystem
•Weighingmachine
•Bassinets

35. •Incubators
•Radiant heatwarmer
•Thermometer
•Oxygenanalyzer

36. •Oxygenconcentrator
•Perpex heatshield
•Photherapyunit
•Heartratemonitor

37. •Respiratory rate andapnea
monitor
•Blood pressuremonitor
•Multichannelvitalsignmonitor
•Infusionpump

38. •Bilirubinanalyzer
•Transcutaneous
bilirubinometer
•Transcutaneous bloodgas
monitor
•Pulseoximeter

39. •Capnographyorendtidalco2
•Neonatalventilators
•Neonatal pulmonaryfunction
tests
•Cranialultrasonogram

40. •Intracranial pressuremonitor
•Extracorporealmembrane
oxygenator
•Placentaprototype

41. •4.Laboratoryfacilities
•5.Transport of sickinfants
•6.Proceduremanual

42. 7.Cooperation between the
obstetrician andneonatologist
•Antenatalcareandfoetaldiagnosis
•Perinatalhypoxia
•Promotionoffeedingwithhuman
milk
•Supervisedcareoflowbirthweight
babies

43. INDICATIONS FOR THE ADMISSION TO NICU
•Babies less then 30 weeks
•Very low birth weight baby of less then 1500 gms
•Cardiopulmonary monitoring
•Surfactant therapy
•Convulsions
•Severe birth asphyxia
•Assisted ventilation
•Total parenteral nutrition
•Major surgery

44. LEVELSORGRADES
OF NEONATALCARE
•Level I
•Level II
•Level III

45. LEVELSOF NEONATALCARE LEVELI CARE
•The minimal care
•Provided by the mother under the supervision of basic
health professionals.
•Neonates weighting more than 2000 gm or having
gestational age maturity of 37 weeks or more belong to
this care.
•This care can be includes care of delivery, provision of
the warmth, maintenance of asepsis, and promotion of
breast feeding.

46. LEVELSOF NEONATALCARE LEVELII CARE
•This care includes requirement for resuscitation, maintenance of
thermo neutral temperature, intravenous infusion, gavage feeding
phototherapy and exchange transfusion.
•10-15 percent of the newborn require this care
•This care s is anticipated for the infants weighing in between
1500 & 1800 gm or having gestational age maturity of 32 to 36
weeks.

47. LEVELSOF NEONATALCARE LEVELIII CARE
•This care includes life saving support system like ventilator
and best suited special intensive neonatal care.
•Three to five percent of newborn require care of this
level.
•This level of care is for critically ill babies, for those
weighing less than 1500 gm or having gestational age
maturity of less than 32 weeks.

48. EQUIPMENT FOR LEVEL III NURSING – 6 BED
Sl.No Item Nos
1 Resuscitation set 6
2 Open care system 4
3 Incubators 2
4 Infusion pumps 12-18
5 Positive pressure ventilators 6
6 Oxygen hoods, oxygen analyzers 6
7 Heart rate – apnea monitors with scope 6
8 Phototherapy unit 6

49. EQUIPMENT FOR LEVEL III NURSING – 6 BED
9 Electronic weighting scale 1
10 Pulse oxymeters 6
11 End tidal CO2 monitor 6
12 Transcutaneous PO2 & PCO2 2-3
13 Noninvasive Bp monitors 1-2
14 Invasive Bp monitors 1-2
15 ECG monitor with defibrillator 1
16 Intra cranial pressure monitor 1
17 Portable radiographic machine 1
18 Portable ultrasound machine 1
19 Blood gas analyzer 1