Organization of NICU

1. ORGANIZATION OF NEONATEL
INTENSIVE CARE UNIT
Ms. Kanchan Mehra
M.Sc. (N) I yr
PCNMS

2. INTRODUCTION
The organization of a good quality
neonatal intensive care unit, special care
neonatal unit is essential for reducing the
neonatal mortality and improving the
quality of life among the neonates.
Patient ratio of 1:1
maintained thought
out day and night is
absolutely essential
for babies on multi
system support
including ventilatory
therapy

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

4. LEVEL OF NICU
According to American academy of pediatrics the neonatal care is devided into
four categories. These are –
1. LEVEL I- WELL NEWBORN NURSERY:- These are generally referred
to as the well baby nursery. These kind of nurseries have the capability to
provide neonatal resuscitation at every delivery.
• Evaluate and provide postnatal care to healthy newborn infants.
• Stabilize and provide care for infant born at 35to 37weeks gestation who
remain physiologically stable.
• Stabilize newborn infants who are ill and those born less than 35weeks
gestation until transfer to a facility that can provide the appropriate level of
neonatal care

5. • The care providers here include-
oPediatrician
oFamily physician
o Nurse practitioner
oOther advance practice registered nurse

6. 2) LEVEL II- SPECIAL CARE NURSERY:-
• These are also known as special care nurseries and have all the capabilities of
a level I nursery
• These provide care for infants born at 32 weeks gestation or older and
weighing more than and equal to 1500g who have physiologically immaturity
and moderately ill with a problems that are expected to resolve rapidly.
• Provide care for infants who are feeding and growing stronger or recovering
after intensive care.
• Provide mechanical ventilation for a brief duration or continuous positive
airway pressure.

7. • Stabilize infants born before a gestation period of 32 weeks and with weight
less than 1500g until transfer to a neonatal intensive care facility.
• The care providers here include-
oNeonatologists
oPediatric hospital staff
oNeonatal nurse practitioners and all the level I health care providers.

8. 3) LEVEL III- NEONATAL INTENSIVE CARE UNIT:-
• It provide sustained life support.
• Comprehensive care for infants born at all gestational ages and birth weight
with critical illness.
• An immediate access to a full range of pediatric medical sub- specialties
,pediatric surgical specialties, pediatric anesthesiologist and pediatric
ophthalmologist.
• Provide a full range of respiratory support that may include conventional and or
high frequency ventilation.
• Performed advance imaging with interpretation on an urgent basis including
Computed Tomography, MRI, Echocardiography.
• It include all the care providers of level I and level II

9. 3) LEVEL IV- REGIONAL NICU:-
• This is the unit which provides the highest level of neonatal care.
• These unit have pediatric surgical sub specialists and all the care providers for
all level III unit.
• It include all capabilities of level I, level II, and level III.
• These are located within an institutional performing complex care and
provide surgical repair of congenital or acquired conditions.
• Maintain a full range of pediatric medical subspecialists, pediatric surgical
sub specialists anesthesiologists at the site.
• Facilitate transport and provide outreach education

10. ORGANIZATION OF NICU
1) SPACE :- The size of the unit is related to the expected population intended
to be served. In a maternity unit having 2000 deliveries/year, facilities for
special care of 6- 8 high risk infants should be available Each infant should be
provided with a minimum area of a 100 sq ft (10 meter square).There should
be no compromise on space and its adequacy is crucial for reduction of
nosocomial infections.

11. 2) LOCATION :-The neonatal unit should be located as close as possible to the
labor room and obstetric operation theatre to facilitate prompt transfer of sick
neonate.
• The presence of an elevator in close proximity is desirable for transport of out
born babies.

12. 3) FLOOR PLAN:- The walls should be made of washable glazed tiles and
windows should have 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 should room should be there.

13. 4) 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. A simple method to achieve satisfactory ventilation consists of
provision of exhaust fan in a reverse direction near the ceiling for input of
fresh uncontaminated air and fixation of another exhaust fan in the
conventional manner near the floor for air exit.

14. 5) 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. Spot illumination for various procedures can be provided
by a portable 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. In places where electrical failure is frequent and prolonged,
the electrical system of the nursery complex must be attached to a generator

15. 6) TEMPERATURE AND HUMIDITY:- The temperature of the nursery complex
must be maintained between 26-28 ͦ C (78.8 - 82.4°F) 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. In most parts of
India, relative humidity averages above 50%, which is quite satisfactory for
routine needs of newborn babies. 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.

16. 7)ACOUSTIC CHARACTERISTICS:-The ventilation system, incubators, air
compressors, suction pumps and many other devices used in the nursery
produce noise. Sound intensity in the nursery should not exceed 75 dB to
protect hearing of nursery personnel and infants. Excessive noise may lead to
hearing loss, physiological and behavioral disturbances, such as sleep
disturbances, startles and crying episodes, hypoxia, tachycardia and increased
intracranial pressure.

17. 8) ELECTRIC OUTLETS:- The electrical equipment used in the nursery must
be checked at least once a month for leakage of current. Special fittings with
safety devices should be installed. The unit should have round-the clock
uninterrupted servo-stabilized power supply. There should be round-the-clock
power back-up including provision of UPS system for the sensitive
equipments.

18. 9) EQUIPMENT:- During past few years, a large number of sophisticated
devices for diagnostic and therapeutic purpose have been developed.
Acquisition of new equipment does not necessary mean better services and
outcome. Machine can not replace men. The best monitors are dedicated
nurses and resident doctors involved in the care of new born babies. The
maintenance of existing equipment in proper working condition is more
important than acquiring new and sophisticated gadgets. The equipments used
in wards are-

19. • Resuscitation equipments:- Through the children in ward are stable but
emergency can arise any time. So an emergency tray should be available in
each pediatric ward. The tray should contain pediatric ambu bag, and mask,
infant laryngoscope, tracheal tube, suction catheters and emergency drugs.

20. • Ambu and mask resuscitation:- Self-inflating bag of 250 / 500 mL capacity
is ideal for resuscitation of a newborn baby.

21. • Oxygen facility:- Oxygen is supplied through central Oxygen source or
portable oxygen cylinders. Portable oxygen cylinders are expensive and not
readily available in a district hospital or community health centre. Oxygen
must be warmed (36.0 - 36.5°C) and humidified before administration to the
baby. Oxygen concentrators are cost-effective and promoted by WHO in
developing countries.

22. • Catheter, syringe and needle:- Nasogastric feeding tube, suction catheter,
umbilical vein catheter, small vein infusion set, and medications should be
kept in ward. Only disposables syringes and needles should be used.

23. • Feeding Equipment:- Glass or steel bowls of adequate size (120ml capacity)
should be available in the nursery and ward for collection of expressed breast
milk or mixing and preparing formula. Storage facility like refrigerator should
be available in the nursery.

24. • Weighing machine:- Accurate weight record of babies is a sensitive index of
their well being. Different type of weighing machine should be available in
NICU like electric weighing machine with a digital read- out.
• Thermometer:- Both oral and rectal thermometer should be available in the
NICU , as babies are prone to hypothermia. If common thermometer of NICU
is to be used for all babies, then must be properly disinfected.

25. • Phototherapy Unit :- Phototherapy is now generally accepted as a safe and
effective method for treatment of neonatal hyper bilirubinemia. A light source
design between 400 -520 nm wave length range at the mattress is ideal. The
infant may be exposed under a portable or fixed blue light source (425 to 475
nm) kept at a distance of about 18 inches (45 cm) from the skin.

26. • Infusion pump:-In view of the fact that small quantities of fluid need to be
infused and minor errors in rate of administration may prove lethal to low
birth weight babies, the use of infusion pump with accurate control is
essential to meet these requirements. When total parenteral nutrition is used
for care of sick babies, use of infusion is obligatory.

27. • Laboratory Facilities: Satisfactory facilities for routine radiological
examination should be available in the nursery round-the clock. A side
laboratory for routine analysis of blood, urine, glucose, bilirubin, hematocrit
should be available. Facilities for analysis of serum sodium, potassium,
calcium and total serum proteins, and albumin should be at hand.

28. ROLE OF MIDWIFE IN NICU
• Maintenance of Airway.
• Maintenance of breathing and circulation.
• Maintenance of thermoregulation.
• Prevention of accidents.
• Maintaining aseptic technique.
• Prevention of illness.
• Maintaining nutritional level of newborn
• Prevention of nosocomial infection.
• Properly checking of NICU equipments

30. REFERENCE
• https://www.uptodate.com/contents/pathogenesis-clinical-features-and-
diagnosis-of-thrombosis-in-the-newborn/abstract/15
• Sharma Rimple, Essential Of Pediatric Nursing, Eddition 1st, JP Brothers
Medical Publisher(p)ltd 2013 page no 249- 256