The document discusses guidelines for handling neonates and pediatric patients. It defines neonates as infants under 28 days old. It outlines policies for pediatric services, including outpatient and inpatient services from 10am to 7pm daily. The document also discusses guidelines for establishing and operating a newborn care corner or NICU, including necessary equipment, staffing, environmental conditions, and indications for admission. Key responsibilities in the NICU include improving clinical care of critically ill neonates and reducing neonatal morbidity and mortality.

1. HANDLING OF NEONATES
AND
PAEDIATRICS

2. INTRODUCTION
PAEDITRICS:
Pediatric can be defined as the branch of medical
science that deals with the care of childhood from conception to
adolescent in health and illness. It concern with prevention,
promotion, curative and rehabilitative care of children.
NEWBORN :
The Newborn infant, or neonate, is a child under 28 days of
age.
Early newborn - 1-7 days
late newborn - 8-28 days

3. NABH ASPECTS
PURPOSE:
To define policies guiding the care of Pediatric patients.
SCOPE:
All the paediatric patients undergoing treatment in hospital.
POLICY:
The hospital has defined and displayed the services it
can provide for pediatrics by competent medical staff trained in
paediatrics.

4. OUT PATIENTS
SERVICES
From 10 AM to 2 PM & 4
PM to 7 PM.
 From Mon - Sat.
 Walk in patients are taken in
Appointment scheduling is also
done.
Diagnostics & cross referrals
IN PATIENTS SERVICES
Stream of admissions:
 From OPD
From OT/ Labor room
 From Emergency 24x7
 Referral from Pediatric &
External physicians

5. COP-11 Documented Procedures guide the care of
paediatric patients as per the Scope of services
a. Paediatric services are organised and provided safely.
b. Neonatal care is in consonance with the national/ international
guidelines.
c. Those who care for children have age-specific competency.
d. Provisions are made for special care of children.
e. Paediatric assessment includes growth, developmental and immunisation
assessment.
f. The organisation has measures in place to prevent child/neonate
abductionand abuse.
g. The child's family members are educated about nutrition, immunisation
and safeparenting.

6. HOW TO IMPLEMENT COP-11

7. CODE PINK

8. NEWBORN CARE CORNER (NICU)
It is very specialized unit where critically ill neonates are cared to
reduce theneonatal morbidity and mortality.
 Those who weigh < 1500 gms or <32 wks of gestation
 3 – 5 % of newborns would need these services
depending upon conditions.
GOALS :
 To improve the clinical care of the critically ill neonate
 To reduce the neonatal morbidity & mortality
To provide continuing in- service training of medical &

9. SETTING UP
• Space-100 sq. ft. or 10 m2
• Location- labor rooms & obstetric
OT.
• Baby care area-Examination
area,Mother’s area for breast feeding
and expression ofbreast milk.
• Hand washing and gowning room
Should be located at the entrance,
Self closing doors.
• Nurses stations.Central area,
Newborn charts, hospital forms,
computer terminals,telephone lines
should be located in this area
• Clean utility and soiled utility
holding rooms-Stocking clean utility
items and sterile disposables,and for
disposal of dirty linen and
contaminateddisposables.
• Ventilation-Effective air ventilation
of nursery,Provision of exhaust fan.
• Environmental temperature and
humidity-26-28◦C, baby beds should
be located at least 2 feet away from
the wall and windows.
• Lighting- Well illuminated and
painted while or slightly off.
• Cool white fluorescent tubes

10. Equipment’s
 Thermometer
 Stethoscope
 Electronic Baby weighing scale
 Incubator, Phototherapy
 Over head radiant warmers
 Resuscitation equipment
 Cardiac monitor
 Respiratory support equipment
 Suction facilities
 Suction facilities and needles
 There must also be access 24hour
laboratory serviceoriented to
neonatal service needs.

11. STAFFING PATTERN OF NICU
Medical personnel
 Neonatal physician for each 6 to 10
admissions.
 1:5 ratio of neonatal physician to
patient
 Resident doctor available for 24hrs
Para medical personnel
 1 Respiratory therapist
 patient ratio: 1:1 in special care units
and in PICU, the ratio is 1:3
Nursing staff
 The nurse to patients ratio should be
1:4 -5 per shift in SICU.
 While in more intensive care area
providing mechanicalventilation
support, nurse: baby ratio should be
1:1-2 per shift.
Other Staff
 Maintenance staff: 1 sweeper should be
there for 24hrs
 1 laundry boy
 1 Lab technician
 1 Social worker attached to NICU care

12. INDICATIONS FOR ADMISSION
• • Prematurity <34 weeks’ gestation
• LBW < 1800g
• Cardiopulmonary problems:
• » Central cyanosis
• » Respiratory distress
• » Apnoea/bradycardia
• » Tachycardia >200 beats per minute
(bpm)
• Neonates that required resuscitation
• Neurological problems:
• » Seizures
• » Impaired consciousness
• » Abnormal neonatal reflexes
» Severe hypotonia
• Low 5-minute Apgar score <7
• Gastrointestinal and genitourinary
problems:
 Delayed passage of meconium beyond
48 hrs
 Bile stained vomiting or other signs
suggesting bowel obstruction
 Feeding problems severe enough to
cause clinical concern
 Abdominal masses
 Delayed passage of urine beyond 24
hrs

13. • Haematological problems:
• » Pallor
• » Polycythaemia with venous
haematocrit > 65%, or 60-64% with
• clinical symptoms
• » Petechiae and purpura
• » Bleeding
• Neonatal jaundice requiring
treatment
• Neonatal infection
• Metabolic problems:
• » Infant of diabetes mother (IDM)
• » Hypothermia or hyperthermia
• » Hypoglycaemia or hyperglycaemia
• • Dehydration
• • Electrolyte disturbances
• • Congenital malformations
• • Birth injuries
• • Surgical conditions

14. 1.IMMEDIATE NEWBORN CARE AT BIRTH
• Dry and stimulate the baby
• Assess the baby’s breathing and colour
• Keep the baby warm
• Help the mother initiate breastfeeding
• Give eye care and antiretroviral (arv) prophylaxis
• Prevent bleeding
• Identify infant
• Weigh the newborn
• Ecord all observations and treatment