3. DEFINITION OF NICU
• Newborn or neonatal intensive
care unit, an intensive care unit
designed for premature and ill
newborn babies.
4. DEFINITION OF NEONATAL CARE
The management of complex life
threatening diseases, provision of
intensive monitoring and institution of
life sustaining therapies in an organized
manner to critically ill children in a
separate neonatal intensive care unit.
5. AIMS /GOALS OF
ORGANIZATION OF NICU
• Reducing the neonatal
mortality and improving
the quality of life.
• To provide continuing in-
service training to medicine
and nursing personnel in the
care of newborn.
• To maintain the function of
the pulmonary,
cardiovascular, renal and
nervous system
6. • To monitor the heart rate, body
temperature, blood pressure, central
venous pressure and blood by non
invasive techniques.
• To measure the oxygen concentration
of the blood by oxygen analysers
• To check/observe alarms systems
signal ,to find out the changes beyond
certain fixed limits sets on the
monitors.
• To administer precise amounts of
fluids and minute quantities of drugs
through I.V infusion pumps.
10. • Care for infants with corrected
gestational age greater than 37
weeks or weight above 2000 gm
who have mild illness.
• Babies with mild medical
conditions like G6PD deficiency,
babies of hepatitis B mothers.
• Evaluation and postnatal care of
healthy newborn infants
• Phototherapy
11. • Nasal oxygen with oxygen saturation
monitoring (e.g. for infants with chronic
lung disease needing long-term oxygen
and monitoring
• Normal new born care
• Babies born to mothers with maternal
complications like diabetes mellitus,
pyrexia, prolonged rupture of membrane,
mild meconium staining, but who are
free from all clinical manifestation of
illness are also included.
• The emphasis is to provide mother craft
and the encouragement of
breastfeeding.
13. • Neonates weighing between 1500 to 2000 gm
• All preterm deliveries within 32 to 36 weeks
• Neonates with Apgar Score of 4 to 6 at five
minutes, and/or requiring any form of
resuscitation at birth.
• Babies who require continuous monitoring of
respiration or heart rates by apnoea monitor,
pulse oximeter or by transcutaneous
monitors.
• Babies who are receiving additional oxygen.
• Babies who are receiving intravenous
glucose, electrolyte solution, antibiotics.
• Babies who are being tube fed.
14. • Babies who are being barrier-
nursed.
• Babies receiving phototherapy, at
the direction of doctor in charge.
• Babies with persistent hypothermia
of 36 degree C and below.
• Babies with congenital malformation
that require special care.
• Babies who have had minor surgery
in the previous 24 hours.
• Babies requiring special monitoring
16. • Infants weighing less than 1500 gms or
preterm deliveries before 32 weeks of
gestation.
• Critically ill babies receiving assisted
ventilation.
• Critically ill babies, including those
with recurrent apnoea requiring
constant attention.
• Babies who have had major surgery
e.g. PDA ligation.
17. • Babies with convulsions.
• Babies receiving partial or total
parenteral nutrition.
• Babies undergoing major medical
procedures, such as arterial
catheterization, peritoneal dialysis or
exchange transfusions.
• Babies with Severe Perinatal asphyxia.
• Severe meconium aspiration syndrome
18. Equipment recommended for
different levels of neonatal
intensive care:
SPECIAL CARE NURSERY (LEVEL 2)
The following equipment is recommended for babies
under special care:
• Incubator or cot adequate for temperature control
• Ambient oxygen analyser
• Apnoea alarm
• Heart rate monitor
• Infusion pump
• Phototherapy unit
• Access to frequent blood gas analysis using micro
methods
• Access to biochemical analysis using micro
methods
• Access to equipment for radiological examinations.
21. Neonatal Intensive Care
Unit (Level 3)
The following equipment is
recommended for care of critically ill:
• Intensive care incubator or unit with
overhead heating
• Respiratory or apnoea monitor
• Heart rate monitor
• Intravascular blood pressure transducer
or surface blood pressure recorder
• Transcutaneous pO2 monitor or
intravascular oxygen transducer
• Syringe pumps
• infusion pumps
22. • Ventilator
• Continuous temperature monitor
• Pulse oximeter
• Phototherapy unit
• Ambient oxygen monitor
• Facilities for frequent blood gas
analyses using micro methods
• Facilities biochemical analyses
including glucose, bilirubin and
electrolytes by micro methods
• Access to ultrasound equipment
for visualization of organs such
as brain
• Access to equipment for
radiological examination.
23. MAIN COMPONENTS TO BE CONSIDER
WHILE ORGANIZING NICU
1. PERSONNEL
2. PHYSICAL FACILITIES
3. EQUIPMENTS
4. SERVICES AVAILABLE(MONITORING,
THERAPEUTIC MODALITIES, SUPPORT
SERVICES, ANCILLARY SERVICES)
5. QUALITY ASSURANCE
6. INFECTION CONTROL
27. • Environmental temperature
and humidity
• Acoustic characteristics
• Handling and social contacts
• Communication system
• Electrical outlets
• Scrub areas
• General Support Space
28. 1.SP
ACE:
• Each infant should be provided with
minimum area of 100 sq. ft. or 10 meter
sq.
• Space should be allotted within the
nursery for promotion of breastfeeding,
expression of
breast milk and its storage.
• The entry of visitors to this
area should be restricted
and kept adequately warm.
29. 2.LOCATION:
•Located as close as to labour
room and obstetric care
unit.
•Adequate sunlight for
illumination and provide
UV rays to augment
Sepsis.
30. 3.FLOOR PLAN
Open Unencumbered space
The walls should be made of
washable 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.
31. The special care neonatal unit should
include:
• Special care area
• Minimal care
• Isolation rooms
• X-ray room
• Laboratory
• Procedure room
• Cleaning area
• Septic nursery
33. 5. LIGHTING
The whole unit must be well
illuminated and painted white
The lighting arrangement should
provided uniform shadow-free,
illumination of 100
foot candles at the baby’s level
34. 6. Environmental temperature and
humidity:
• The temperature in the nursery must
be maintained around 26 degree
Celsius.
• This is best achieved by centralized air
conditioning having temperature
control knobs in the nursery.
• In places where it is not feasible,
portable radiant heater, infrared lamp,
hot air blowers can be used to provide
source of heat to an individual infant
especially in winters.
35. 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 unit should
not be exceed 75 decibels.
•Telephone rings and equipment
alarms should be replaced by
blinking lights.
36. 8. Handling and social contacts
• Excessive, rough handling of delicate
newborn babies should be avoided.
• Soothing words, gentle stoking and
cuddling and touching by both staff
and mother provided.
• Infants should be exposed to tactile,
kinesthetic, vestibular, motor, auditory
and visual experiences to provide for
sensorimotor stimuli.
37. 9. COMMUNICATION SYSTEM:
•The unit should also have an intercom &
a direct outside telephone line.
• Mobile phones should
not used near the
vicinity of the nursery .
38. 10. ELECTRICAL OUTLETS
•Each patient station should have
8 central voltage – stabilized
electrical outlets sufficient to
handle all pieces of equipment
• An additional power plug point
•There should be round-the-clock
power back up including
provision of UPS system
39. 11.Scrub Area
• Should be located at the entrance with an area
of 150 sq ft.
self closing doors.
Pictorial Hand Washing instructions.
• Bins for tissue paper disposal
40. 12. General Support Space
1. Clean utility/ Holding area
• It should be designed for storage of
supplies frequently used in care of
newborn such as diapers, linen, charts,
gowns, information booklets .
• There should be at least 8 cu ft of
space for each infant, for storing
syringes, needles, I/V sets, trays;
bedside cabinet area should be 16 cu ft
for each infant in the intermediate care
area and 24 cu ft in intensive care area.
41. 2. Soiled utility/ holding room
• This space is essential for storing used
and contaminated material before its
removal from the care area.
• The ventilation system should be
engineered to have negative air
pressure with all the air sent out
through an exhaust fan.
• This room should be strategically
allowed removal of soiled material
without passing through the infant care
area.
42. 3. Medical equipment storage
• This space is used to store equipment
which is not being used, especially
after it has been washed and cleaned
immediately after the discharge of a
baby.
43. 4. Nursing station
• Charting space at each
bedside should be provided.
• An additional separate area
or desk for tasks such as
compiling detailed records,
completing requisitions and
telephones communication
should be provided in each
room.
. It should be located near the
entrance of neonatal care
unit
44. 5. Staff support space:
• Staffing areas are defined as space
that should only be used by staff
members to meet personal,
professional and administrative needs.
45. iii. EQUIPMENT
• The in-charge nurse should maintain a
register with the equipment name, company
address and contact number, date of
installation, warranty period, problems and
repairs and all other details pertaining to
each equipment.
• There should be three each of air, oxygen and
vacuum outlets per bed.
• Standard equipment for a six bedded level III
neonatal intensive care unit include:
– Resuscitation sets
– Radiant warmers / open care system
– Incubators
47. IV. SERVICES THAT SHOULD
BE AVAILABLE
A. Monitoring:
• Cardiac and hemodynamic indices
• Respiratory functions.
• Temperature-including core
temperature.
• Cerebral functions.
48. B. Therapeutic / Diagnostic
modalities:
• Emergency resuscitation
• Respiratory support.
• Cardiac support- Defibrillation,
temporary cardiac pacing
• Infusion pumps and pressure
infusion devices for administration of life
saving drugs.
• Desirable-left heart support, intra-aortic
balloon assist, extracorporeal
membrane oxygenation, hyperbaric
oxygen.
49. C. Support services necessary
for NICU:
• Radio diagnosis and imaging
facilities
• 24 hrs laboratory services
• Others- microbiology, blood
biochemistry, toxicology and drug
level measurement.
• Centralized oxygen, compressed
air, and suction facility.
• Blood bank and pharmacy.
• Transport facilities.
50. D. Ancillary Services:
• Housekeeping- cleaning,
water, electricity, air
conditioning,
linen cleaning and
central sterilization services.
• Communication within ICU and outside
through telephone, paging, intercom and
outside telephone.
• Computerized record
keeping.
• Social services.
51. V. QUALITY ASSURANCE
• There should be documented indications on
the criteria for admission of all neonates to
the NICU.
• NICU should have a written Quality
Assurance Programme.
• Policies and procedures related to the safe
conduct of all patient care activities.
• Infection Control is one of the prime areas.
• Clear guidelines for the management and
referral of severely ill neonates’ cases that
may requires admission to the NICU.
• Department shall be equipped to performed
neonatal resuscitation.
52. VI. INFECTION CONTROL
The director of neonatal services
through the hospital’s infection control
program shall establish procedures for
the control of infection, governing
matters such as appropriate attire,
isolation and cleaning of equipment in
the neonatal care unit.
53. Infection control procedures shall do
the following:
• Prohibit common or group carriers for
transporting infants to their mothers.
• Require and specify procedures for
scrupulous hand cleansing by all neonatal
care unit personnel and visitors before and
after each infant contact.
• The infection control standards shall be
consistent with the current guidelines.
54. Procedures Manual (Protocol Book)
• it is essential to have a procedure
manual to establish uniformity
and continuity of care.
• Indications for admission to
SCNU.
• Routines to be followed regarding
feeding, prophylaxis, etc.
• Various housekeeping practices
for prevention of infection.
55. • Instructions regarding temperature control
of nursery, incubator care, nurses
observations, weight record, working
knowledge of various equipment.
• Policies regarding discharge, after care,
death care should be clearly defined.
• Various charts such as intrauterine growth
charts, feeding routines, ambient
temperature ranges for LBW babies, drugs
and dosages for ready references.
• Resident doctors should be given guidelines
for management of common neonatal
emergencies such as birth asphyxia,
hypothermia, respiratory distress
syndrome, jaundice, sepsis and bleeding.
