This document discusses the guidelines for setting up and operating newborn care units at various levels of healthcare facilities in India. It describes the objectives and services provided by Newborn Care Corners (NBCC), Newborn Stabilization Units (NBSU), and Special Newborn Care Units (SNCU). It outlines the necessary infrastructure, equipment, staffing, and training required for proper functioning of these units. The document emphasizes the importance of infection control, documentation, cooperation between obstetric and neonatal staff, and providing standardized care according to the unit's designated level of care.

1. Dr.N.Vinay kumar
Junior resident

3.  Newborn or neonatal care unit is an intensive care unit
designed for premature and ill newborn babies.
HISTORY
 Mid 19 th century: Dr.Stephane tarnier designed
incubator and he is called as father of incubator .
 Dr.Budin :father of perinatology.

4. AIM
 Reducing the neonatal mortality and improving the
quality of life among the survivors.
OBJECTIVES
 ICU Services.
 Reduce neonatal mortality & morbidity.
 Meeting the special needs of the neonates.
 Maternal Bonding.
 To meet the nutritional needs of the neonate.
 Continuing in-service education.

6. Newborn Care Corner (NBCC)
 NBCC is a space within the delivery room in any health
facility where immediate care is provided to all
newborns at birth. This area is MANDATORY for all
health facilities where deliveries are conducted.
Newborn Stabilization Unit (NBSU)
 NBSU is a facility within or in close proximity of the
maternity ward where sick and low birth weight
newborns can be cared for during short periods. All
FRUs/CHCs1 need to have a neonatal stabilization
unit, in addition to the newborn care corner.

7. Special Newborn Care Unit (SNCU)
SNCU is a neonatal unit in the vicinity of the labor
room which will provide special care for sick
newborns. Any facility with more than 3,000 deliveries
per year should have an SNCU (most district hospitals
and some sub-district hospitals would fulfil this
criteria).

8.  Level – III - High – Intensive -Tertiary
 Level – II - Ideal - Specialised
 Level – I - Adequate – Basic

9. LEVEL 1 LEVEL 2 LEVEL 3
•80 percent babies require
minimal care
•provided b mothers
under supervision.
•Neonates >1800 gm and
>34 week gestation.
•Care can be provided at
home, subcenter and phc.
•Basic care at birth
•Provision of warmth
•Maintainence of asepsis
•Exclusive breast feeding
•10-15 percent babies
require specialised care
•Supervised by trained
nurses and pediatricians
•Neonates between
1200gm-1800gm or 30-34
weeks gestation.
•Care provided at
FRU,dist hospitals,nursin
homes.
•Equipment for
resusitation,maintainence
of themoneutral
environment,iv
infusion,gavage
feeding,phototherapy,exc
hange blood transfusion
•3-5 percent babies
require intensive care
•Supervised by skilled
nurses and neonatologists
•Neonates <1200gm or<30
weeks gestation.
•Care provided at apex
institute or regional
perinatal centers
•Centralised O2, suction
,servo controlled
incubators,monitors,venti
llators,inusion pumps.

10.  Adequate space.
 Availability of running water round the clock.
 Centralized oxygen and suction facilities.
 Maintenance of thermo neutral environment.
 Availability of plenty of linen and disposables.
 Facilities for availability to treat common neonatal
problems.

11. 1.PHYSICAL FACILITIES(Space,Location,Floor
Plan,Ventilation,Lightings,Temperature and Humidity,
Handling and Social Contacts, Communication
Systems, Electrical Outlets)
2.PERSONNEL
3.EQUIPMENTS
4.LABORATORY FACILITIES
5. PROCEDURE MANUAL
6. TRANSPORT OF SICK INFANTS

12. Newborn Care Corner
 Earmark an area about 20-30 sqft in size within the
labor rooms of all health facilities for establishing a
newborn corner. For FRUs and district hospitals, also
set up newborn corners in operation theatres where
caesarean sections are conducted.
 Equip the corner with a radiant warmer and
resuscitation kits

13. Newborn Stabilization Unit
 For setting up a 4-bedded stabilization unit, at least
200 sqft of floor space is required. The unit should be
located within or in close proximity to the maternity
ward.
 In addition, two beds in the postnatal ward should be
dedicated for rooming in.
Civil work. Basic civil work required to set up a
stabilization unit are:
 Power supply: The unit should have 24 hr
uninterrupted stabilized power supply

14.  Water supply: The unit should have 24 hr
uninterrupted running water supply.
 Lighting: The unit should be well lit, preferably with
compact fluorescent light (CFL) panels.
 Floor surfaces: The floor surfaces should be easily
cleanable thus minimizing the growth of micro-
organisms.
 Walls: As with floors, the ease of cleaning, durability,
and acoustical properties of wall surfaces needs to be
considered.
 Equipment: The equipment for maintaining
temperature and conducting resuscitation are required

15.  LOCATION – Close to labour room, Operation
Theaters.
 It should be situated in the Ground Floor.
 Good ventilation should be there.
 It should be located on to one side of the corridor.
 Split unit should be avoided.
 It should be located with in nursery complex for the
promotion of breast feeding and expression of breast
milk and storage.

16. 1. Project the bed demand.
 minimum recommended number of beds for an SNCU at
the district hospital is 12.
 if the district hospital conducts more than 3,000 deliveries
per year, 4 beds should be added for each 1,000 additional
deliveries.
2. Estimate the required space and identify the space.
 An average floor area of 50 sqft per bed should be available
for a patient care area with an additional 50 sqft to be
utilized as ancillary area. Therefore, on an average, a total
area of 100 sqft per patient is required. For example, for a
12-bedded SNCU, 1,200 sqft floor area is required.

17.  Additional space will be required for the step-down
area which will have beds for babies rooming-in with
the mothers after the acute phase of illness is over. The
number of beds (adult beds would be required for
rooming-in babies with mothers) is 30% of the SNCU
beds. For example, a 12-bedded unit will require 4
additional adult beds for the step down.
3. Design the unit
 Patient care area
 Ancillary area
 Step-down area

18.  Patient care area
 For a unit of 12 beds, the patient care area would be
600 sqft (50 sqft per bed).
 The patient care area can be designed to have two
interconnected rooms separated by transparent
observation windows from the nurses' working place
in between.
 While one room can be used for intramural newborns
(those born within the health facility), another room
can be used for extramural newborns (those born
outside the health facility).

19. Ancillary area:
 600 sqft ancillary area should include separate areas
for hand washing and gowning area , nurses' work
station, clean area for mixing intravenous fluids and
medications, doctors duty room, computer terminal,
mother's area for expression of breast milk and
learning mother crafts, unit store and side lab.
 It is desirable to have areas for portable x- ray, boiling
and autoclaving and laundry room.

20. a)Hand washing and gowning areas
 Should be located at the entrance of the unit.
 Elbow operated taps should be there for hand washing
 Sink should be made of stainless steel with no counter
tops.
 Walls surrounding the sinks should be made of
nonporous material.
 Handwashing instructions should be displaed.

22. b)Mother area
 It should be comfortable to the mother for breast
feeding their babies and expression of breast milk.
c)Nurse station
 It should be located in central area from where all the
neonates are visible.
d)Handwashing stations
 Should be 20 feet distance to each infant.
 Sinks should be large and deep(24*16*10).
e)preparation of iv fluids
Separate area should be earmarked for preparation of
enteral feed,medications ,preparation of tpn.

23. f)Examination area
 There should be a table with comortable seating
 good light and warmth should be there
 Every baby before admission assesed and cleaned in
this area.
g)Staff rooms
 Chaning room should be there for nurses.
 Separate room should be there or resident doctors
Step-down area
 The SNCU design should include the step-down unit.
The step-down could be within the premises or in close
proximity.

24.  Power supply: The unit requires 24 hr uninterrupted stabilized power
supply, sufficient to take the load of equipment.There should be a
generator facility as power backup.
 Floor surfaces: The floor surfaces are made of glazed tiles which can be
easily cleanable and minimize the growth of microorganisms.
 Walls: walls should be painted white or off white,and walls should have
the properties of heat and sound insulation.
 Water supply: The unit should have 24 hr uninterrupted running water
supply. An overhead tank of appropriate size should be provided for.
 Lighting: Light sources should be as free as possible of glare or veiling
reflections. No direct view of the electric light source or sun should be
permitted in the newborn space.

25.  Temperature: The unit should be designed to provide an air
temperature of 78.8°F to 82.4°F (28 ± 2°C). temperature can
be maintained with the help of A/C.
 sound: Should not exceed 75 db (decibels)
Excessive Sound leads to Hearing loss , Startle ,Sleep
Disturbance , Hypoxia ,Crying episode , Tachycardia raised
ICP .
Telephone rings & Equipment alarms should be Replaced by
blinking Lighting

26. Electric Outlet
 Adequate numbers of electrical points should be there
attached to common ground.
 Each bed – 8 electrical outlets (four-5amp and four-
15amp)
 Do not use adopter or extension board.
 Safety devices must be installed.
 UPS system should be available for the sensitive
equipment.
5. Procure and install equipment
SNCU equipment include equipment for resuscitation,
phototherapy and thermoregulation such as radiant
warmers and phototherapy units etc

27. 5)Personnel
1 full time pediatrician
1 senior resident
1 junior resident for 8babies round the clock
1 social worker
Nurses-1:4
Lab tecnician
Phsiotherapist
Biomedical tecnician
Pathologist

28. 6 .INFECTION CONTROL
 Hand washing is essential and needs to be monitored
regularly
 steps of hand washing posters should be displayed
near the sinks.
7. DOCUMENTATION
 Unit should have -printed form of admission
and discharge slips
 Records of all admission should be maintained in
regular

29. 8.COOPERATION BETWEEN THE
OBSTETRICIAN AND NEONATOLOGIST
 Antenatal care and foetal diagnosis
 Perinatal hypoxia
 Promotion of feeding with human milk
 Supervised care of low birth weight babies

31. EQUIPMENT REQUIRED AT VARIOUS CENTERS

42.  IV Catheters
 IV Sets
 Feeding Tubes
 ET Tubes
 Suction catheters
 Umblical central
venous catheter
 Syringes
 Needles
 splints
 extention
 Gloves

44. NBCC
 One doctor and one sister required for NBCC.
 All doctors and nurses attending deliveries
should attend training in Navjaat Shishu Suraksha
Karyakram (NSSK).

45. NBSU:
One trained doctor is required for the stabilization unit.
At least one full-time staff nurse trained in newborn
care per shift should be available. This would require
at least 4 fulltime staff nurses per unit. The staff at
NBSU must be trained in facility based IMNCI (F-
IMNCI).

46. SNCU:
 It is proposed that one paediatrician trained in
neonatology should be posted at the unit, supported
by two or three medical officers trained in FBNC.
 Three nurses in each shift, round-the-clock.
 In addition to doctors and paramedics, support staff
should be available to clean the nursery at least once
during every shift and more often depending on the
need. In addition, a part-time lab technician and a
data operator will be required for the unit.
 The Doctors and nurses posted at the SNCU need to
further undergo training in FBNC

48. NBCC NBSU SNCU
MO 1 1 3 – 4 MOs
(including 1
Ped)
SN 1 4 (1/ shift) 10 (3/ shift)
Training NSSK F-IMNCI FBNC

49.  NSSK addresses important interventions of care at
birth, that is basic newborn resuscitation, prevention
of hypothermia, prevention of infection, early
initiation of breast feeding, and equips the staff with
appropriate knowledge and skill to provide essential
newborn care in primary health care settings.

50.  Capacity building of service providers at NBSUs is
essential to ensure quality care for normal and sick
newborns. Keeping in view the non-availability of
specialists (paediatricians) at many FRUs, it becomes
important to build skills of medical officers and staff
nurses at these facilities. It is recommended that all
NBSU staff at FRUs is trained in F-IMNCI, which
includes the package on 'facility based care of sick
newborns and children'. F-IMNCI is skill-based
training, based on a participatory approach combining
classroom sessions with hands-on clinical sessions.

51.  FBNC Training in 3 steps
 Step I:
 Training of Trainers from the sites selected for
FBNC training
 minimum 2-3 Trainers from each site who will be
involved in training
 Professors, Asso-Professors, lecturers, Chief
resident, Senior Staff Nurses with good
communication skills.
 Depending on the sites 2-3 TOTs will be done
preferably at State collab. Centers.

52.  Step II:
Actual training for personnel's working in SNCUs
 4 Days classroom training
 Batch Size: 20 Participants
 Facilitators: 04 (ratio of 1:5)
 Participants: MO/ Pediatricians/ Staff Nurses
 Duration : 4 days
 Step III:
 Observer-ship for 12 days
 At a time 3 -4 participant in each training site for
Hands-on training in developing skills

53.  The manual should contain detailed instructions
regarding care of baby in labour room.
 Indication for admissions in to nicu.
 Detailed description for the prevention of
infections,temperature control,incubator care,keeping
babies warm,nurses observation and working knowledge
of various equipments.
 The policy regarding mother baby contact,
discharge,what to do after baby dies should be clearly
defined.
 guidelines for mangement of birth
asphyxia,RDS,jaundice,sepsis,bleeding.

54. THANK YOU