The document discusses the organization and levels of neonatal intensive care units (NICUs). NICUs are designed to provide intensive monitoring and life-saving therapies to critically ill newborns, especially preterm and low birth weight babies. They aim to reduce neonatal mortality and morbidity. NICUs require adequate facilities, staffing, and space to treat common neonatal problems. Care is divided into four levels depending on the needs of the newborn, from basic care at home or primary health centers to highly specialized regional NICUs that can manage complex conditions.

1. ORGANIZATION
& LEVELS OF
NICU
AMY LALRINGHLUANI
CONSH

2. DEFINITION
“Neonatal intensive care unit is designed
for treatment of premature and ill newborn
babies”

3. NEONATAL INTENSIVE CARE
The NICU is specially designed for management of life
threatening diseases, continuous intensive
monitoring and to provide life saving therapies in an
organized manner to a critically ill child

4. INDICATIONS FOR ADMISSION
TO NICU
◈Babies less than 30 weeks
and very low birth weight
baby less than 1500gm.
◈Cardiopulmonary monitoring
◈Surfactant therapy
◈Convulsion
◈Birth asphyxia
◈Assisted ventilation
◈Total parenteral nutrition
◈Major surgery

5. AIMS OF NICU
◈ To reduce neonatal mortality and morbidity
◈ To improve the quality of life among the survivors

6. OBJECTIVES
To save the
life of the
critically ill
new born
To prevent
damage in babies
who born with
problems and
also reduce
morbidity in later
life
To monitor
high risk
newborns to
reduce
mortality and
morbidity

7. BASIC FACILITIES
Facilities to treat common
neonatal problems
Adequate
space
Continuous
supply of
running water
and electricity
Centralized oxygen and
suction facilities
Maintenance of
environmental temperature
Availability of
sufficient
linen and
equipment

8. PHYSICAL
FACILITIES

9. Location
◈ Located close to labour room and obstetric
care unit
◈ Adequate sunlight for illumination
◈ Proper ventilation for fresh air

10. Space
◈ Each infant should be provided with 100 sq. ft.
or 10sq. meter area. 500-600 square feet per
bed.
◈ Space for promotion of breast feeding, patient
care area, storage area, space for doctors,
nurses, other staff, office area, seminar room
area, laboratory area and space for families.

11. Space
◈ 6 Feet space between two incubators for
adequate circulation and keeping the essential
lifesaving equipment
◈ Isolation room
◈ Examination area
◈ Hand washing and gowning room should be
located at the entrance

12. Floor Plan
◈ The walls should be made of washable glazed
tiles and windows should have two layers of
glass.
◈ Wash basins with elbow operated taps facility
having continuous water supply should be
provided.
◈ The doors should be provided with self closing
doors.

13. Ventilation
◈ Adequate air ventilation
◈ Whole NICU should have central air
conditioning

14. Lighting
◈ The NICU must be well illuminated and wall
should be painted white.
◈ There should be uniform shadow free lighting
and 100 foot candles lighting at the baby’s level
◈ Avoid excess of light

15. Temperature & Humidity
◈ The temperature inside the NICU should be
maintained at 28 – 30 °C, while the humidity
must be above 50%.
◈ Portable radiant heater, infra red lamp can be
used.

16. Acoustic Characteristics
◈ Many devices used in NICU such as ventilator, incubators,
air compressors, suction pumps etc. produce noise.
◈ Sound intensity in the unit should not be more than 75
decibels.
◈ Telephone rings and equipment alarms should be replaced
by blinking lights.

17. Electrical outlets
◈ Each bed should have 12 to 16 central voltage –
stabilized electrical outlets sufficient to handle all
pieces of equipment and some extra power plugs
should be there.
◈ There should be continuous power back up

18. DOCTORS
◈ A full time neonatologist
◈ One neonatal physician is required for every 6-10
patients
◈ One resident doctor should be present in the unit 24
hours

19. NURSES
◈ A nurse : patient ratio of 1:1 maintained through out day and
night is absolutely essential for babies on multi system support
including ventilatory therapy.
◈ For intermediate care nurse to patient ratio is 1:3 but 1:5 per
shift is manageable.
◈ One nurse in-charge

20. OTHER STAFF
◈ Respiratory therapist
◈ Laboratory technician
◈ Public health nurse or social worker
◈ Biomedical engineer
◈ Clark

21. LEVELS OF
NEONATAL
CARE
◈ Level I
◈ Level II
◈ Level III
◈ Level IV

22. Level I-Basic neonatal care
At home, subcenters, PHC
Postnatal care to stable term newborn born at 35 – 37 wks
Provide neonatal resuscitation at every delivery
Stabilize newborn infants (born at <35wks) who are ill until
transfer to higher levels of care

23. Level II-Special Care Nursery
At district hospitals
Provide care for
Infants born ≥ 32wks/ ≥1500gm who are moderately ill and not
anticipated to require subspeciality on an urgent basis
Convalescing newborn after intensive care
Neonate on mechanical ventilation
Stabilize infants born ≥ 32wks/ ≥ 1500gm until transfer to
higher levels of care

24. Level III-NICU
At Tertiary level care centres
Provide care for
Infants born < 32wks/ <1500gm with critical illness
Sustained life support
Neonate on mechanical ventilation
 Provide subspeciality care, full range and avanced care
with investigations

25. Level IV- Regional NICU
At tertiary level care centres
Manage complex conditions
Facilitate transport
Provide outreach education
All specialities and subspeciality care

26. THANK YOU