The document outlines the organization and essential components of a neonatal care unit (NICU), emphasizing the need for proper physical setup, location, medical staff qualifications, and necessary equipment to reduce neonatal mortality and maintain quality care. It details the space requirements, water supply, ventilation, and administrative setup, along with the levels of neonatal care ranging from basic to subspecialty care. Additionally, it describes operational standards for handling, communication, and the qualifications required for staff across different care levels.

1. ORGANIZATION OF
NEONATAL CARE UNIT
JANNET MARIA ELIAS
LECTURER
CHILD HEALTH NURSING
COLLEGE OF NURSING,
NIRMALA MEDICAL CENTRE
MUVATTUPUZHA

2. INTRODUCTION
• Neonatal care unit (NICU) is a most crucial aspect of neonatal care.
Organization of neonatal care unit should be well equipped to reduce
the neonatal mortality and maintain quality care.

3. PHYSICAL SETUP
Space
• Minimum area for each neonate should be 100 square feet.
• The gap between two incubators should be minimum 6 feet.
• Space for breast feeding, expression of breast milk and storage should be
available.
• Separate area for transitional care of high risk babies by mothers may be
arranged.
• Each neonate should have 12-16 central voltage outlets, 2-3 oxygen outlets, 2
compressed outlets, 2-3 suction outlets, additional plug points for portable X-
ray machine.

4. Location
• The NICU should be close to the labor rooms and obstetric operation theatre.
An elevator is desirable in close proximity to facilitate prompt transfer.
• Floor plan
• The unit should be preferably in a square shape.
• The walls should have washable tiles and windows have two layers of glass
pane to ensure heat and sound insulation.

5. • Doors should be equipped with automatic door closers.
• There should be rooms for isolation and procedures.
• Additional space may be needed for scrubbing, gowning.
Water supply
• The unit should have constant water supply and should have foot or elbow
operated taps in adequate number.
Ventilation
• Effective air ventilation of nursery is needed for reducing nosocomial infection.
• Laminar airflow system is desirable.
• Centralized air conditioning and exhaust fan.

6. Lighting
• Well-illumination with cool white fluorescent tubes to provide at 100 foot
candle, shadow free light.
• Light should be dimmed at night to stimulate day night pattern.
Color
• walls - painted with white or half white color.
Sounds
• The intensity of noise is maintained below 75 db.
• Effective sound proof ceiling, walls, doors and floor.
• Telephone rings and equipment alarms should be replaced by blinking lights.

7. Communication
• Intercom facility
• Mobile phones are not allowed
Handling and contacts
• Gentle and minimal handling
• Parents are allowed to handle babies under supervision

8. Administrative Setup
Medical staff
• The unit should be headed by a senior neonatologist with special
qualification and training in neonatal medicine.
• There must be one senior resident and one junior resident doctor round
the clock for every 8 babies under special care.
Nursing staff
• one nurse is needed for special or intermediate care of 3 babies or
intensive care of one baby.
Other staffs
• One pediatric pathologist, laboratory technician, respiratory therapist and
housekeeping staffs are required

9. Equipment for NICU
• Thermoregulation: Radiant warmers, incubators, thermometer.
• Respiratory support: Ventilators, ABG analyzers, oxygen hoods, O2 analyzer,
Pulse oxymeter. Transcutaneous monitor, resuscitation equipment.
• Jaundice: Phototherapy units, transcutaneous bilirubinometer, biliblanket,
bilirubin analyzer.
• Glucose monitoring: Glucometer.

10. • Fluid therapy: Infusion pumps, syringes.
• Vital signs: Cardiorespiratory monitors, apnea monitors, noninvasive and
invasive blood pressure apparatus.
• Miscellaneous: ECG monitor, defibrillator, ICP monitor, suction facilities,
catheters, capnography or end tidal CO, monitor, laminar flow system,
weighing machine, bassinets

11. LEVELS OF NEONATAL CARE
3 Levels
1. Level I – basic care
2. Level II – specialty care for newborns at 32 weeks of gestation and weighing
1500gms or more.
3. Level III – subspecialty care for high risk newborns .
- weight < 1500 gms and <32 weeks of gestation.
4. Level IV – with all level III facilities and on-site pediatric medical and surgical
specialists for infants with complex congenital problems

12. LEVEL I : BASIC CARE IN WELL NEWBORN NURSERY
• Provide neonatal resuscitation at every delivery.
• Evaluate and provide postnatal care to stable term newborn infants.
• Stabilize and provide care for infants born 35-37 weeks gestation who remain
physiologically stable.
• Stabilize newborn infants who are ill and those born at <35 weeks gestation
until transfer to a higher level of care.
Service Provider
Pediatricians, family physicians, nurse practitioners, and other advanced
practice registered nurses.

13. LEVEL II : SPECIAL CARE NURSERY
• All level I capabilities.
• Provide care for infants born ≥32 weeks gestation and weighing ≥1500 g
moderately ill with problems that are expected to resolve rapidly
• Provide mechanical ventilation for brief duration (<24 hour) or continuous
positive airway pressure or both.
Service Provider
• In addition to level I healthcare providers, pediatrician, neonatologist and
neonatal nurse practitioners.

14. LEVEL III :NICU
• All level II capabilities.
• Provide sustained life support.
• Provide comprehensive care for infants born <32 weeks gestation and
weighing <1500 g.
• Provide prompt and readily available access to a full range of pediatric
medical subspecialists, pediatric surgical specialists, pediatric
anesthesiologists, and pediatric ophthalmologists.

15. LEVEL III

16. LEVEL IV : REGIONAL NICU
• All level III capabilities.
• Located within an institution with the facility to provide surgical repair of
complex congenital or acquired conditions.
• Facilitate transport and provide outreach education.
Service Providers
• In addition to all level III healthcare providers, pediatric surgical
subspecialists.