Neonatal intensive care unit: New born or neonatal intensive care unit, an intensive care unit designed or premature and ill new born babies. 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 paediatric intensive care unit. INDICATIONS : Babies less then 30 weeks Very low birth weight babies of less then 1500 gm Cardiopulmonary monitoring. Surfactant therapy. Convulsion Sever birth asphyxia Assisted ventilation Total parenteral therapy Major surgeries aims: Reducing the neonatal mortality and improving the quality of life among the survivors basic facilities: Adequate space Availability of running water 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 EMPHASIS SHOULD BE LAID ON THEFOLLOWING:  Asepsis  Warmth and thermo neutral environment  Adequate nutrition with human milk  Non stimulating noise free ward  Safety from all biological, physical and chemical hazards. NEONATAL CARE SERVICES  LEVEL - l NORMAL NEONATALCARE  LEVEL – II SPECIAL CARE NURSARY  LEVEL – III INTENSIVE NEONATALCARE UNIT LEVEL - I  The minimal care  Provided by the mother under the supervision of basic health professionals.  Neonates weighting more than 2000 gm or having gestational age maturity of 37 weeks or more belong to this care.  This care can be includes care of delivery, provision of the warmth, maintenance of asepsis, and promotion of breastfeeding. LEVEL - II  This care includes requirement for resuscitation, maintenance of thermo-neutral temperature, intravenous infusion, gavage feeding phototherapy and exchange transfusion.  10-15 percent of the newborn require this care  This care s is anticipated for the infants weighing in between1500 & 1800 gm or having gestational age maturity of 32 to 36weeks. LEVEL - III  This care includes life saving support system like ventilator and best suited special intensive neonatal care.  Three to five percent of newborn require care of this level.  This level of care is for critically ill babies, for those weighing less than 1500 gm or having gestational age maturity of less than 32 weeks TRANSPORT: DEFINITION Newborn transport is used to move premature and other sick infants from hospitals without specialist, intensive care facilities require for optimal care of the baby to hospitals with neonatal intensive care and other specialist services Out born newborns: A significant number of neonates require emergent transfer to a tertiary care center, often because of medical, surgical, or rapidly emerging postpartum problems. These are termed “out born” neonates, because they have been born somewhere besides the facility to which they’ve been transferred.

1. ORGANIZATION
OF NEONATAL
UNIT
PRESENTED BY,
MISS.C.KEERTHANA M.SC(N).,
NURSING TUTOR
SRMTCON.

2. INTRODUCTION
Neonatal intensive care unit:
New born or neonatal intensive care unit, an intensive care unit
designed or premature and ill new born babies.
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 paediatric
intensive care unit.
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3. INDICATION FOR THE ADMISSION TO
NICU
• Babies less then 30 weeks
• Very low birth weight babies of less then 1500 gm
• Cardiopulmonary monitoring.
• Surfactant therapy
• Convulsion
• Sever birth asphyxia
• Assisted ventilation
• Total parenteral therapy
• Major surgeries
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4. AIMS OF ORGANIZING OF NICU
• Reducing the neonatal mortality and improving the quality of
life among the survivors
OBJECTIVES:
• To prevent damage in infants with problems at birth and also
reduce morbidity in later life.
• To monitor high risk new-born's so as to reduce mortality and
morbidity in these babies
• To save the life of sick new born.
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5. BASIC FACILITIES:
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• Adequate space
• Availability of running water
• 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

6. Cont..
• Equipment and articles of general and special use like iv
stands, various procedure trays, stethoscope, torch,
syringes, bowels, kidney trey, feeding cup, jugs, basin
etc.
• Machines like incubator, phototherapy unit, ventilator,
monitors etc.
• Stationary as per need.
• Toilets and bathrooms
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7. EMPHASIS SHOULD BE LAID ON
THEFOLLOWING:
• Asepsis
• Warmth and thermo neutral environment
• Adequate nutrition with human milk
• Non stimulating noise free ward
• Safety from all biological, physical and chemical
hazards.
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8. NEONATAL CARE SERVICES
• LEVEL - l NORMAL NEONATALCARE
• LEVEL – II SPECIAL CARE NURSARY
• LEVEL – III INTENSIVE NEONATALCARE UNIT
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9. LEVEL - I
• The minimal care
• Provided by the mother under the supervision of basic
health professionals.
• Neonates weighting more than 2000 gm or having
gestational age maturity of 37 weeks or more belong
to this care.
• This care can be includes care of delivery, provision of
the warmth, maintenance of asepsis, and promotion of
breastfeeding.
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10. LEVEL - II
• This care includes requirement for resuscitation, maintenance of
thermo-neutral temperature, intravenous infusion, gavage feeding
phototherapy and exchange transfusion.
• 10-15 percent of the newborn require this care
• This care s is anticipated for the infants weighing in between1500
& 1800 gm or having gestational age maturity of 32 to 36weeks.
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11. LEVEL - III
• This care includes life saving support system like
ventilator and best suited special intensive neonatal care.
• Three to five percent of newborn require care of this level.
• This level of care is for critically ill babies, for those
weighing less than 1500 gm or having gestational age
maturity of less than 32 weeks
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12. DEFINITION
• Newborn transport is used to move premature and other sick
infants from hospitals without specialist, intensive care facilities
require for optimal care of the baby to hospitals with neonatal
intensive care and other specialist services
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13. Out born newborn:
• A significant number of neonates require emergent transfer to a
tertiary care center, often because of medical, surgical, or rapidly
emerging postpartum problems. These are termed “out born”
neonates, because they have been born somewhere besides the
facility to which they’ve been transferred.
•
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14. TRANSFER
• Transfer can be within the hospital; to ICU■Transfer
can be to other hospital
• NEONATAL TRANSFER TYPES
• Emergency: unplanned
• Elective : planned and informed
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15. How can we transfer?
• The short distance transport within the hospital can be accomplished in a transport
incubator.
• The use of plastic basket with perforated sides coupled with careful placing of hot water
bottles is recommended for use in the rural setting.
• The baby can be wrapped in tin foil or covered with several layers of cotton.
• Themocole (polystyrene) box is an effective insulator and can be used in community.
• Skin to skin contact with mother or a care taker is a useful modality of transport in rural
areas or resource poor settings.
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16. INDICATIONS OF NEONATAL TRANSPORT
• Preterm infant with a birth weight
<1500g or gestation <32 weeks
• Respiratory distress requiring CPAP
or assisted ventilation
• Severe hypoxic-ischemic
encephalopathy
• Life threatening sepsis
• Intractable seizures
• Bleeding neonate
• Congenital anomalies or surgical
neonate
• Inborn errors of metabolism
• Severe jaundice
• Procedures or diagnostic facilities
unavailable at parent hospital.
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17. TRANSPORT EQUIPMENTS
• Transport incubator with multi-channel vital signs monitor for recording
temperature, heart rate, NIBP, oxygen saturation
• CPAP facility with nasal prongs and portable ventilator
• Airway equipment: suction devices, oral airways, bag and mask,
laryngoscopes (size 00,0 and 1 blades)
• Infusion facilities: infusates, infusion pumps, glucometer
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18. Cont..
• Oxygen, compressed air cylinder, oxygen mask, hood, heat and light,
sources of electric powers and adapters.
• Disposables: catheters (5, 6, 7,8,10,12Fr), syringes, needles, feeding tubes
(8 & 10Fr), alcohol, betadine swabs, micropore tape, gloves etc.
• Instrument tray for ET intubation, vascular access, insertion of chest
tubes, NG tube etc.
• Life saving drugs
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19. TRANSPORT TEAM
• The neonate needing special or intensive care should be transported
by a skilled transport team.
• Teams include at least,1.One senior resident2.One specially
trained neonatal nurse
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20. • STABLE
• Sugar
• Temperature
• Airway
• Blood pressure
• Lab work
• Emotional support
• SAFER
• Sugar
• Arterial circulatory
support
• Family support
• Environment
• Respiratory support
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21. • TOPS
• Temperature
• Oxygenation (airway and breathing)
• Perfusion
• Sugar
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22. Protocols
• Maintain airway, oxygenation, thermal stability and
tissue perfusion
• Stop oral feeding and start parenteral feeding with
10% of dextrose.
• Ensure umbilical or peripheral venous access
• Insert an NG tube and decompress the stomach
• Maintain adequate blood glucose level
• Obtain culture samples and administer first dose of
antibiotics.
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23. Cont..
• Obtain a recent chest skiagram as a base line and to check the
position of catheters and tubes.
• Take the family member or parents along with the baby
whenever feasible.
• When required transport team should undertake life
saving procedures (like ET tube insertion, chest tube insertion
etc)
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24. • Administer life saving drugs like surfactant and
prostaglandins
• The referring hospital should prepare a detailed transport
note including copies of obstetric and neonatal charts for
the transport team.
• Monitor the baby’s color and temperature.
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25. Arrival at the receiving NICU
• The transport team should remain in constant touch with the referral
NICU during the course of journey.
• The team should brief the NICU care givers regarding the status of the
baby and immediate clinical concerns.
• Hand over all the documents
• The referring hospital and parents should be informed about the safe
arrival and latest condition of the baby.
• The inventory of transport equipment should be checked, medications
and essential supplies should be restocked for the next transport
service.
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26. ORGANIZATION
OF NEONATAL
INTENSIVE CARE
UNIT
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27.  MAIN COMPONENTS TO
BECONSIDER WHILE ORGANIZING A NICU
Physical facilities
Personnel
Equipment
Laboratory facilities
Procedure manual
Transport of sick infants
Cooperation between the obstetrician and
neonatologist
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28.  I.PHYSICAL FACILITIES
Location
Space
Floor plan
Lighting
Environmental temperature and humidity
Handling and social contact
Communication system
Acoustic characteristics
Ventilation
Electrical outlets
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29. Date Your Footer Here 29

30. A) LOCATION
Located as close as to labor room and obstetric care unit
Adequate sunlight for illumination
Fair degree of ventilation for fresh air
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31. B) SPACE
• Serve as a referral unit for the infants born outside the hospital,
allowance should be made for additional physical facilities and space.
• Each infant should be provided with a minimum area of 100 sq. ft.
or10sq. Meter. However , additional space would be needed to provide
for additional facilities
• Space for promotion of breast feeding, expression of breast milk and its
storage.
• 500-600 Gross square feet per bed.
• Space includes patient care area, storage area, space for doctors, nurses,
other staff, office area, seminar room area, laboratory area and space for
families
• 6 Feet gap between two incubators for adequate circulation and keeping
the essential lifesaving equipment.
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32. C) FLOOR PLAN
• Ward should preferably be in square
shape so that abundant open space is
available.
• The walls should be made of washable
glazed tiles and windows should have
two layers of glass planes to ensure
the protection from heat and sound
insulation.
• 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.
• solation room
• There should be nursing station,
doctor’s room, store room, a procedure
room, pantry, toilet and bathroom, milk
storage room and cleaning area.
• The ward should have the clean area,
infected area, separately located where
infants can be segregated
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33. VENTILATION
• Effective air ventilation is necessary to reduce nosocomial
infection.
• The most satisfactory ventilation is achieved with laminar flow
system which is bit expensive.
• A simple method for achieving satisfactory ventilation consist
of provision for exhaust fans in reverse direction near ceiling
for input of fresh uncontaminated air.
• Central air conditioning
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34. LIGHTING
• The whole unit must be well illuminated and painted white or
slightly off white to permit prompt detection of jaundice and
cyanosis.
• The lighting arrangement should provided uniform shadow-free,
illumination of 100 foot candles at the infant’s level.
• The number and exact location of fixation of lights depends upon
size of ward, height of ceiling and availability of natural light.
• Spot illumination for various procedure can be provided by portable
angle poise lamp having two, 15 watt florescent bulbs.
• In place where electric failure is frequent, the ward must be attached
with generator.
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35. • ENVIRONMANTAL TEMPERATURE AND HUMIDITY
• The temperature inside the unit should be maintained at 28’ +_2’C,
while the humidity must be above50%.
• Portable radiant heater, infra-red lamp can be used.
• 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 be exceed 75 decibels.
• Telephone rings and equipment alarms should be replaced
by blinking lights.
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36. COMMUNICATION SYSTEM
• The unit should also have an intercom so that the ward is well
connected with other units of the hospital, & a direct outside
telephone line so that the parents have easy access to enquire about
the well-being about their child.
• ELECTRICAL OUTLETS
• Each patient station should have 12 to16 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
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37. A direct who is a full
time neonatologist
Anaesthetist - paediatric surgeon
and paediatric pathologist are
essential persons in establishment
of a good quality NICU
PERSONNEL
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38. • NURSES
• A nurse : patient ratio of 1:1 maintained thought out day and night is absolutely
essential for babies on multi system support including ventilator therapy.
• For special care neonatal unit and intermediate care, nurse to patient ratio of
1:3 is ideal but 1:5 per shift is manageable.
• Head nurse is the overall in-charge
• In addition to basic nursing training for level-II care, tertiary care requires, staff
nurse need to be trained in handling equipment, use of ventilators and initiation
of life-support like use of bag and mask resuscitation, endotracheal intubations,
arterial sampling and so-on.
• The staff must have a minimum of 3 years work experience in special care
neonatal unit in addition to having 3 months hand on-training in an intensive
care neonatal unit.
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39. • OTHER STAFF
• Respiratory therapist
• ■Laboratory technician
• ■ Public health nurse or social worker
• ■Biomedical engineer
• ■Clark
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40. EQUIPMENT
• During past few years, a large number of sophisticated devices for
diagnostic and therapeutic purpose have been developed.
• Acquisition of new equipment does not necessarily mean better services
and outcome.
• The maintenance of existing equipment in proper working condition is
more important then acquiring new and sophisticated gadgets.
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41. DISPOSABLE ARTICLES REQUIRED FOR
THE NICU:
• IV Catheters
• IV sets
• Micro burette sets
• Bacterial filters
• Feeding tubes
• Endotracheal tubes
• Suction catheters
• Three-way stopcocks
• Extension tubing
• Umbilical arterial and venous
catheters
• Syringes, needles
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42. MEDICAL EQUIPMENT IN THE NICU
• Beds
• Your baby will be admitted to a radiant warmer or giraffe bed, then changed into an
isolette or open cribde pending on age and medical condition.
• Monitor
• Three sticky leads are placed on your baby’s skin to monitor heart rate and
breathing.
• A saturation probe is placed on your baby’s hand or foot to read the oxygen level.
• A temperature probe may be placed on the skin, under the baby’s arm to measure
the body temperature.
• A blood pressure cuff will be placed on your baby’s legor arm to measure blood
pressure.
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43. Oxygen Saturation
• (blue line and number) is a measurement of how much oxygen the blood cells are
carrying and is described as a percentage of 100%, normal = 80 to 93 for pre-term
infants, 85 to 100 for term infants
• Heart rate- (green line and number) varies depending on infant
• Temperature- (orange number)normal is 36.2 to 37.6 Celsius or 97.2 to 99.7
Fahrenheit)
• Respirations-(white line and number)are your baby’s breaths, normal rate is 40
to 60
• Blood pressure- (purple number)varies depending on infant
• Blood pressure cuff-(left leg) reads the baby’s blood pressure
• Leads-(purple hearts) read the baby’s heart rate and respirations
• Saturation probe-(right foot) reads the oxygen level the baby is receiving
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44. RESPIRATORY EQUIPMENT
• VENTILATOR: It is a machine that provides breathing
support while the baby is unable to breathe on his or her own.
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45. • ET Tube- is a tube that is placed in the windpipe (trachea) and
goes to the lungs to help the ventilator provide breathing support
for the baby
• CPAP--- is a machine that helps the baby breathe. CPAP
prongs/mask will be placed in/on the baby’s nose. The
prongs/mask allow the CPAP machine to provide breathing
support to the baby.
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46. • Nasal Cannula are small tubes that go just inside your baby's nose to
give oxygen for breathing support.
• Humidified Air for the nasal cannula helps keep your baby's nose from
being dried out.
•
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47. • The bag and mask set-up is at every bedside. This emergency
equipment is used only temporarily until the ventilator or CPAP
machine is brought to your baby.
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48. • A suction set-up is at every bedside. Suction is used to clear collected
secretions/materials from airways to allow babies to breathe easier.
Suction is also used to pull contents from the stomach or the lungs.
Babies with certain conditions or breathing equipment may require
routine suctioning of their airway with their care. Suction is readily
available to use in emergencies or with procedures your baby may
have done at the bedside.
• IV Therapy Infusion and IV pump are machines to provide
intravenous nutrition, IV fluidsand/or medications.
• PIV or PICC are catheters that deliver medications and IV fluid from
the medfusion and IV pump to the baby.
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49. Phototherapy
• Some babies have an elevated bilirubin level which is referred to
as“jaundice”.
• Jaundice is a yellow-tinge in the baby’s skin or eyes.
• The bili-light helps to reduce the bilirubin level in the baby’s body
and will prevent side effects associated with severe jaundice.
• The baby will have an eye mask to protect his or her eyes from the
bright lights of the bili-light.
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50. • TOWARDS A GENTLE AND FRIENDLY NICU
ENVIRONMENT:
• Attempts should be made to reduce unnecessary noise and light.
• Avoid excess of light
• Handling should be gentle
• Neonates including pre terms feel pain and painful stimuli can cause
deleterious physiological responses.
• Analgesia should be provided during all procedure including
ventilation.
• Parent should be allowed unrestricted entry to the nursery
• They should be explained about various tubing and attachments to
the baby and should be involved in care of their baby.
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51. MANAGEMENT OF NURSING CARE
• Assessment
• Monitoring physiological data
• Safety measures
• Respiratory support
• Thermoregulation
• Protection from infection
• Hydration
• Nutrition
• Feeding resistance
• Skin care
• Administration of medication
• Developmental outcome
• Facilitating parent-infant
relationship
• Discharge planning and home
care
• Neonatal loss
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52. TRANSPORT OF SICK NEONATES:
• The goal of every transport is to bring a sick neonate to
specialized neonatal center in a stable condition.
• To avoid complications during transport, the infant should be as
stable as possible before leaving the referring hospital and
warm chain should be maintained.
• The transport service gives high — risk patients timely access
to the appropriate services without interrupting their care
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53. TRANSFER PATTERNS IN REGIONAL
SYSTEM:
• Level I [Basic Care] — Relatively minor problems
• Level II [Speciality Care] — Low birth weight babies (1500 to 2500
gm, 32 to 36 weeks of gestation)
• Level III [Subspeciality Care] — Maternal and Neonatal those at high
risk (less than 1500 gm birth weight or less than 32 weeks gestation)
• Level I to Level II: Complicated cases not requiring intensive care.
• Level II to Level III: Complicated cases requiring intensive care. Labor
less than 34 weeks gestation
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54. REFERENCE
• R Dorothy Textbook of Pediatric Nursing6th 19881316
• Piyush Gupta Essential Pediatric Nursing
• M Singh Care of the Newborn 640
• D L Hartl E W Jones Genetics: Analysis of Genes and Genomes, Sixth EditionNeuro
oncol200572204510.1215/S1152851704200059
• Gardner Principles of Genetics8th 2012
• Ati Ati Maternal Newborn Nursing, RN Edition, Review2006468
• Services & Treatments2018https://www.floyd.org/medical-services/.../NICU/Pages/Levels-of-Neonatal-
Care.aspx.CITED ON 1-05-18
• The Neonatal Intensive Care Unit
(NICU)2019105https://www.stanfordchildrens.org/en/topic/default?id=the-neonatal-intensive-care-unit-
nicu-90-P02389
• https://www.scribd.com/presentation/485489884/5-Organization-of-neonatal-care-services-pptx
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55. JOURNAL REFERENCE:
• Organization and management of nursing services in NICU, levels of transport
• Javaid Ahmad Mir[1]Designation:Faculty
• Bushra Mushtaq[2]Designation:Faculty
• Onaisa Aalia Mushtaq[3]Email: onaisamushtaq@gmail.comDesignation:P G
Nursing Scholar
• Dept. of Nursing, Govt. Nursing College Baramulla, Jammu and Kashmir India
• Dept. of Nursing , Islamic University of Science & Technology Awantipora, Jammu
& Kashmir India
• Dept. of Nursing Education, Sher E Kashmir Institute of Medical Sciences Srinagar,
Jammu and Kashmir India
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56. ThankYou!
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C.KEERTHANA M.SC (N).,
SRMTCON