The document outlines the organization and setup of a neonatal intensive care unit (NICU). It discusses the goals of ICU services and meeting the special needs of neonates. It describes the round-the-clock resources needed like running water, oxygen, and continuous power supply. It details the three levels of neonatal care - Level III for very preterm and critically ill babies, Level II for standard care of preterm babies, and Level I for basic care of term babies. It provides information on necessary personnel, equipment, physical facilities including space, floor plan, lighting, temperature/humidity control, and infection control protocols. It emphasizes the need for a gentle, friendly environment to reduce stress on the neonates.

1. ORGANIZATION OF NICUORGANIZATION OF NICU
Mr. P. R. Koti
Child health nursing
KLE Nursing College Belagavi

2. GOALSGOALS
 ICU Services,ICU Services,
 Reduce neonatal mortality & morbidity,Reduce neonatal mortality & morbidity,
 Meeting the special needs of the neonatesMeeting the special needs of the neonates
 Maternal BondingMaternal Bonding
 To meet the nutritional needs of theTo meet the nutritional needs of the
neonateneonate
 Continuing in-service educationContinuing in-service education

3. ROUND- THE CLOCK
 Running waterRunning water
 Centralized OCentralized O22 & suction& suction
 Thermo neutral environmentThermo neutral environment
 Doctor & NursesDoctor & Nurses
 Laboratory facilitiesLaboratory facilities
 DisposablesDisposables
 Continuous Power SupplyContinuous Power Supply
 RefrigeratorRefrigerator
 IntercomIntercom
 LinenLinen
 Bio-Medical EngineerBio-Medical Engineer
 SweeperSweeper

4. Round the clock

5. Round the clock

6. LEVELS OF NEONATAL CARELEVELS OF NEONATAL CARE
 Level – IIILevel – III - High – Intensive -Tertiary- High – Intensive -Tertiary
 Level – IILevel – II - Ideal- Ideal - Standard- Standard
 Level – ILevel – I - Adequate- Adequate – Basic– Basic

7. LEVEL – III – High LevelLEVEL – III – High Level
(Tertiary Care)(Tertiary Care)
 Intensive Neonatal CareIntensive Neonatal Care
 Prolonged assisted ventilatorProlonged assisted ventilator
 Warmers, OWarmers, O22 ,Suction, Servo-,Suction, Servo-
control Ventilator, Monitorscontrol Ventilator, Monitors
 Skilled doctors (Neonatalogist ) &Skilled doctors (Neonatalogist ) &
NursesNurses
 Babies <1.5 kgs & < 34 weeksBabies <1.5 kgs & < 34 weeks
 Seriously ill & organic systemicSeriously ill & organic systemic
failurefailure
 3 to 5 % require this care3 to 5 % require this care

8. LEVEL – II – IDEAL RESUSCITATION FACILITIESLEVEL – II – IDEAL RESUSCITATION FACILITIES
 Non invasive monitorsNon invasive monitors
 Thermo neutral EnvironmentThermo neutral Environment
 Short Term Assisted ventilatorShort Term Assisted ventilator
 Gavage FeedingGavage Feeding
 IV InfusionIV Infusion
 Exchange TransfusionExchange Transfusion
 Supervised by Trained Nurses & DoctorsSupervised by Trained Nurses & Doctors
 Babies < 2 kg < 36 weeksBabies < 2 kg < 36 weeks
 10 to 15% need this care10 to 15% need this care
 Available at all Teaching Hospital, District, CHC.Available at all Teaching Hospital, District, CHC.
Taluk Hospital & Nursing HomesTaluk Hospital & Nursing Homes

9. LEVEL – I : ADEQUATE (Minimal)LEVEL – I : ADEQUATE (Minimal)
 Adequate Resuscitation at birthAdequate Resuscitation at birth
 Suction, Bag & Mask VentilationSuction, Bag & Mask Ventilation
 Thermo neutral EnvironmentThermo neutral Environment
 Breast and Spoon FeedingBreast and Spoon Feeding
 Adequate for term babies > 2 kgAdequate for term babies > 2 kg
 80% will need this care80% will need this care
 Mother’s Care under supervisionMother’s Care under supervision
 Care at level of home / Sub central /Care at level of home / Sub central /
PHCPHC
 > 2000 gms, 37 weeks> 2000 gms, 37 weeks

10. RESOURCESRESOURCES
Medical
Nursing
PERSONNELPERSONNEL
Class IV
Students
EQUIPTMENTSEQUIPTMENTS
OTHERSOTHERS
PHYSICAL FECILITIESPHYSICAL FECILITIES SpaceSpace
LocationLocation
Floor PlanFloor Plan
VentilationVentilation
LightingsLightings
EnvironmentalEnvironmental
Temperature and HumidityTemperature and Humidity
Handling and Social ContactsHandling and Social Contacts
Communication SystemsCommunication Systems
Electrical OutletsElectrical Outlets

11. PLANINGS OF THEPLANINGS OF THE
UNITSUNITS
NeonatologistNeonatologist
Nurse InchargesNurse Incharges
LOCATION –LOCATION –
Close to labour roomClose to labour room
Operation TheatersOperation Theaters
Ground FloorGround Floor
Preferable to combine with level – II NICUPreferable to combine with level – II NICU
Good ventilationGood ventilation
Central a/c Ducts with Multipores filters, Exhaust Fan EasyCentral a/c Ducts with Multipores filters, Exhaust Fan Easy
acsessable entrances from ambulance fromacsessable entrances from ambulance from
other hospital for referenceother hospital for reference

12. SPACESPACE
 500 – 600 gross square feet / bed includes- Patient care
area, storage area
 100 sq. feet or 10 m2
for each baby
 6 feet gap between two Incubators
 Promotion of Breast Feeding, EBM
 Storage of breast milk
 Weighing the babies

13. FLOOR PLANFLOOR PLAN
 Washable glazed tiles
 Windows – two layer glass helps for heat
and sound insulation
 Deep wash basin
 Elbow and foot operated taps
 Automatic door closure
 Unit linked with lab, procedure room,
ultrasound room, sterilization room
 Septic Nursery

14. LIGHTINGLIGHTING
 White or light white paint for walls
washable walls and have white or off white
colour for better apparent colour of
Neonate
 Provides shadow free light
 Alternative electrical system
 Dim light at night ? ? ? -to stimulate day
and night patterns
 To promote hormonal balance which
facilitate growth & Development

15. ENVIRONMENT TEMPERATURE AND HUMIDITYENVIRONMENT TEMPERATURE AND HUMIDITY
 Maintain around 28 ± 2°C
 Humidity above 50% (Hygrometer)

16. ACOUSTIC CHARACTERISTIC ( Sound )ACOUSTIC CHARACTERISTIC ( Sound )
 Should not exceed 75 db (decibels)
 Excessive Sound leads to
 * Hearing loss
 * Startle
 * Sleep Disturbance
 * Hypoxia
 * Crying episode
 * Tachycardia
 * ICP
 Telephone rings & Equipment alarms  Replaced by
blinking Lighting
 Recording of parent voice or gentle music should be
harnessed provides physiological stability to the babies

17. HANDLING AND SOCIAL CONTACTHANDLING AND SOCIAL CONTACT
 Minimum HandlingMinimum Handling
 Maternal TouchMaternal Touch
 NestingNesting
 Visitors not allowedVisitors not allowed

18. COMMUNICATIONCOMMUNICATION
SYSTEMSYSTEM
 Intercom and Direct outside telephoneIntercom and Direct outside telephone
 Mobile Phones Prohibited – interferes withMobile Phones Prohibited – interferes with
the functioning of electronic equipmentthe functioning of electronic equipment

19. ELECTRIC OUTLETELECTRIC OUTLET
 Adequate numbers of electrical pointsAdequate numbers of electrical points
 Attached to common groundAttached to common ground
 Each bed – 8 electrical outletsEach bed – 8 electrical outlets
 Do not use adopter or extension boardDo not use adopter or extension board
 Safety devices must be installedSafety devices must be installed
 UPS system for the sensitive equipmentUPS system for the sensitive equipment

20. PERSONNELPERSONNEL
DOCTORSDOCTORS
 1 Neonatal Physician – on 24 hour basis for1 Neonatal Physician – on 24 hour basis for
consultationconsultation
 1 Resident Doctor – round the clock1 Resident Doctor – round the clock
 1 Reliever1 Reliever
 On call-Pediatric surgeon, Microbiologists,On call-Pediatric surgeon, Microbiologists,
Hematologist, Cardiologist, Radiologist,Hematologist, Cardiologist, Radiologist,
Pharmacist, AnesthetistPharmacist, Anesthetist

21. NURSESNURSES
 Nurse –patient – 1:1 ratio throughout the day and nightNurse –patient – 1:1 ratio throughout the day and night
on ventilator multi-system supporton ventilator multi-system support
 1:2 for sick babies not on ventilation1:2 for sick babies not on ventilation
 Special care or intermediate care 1:3Special care or intermediate care 1:3
 But 1:5 per shift is manageableBut 1:5 per shift is manageable
 Fully trained 2/3rd of staff nurses round the clockFully trained 2/3rd of staff nurses round the clock
 Head Nurse – Overall inchargeHead Nurse – Overall incharge
 Staff should haveStaff should have
 3 years work experience in special care3 years work experience in special care
 neonatal unit.neonatal unit.
 3 months hands on training in NICU3 months hands on training in NICU
 Training in handling equipment use of ventilation bag & maskTraining in handling equipment use of ventilation bag & mask
ventilation, ET & RT intubations, arterial samplingventilation, ET & RT intubations, arterial sampling
 Basic nursing training of level II tertiary care requires dedicated,Basic nursing training of level II tertiary care requires dedicated,
committed and well trained staff of highest qualitycommitted and well trained staff of highest quality

22. OTHER STAFFOTHER STAFF
 Motivated staff - responsible forMotivated staff - responsible for
cleanliness of the unit.cleanliness of the unit.
 1 Sweeper- round the clock1 Sweeper- round the clock
 1 Lab Technician1 Lab Technician
 1 public health nurse / social worker1 public health nurse / social worker
 1 Biomedical engineer1 Biomedical engineer
 1 Store keeper1 Store keeper

23. EQUIPMENTEQUIPMENT
 Maintenance of existing equipment inMaintenance of existing equipment in
proper working condition is moreproper working condition is more
important then getting additional gadgetsimportant then getting additional gadgets

24. EQUIPMENT NEEDED FOREQUIPMENT NEEDED FOR
LEVEL III – 6 BEDLEVEL III – 6 BED
 Resuscitation set -6Resuscitation set -6
 Ventilators – 6Ventilators – 6
 OO22 hood analyser – 6hood analyser – 6
 Pulse oximeter – 6Pulse oximeter – 6
 End tidal COEnd tidal CO22 Monitor- 6Monitor- 6
 Non invasive BP MonitorNon invasive BP Monitor
 Open care system- 4Open care system- 4
 Incubators - 2Incubators - 2

25.  Infusion pump -12 – 18Infusion pump -12 – 18
 Electronic weighing scale – 1Electronic weighing scale – 1
 ECG Monitor – 1ECG Monitor – 1
 Portable X-ray machine – 1Portable X-ray machine – 1
 USG machine – 1USG machine – 1
 Blood gas analysor- 1Blood gas analysor- 1
 Transport incubatorTransport incubator

29. DISPOSABLE ARTICLESDISPOSABLE ARTICLES
REQUIREDREQUIRED
 IV Catheters
 IV Sets
 Feeding Tubes
 ET Tubes
 Suction catheters
 Stop cocks
 Umbalical central venous catheter
 Syringes
 Needles
 Trochar cannula
 Infusion pump
 Gloves

30. INFECTION CONTROLINFECTION CONTROL
 Hand washing is essential and needs toHand washing is essential and needs to
be monitored regularlybe monitored regularly
 Asepsis TechniqueAsepsis Technique

31. DOCUMENTATIONDOCUMENTATION
 Unit should have -Unit should have -
printed problemprinted problem
oriented admissionoriented admission
and discharge slipsand discharge slips
 Records of allRecords of all
admission should beadmission should be
maintained in regularmaintained in regular

32. EDUCATION PROGRAMMESEDUCATION PROGRAMMES
 MannualMannual -- Management of common problemsManagement of common problems
 CMECME (1) Resuscitation(1) Resuscitation
 CNECNE (2) Exchange Transfusion(2) Exchange Transfusion
 SeminarSeminar (3) Stablization of critically ill babies(3) Stablization of critically ill babies
 Journal ClubJournal Club (4) Recognition & treatment of air leaks(4) Recognition & treatment of air leaks
 Group discussionGroup discussion (5) Putting arterial catheter(5) Putting arterial catheter
(6) Maintenance of ventilator(6) Maintenance of ventilator

34. GENTLE & FRIENDLYGENTLE & FRIENDLY
NICUNICU
 Reduce unnecessary noise & lightReduce unnecessary noise & light
 Gentle handling, only when neededGentle handling, only when needed
 Parents allowedParents allowed
 NestingNesting
 Humanistic approachHumanistic approach
 Maternal bondingMaternal bonding
 Avoid overcrowdingAvoid overcrowding

35. Thank YouThank You