NEONATAL CARE IN NICU

1. ORGANIZATION OF NEONATAL CARE,
SERVICES,TRANSPORT,NICU,ORGANIZATION AND
MANAGEMENTOF NURSING SERVICESIN NICU

2. INTRODUCTION
• The infant mortality rate and neonatal mortality
rate is very high in India. The organization of a good
quality special care unit and paediatric ward is
essential for reducing the high mortality and
improving the quality of care being given to
children.
• Neonatal intensive care units(NICU) are highly
specialized areas in a hospital that cater to the
needs of all types of sick newborn babies.

3. PURPOSES
• To document the need for such unit in a given set-
up
• Assessment of need based on the existing patient
load and type of illness cared for in the set-up
• To determine the availability of committed and
appropriately trained staff, adequate financial
resources and other important considerations.

4. • I-NORMAL NEONATAL CARE(LEVEL-1)-
This is care given, usually by the mother in a
postnatal ward, supervised by the nurse and doctor
but requiring minimal medical or nursing advice.
• II-SPECIAL CARE NURSERY(LEVEL-2)-
Care given in a special care nursery which provides
observation, treatment and monitoring falling short
of intensive care but exceeding normal routine care.

5. • III-INTENSIVE NEONATAL (LEVEL-3)-
Care given in an intensive care nursery for seriously
ill neonates who require intensive skilled
management by nursing and medical staff.

6. EXAMPLES OF LEVELS OF NEONATAL CARE
1.NORMAL NEONATAL CARE(LEVEL-1)
Babies with mild medical conditions who can be
observed in level-1 neonatal care include babies
with G6PD deficiency, babies of hepatitis B carrier
mothers, babies with mild congenital
malformations(eg-polydactyly ,pre-auricular tags,
hydrocele etc) and babies receiving phototherapy,
at the discretion of the specialist in charge.

7. • Babies born to mothers with maternal
complications like DM, pyrexia, prolonged rupture
of membrane, mild meconium staining, but who are
free from all clinical manifestations of illness are
also included.
• The emphasis is to provide mother craft and the
encouragement of breastfeeding.

8. 2.SPECIAL CARE NURSERY(LEVEL-2)
• All low birth weight infants 2000gm and below.
• All preterm deliveries 35wks and below
• Neonates with Apgar score of 4-6 at five
minutes,and/or requiring any form of resuscitation
at birth
• Babies who require continous monitoring of
respiration or heart rates by apnoea monitor, pulse
oximetry
• Babies who are receiving additional oxygen

9. • Babies who are receiving intravenous glucose,
electrolyte solutions, antibiotics.
• Babies who are being tube feed
• Babies receiving phototherapy
• Babies with persistent hypothermia of 36c and
below
• Babies with congenital malformations that require
special care

10. 3. NEONATAL INTENSIVE CARE UNIT(LEVEL-3)
• Critically ill babies receiving assisted ventilation
• Recurrent apnea
• Who have had major surgeries like PDA
• Perinatal asphyxia(Apgar score of 3 or less at 5
minute)
• Severe meconium aspiration syndrome

11. • Infant weighing less than 1250gms or preterm
deliveries below 30wks
• Babies with convulsions
• Partial or total parenteral nutrition

12. EQUIPMENT RECOMMENDED FOR DIFFERENT
LEVELS OF NEONATAL INTENSIVE CARE
1. Special care nursery level-2
• Incubator or cot adequate for temperature control
• Oxygen analyzer
• Apnoea alarm
• Infusion pump
• Phototherapy unit
• Facilities for frequent ABG monitoring
• Access to equipment for radiological examination

14. NICU
• NICU stands for neonatal intensive care unit also
called a special care nursery. These nurseries care
for babies who born early, who have problems
during delivery, or who develop problems while still
in the hospital.

15. 1.PERSONNEL-
• Doctor incharge of NICU-
• The neonatal intensive care unit shall be under the
charge of an accredited paediatrician who has the
necessary training and experience in neonatal
intensive care or its equivalent.
• Nurses in NICU-

16. • At least 60% of the total nursing complement
• Level-3- the minimum ratio of nurse to baby shall
be 1:1.at least 50% of registered nurses on duty
each shift shall have the relevant training in
neonatal care.
• Level-2- the minimum nurse to baby ration shall be
1:2. There shall be at least one registered nurse
with the relevant training on duty.

17. • Patients- an admitting paediatrician is designated to
be responsible for each neonate admitted to the
NICU
Others-
• At least 1 sweeper and one helper should be
available
• A medico-social worker who can talk parents,
ensure bills are paid, fix appointment for varies
check-up

18. • A biomedical engineer should be available on call
for uninterrupted functioning of all equipment
• A ward clerk will be helpful in maintaining store and
patient records, corresponding with referring
doctors and help in other administrative work.

19. 2. PHYSICAL FACILITY-
• Space-
Each infant should be provided with a minimum
area of 100sq ft or 10metersq. However additional
space would be needed to provide for special
facilities.

20. • Location-
The neonatal unit should be located as close as
possible to the labour room and obstetric operation
theatre, to facilitate prompt transfer of sick and
high risk infants. The nursery should not be located
on the top floor of the hospital, there should be
adequate sunlight to enhance brightness and
provide UV rays to augment asepsis.

21. • Floor-
The unit facility should preferably be in a square
space so that abundant open berred space is
available. The walls should be made of washable
tiles and windows should have two layers of glass
pares to ensure some measure of heat and sound
insulation. Adequate wash basins having constant
water supply should be provided.

22. • Ventilation-
Effective air ventilation is essential to reduce
nosocomial infection. The most satisfactory
ventilation is achieved with laminar air flow system
• Lighting-
Nursery must be well-illuminated and painted white
or off-white to permit prompt detection of jaundice
or cyanosis. It can be best achieved by cool,
fluorescent tubes. Spot lights should be present for
performing various procedures.

23. • Environmental temperature and humidity-
The temperature in the nursery must be maintained
around 26c in order to minimize the effects of
thermal stress on the babies. The air movements
should be so designed that drought is minimized.

24. • Communication system-
The nursery should be provided with an intercom
system so that additional can be called for helping
case of an emergency without leaving the sick
infant.
• Electrical outlets-
There should be adequate number of electrical
sockets at a height of 4-5ft attached to a common
ground. Each infant must be provided with at least
8 electrical outlets.

25. 3. GENERAL SUPPORT SPACE-
Clean utility/ soiled utility area-
• It should be designed for storage of supplies
frequently used in care of newborn such as diapers,
linen, charts and gowns.
• Soiled utility space is essential for storing used and
contaminated material before its removal from the
care area.

26. Nursing station-
• Charting space at each bedside should be provided
• An additional separate area or desk for tasks. Such
as compiling detailed records, completing
requisitions and telephone communication should
be provided.

27. EQUIPMENTS FOR NICU

28. NEONATAL TRANSFER SERVICES
• A transfer service is concerned with organizing and
implementing the transfer of babies and or mothers
from within a defined geographical area.
TYPES OF TRANSFER SERVICES-
• Inutero transfer
• Exutero transfer

29. 1.INUTERO TRANSFER-(based on clinical and
operational patient priority)
• Unplanned(time-critical) transfer-
Transfer of babies from units in the network inorder
to access intensive care or specialist services.
• Unplanned (emergency/urgent) transfer-
Transfer of babies from units in the network in
order to access intensive care or specialist services

30. • Planned (next few days) transfer-
Transfer of babies from units in the network for
investigation and treatment or continuing intensive
care, either to other units in the network or to units
outside the network.

31. 2. EX UTERO TRANSFER(based on clinical priority)-
• Unplanned acute transfers of mothers for specialist
maternal or anticipated neonatal care which cannot
be provided locally, either to other units in the
network or to units outside the network(e.g. other
designated tertiary center)