Steps organization ofSteps organization ofNeonatal Intensive CareNeonatal Intensive CareReorganization of existing neonatalcare facilitiesDeveloping the units should beBasic level – IIHigh level IILevel III
PHYSICAL FACILITIESPHYSICAL FACILITIESThe neonatologist and thenurse in charge must beinvolved while planning theunit.
LOCATIONLOCATION• Neonatal unit should be located as close aspossible to the labour rooms and obstericoperation theatre• Adequate sunlight for illumination• Fair degree of ventilation of fresh air
SPACESPACE500-600 Gross square feet per bed.Space includes patient care area,storage area, space for doctors, nurses,other staff, office area, seminar roomarea, laboratory area and space forfamilies6 Feet gap between two incubators foradequate circulation and keeping theessential lifesaving equipment
FLOOR PLANFLOOR PLANOpen encumbered spaceThe walls should be made of washableglazed tiles and windows should havetwo layers of glass panes.Wash basins with elbow or floor operatedtaps facility having constant round-the-clock water supply should be provided.The doors should be provided withautomatic door closers.Isolation room
VENTILATIONVENTILATIONEffective air ventilationCentral air conditioning
LIGHTINGLIGHTINGThe whole unit must be wellilluminated and painted whiteThe lighting arrangement shouldprovided uniform shadow-free,illumination of 100 foot candlesat the baby’s level
ENVIRONMANTAL TEMPERATUREENVIRONMANTAL TEMPERATUREAND HUMIDITYAND HUMIDITY• The temperature inside the unit should bemaintained at 28’ +_2’C, while the humiditymust be above 50%.• Portable radiant heater, infra red lamp canbe used
ACOUSTIC CHARACTERISTICSACOUSTIC CHARACTERISTICS• The ventilation system, incubators, aircompressors, suction pumps and manyother devices used in the nursery producenoise.• Sound intensity in the unit should beexceed 75 decibels.• Telephone rings and equipment alarmsshould be replaced by blinking lights.
COMMUNICATION SYSTEMCOMMUNICATION SYSTEM• The unit should also have anintercom & a direct outsidetelephone line
ELECTRICAL OUTLETSELECTRICAL OUTLETS• Each patient station should have 12 to 16central voltage – stabilized electrical outletssufficient to handle all pieces of equipment• An additional power plug point• There should be round-the-clock powerback up including provision of UPS system.
STAFFSTAFF• A direct who is a full time neonatologist• One neonatal physician is required forevery 6-10 patients• One resident doctor should be present inthe unit round-the-clock.• Anesthetist - pediatric surgeon andpediatric pathologist are essential personsin establishment of a good quality NICU
NURSESNURSES• A nurse : patient ratio of 1:1 maintained thought outday and night is absolutely essential for babies onmulti system support including ventilatory therapy.• For special care neonatal unit and intermediate care,nurse to patient ratio of 1:3 is ideal but 1:5 per shift ismanageable.• Head nurse is the overall in-charge• In addition to basic nursing training for level-II car,tertiary care requires, staff nurse need to be trained inhandling equipment, use of ventilators and initiation oflife-support like use of bag and mask resuscitation,endotracheal intubations, arterial sampling and so-on.• The staff must have a minimum of 3 years workexperience in special care neonatal unit in addition tohaving 3 months hand-on-training in an intensive careneonatal unit.
OTHER STAFFOTHER STAFF• Respiratory therapist• Laboratory technician• Public health nurse or social worker• Biomedical engineer• Clark
EQUIPMENTEQUIPMENT• Equipment and supplies should including allthat is necessary for resuscitation andintermediate care areas.• Supplies should be kept close to the patientstation so that nurses do not have to goaway from the neonate unnecessarily andnurses time & skills are used efficiently.• There should be servo-controlledincubators and open care systems forproviding adequate warmth
EQUIPMENT FOR LEVEL IIIEQUIPMENT FOR LEVEL IIINURSING – 6 BEDNURSING – 6 BEDSl.No Item Nos1 Resuscitation set 62 Open care system 43 Incubators 24 Infusion pumps 12-185 Positive pressure ventilators 66 Oxygen hoods, oxygen analyzers 67 Heart rate – apnea monitors withscope68 Phototherapy unit 6
EQUIPMENT FOR LEVEL III NURSING – 6 BEDEQUIPMENT FOR LEVEL III NURSING – 6 BED9 Electronic weighting scale 110 Pulse oxymeters 611 End tidal CO2monitor 612 Transcutaneous PO2& PCO22-313 Noninvasive Bp monitors 1-214 Invasive Bp monitors 1-215 ECG monitor with defibrillator 116 Intra cranial pressure monitor 117 Portable radiographic machine 118 Portable ultrasound machine 119 Blood gas analyzer 1
DISPOSABLE ARTICLES REQUIRED FOR THEDISPOSABLE ARTICLES REQUIRED FOR THENICUNICU•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•Trocar and cannula
LABORATORY FACILITIESLABORATORY FACILITIES•Microchemistry laboratory•Well equipped to providequick and reliable•Facilities for creative protein,total leukocyte counts andmicroscopic examination ofperipheral blood
TOWARDS A GENTLE AND FRIENDLY NICU ENVIRONMENTTOWARDS A GENTLE AND FRIENDLY NICU ENVIRONMENT•It has been realized that physical and social environmentof nursery affect the recovery and long term morbidity ofthe neonate.•Attempts should be made to reduce unnecessary noiseand light.•Avoid excess of light•Handling should be gentle•Neonates including pre terms feel pain and painful stimulican cause deleterious physiological responses. Analgesiashould be provided during all procedure includingventilation.•Parent should be allowed unrestricted entry to the nursery,•They should be explained about various tubing andattachments to the baby and should be involved in care oftheir baby.
INDICATIONS FOR THE ADMINSSION TO NICUINDICATIONS FOR THE ADMINSSION TO NICU•Babies less then 30 weeks•Very low birth weight baby of less then1500 gms•Cardiopulmonary monitoring•Surfactant therapy•Convulsions•Severe birth asphyxia•Assisted ventilation•Total parenteral nutrition•Major surgery
LEVELS OF NEONATAL CARELEVELS OF NEONATAL CARELEVEL I CARELEVEL I CARE•The minimal care•Provided by the mother under thesupervision of basic health professionals.• Neonates weighting more than 2000 gmor having gestational age maturity of 37weeks or more belong to this care.•This care can be includes care ofdelivery, provision of the warmth,maintenance of asepsis, and promotion ofbreast feeding.
LEVELS OF NEONATAL CARELEVELS OF NEONATAL CARELEVEL II CARELEVEL II CARE•This care includes requirement forresuscitation, maintenance of thermo neutraltemperature, intravenous infusion, gavagefeeding phototherapy and exchangetransfusion.•10-15 percent of the newborn require thiscare• This care s is anticipated for the infantsweighing in between 1500 & 1800 gm orhaving gestational age maturity of 32 to 36weeks.
LEVELS OF NEONATAL CARELEVELS OF NEONATAL CARELEVEL III CARELEVEL III CARE•This care includes life saving support systemlike ventilator and best suited specialintensive neonatal care.•Three to five percent of newborn requirecare of this level.•This level of care is for critically ill babies, forthose weighing less than 1500 gm or havinggestational age maturity of less than 32weeks.
OUTLINE OF MCH SERVICESOUTLINE OF MCH SERVICESLEVEL FOR WHERE BY WHOM COMPONENTSI(at village)for lowriskmotherandneonate.75% HomeSub-centrePHC• Mother• Trained birth attendant• Multipurpose worker orANM• Doctors• Anganwadi workers.Basis careII (at sub-district)for higherriskmothersandneonates.20% UpgradedPHC,Sub-districtDistricthospitals, nursinghomes,medicalcollegehospitals• Trained nurses• Resident doctors• Trained in obstetrics• Neonatology andanesthesiaFirst referralunitsSpecialneonatalcare
OUTLINE OF MCH SERVICESOUTLINE OF MCH SERVICESIII (inmetropolitan centersfor stillhigher riskmothers &infants)5% LargehospitalsMedicalcollegehospitalsandinstitutes.•SpecialistsSophisticated caregiven by trainednurses, residentdoctors,obstetricianneonatologist,pediatric surgeon,haematologist,radiologist,ultrasonologist &well equippedlaboratories.
THE MCH SERVICESTHE MCH SERVICESDIFFERENT LEVELSDIFFERENT LEVELSLevel I Care:Prenatal care:Early detection of pregnancy.•Identification of high risk pregnancy.•Immunization against tetanus.•Nutrition supplements with iron & folic acid.•Antenatal assessments at 20,30,34 & 38 weeksof pregnancy.•Assessment of pelosis.•Early detection of fortal growth failure.
THE MCH SERVICESTHE MCH SERVICESDIFFERENT LEVELSDIFFERENT LEVELSINTERNAL CARE :•Proper management of labour and delivery.•Adequate support of establishment of respirationoropharyngeal suction and warmth.•Identification of low birth weight, preterm birth &malformations requiring immediate correction andtheir referral.
THE MCH SERVICESTHE MCH SERVICESDIFFERENT LEVELSDIFFERENT LEVELSLEVEL II CARE:Prenatal care:This must be offered to mothers “at risk” identifiedthrough the high risk approach or mothers developingcomplications during pregnancy and / or labour.Intranatal and neonatal care:Deliveries of all “at risk” mothers must be attended by atrained obstetrician and neonatologist at first referral units.The new-born are expected to get special care for anoxiahyperbilirubinaemia, respiratory distress syndrome andsepticaemia.
THE MCH SERVICESTHE MCH SERVICESDIFFERENT LEVELSDIFFERENT LEVELSLEVEL III CARE:This level of care is meant for high risk pregnant women &neonates.•Low birth weight babies•Severe respiratory distress•Serve anoxia at birth•Shock & metabolic problemsIntensive neonatal care unit having a full time neonatologist,trained nursing staff and resident doctors, equipped withbiochemical laboratory support, ultra sound, electronicmonitory of foetal condition, ventilation and respiratory support,blood transfusion arrangement & monitoring.
SUMMARYSUMMARYSo far we have seen about neonatal intensivecare unit, its organization, physical facilities,personnel, equipment necessary, laboratory facilitiesand level of neonatal are and MCH services availableat different level.
CONCLUSIONCONCLUSIONThought NICU services require hightechnology input and expensive one should notlose sight of the human approach towards thefragile and sick babies & their anguishedparents. To obtain best results from neonatalintensive care we need a well equipped unit.