2. Steps -organization of Neonatal Intensive
Care
Reorganization of existing neonatal care facilities
Developing the units should be
Basic level – I
High level II
Level III
4. LOCATION
Neonatal unit should be located as close as possible
to the labour rooms and obstetric operation theatre
Adequate sunlight for illumination
Fair degree of ventilation of fresh air
5. SPACE
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
6. FLOOR PLANFLOOR PLAN
Open encumbered space
The walls should be made of washable glazed tiles
and windows should have two layers of glass panes.
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.
Isolation room
8. LIGHTING
The whole unit must be well illuminated and
painted white
The lighting arrangement should provided uniform
shadow-free, illumination of 100 foot candles at the
baby’s level
9. ENVIRONMANTAL TEMPERATURE ANDENVIRONMANTAL TEMPERATURE AND
HUMIDITYHUMIDITY
The temperature inside the unit should be maintained
at 28* +_2*C, while the humidity must be above 50%.
Portable radiant heater, infra red lamp can be used
10. ACOUSTIC CHARACTERISTICSACOUSTIC 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.
12. ELECTRICAL OUTLETSELECTRICAL OUTLETS
Each patient station should have 12 to 16 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.
13. STAFF
A direct who is a full time neonatologist
One neonatal physician is required for every 6-10
patients
• One resident doctor should be present in the unit
round-the-clock.
Anesthetist - pediatric surgeon and pediatric
pathologist are essential persons in establishment of a
good quality NICU
14. NURSESNURSES
• 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
15. • In addition to basic nursing training for level-II
car, 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.
17. EQUIPMENT
Equipment and supplies should including all
that is necessary for resuscitation and
intermediate care areas.
Supplies should be kept close to the patient
station so that nurses do not have to go away
from the neonate unnecessarily and nurses
time & skills are used efficiently.
There should be servo-controlled incubators
and open care systems for providing adequate
warmth
18. EQUIPMENT FOR LEVEL III NURSING – 6 BED
Sl.No Item Nos
1 Resuscitation set 6
2 Open care system 4
3 Incubators 2
4 Infusion pumps 12-18
5 Positive pressure ventilators 6
6 Oxygen hoods, oxygen analyzers 6
7 Heart rate – apnea monitors with
scope
6
8 Phototherapy unit 6
19. EQUIPMENT FOR LEVEL III NURSING – 6 BED
9 Electronic weighting scale 1
10 Pulse oxymeters 6
11 End tidal CO2
monitor 6
12 Transcutaneous PO2
& PCO2
2-3
13 Noninvasive Bp monitors 1-2
14 Invasive Bp monitors 1-2
15 ECG monitor with defibrillator 1
16 Intra cranial pressure monitor 1
17 Portable radiographic machine 1
18 Portable ultrasound machine 1
19 Blood gas analyzer 1
20. 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
•Trocar and cannula
22. TOWARDS A GENTLE AND FRIENDLY NICU ENVIRONMENT
•It has been realized that physical and social environment of
nursery affect the recovery and long term morbidity of the
neonate.
•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.
23. INDICATIONS FOR THE ADMINSSION TO NICU
•Babies less then 30 weeks
•Very low birth weight baby of less then 1500 gms
•Cardiopulmonary monitoring
•Surfactant therapy
•Convulsions
•Severe birth asphyxia
•Assisted ventilation
•Total parenteral nutrition
•Major surgery
24. LEVELS OF NEONATAL CARE
LEVEL I CARE
•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 breast feeding.
25. LEVELS OF NEONATAL CARE
LEVEL II CARE
•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 between 1500 & 1800 gm or having
gestational age maturity of 32 to 36 weeks.
26. LEVELS OF NEONATAL CARE
LEVEL III CARE
•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.
27. OUTLINE OF MCH SERVICES
LEVEL FOR WHERE BY WHOM COMPONENTS
I
(at village)
for low
risk
mother
and
neonate.
75% Home
Sub-centre
PHC
• Mother
• Trained birth attendant
• Multipurpose worker or
ANM
• Doctors
• Anganwadi workers.
Basis care
II (at sub-
district)
for higher
risk
mothers
and
neonates.
20% Upgraded
PHC,
Sub-district
District
hospitals
, nursing
homes,
medical
college
hospitals
• Trained nurses
• Resident doctors
• Trained in obstetrics
• Neonatology and
anesthesia
First referral
units
Special neonatal
care
28. OUTLINE OF MCH SERVICES
III (in
metropolit
an centers
for still
higher risk
mothers &
infants)
5% Large
hospitals
Medical
college
hospitals
and
institutes.
•Specialists
Sophisticated care
given by trained
nurses, resident
doctors,
obstetrician
neonatologist,
pediatric surgeon,
haematologist,
radiologist,
ultrasonologist &
well equipped
laboratories.
29. THE MCH SERVICES
DIFFERENT LEVELS
Level 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 weeks of
pregnancy.
•Assessment of pelosis.
•Early detection of fortal growth failure.
30. THE MCH SERVICES
DIFFERENT LEVELS
INTERNAL CARE :
•Proper management of labour and delivery.
•Adequate support of establishment of respiration
oropharyngeal suction and warmth.
•Identification of low birth weight, preterm birth &
malformations requiring immediate correction and their
referral.
31. THE MCH SERVICES
DIFFERENT LEVELS
LEVEL II CARE:
Prenatal care:
This must be offered to mothers “at risk” identified
through the high risk approach or mothers developing
complications during pregnancy and / or labour.
Intranatal and neonatal care:
Deliveries of all “at risk” mothers must be attended
by a trained obstetrician and neonatologist at first referral
units. The new-born are expected to get special care for
anoxia hyperbilirubinaemia, respiratory distress syndrome
and septicaemia.
32. THE MCH SERVICES
DIFFERENT LEVELS
LEVEL 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 problems
Intensive neonatal care unit having a full time neonatologist, trained
nursing staff and resident doctors, equipped with biochemical
laboratory support, ultra sound, electronic monitory of foetal
condition, ventilation and respiratory support, blood transfusion
arrangement & monitoring.
33. SUMMARY
So far we have seen about neonatal intensive
care unit, its organization, physical facilities,
personnel, equipment necessary, laboratory
facilities and level of neonatal are and MCH
services available at different level.
34. CONCLUSION
Thought NICU services require high technology input and
expensive one should not lose sight of the human
approach towards the fragile and sick babies & their
anguished parents. To obtain best results from neonatal
intensive care we need a well equipped unit.
