Neonatal Intensive Care Unit: Definition, objectives, major components, requirements, physical setup, admission criteria, space, location, baby care area, electrical outlet, ventilation, counselling, handwashing area, acoustic characteristics, personnel, equipments available in the NICU, services, levels of NICU

1. Presented by:
Ms. Manisha Thakur
Nursing Tutor
Child Health Nursing

2. WHAT IS A NICU ?

3. NICU means….
Neonatal Intensive
Care Unit

4. DEFINITION
Newborn or neonatal
intensive care unit, an
intensive care unit
designed for
premature and ill
newborn babies.

5. OBJECTIVES
To save the life of the sick new born.
To prevent damage in infants with problems at birth
and also reduce morbidity in later life.
To monitor high risk newborns so as to reduce
mortality and morbidity in these babies.

6. BASIC REQUIREMENTS
Adequate space
Availability of running water
round the clock
Maintenance of
thermo neutral
environment
Availability of
plenty of linen
and disposables
Centralized
oxygen and
suction facilities
Facilities for
availability to
treat common
neonatal
problems

7. MAIN COMPONENTS TO BE
CONSIDER WHILE ORGANIZING
A NICU
PHYSICAL FACILITIES
 Space
 Location
 Floor plan
 Ventilation
 Lighting
 Environmental temperature & humidity
 Handling & social contacts
 Communication system
 Electrical outlets

8. PHYSICAL FACILITIES

11. SPACE
 Requirement as per population
 To serve as a referral unit for infant born outside the
hospital (extra mural), additional physical facilities.
 Each infant to be provided minimum 100 sq. feet.
 Place for promotion of breast feeding.
 No compromise in space regarding nosocomial
infection.

12. LOCATION
 Close to labour room &
OT
 Elevator in close
proximity
 In tropical countries –
located on top floor
 Feasibility for sunlight

13. BABY CARE AREA
 Areas and rooms for inborn
or intramural babies, out
born or extramural babies,
 examination area,
 mother’s area for breast
feeding and expression of
breast milk
 nurses station and charting
area.

14. NICU LAYOUT
 Unit design may be in a square or single corridor
based rectangular unit.
 A unit should occupy one side of corridor.
 The distance should ensure minimal walking
distance

15. HAND WASHING AND GOWNING ROOM
 Hand washing and gowning facilities at the entrance.
 Self-closure door and abundant space provided.
 Positive air pressure is maintained in SNCU, so that
corridor air does not enter.
 Hand free elbow operated hand washing taps.
 Sink or wash basins are of porcelain or stainless steel.
 Pictorial presentation of hand washing steps near hand
washing area.
 Single use disposable napkins or hand dryer should be
provided in hand washing area.

18. EXAMINATION AREA
Small comfortable
room with
examination table,
comfortable seating,
sufficient light and
warmth .

19. MOTHER AREA
Comfortable seating and
privacy to mother to
express breast milk with
the help of lactation
nurse.

20. COUNSELLING ROOM
 Separate counseling room should be there in the
NICU where doctors can counsel parents regarding
the babies condition, prognosis, treatment, home
care and follow-up care.

21. NURSES STATION
Central area
Newborn charts,
hospital forms,
computer
terminals,
telephone lines
should be located
in this area.

22. CLEAN UTILITY AND SOILED UTILITY
HOLDING ROOMS
Stocking clean utility items and sterile disposables,
and for disposal of dirty linen and contaminated
disposables.

23. STAFF ROOMS
A comfortable
room with
intercom,
telephone,
computer
facility
 It is the space provided within the NICU.
 Nurses staff room
 Residents duty room
 Nurses changing room

24. VENTILATION
 Effective air ventilation of nursery.
 Provision of exhaust fan.
 Do not use chemical air disinfection and ultra-violet
lamps.

25. LIGHTING
 Well illuminated & painted
white/off white.
 Cool white fluorescent tube
to provide at least 100 foot
candle illumination at
infant’s level.
 Spot illumination – portable
angle poise lamp with two
15 watt fluorescent bulb
provide 100 foot candle at a
distance of 1 foot from
infant.
 GENERATOR: 24X 7 hours
electrical facility.

26. ENVIRONMENTAL TEMPERATURE
AND HUMIDITY
 Temperature of NICU is
maintained between 26-28
oC.
 Rooms’ temperature should
be maintained by radiant
heaters and hot air blowers in
winters.
 External windows of nursery
should be glazed to minimize
heat gain or loss.
 Baby should be located at
least 2 feet away from walls.

27. 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 not be exceed 75
decibels.
 Telephone rings and equipment alarms should be
replaced by blinking lights.

28. ELECTRICAL OUTLETS
 8-12 electrical points at 4-5 feet
height of 5 amperes and 15
amperes electrical points.
 Each infant should be allotted
with 8 electrical sockets, 4 of
each ampere.
 No extension board or adapter
should be used.
 Electrical equipment should be
checked once a month.
 Round the clock uninterrupted
servo supplied power supply
and power back up.

29. PERSONNEL
Availability of
sufficient number
of adequately
trained personnel.
Nurse patient ratio
in special care and
NICU.

30. PERSONNEL
Availability of
sufficient number
of adequately
trained personnel.
Nurse patient ratio
in special care and
NICU.

31. PANTRY AREA
 Breast feeding articles are washed and autoclaved in this area.
 Refrigerator is kept in this area for keeping medicines and samples.
Pantry area Refrigerator

32. STAFF
 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

33. NURSES
 According to National Neonatology Forum of
India:
 1 trained nurse: 4 babies
 If 8 bedded NICU, 8nurses should be
sanctioned to ensure availability of 2 nurses in
each shift along with sister In charge in the
morning.

34. HANDLING AND SOCIAL CONTACTS
 Minimal and gentle handling
 Soothing words gentle stoking and rocking after
painful procedures
 Gentle and soothing tactile stimulation.

35. COMMUNICATION SYSTEM
 NICU should have intercom system.
 Direct lines should be made available with external
telephones.
 No mobile phones should be allowed in the inborn
and out born area.

36. EQUIPMENTS

50. NURSING CARE AND NURSING
SERVICES IN NICU
1. Assessment
2. Monitoring physiological data
3. Safety measures
4. Respiratory support
5. Thermoregulation
6. Protection from infection
7. Hydration
8. Nutrition
9. Feeding resistance
10. Skin care

51. CONT…
11. Administration of medication
12. Developmental outcome
13. Facilitating parent-infant relationship
14. Discharge planning and home care

52. LABORATORY FACILITIES
 Lab for routine analysis
of blood, urine , amniotic
fluid, gastric aspirate for
shake test , blood gases
and acid base parameters
should be available.
 Portable X- Ray machine

53. TRANSPORT OF SICK
NEONATES
 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.
 Themocele (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.

54. INDICATIONS FOR THE
ADMINSSION TO NICU
 Birth weight less then 1800 gram.
 Gestational age less than 34 weeks.
 Neonates with postnatal age less than 14 days.
 Moderate to severe asphyxia.
 Respiratory distress at birth.
 Rh isoimmunization.
 Maternal insulin dependent diabetes mellitus.
 Neonatal and major congenital malformation.
 Suspected inborn error of metabolism.
 Unwell baby from maternity ward.
 Sick neonate referred from peripheries to the hospital.

55. GRADE OF NEONATAL CARE
LEVEL - l
NORMAL
NEONATAL
CARE
LEVEL - ll SPECIAL CARE
NURSERY
LEVEL - III
INTENSIVE
NEONATAL
CARE UNIT

56. 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.

57. 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 is anticipated for the infants weighing in
between 1500 & 1800 gm or having gestational age
maturity of 32 to 36 weeks.

58. 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.
 The care is provided at apex institutions and regional
perinatal centers equipped with centralized oxygen and
suction facilities, servo-controlled incubators, vital signs
monitors, transcutaneous monitors, ventilators, infusion
pumps etc. This type of care is provided by skilled nurses and
neonatologists.

59. SUMMARY
 So far we have seen about neonatal intensive care unit,
its organization, physical facilities, personnel, equipment
necessary, laboratory facilities and level of neonatal care
etc.

60. 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.

61. REFERENCES
 Singh Meharban; medical emergencies in children 5th ed.
New Delhi; Sagar Publication 2012; 13-31.