CHILD HEALTH NURSING

ORGANIZATION OF
NEONATAL INTENSIVE
CARE UNIT

Submitted To: Submitted By

INTRODUCTION

Newborn intensive care approach developed from the concept that a more

intensive approach to neonates who require special care would result in a

significant decrease in neonatal mortality and morbidity. A neonatal intensive

care unit (NICU) is an intensive care unit specializing in the care of ill or

premature newborn infants. The first official ICU for neonates was established

in 1961 at Vanderbilt University Mildred Stahlman, officially termed a NICU

when Stahlman used a ventilator off-label for a baby with breathing difficulties,

for the first time ever in the world.

DEFINITION OF NICU

It is very specialized unit where critically ill neonates are cared to reduce the

neonatal morbidity and mortality.

INDICATIONS FOR ADMISSION IN NICU

 Low birth weight

 Large babies
 Birth asphyxia(APGAR score less than or equal to 6)

 Me conium aspiration syndrome

 Severe jaundice

 Infants of diabetic mother

 Neonatal sepsis/meningitis

 Neonatal convulsions

 Severe congenital malformation

 O2 therapy/parenteral nutrition

 Immediately after surgery

 Cardio respiratory monitoring

 Exchange blood transfusion

 PROM/foul smelling liquor

 Mother of Hepatitis B carrier

 Injured neonate.
AIMS /GOALS OF NICU

The goals of neonatal intensive care unit are

 To improve the condition of the critically ill neonates keeping in mind

the survival of neonate so as to reduce the neonatal mortality and

morbidity

 To provide continuing in-service training to medicine and nursing

personnel in the care of newborn.

 To maintain the function of the pulmonary ,cardiovascular, renal and

nervous system

 To monitor the heart rate, body temperature, blood pressure,central

venous pressure and blood by non invasive techniques.

 To measure the oxygen concentration of the blood by oxygen analysers

 To check/observe alarms systems signal ,to find out the changes beyond

certain fixed limits sets on the monitors.

 To administer precise amounts of fluids and minute quantities of drugs

through I.V infusion pumps.

CATAGORIES OF NICU:- LEVEL 1
  Evaluation and postnatal care of healthy newborn infants;
 Phototherapy
 Care for infants with corrected gestational age greater than 34 weeks or

weight greater than 1800 g who have mild illness expected to resolve

quickly or who are convalescing after intensive care

 Ability to initiate and maintain intravenous access and medications

 Nasal oxygen with oxygen saturation monitoring (e.g., for infants with

chronic lung disease needing long-term oxygen and monitoring

 Normal new born care

LEVEL 2
 Care of infants with a corrected gestational age of 32 weeks or greater or

a weight of 1500 g or greater who are moderately ill with problems

expected to resolve quickly or who are convalescing after intensive care

 Peripheral intravenous infusions and possibly parenteral nutrition for a

limited duration
 Resuscitation and stabilization of ill infants before transfer to an

appropriate care facility

 Mechanical ventilation for brief durations (less than 24 h) or continuous

positive airway pressure. Intravenous infusion, total parenteral nutrition,

 and possibly the use of umbilical central lines and percutaneous

intravenous central lines

 Mild to moderate respiratory distress syndrome
 Suspected neonatal sepsis
 Hypoglycemia
 Infants of diabetic mother

LEVEL 3
 Care of infants of all gestational ages and weights; Mechanical

ventilation support, and possibly inhaled nitric oxide, for as long as

required immediate access to the full range of subspecialty consultation

 Comprehensive on-site access to subspecialty consultants; Performance

and interpretation of advanced imaging tests, including computed

tomography, magnetic resonance imaging and cardiac echocardiography

on an urgent basis Performance of major surgery on site but not

extracorporeal membrane oxygenation, hemofiltration and

 haemodialysis, or surgical repair of serious congenital cardiac

malformations that require cardiopulmonary bypass.

 Severe respiratory distress syndrome
 Persistent pulmonary HTN
 Sepsis
 Prematurity at<32 weeks
Major congenital malformations

ORGANISATION OF NICU

 Physical Organization

 Personal Organization

 Equipment Organization

PHYSICAL ORGANISATION

The neonatologist and nurse incharge must be involved while planning the unit.

The intensive area should be localised preferably next to labour ward and

delivery rooms. For economising costs it would be preferably to have combined

with level 2 facilities, through both the areas there must have separate and

adequate staff and single administrative control. the neonatal unit can be

conceptualised in terms of four elements which exist in a concentric layering

inside outwards with designed work traffic flow pattern.

a) Clinical care areas

b) Clinical support areas

c) Administrative zones

d) Family support area

a) Clinical care areas

 Scrubbing areas

 Storage spaces

 Hand washing scrub zones

b)clinical support areas

  Laboratory

 X ray machine

 Formula preparation

 TPN preparation

 Breast milk expression

 Equipment storage

 Clean and dirty utility areas

c) Administrative and staff support areas

 Central reception area

  Separate unit office for ward master, resident doctor,and nursing

staff

 Staff changing room

 On call duty doctor room

 Staff rest room

 Counselling room

 Seminar rooms

 Library

1. Family support area

 Children play area

 Nourishment area

 A lounge

 Lockable storage

 Education area

PHYSICAL ENVIRONMENT CHARACTERSTICS:

 1. Bed strength

The NICU can be in a single area or it can be in multiple rooms with a capacity

of 2-4 infants each..one intensive care bed is generally required for 100

deliveries provided the prematurity ratio is around 8 percent and hence for a

population of one million,30 intensive care beds would be required for our

country. It would be uneconomical to have a NICU of less than 6-8bed.

2. Space between the patient

 For the patient care,100 square feet is required for each baby as it is true

for any adult bed

 There should be a gap of about 6 feet between two incubators for

adequate circulation and keep the essential life saving equipments,space

needed about 120 square feet.

 Each patient station should have 12-16 central voltage stabilised

electrical outlets

 2-3 oxygen out lets

 2 compressed air outlets

 2 compressed air outlets

 2-3 suction outlets

 Additional power plug point would be required for the portable x-ray

machine close to the patient care area

3. TEMPERATURE AND HUMIDITY CONTROL OF THE UNIT

 In case of controlling the environmental temperature, the NICU should

not be located on the top floor, but there must be adequate sunlight for

illumination

 The unit must have a fair degree or ventilation of fresh air through

central air conditioning is must. The temperature inside the unit should

be maintained at 28+_2deg c while the humidity must be above 50%.

 4. WATER-HAND WASHING

 The unit must have an uninterrupted clean water supply and each patient

care area must also have a wash basin with foot or elbow operated

tapes. Neat wash basin, placing paper towel and receptical.

 The unit should be equipped with laminar air flow system, however

alternatively air conditioned with multipore filters and fresh air

exchange of 12 per hours should be provided.

5. COLOUR

The walls of the whole unit should be washable and have a white or slightly off

white colour for better colour appreciation of the neonates.

6. LIGHTING

The lighting arrangement should provide uniform, shadow free illumination. In

addition spot illumination should be available for each baby for any procedure.

A generator back up is mandatory where there is frequent power fluctuations or

power failures.

7. SOUNDS
The acoustic characteristics should be such that the intensity of light kept below

75 decibels. The unit should also have an intercom and a direct outside

telephone so that the parent of the patient can have an easy access to the medical

personnels in case of an emergency

8. ROOMS

Apart from the patient care area including rooms for isolation and procedures,

her e is need of space for certain essential functions, like a room for scrubbing

and gowning near the entrance, a side laboratory mothers room, adequate stores

for keeping consumable and non-consumable articles

 A room for keeping x-ray and ultrasound machines

 One or two rooms each would be needed for doctors and nurses on day

and night duties

 There is space available for a biomedical engineer to provide essential

periodic preventive maintenance of costly equipments.

 Additional space will be required for educational activities and storing

of data

9. VENTILATION

Minimum of six air changes,2 air changes should be outside for filtering the

inner air.
  Effective air ventilation of nursery is essential to reduce nasocomial

infections

 The air conditioning ducts must be provided with Millipore filters(0.5H)

to restrict passage of microbes

10. ENVIRONMENTAL DESIGN:

WALL SURFACES

 Easily cleaneable, protect at point with moveable equipment, made with

sound absorbable material

FLOORS

 Easily cleanable with out use of hazardous material, minimize microbial

growth

CEILINGS ;

 Easily cleanable, noise reduction

11. COMMUNICATION:

 One emergency call bell in each room connected to doctors room

12.DATABASE AND RESEARCH ENVIRONMENT:

 Computer ports with internet access should be readily available to

maintain database and data analysis.

 Database of all NICU information, teaching aids like X rays, ECG, and

ABG reports must be maintained for future training and research.

13.SEPTIC NURSERY

14.SECURITY

15.HEAD WALL SYSTEM

Refers to the array of the medical gas outlet+electrical+data outlet at each

patient care station

 Electric environment

 Medical gases

 Data outlets

16. Toilets

It is important to plan the number and position of water closets in the Neonatal

Unit. Parents’ bedrooms, Transitional Care, medical on-call rooms, and the area

dedicated to counselling (Parents’ Quiet Rooms) should all have separate toilet
facilities. In a large Neonatal Unit there should be at least 3 further toilets for

staff and the general public.

17. Transport incubator store

Transport incubators are bulky and should not be stored in public corridors.

There should be a designated area for storing them within the Equipment Store

18.Pneumatic tube system

Careful thought should be put into how specimens can be transferred urgently to

central laboratories in the Hospital. If a pneumatic tube system is chosen, it

should be easily accessible, robust and reliable. The outlet might be best

positioned at the central station next to the Unit Office. Readily available

personnel can then identify problems if the system were to fail to send an urgent

specimen

19. Stationery

Although some NNUs are striving towards becoming paperless, most will not

achieve this in the next five years. There should therefore be a room of 12 sqm

with extensive shelving for storage of all the paper sheets and forms necessary

for the efficient running of the NNU.

20. CLINICAL

Pendants, gantries, cabinetry or head-rails?

Choosing to equip the rooms with pendants, gantries or cabinetry is a crucial

early decision. Pendants descend from the ceiling and are single-armed or

double-armed. The pendants contain intensive care facilities including electrical

outlets, oxygen and air pipes and a vacuum facility for suction. The clinician has

the opportunity of specifying the number of electric sockets, and the number of

shelves which are fixed to the pendant arms. These shelves can hold ventilators,

monitors, syringes drivers, and indeed any intensive care equipment required to

service the infants in the incubator.

Gantries
Gantries have many of the advantages of pendants containing internally all the

pipin and wiring required to provide the oxygen, air, vacuum and power points

as well as the computer networks. The clinicians again have the opportunity of

specifying the number of sockets and the number of shelves. Many of the

gantries allow movement laterally of the hangars and ventilators, monitors and

syringe drivers can all be attached to the gantry.

Cabinetry

If designed carefully, cabinetry is fully consistent with the demands of intensive

care. All intensive care and high dependency cots can be contained in spacious

bays. Electric sockets, computer and piped gas outlets can all be positioned so

that there is no interference with the movement of staff caring for the infant. It

is recommended that all such bays be identical in the Unit, so that staff can be

familiar with the work area no matter which room or cots have been allocated to

them. The size of the bays is critical. Each must accommodate an incubator, a

mother and father with comfortable seating, two members of nursing staff, and

it should be possible to manoeuvre all machinery (e.g. for taking X-rays) within

the allocated space. Such bays should be at least 3.2m wide and the bay walls

may extend 2-3 cm in room

Head-rails
It is possible to combine cabinetry systems with horizontal rails at the head of

the incubator. These rails then carry most of the intensive care monitoring

equipment

WORK FLOW PATTERN AND ATMOSPHERE

The NICU should be designed to allow efficient patient and staff movements

within the unit. The following should be included.

• Ready access of the NNU to Labour Suite including Operating Theatres

• All doors between Labour Suite and NNU, and also those within NNU, should

be designed to maximise safety and convenience. Automatic opening, push pad

opening, swipe-card access, punch-code access and manual opening may all be

appropriate in individual circumstances

• Positioning of Neonatal intensive care cots closest to the Labour Suite

• Access for mothers on trolleys or in wheelchairs. Widths of doors, corridors

and corners should be considered so that mothers have access to all clinical

areas

• Access to all cots in all clinical areas for X-ray, ultrasound and other mobile

equipment. An MRI scanner ideally should be available nearby on the same

floor
• Clinical support areas should be as close as possible to clinical care areas.

Such supports include near patient testing laboratory, pharmacy, equipment

storage, milk storage, clean and dirty linen store

• Family access to the waiting area, counselling rooms, support services (e.g.

social work and community neonatal nursing) and recreational facilities

• Positioning of the Clinical Manager’s office on the NNU floor, easily

available to all staff and, by arrangement, to families

• Attending consultant’s office should be in the NNU so that family interviews

and staff interviews can take place readily

• Doctors’ on call rooms should be in the NNU, sound-proofed, and sufficiently

distanced from busy corridors and extraneous noises to allow adequate rest

opportunities

• Consultant and research offices can be positioned further away from the

clinical care area

• Ideally there should be ready access to the mortuary, a viewing area for the

bereaved, and to the autopsy suite.

Atmosphere

The NNU should be thought of as “baby’s first home”. It must have a

welcoming atmosphere. This is achieved by thinking of the comforts of the

infant and family. Natural lighting and where possible views of the surroundings

outside are beneficial. Internal decoration can convert a clinical area into a room

which is appealing to families, and encourages all members of staff to treat the

care area as the infant bed room

PERSONAL ORGANISATION

MEDICAL STAFF-The unit should be headed by a director who is full time

neonatologist with special qualification and training in neonatal medicine.

 He should be responsible for maintenance of standard of patient care

 Development of operating budget

 Equipment evaluation and purchase

 Planning and development of education programme

 Evaluation of effectiveness of perinatal care in the area

 He should devote time to patient care services,research and teaching as

well as co-ordinate with level 1 and level 2 hospital in the area .

STAFF REQUIREMENTS
  Neonatal physician 6-12 in the continuing care, intermediate care and

intensive care areas.

 He should be available for 24 hrs basis for consultation

 A ratio of one physician in training to every 4-5 patient who requires

intensive care ideal round the clock

 Services of other specialists like micro biologists, hemtologists,

radiologists cardiologists and should be available on call.

 An anaesthetist capable of administering anaesthesia to neonate

 Paediatric surgeon and paediatric pathologists should be available

NURSES RATIO

 Nurse patient ratio of 1:1 maintained throughout the day and night

 A ratio of one nurse for two sick babies not requiring ventilator support

may be adequate

 For an ideal nurse patient ratio, four trained nurses per intensive care

bed are needed

 Additional head nurse who is the overall incharge

  In addition to basic nursing training for level 2 carer, tertiary care

requires dedicated committed and trained staff of the highest quality

 The training must include training in handling equipment, use of

ventilators and the use of mask resuscitations and even endotracheal

intubation, arterial sampling and so on

EXPERIENCE

The staff nurse must have a minimum of three 3yrs experience in special

neonatal care unit in addition to having three months training in a intensive care

unit.

OTHER STAFF

 One sweeper should be available round the clock

 Laboratory technician

 Public health nurse/social workers

 Respiratory therapist

 Bio medical engineer

  Ward clerk can help in keeping track of the stores

EQUIPMENT ORGANISATION

 Equipment and supports should include all that is necessary to

resuscitation and intermediate areas

 Supply should be kept to the patient station so that nurse does not have

to go away from the neonate unnecessarily and nurses time and skills are

used efficiently

 There should be controlled incubators and open air system for providing

adequate warmth

 Adequate number of infusion pumps for giving fluid and parenteral

nutrition solutions and drugs should be available

 Infant ventilators capable of giving pressure ventilation and various

cardiopulmonary monitor.

EQUIPMENT REQUIRED FOR ANY NEONATAL ICU

1. Radiant warmer

2. Incubator
3. Radiography

4. Oxygen catheter

5. Infusion pumps

6. Positive pressure ventilator

7. Oxygen analyser

8. Phototherapy

9. Electronic weighing machine

10. Transcutaneous PO2 and PCO2 monitor

11. Non invasive BP monitor

12. Invasive BP monitor

13. Intracranial pressure monitor.

14. Microdrips

15. Suction apparatus

16. Open care system

17. ECG monitor

 18. Pulse oxymeter

19. Resuscitation set

20. Oxyhood

Disposable articles

21. Nasogastric tubes

22. Feeding bottles and cups.

23. Diapers.

24. Specimen bottles

25. I.V catheter

26. IV set,

27. Bacterial filters.

28. Three way stop cocks,

29. umbilical arterial and venous catheter,

30. syringes, needles,

31. ventilator tubes,

 32. Canula,

33. Catheters suction, urinary ET tube, nasal catheters.

DOCUMENTATION IN NICU

The unit should have printed problem oriented stationary for maintaining

records, admission and discharge slips

Record of all admission should be maintained in a register or on a computer

The information should be analyzed and discussed at least once a month to

improve the effectiveness of the nicu in providing the services

EDUCATION PROGRAMME AT NICU

 There should be continuing medical education programmes for

physicians and nurses in the form of lectures, demonstrations and group

discussions.
 This should cover important issues like resuscitation, steralisation to be

maintained for critically ill babies, putting in arterial catheters,

conducting exchange transfusions, maintenance of ventilators.

 Educational programmes covering the nurses and physicians in the

community should be developed.

 There should be regular discussion with the obstetrician to discuss the

perinatal care and condition Individual high risk cases

 Education and follow up is necessary

ROLE OF A NURSE IN NICU

A Neonatal nurse job role involves working in a specialist neonatal baby care

unit (within maternity or children’s hospitals) or in the local community.

Neonatal nurses care for new-born babies who are premature or are born sick.

There are a vast number of conditions that can affect a new-born baby and

require treatment from specialists within the healthcare team.

As a neonatal nurse its important to be sensitive to the needs of others, have a

caring attitude. As a neonatal nurse has an important role of supporting parents

of the sick baby at a time when they themselves are frightened of losing their

child, very anxious and stressed or upset seeing baby coupled up to wires and

monitors. As far as possible, the parents and occasionally other family members

are encouraged to take an active role in the care of the baby.

ESSENTIAL DUTIES:

 Managing patient care of newborns and pediatrics, assisting with the

admission assessment discharge of these patients;

 Providing health education and counselling to patients;
 Maintaining medical records
 Participating in nursing and unit staff meetings and patient care conferences;
 Performing other related duties as assigned/required.
 Provides and/or manages the nursing plan of care for neonates with complex

problems;
 Provides education, training, information, and consultation services to

physicians, registered nurses, and other members of the clinical team;

 Interprets, coordinates, and implements new and existing policies, methods

and procedures for neonatal nursing in the Perinatal areas;

 Keeps informed of current practices and trends and incorporates them into

practice
 Works in cooperation with other members of the multidisciplinary health

teams;
 Makes professional contacts with a variety of public, private and professional

institutions/organizations;
 Performs other related duties as assigned/required.
 The duties for a neonatal nurse may vary slightly at each hospital, but overall

their care tasks are the same. A neonatal nurse is one of the primary

caregivers of a baby in the intensive care unit, and often becomes the saving

grace to worried parents who have plenty of questions and few answers about

their situation.

General Care

One of the main duties for a neonatal nurse is the general care of the infant.

Babies, even tiny ones or those with physical ailments, need regular changes,

feedings and cuddles. Customarily, the NICU will assign each baby "care times"

throughout the day and night, usually about 3 or 4 hours apart from each other.

At each care time, the nurse will change the baby's diaper, take his temperature,

and feed him breast milk or formula. If a baby is receiving any medications,

these may also be administered during these times.

If the parents of an infant are able to visit regularly, a neonatal nurse will teach

them how to perform these basic cares. With time, nurses will help parents to

feel equipped in all aspects of meeting their little one's needs and will continue

to serve as a basic support system during the hospitalization.

Special Needs

Sometimes babies are too fragile or small to eat directly from breast or bottle.

When this is the case, they are fed either intravenously, or through a gavage

tube, which is a small tube that goes from the nose or mouth into the stomach.

Nurses will carefully place the correct amount of formula or dietary

supplementation if a baby is not yet eating, into either of these methods of

nutrition, and monitors the baby for any positive or negative changes in the

infant.

The duties for a neonatal nurse also include inserting and changing IVs,

administering blood transfusions when necessary, and drawing blood for various

testing. Nurses are able to perform many other procedures as well, and it fully

depends upon each hospital's individual protocol, as well as the nurse's

experience level and staff rating.

Technical Duties for a Neonatal Nurse

Regardless of their other responsibilities, all neonatal nurses do a fair bit of

charting on each of their patients. This may be on a paper sheet, or more

commonly every year, completed electronically via a special hospital computer

system. The details logged into the online chart allow doctors, other nurses, and

anyone else within the baby's medical care team to view a baby's updated health

records.
A nurse may also be responsible for emailing the neonatologist (NICU doctor)

or calling the parents with specific requests or information. While a neonatal

nurse's priorities are found in caring for the child assigned to them, they often

also spend a large portion of their shift charting and getting messages out to

those who need to receive them.

Emotional Support

A neonatal nurse often gets to know the families of infants very well, especially

if they happen to have a primary baby they take care of. A primary nurse will

care for the same infant for the duration of his hospital stay, whenever he/she is

on shift. This works well, as the nurses become very familiar with their babies

and can in turn provide them with the best care possible.

In building relationships with these families, they can often provide emotional

support and comfort during scary times. If a baby has to go through surgery or

is exceptionally ill, nurses are great for reassuring the parents and providing as

concrete of answers as they are permitted to.

Neonatal nurses are often the unsung heroes to families and able to give the

earliest of lives a fighting chance. Their daily duties add up to countless

miracles and a rewarding career at the same time.

CONCLUSION

A neonatal intensive-care unit (NICU), also known as an intensive care

nursery (ICN), is an intensive-care unit specializing in the care of ill or

premature newborn infants. A NICU is typically directed by one or more

neonatologists and staffed by nurses, nurse practitioners, pharmacists, physician

assistants, resident physicians, and respiratory therapists, dietitians. Many other

ancillary disciplines and specialists are available at larger units. Neonatal

intensive care is costly not only to the individual but also to the family. These

cost increase with decreasing birth weight and gestational age. Therefore

neonatologists must include parents in any discussion about whether to continue

the extreme measures being provided to their extremely low birth weight

preterm infants. Development of neonatal intensive care unit requires careful

planning with the joint efforts of physicians, nurses and architects. The plan

should be based on functional efficiency. Neonatal intensive care unit ideally

should be next to the obstetric suite.

RESEARCH PUBLICATIONS:

Journal of Health Population & Nutrition. 2011 Oct;29(5):500-509

(1) Assessment of special care newborn units in India.

The neonatal mortality rate in India is high and stagnant. Special Care Newborn
Units (SCNUs) have been set up to provide quality level II newborn-care
services in several district hospitals to meet this challenge. The units are located
in some remotest districts where the burden of neonatal deaths is high, and
access to special newborn care is poor. The study was conducted to assess the
functioning of SCNUs in eight rural districts of India. The evaluation was based
on an analysis of secondary data from the eight units that had been functioning
for at least one year. A cross-sectional survey was also conducted to assess the
availability of human resources, equipment, and quality care. Descriptive
statistics were used for analyzing the inputs (resources) and outcomes
(morbidity and mortality). The rate of mortality among admitted neonates was
taken as the key outcome variable to assess the performance of the units. Chi-
square test was used for analyzing the trend of case-fatality rate over a period of
3-5 years considering the first year of operationalization as the base. Correlation
coefficients were estimated to understand the possible association of case-
fatality rate with factors, such as bed:doctor ratio, bed:nurse ratio, average
duration of stay, and bed occupancy rate, and the asepsis score was determined.
The rates of admission increased from a median of 16.7 per 100 deliveries in
2008 to 19.5 per 100 deliveries in 2009. The case-fatality rate reduced from 4%
to 40% within one year of their functioning. Proportional mortality due to sepsis
and low birth weight (LBW) declined significantly over two years (LBW <2.5
kg). The major reasons for admission and the major causes of deaths were birth
asphyxia, sepsis, and LBW/prematurity. The units had a varying nurse:bed ratio
(1:0.5-1:1.3). The bed occupancy rate ranged from 28% to 155% (median
103%), and the average duration of stay ranged from two days to 15 days
(median 4.75 days). Repair and maintenance of equipment were a major
concern. It is possible to set up and manage quality SCNUs and improve the
survival of newborns with LBW and sepsis in developing countries, although
several challenges relating to human resources, maintenance of equipment, and
maintenance of asepsis remain.

- By Malhotra S & Mohan P.

(2) Challenges in scaling up of special care newborn units--

lessons from India.

Indian Journal of Pediatrics. 2011 Dec;48(12):931-935.

Neonatal mortality rate in India is high and stagnant. Special Care

Newborn Units (SCNUs) are being set up to provide quality level II newborn

care services in district hospitals of several districts to meet this challenge. The

units are located in some of the remotest districts where the burden of neonatal

deaths and accessibility to special care is a concern. A recently concluded

evaluation of these units indicates that it is possible to provide quality level II

newborn care in district hospitals. However, there are critical constraints such as

availability and skills of human resources, maintenance of equipment and bed

occupancy. It is not the SCNU alone but an active network of SCNU (level II

care), neonatal stabilization units (level I care) and newborn care corners can
impact neonatal mortality rate reduction higher. Number of beds is also not

sufficient to cater to the increasing demand of such services. Available number

of nurses is a problem in many such units. An effective and sustainable system

to maintain and repair the equipment is essential. Scaling up these units would

require squarely addressing these issues.

- By Neogi S & Zodpey S

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