S.NO SPECIFIC OBJECTIVES TIME CONTENT TWACHING A.V.

AIDS EVALUATION
AND
LEARNING
ACTIVITY

1 To introduce the 2 min INTRODUCTION Lecture cum Board

topic. New born intensive care approach discussion
developed from the concept that a more
intensive approach to neonates who
requires special care would result in a
significant decrease in neonatal mortality
and morbidity .
2 To define nicu. Board
DEFINITION
3 min NICU is a very specialized unit Explanation What is the
where critically ill neonates. nicu?
Nicu is also called a special care
nursery & special care baby unit (SCBU)
is an intensive care unit specializing the
care of ill or premature newborn babies.
wikipedia
Mostly from the labour ward, operation
theatre and hospital or any other referral
they will be sent to INTENSIVE CARE
UNIT (ICU).

What are the

3 To list out the 5 min CRITERIA FOR ADMISSION IN Over head indications for
NICU:
indications for Lecture cum projector admission in
 Maternal factors:
admission in nicu. discussion nicu?
 Age younger than 16 or older than 40
 years

Drug or alcohol exposure

 Diabetes
 Hypertension (high blood pressure)
 Bleeding
 Sexually transmitted diseases
 Multiple pregnancy (twins, triplets, or
more)
 Too little or too much amniotic fluid
 Premature rupture of membranes (also
called the amniotic sac or bag of waters)
 Delivery factors:
 Fetal distress/birth asphyxia (changes in
organ systems due to lack of oxygen)
 Breech delivery presentation (buttocks
delivered first) or other abnormal
presentation
 Meconium (the baby's first stool passed
during pregnancy into the amniotic fluid)
 Nuchal cord (cord around the baby's neck)
 Forceps or caesarean delivery
 Baby factors:
 Birth at gestational age less than 37 weeks or
more than 42 weeks
 Birth weight less than 2,500 grams (5
 pounds, 8 ounces) or over 4,000 grams (8
pounds, 13 ounces)
 Small for gestational age
 Medication or resuscitation in the delivery
room
 Birth defects
 Respiratory distress including rapid
breathing, grunting, or apnea (stopping
breathing)
 Infection such as herpes, group B
streptococcus, Chlamydia
 Seizures
 Hypoglycaemia (low blood sugar)
 Need for extra oxygen or monitoring,
intravenous (IV) therapy, or medications
 Need for special treatment or procedures
such as a blood transfusion What are the
4 To explain the 5min objectives for
objectives for The goals of neonatal intensive care admission in
admission in nicu. unit are nicu?

 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.

PREPARATION OF NICU What things to

To explain the 5 min prepare for
5
preparation for  Warm (33-36) incubator. admitting sick
admission.  Adequate light source. neonate in
nicu?
 Resuscitation and treatment trolley
stocked.
  Oxygen, air and suction apparatus.
History, continuation sheet, treatment
and diet sheet, problem list and flow
charts.

 Oxygen line connected to oxygen and
air flow meter.
 Suction – complete suction unit
tubing and various sizes of suction
catheters.
 Ventilation bag & mask of
appropriate sizes.
 Vital signs monitor.
 Specific equipment as indicated by
diagnosis. What is the
6 To ADMISSION PROCEDURE IN NICU procedure for
explain the 10min admitting the
admission neonate?
procedure. All babies admitted to neonatal unit
should have the following data recorded
carefully within 24 hours of admission
(if possible much sooner).
HISTORY AND EXAMINATION
 Maternal history.
 Paternal history.
 Previous obstetric history.
 Details of present pregnancy.
  Labour
 Delivery
 Apgar score.

ON ADMISSION
 Notify the doctor and the nurse
incharge.
 Resuscitate infant as necessary
and maintain warmth.
 Check infant identification label.
 Quickly examine the infant from
head to toe for obvious
abnormalities if the condition
permits.
 Record weight, length and head
circumference as soon as
possible.
 Common observations are :-
a) Temperature- infant normal
temperature range 36c to 37c.
b)heart rate
c) respiration
d) colour
e) activity
  Explain to parents.
 Hand over from transferring unit
staff

CATEGORIES OF NICU

To explain the India has 3 –tier system based on weight List the levelof
7 and gestational age of neonate.
levels of nicu care. 5min care in nicu?
 LEVEL 1 CARE
Neonates weighing more than
1800 grams or having gestational
maturity of 30-34 weeks are categorized
under level 1 care. The care consists of
basic care at birth, provision of warmth,
maintaining asepsis and promotion of
breast feeding. This type of care can be
given at home, subcenter and phc.
 LEVEL II CARE
Neonates weighing 1200-1800
grams or having gestational maturity of
30-34 weeks. The equipment and
facilities used for this level of care
include equipment for resuscitation,
maintenance of thermo neutral
environment, intravenous infusion,
gavage feeding, phototherapy, and
exchange blood transfusion. This type of
care can be given at first referral units,
district hospitals, teaching institutions
and nursing homes.
  LEVEL III CARE
Neonates weighing less
than1200 grams or having gestational
maturity of less than 30 weeks. The care
is provided at apex institutions and
regional perinatal centres 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.

ASPECTS OF NICU
Two main aspects in NICU What are the
To describe the 10 aspects of nicu?
8 1) physical setup 2) administrative set
aspects of nicu. min
up

1) PHYSICAL SETUP
Space between patient
 For the patient care, 100 square
feet is required for each baby.
 There should be a gap of about 6
feet between two incubators for
adequate circulation and keeps
the essential life saving
equipments, space needed 120
square feet.
  Each patient station should have
12-16 central voltage stabilised
electrical outlet.
 2-3 oxygen 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.
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 taps.
COLOUR
The walls of the whole unit ust be
washable & have a white or slightly off
white colour.
LIGHTING
The lighting arrangement should
provide uniform, shadow free
illumination of 100 foot candles at the
babys level. In addition spot illumination
should be available for each baby for any
procedure.
SOUNDS
The acoustic characteristics should be
such that the intensity of noise is kept
well below 75 decibles.
ROOMS
Apart from patient area including
rooms for isolation and procedures, there
is need for certain essential functions like
a room for scrubbing and gowning near
the entrance, a seide labarotory, mothers
feeding room, adequate stores for
keeping articles, additional space for
biomedical engineer to provide essential
periodic preventiove maintainence of the
costly equipments. Room for educational
activities & storing of data.
VENTILATION
effective air ventilation of nursery is
essential to reduce nosocomial infection.
The air conditioning ducts must be
provided with multiport filters (0.5h) to
restrict the passage of microbes.
EXASTER keep away from the baby.

2)ADMINISTRATIVE SET UP
MEDICAL STAFF: the unit
should be headed by a director who is
full time neonatologist with special
qualification and training in neonatal
medicine.
STAFF REQUIREMENTS:
 Neonatal physician 6-12 patient
in the continuing care,
intermediate care and intensive
care areas.
 Should be available on 24 hrs
bases for consultation.
 A ratio of one physician in
treating to every 4-5 patients who
requires intensive care ideal
round the clock.
 Service to other specialists like
microbiologist, haematologist,
radiologists, and cardiologists
and should be available on call.
 An anaesthetist capable of
administering anaesthesia to
neonate.
 Paediatric surgeon and paediatric
pathologist should be available.

NURSE RATIO
 Nurse patient ratio of 1:1
maintained throughout day and
night.
 A ratio of one nurse for two sick
 babies not requiring ventilator
support may be adequate.
 Additional head nurse who is the
overall incharge.
 In addition to basic nursing
training for level ii care, tertiary
care requires dedicated,
committed & trained staff of the
highest quality.
 Their training must include
training in handling equipment
use of ventilators & use of mask
resuscitations & even
endotracheal intubation, arterial
sampling and so on.
EXPERIENCE
The staff nurse must have minimum
3 years of work experience in special
neonatal care unit in addition to having 3
months hands on training in a intensive
neonatal care unit.
OTHER STAFF
 There is a special need of
motivated staff responsible for
upkeep and cleanliness of the
unit.
 One sweeper should be available
round the clock.
  Laboratory technician.
 Public health nurse/social
workers.
 Respiratory therapist.
 Biomedical engineer.
 Ward clerk can help in keeping
track of the stores.

EQUIPMENTS FOR NICU Listout the

 Resuscitation equipment equipments
9 To list out the 5 min used in nicu?
 Bag and mask resuscitator.
equipments used in
nicu.  O2 and suction facilities.
 O2 hoods ,o2 analyzer
 Weighing machine
 Incubators
 Radiant heat warmer
 Thermometer
 Phototherapy unit.
 Cardiopulmonary monitor.
 Apnea monitor.
 Non invasive BP monitor.
 Infusion pumps, syringe pumps.
  Transcutaneous bilirubinometer.
 Intracranial pressure monitor.
 Neonatal ventilator.
 Ultrasound machine.
 X-ray machine.
 Procedure manual

LABORATORY FOR NICU

 A micro chemistry laboratory
attached to the unit and providing
round the clock service, in
preferable through under certain
conditions, this may not be
mandatory.
 Should be well equipped to
provide quick and reliable
hematocrit, blood glucose and
total serum bilirubin. total
leukocytes count, and
microscopic examination of
peripheral blood films for
evidence of infection.
 x-ray machine and an ultra sound
machine should be mandatory for
modern day neonatal care units.
 DOCUMENTATIONS IN NICU
The unit should have printed oriented
10 stationary for maintaining records
admission and discharge slips etc.
Records 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 lecturers,
demonstrations and group discussions
This should cover important issues like
resuscitation, sterilisation to be
maintained for critically ill babies,
putting in arterial catheters conducting
exchange transfusion maintenance of
ventilators etc.
Educational programmes covering the
nurse and physician in the community
should be developed.
 2min SUMMARY

11
Till now we have discussed about
introduction, definition, criteria for
admission in nicu and its goals and
objectives, preparation for admission,
staffing of nicu ,setup and facilities and
equipments used in nicu.

CONCLUSION
NICU can be of great comfort and
12 support to families of multiples.
Although the family is experiencing the
joy of having baby at home, there is still
concern for the baby that remains in
nicu. good communication between
nurse and can go a long way in easing
the anxieties and stress families may feel.

BIBLIOGRAPHY
 J.M RENNIE & N.R.C ROBERTON
“ a manual of neonatal intensive care
published by great britian in 2002, 4th
edition.
MANOJ YADAV “ a text book of
child health nursing” pv publishers 2013
edition.
DOROTHY R.MARLOW “ a text
book of pediatric nursing ”published by
elsiever publication, south asia
edition,2018,india.
WEB SIT
www.wikipedia.org.
www.standforchildrens.org,topic
www.slideshare.net
GENERAL OBJECTIVES : GENERAL OBJECTIVES :
At the of the class students will able to gain indepth the knowledge on the topic of organization of NICU and can apply in the clinical
area.

SPECIFIC OBJECTIVES :

 Introduction to the topic

 Define the NICU

 Enlist the goals of NICU

 Explain the golas of NICU

 Enumarate the preparation of NICU
 Define the categories of NICU
 Explain the aspects of NICU
 Explain the education PROGRAMME at NICU