RUFAIDA COLLEGE OF NURSING JAMIA HAMDARD

Physical layout
Of
N.i.c.u.

SUBMITTED TO:- SUBMITTED BY:-

MS. JHANARA RAHAMAN ms. Meena kumari
Assistant prof. M.sc (nursing) 2nd year

NICU
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 new-born infants. Neonatal refers to the first 28 days of life. Neonatal care, as known as specialized nurseries
or intensive care, has been around since the 1960s.
NICU is a very specialized unit where critically ill neonatal cared to reduce the neonatal morbidity and mortality. The admission to
neonatal special care unit or intensive care unit has some can. If the child is neonatal in the critical condition, the neonate needs the
care of interer unit. Mostly from the labour wards, operation theatre and hospital or any other referred they will be send to intensive
care unit (ICU).
AIMS/GOALS OF NEONATALINTENSIVE CARE UNIT
The goals of a 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
morbidity and mortality.
 To provide continuing in-service training to medicine and nursing personnel in the care of the newborn.
 To maintain the function of the pulmonary, cardio-vascular, 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 is by oxygen analyzers.
 To check/observe alarms systems signal, to find out the changes beyond certain fixed limits set on the monitors.
 To administer precise amounts of fluids and minute quantities of drugs through I.V. infusion pumps
CRITIRIA FOR ADMISSION IN NICU:
Indications for admission to the neonatal intensive care 
• Large babies(more than or equal to 4kg)
• Birth asphyxia(apgar score less than or equal to 6)
• Meconium aspiration syndrome. If symptomatic/ thick meconium seen in lab
• Sever jaundice
 • Infants of diabetic mother
• Neonatal sepsis/meningitis
• Neonatal convulsions
• Severe congenital malformation/cyanotic congenital heart disease
• O2 therapy/parentral nutrition
• Immediate after surgery/cardiological investigation
• Cardio respiratory monitoring, if heart Rate and respiratory rate are unstable
• Exchange blood transfusion
• PROM/foul smelling liquor
• Mother of hepatitis ‘B’ carrier
• Injured neonate
Intensive care needs highly trained personnel including the intensive care specialist,and nurses and techniques. Sophisticated
equipment for the monitoring and if vital functions and the availability for continuous laboratory support are in the intensive care.
PREPARATION OF NICU:-
 Warm (33-36°C) incubator
 Adequate light source
 Resuscitation and treatment trolly stocked.
 History, continuation sheet treatment and diet sheet, problem listand flow charts.
 Oxygen air and suction apparatus (as available in the unit)
 Oxygen line connected to oxygen and air flow meter.
 Suction - complete suction unit tubing and various sizes of suction catheters
 Ventilation bag and mask of appropriate sizes
 Vital signs monitors
  Specific equipment as indicated by diagnosis.
ADMISSION PROCEDURE IN NICU
All babies admitted to the neonatal unit should have the following data recue carefully within 24 hours of admission (if possible
much sooner)
 History and examination
 Maternal history
 Paternal history
 Previous obstetric history
 Details of present pregnancy Labor ; Delivery
 Apgar score on admission (Resuscitate infant as necessary and maintain warmth)
 Check infant identification label
 Quickly examine the infant from head to toe for obvious abnormalities condition permits
 Record Weight, length and head circumference as soon as possible
 Transfer to warm environment as soon as possible.
 Commonest observations are :- (a) Temperature - Infant normal temperature range 36°C to 37°C (b) Heart rate. (c) Respiration
(d) Colour, (e) Activity.
 Explain to parents - Hand over from transferring unit staff
 Record keeping: - Birth history (Done in labor ward); Ward history contains - Apgar score and examination of new born infant,
sheet; Neonatal weight and feed sheet, progress chart.
 Compiled history contains - Patient registration form; Progress sheet; intra uterine growth chart; flow sheets; fluid balance
sheet etc.

LIFETHREATENING CONDITIONS WHICH REQUIRE NICU

The following are the life-threatening conditions in neonates: -
 Apnea
 Baby with respiratory distress
 Birth asphyxia.
 Convulsions
 Low birth weight babies (less than 1500 gm requiring intensive care.)
 Neonatal jaundice requiring exchanges blood transfusion.
 Sepsis and
 Meningitis.

PHYSICAL SET-UP
LEVELS OF NICU
Level I Care
Over 80 percent of new-born babies require minimal carewhich can be provided by their mothers under thesupervision of basic health
professionals. Neonatesweighing above 2000 g or having a gestational maturityof 37 weeks or more belong to this category. The care
can be provided at home, primary health centre level.Basic care at birth, provision of warmth, maintenance ofasepsis and promotion
of breastfeeding form themainstay of level I care.

Level II Care
Infants weighing between 1500 and 2000 g or having agestational maturity of 32 to 36 weeks need specializedneonatal care
supervised by trained nurses andpaediatricians. First referral units, district hospitals,teaching institutions and nursing homes should
beequipped to provide intermediate neonatal care.Equipment for resuscitation, maintenance of thermoneutralenvironment,
intravenous infusion and gavagefeeding, phototherapy and exchange blood transfusionshould be provided. There should be no
compromise onthe basic needs of adequate space, nursing staff andmaintenance of asepsis including provision for disposable gamma-
irradiated suction catheters, feeding tubes,endotracheal tubes, small-vein infusion sets, etc.Intermediate neonatal care is needed for
about 10 to 15percent of the new-born population and should beavailable at all hospitals catering to 1000 to 1500 deliveriesper year.

Level III Care

Intensive neonatal care is required for babies weighingless than 1500 g or those born before 32 weeks ofgestation. Apex institutions
or regional perinatal centresequipped with centralized oxygen and suction facilities,servo controlled incubators, vital sign and
transcutaneous
monitors, ventilators and infusion pumps, etc. are bestsuited to provide intensive neonatal care. Skilled nursesand
neonatologistsespecially trained in the art ofneonatal intensive care are required to organize thisservice. About 3 to 5 percent of the
new-born population
qualify for intensive care. Establishment of intensive careneonatal centre demands a sound infrastructure andshould be envisaged
only when optimal intermediateneonatal care facilities have already been in existence forsome time. The capital and recurring
expenditure for
level III care is exorbitant, and it is not cost-effectiveunless the service is regionalized.

EQUIPMENTS USED IN NICU

 1. RADIANT WARMER

Radiant Warmer, is a body warming device to provide heat to the body. This device helps to maintain the body temperature of the
baby and limit the metabolism rate. Heat has a tendency to flow in the heat gradient direction that is from high temperature to low
temperature. The heat loss in some new born babies is rapid; hence body warmers provide an artificial support to keep the body
temperature constant. In certain areas with very cold climate, babies are kept on Radiant Warmer for couple of hours immediately
after birth to ensure the baby is stabilized after birth. Radiant Warmers consists of an open tray (where the baby is kept) and the
artificial heating is provided by a heating mechanism mounted overhead. The heating mechanism consists of quartz which produces
the desired heat and a reflecting mechanism to divert the heat at the baby tray. The skin temperature of the baby can be monitored by
a temperature measuring knob that is kept continuously attached to the body. The variation in the skin temperature can be seen on a
small LCD panel which continuously shows the body temperature. Radiant warmers are equipped with alarm to indicate the change
in temperature and hence attract attention of medical professional attending the baby. The heat generated can be controlled manually
by a knob as well as automatically depending on theRadiant Warmers can be manual or automatic (servo system – heater output is
determined automatically based on skin temperature. The skin temperature is set at 36.5 degree Celsius) depending on the mechanism
that the manufacturer employs for temperature control. The heat generated and the temperature of the skin can be individually seen
but the basic difference between these two models will be the regulation of temperature. The automatic model increases the heat
output in small predetermined steps to reach at the desired temperature of the body. The device may seem simple to handle, but it is
always recommended to have a proper training and read the manufacturers guidelines for person handling this equipment’s. It is
necessary to regularly clean and disinfect the instrument. 

2. INCUBATORS

Incubators are device that provides sufficient warmth to the body to maintain a desired temperature. Premature babies have very less
fat around them and lose heat rapidly to the surrounding environment. The incubator plays an important role in maintaining the small
environment of desired temperature which minimizes the heat loss. Once the heat loss is reduced, the nutrition given to premature
babies willbe utilized in organ development and weight gain. Incubators consist of the baby tray that is enclosed in a box like
structure to provide a fix warm environment. The box is generally made of fibre glass or acrylic which is transparent and the heating
mechanism is placed below the tray. The heat generated by heating mechanism is not used directly to heat the body. This heat is used
to warm the air mixture which is then circulated in the closed environment around the baby. The temperature of the air as well as the
baby is indicated on panels and the temperature control can be automatic as well as manual based on the incubators. Incubators are
armed with alarms to derive attention for temperature change. Incubators are available with single wall and double wall, and the
selection can depend on the environment temperature in which it is to be used. There is no specific time frame for which a baby has
to be kept in an Incubator, and the choice varies on case to case basis depending on how premature the baby and the weight of baby.
Hence the time for which a baby is kept in an incubator can vary from couple of days to weeks and requires handling by trained
professionals. Hence the universal rule that a baby should be kept in an incubator only as along as it is needed in the best time frame.
Precaution should be taken while removing the baby from the incubator, so as not to move the baby immediately from a comfortable
warm environment to a cold environment resulting in a high temperature gradient. Hence when the baby starts gaining weight, it is a
practice to gradually reduce the temperature of the incubator. 

The cost and the heat lost can be determining factor between selection of warmer and incubators. When it comes to critical care, such
as low birth weight, incubators have been preferred while radiant warmers have been preferred to prevent heat loss in normal
newborn babies. It is recommended to clean and disinfect the instrument regularly to avoid infection. Also, it is necessary to have a
proper training and read the manufacturers guidelines for person handling these equipment’s. 

3. PHOTOTHERAPY

Phototherapy is the most common treatment for reducing high bilirubin levels that cause jaundice in a newborn.
In the standard form of phototherapy,baby lies in a bassinet or enclosed plastic crib (incubator) and is exposed to a type of fluorescent
light that is absorbed by your baby's skin. During this process, the bilirubin in the baby's body is changed into another form that can be
more easily excreted in the stool and urine.
A baby with jaundice may need to stay under a phototherapy light for several days. Phototherapy doesn't damage a baby's skin.
During this type of phototherapy:

 The baby is undressed so that as much of the skin as possible is exposed to the light.
 The baby's eyes are covered to protect the nerve layer at the back of the eye (retina) from the bright light.
 Feeding should continue on a regular schedule. There is no need to stop breastfeeding.
  The bilirubin level is measured at least once a day.

Another type of phototherapy is a fibre-optic blanket or a band. These devices wrap around a baby and can be used at home. Although
fibre-optic phototherapy has been shown to reduce bilirubin levels, it takes longer than conventional phototherapy done in a hospital
setting. It can be a good alternative for babies with mild jaundice who are otherwise healthy.
4. TEMPRATURE

A temperature probe is placed on the baby's skin with an adhesive patch. A wire connects the temperature probe to the overhead
warmer (or isolette) to help regulate the heat needed to keep the baby warm.

5. PULSE OXIMETER
This machine measures the amount of oxygen in the baby's blood through the skin. A tiny light is taped to the baby's finger or toe, or
in very tiny babies, a foot or hand. A wire connects the light to the monitor where it displays the amount of oxygen in the baby's red
blood cells.

6. INFANTOMETER

The infant is placed supine on the infantometer. Assistant or mother is asked to keep the vertex or top of the head snugly touching the
fixed vertically plank. The leg are fully extended by pressing over the knee, and feet are kept vertical at 90⁰ , the movable pedal
plank of infantometer is snuggly apposed against soles and length is read from scale

7. WEIGHING SCALE
New born is placed on the weighing scale. Zero error is checked. Weight is recorded.

8. VENTILATOR

A ventilator is used to provide breathing support for ill or immature babies. Sick or premature babies are often too weak, sick, or
immature to breathe well enough on their own. They may need help from a ventilator to provide "good air" (oxygen) to the lungs and
to remove "bad" exhaled air (carbon dioxide). A ventilator is a bedside machine. It is attached to the breathing tube that is placed into
the windpipe (trachea) of sick babies who need help breathing. Caregivers can adjust the ventilator as needed. Adjustments are made
depending on the baby's condition, blood gas measurements, and x-rays. Most babies who need ventilator assistance have some lung
problems, including immature or diseased lungs, which are at risk for injury. Sometimes, delivering oxygen under pressure can
damage the fragile air sacs in the lungs. This can lead to air leaks, which can make it difficult for the ventilator to help the baby
breathe.

 The most common type of air leak occurs when air gets into the space between the lung and inner chest wall. This is called
a pneumothorax. This air can be removed with a tube placed into the space until the pneumothorax heals.
 A less common kind of air leak occurs when many tiny pockets of air are found in the lung tissue around the air sacs. This is
called pulmonary interstitial emphysema. This air cannot be removed. However, it most often slowly goes away on its own.
Long-term damage may also occur because new born lungs are not yet fully developed. This can lead to a form of chronic lung
disease that is called bronchopulmonary dysplasia (BPD). This is why caregivers closely monitor the baby. Caregivers will try to
"wean" the baby from oxygen or decrease the ventilator settings whenever possible. How much breathing support is given most often
depends on the baby's needs.

9. CPAP

Continuous Positive Airway Pressure (CPAP) is a means of providing respiratory support to neonates with either upper airway
obstruction or respiratory failure. Respiratory failure constitutes either failure of ventilation or failure of lung function. 
CPAP delivers oxygen concentrations and distending airway pressures via the ventilator without the hazards associated with full
endotracheal intubation and mechanical ventilation. The delivery of constant positive pressure to the airway of a spontaneously
breathing neonate maintains adequate functional residual capacity within the alveoli to prevent atelectasis and improves oxygen and
carbon dioxide exchange within the pulmonary circulation. 

INDICATION

 Increased work of breathing – tachypnoea, nasal flaring, grunting, retractions, cyanosis, increasing oxygen requirements
 Respiratory acidosis on blood gas
 The following conditions when associated with the above signs may be responsive to CPAP

 Respiratory Distress Syndrome (RDS)

 Pulmonary oedema
 Atelectasis
 Recent extubation
 Transient Tachypnoea of the newborn (TTN)
 Tracheomalacia or similar disorder of the lower airway
 Apnoea of prematurity

10. ABG
An arterial-blood gas (ABG) test measures the amounts of arterial gases, such as oxygen and carbon dioxide. An ABG test requires
that a small volume of blood be drawn from the radial artery with a syringe and a thin needle, but sometimes the femoral artery in
the groin or another site is used. The blood can also be drawn from an arterial catheter. An ABG test measures the blood-gas
tension values of the arterial partial pressure of oxygen, and the arterial partial pressure of carbon dioxide, and the blood's pH. In
addition, the arterial oxygen saturation can be determined. Such information is vital when caring for patients with critical illnesses or
respiratory disease. Therefore, the ABG test is one of the most common tests performed on patients in intensive-care units. In
other levels of care, pulse oximetry plus transcutaneous carbon-dioxide measurement is a less invasive, alternative method of
obtaining similar information.

BIBLIOGRAPHY

1. https://www.pediatriconcall.com/medical-equipment/incubators/4/incubator/23
2. IAP 4th edition Page 56
3. http://www.stanfordchildrens.org/en/topic/default?id=procedures-and-equipment-in-nicu-90-P02358
4. www.wikipedia.com
5. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Continuous_Positive_Airway_Pressure_(CPAP)_-
_Care_in_the_Newborn_Intensive_Care_Unit_(Butterfly_Ward)/