INTRODUCTION

Neonatal intensive care unit (NICU) are highly specialised area un a hospital that caters to the
need of all types of sick newborn baby. Planning an NICUinvolves a multidisciplinary team
comprising of hospital planners, architects, biomedical engineers, neonatal staff and nurses.

LEVELS OF NEWBORN CARE

 It is well known that all needs some care in first few days of life irrespective of their birth
weight , gestational age and place of birth.

1.)Level -1 care :

 About 80-90% newborn requires minimal care which can be provided by their mothers
with family members support and under supervision of basic health professionals.

 The neonate weighing above 2000gm or having ges age of 36wks ormore belong to this
category.

 This care given at home , subcentre and primary health centers.

 Essential perinatal care provided as basic care at birth, provision of warmth , maintenance
of asepsis & promotion of breastfeeding.

2.)Levels -2 care:

 Neonates weighing between 1500 to 2000 gm or ges age of 32-36 wks need specialised
neonatal care supervised by trained nursing staff and padiatricians

 The intermediate neonatal care provided by equipped district hospitalsand nursing homes.

 There should be arrangement of resusitation procedures, maintenance of thermoneutral

environment, intravenous infusion , gavage feeding ,phototherapy and exchange blood
transfusion.

 Only 10-15 % of all neonates required this care, it should be available at all hospital
where 1000 -1500 deliveries takes place per year.
Levels -3 care :

 Neonatesweighing less than 1500 gm or born before 32 wk of gestation require intensive

neonatal care

 only 3-5% of all newborn babies need this care by skilled nurses & neonatologist
especially trained in neonatal intensive care.

 Regional perinatal centers eqipped with centralised oxygen and suction facilitates,
incubators, ventilators , monitors and infusion pump etc are suited to provude obstetrics
care.

 At birth detection of high risk neonates should be done at all levels of health care delivery
system & appropriate referral is essential to different level of neonatal care for prevention
& reduction of neonatal mortality & morbidity.

LOCATION

 The NICU Should be a distinct area with in the hospital, with controlled access and a
controled envirionment.

 Traffic to other sevices shoulh not pass through the unit.

 It should provide good visibility of infants & circulation of staff , family and eqiupment.

 The NICU should be close proximity to the area of the hospital where births occur.

AREA AND CLEARANCE

 The size of unit planned, depend on number of deliveries in hospital per year, whether it
is areferral maternity centers & whether outborn babies are admitted.

 Extra provision should be made for outborn babies & this can be modified acc to
workload of the unit.

 Each infant care space should be a minimum of 11.2 sq m (120sqfeet) excluding sinks &
aisles.
 The need for privacy of babies and families should be addresed not only indesign of each
bed space, but also in overall unit design.

SCRUB AREA

 Atleast 150 sq feet of space at main entrance should be assigned as ascrub area with
provision for washing hands,hanging coats and foot wear.

 Every room in nursery should have a hand washing sink within 20 feet of any bed.

 Hand washing sinks should be large enough to control splashing .

 Pictorial handwashing instruction should be provided above all sinks.

CLEAN UTILITY HOLDING AREA

 It should be designed for storage of supplies frequently used I care of newborn.

 Routinely used supplies such as diapers , linen , ,covers gown’s charts & information
booklet may be stored in this space.

 There should be atleast 0.225 cu m of space for each infants, for storing syringes, needles
, intravenous infusion sets & sterile tray.

SOILED UTILITY HOLDING AREA

 This space is essential for storing used & contaminated material.

 The ventilation system in room should be engineered to have negative air pressure with
all the air sent out through an exhaust fan.

MEDICAL EQUIPMENT AREA

 There should be atleast 1.7 sq m of floor space allocated for equipment storage per infant
in intermediate care & 30 sq feet for each infant in intensive care.

LIGHTING

• Ambient lighting
• Properly designed lighting is essential for nearly all nursing task, like charting &
evaluation of infant skin tone.

• In past high level 60-100 foot candles have been used to evaluate of infant skin, but
retinal damage is noted , so newly constructed NICU provide lightening at level
recommended by illuminating engineering society(IES) 10-20 foot candles.

 Procedure lightening

• Temporary increases in illuminationis necessary to evaluate a baby or to perform a

procedure.

• This can be done by having overhead , adjustable lights attached to warmer or fixed on
walls.

 Day light

• Window provide an important psychological benefit to staff & families inNICU.

• There should be designed to prevent direct sunlight from striking the infants , IV fluids or
monitor screens.

AMBIENT TEMPERATURE AND VENTILATION

 The NICU should be designed to provide an air temp of 22degC- 26degdb C & relative
humidity of 30-60% while avoiding condensation on wall & window surface.

 A minimum of six air changes per hour is required with a minimum of two changes being
outside air.

 Air delivered to NICU should be filtered with atleast 90% efficiency.

NOISE LEVEL

 Infant bed area & space opening onto them should be designed to produce minimal
background noise & to contain & absorb much of transient noise , which arises within
nursery.
 The combination of background sound & transient sound in any bed spaceshould not
exceed 50db-55db.

EQUIPMENTS

 Investing equipment for an NICU need a lot of thought and planning.

 Attempt shuold be made to use whatever good quality equipement is available inour
country, it has advantage of cost , better services & easy replacements of parts.

Quantity and type

• Equipment required for asix bedded NICU .

• The incharge nurse should maintain with equipment name , date of installation , warranty
period , problem & repair.

EQUIPMENTS

• Resuscitation set

• Open case system

• Incubator

• Infusion pump

• Heart rate monitor

• Pulse oximeter

• Non invasive BP

• Invasive BP

• Neonatal ventilator

• CPAP system

• Phototherapy unit
• Oxygen hovel

• Electronic weighing scale

• ECG monitor with defibrillator

LABORATORY

• Aside laboratory with basic investigation is ideal , but in larger hospital wound the clock
well equipped lab is available.

• The side lab should ideally have following

a) Microcentrifuge with hematocrit reader

b) Microbilieubinometer

c) Bedside chemistry reader such as the I stat to estimate ABG, electrolytes, calcium, urea
& creativity & hematocrit with one drop of blood

d) CRP kit

e) Microscope

f) Slides & stains for total & differential count for blood and CSF

g) Refrigerator for storing specimen like blood for chromosome analysis ,urine for culture &
amino acid estimation ,CSF and serum for amino acid estimation when done off hour

h) The hospital should have facilities for ABG estimation ,bacteriological test including
cultures, coagulation working ,USG & bedside X-ray.

PERSONNEL

1. Medical

• The unit should be headed by a director who is full time neonatologist with special
training in treating all types of sick newborn & with a capacity to organise & run a NICU.
• The director should be able to work in close liason with the director of obstetric unit of
hospital and other smaller neonatal unit in area

• The team should have one clinical neonatologist for every 6-10 babies. One trained
neonatologist should be on call at all times for the unit.

• Resident doctors, who should be trained in pediatrics ,must man the unit at all times

• Pediatric surgeon , pediatric cardiac surgeon, neuro surgeon , neonatal

anesthesiologist ,geneticists, plastic surgeon, nephrologists , cardiologists & radiologists
are other specialist who form part of any NICU.

2. Nursing

• Well trained and adequate numbers of nursing staff from the cornerstone of any neonatal
unit be it a district hospital or a sophisticated neonatal unit.

• A nurse to baby ratio 1:1 is a must for very sick babies on the ventilator and those
requiring multi-organ support

• The workout to 4 nurses for every NICU bed, to accommodate off days & leave

• Babies who are healthy will need a nurse by baby ratio 1:3-4

that is 2 nurses for every special case bed.

3. Other

• Motivated staff who will be responsible for cleanliness and upkeep of unit should be
employed

• At least one sweeper & one helper should be available at all times.

• One medico-social worker who can talk to parents

• A biomedical engineer available on call.

• Transport
• Transport is a neglected aspects of care in any areas of the world owing to lack of
resources ( trained personnel , vehicles ,resources to pay personnel , lack of roads &
attack on transport vehicles during conflict. Under circumstances, adverse events are
high & improvement in outcome is not demonstrated .

• Pediatric critical care transport program are part of continuum of care of emergency
medical services(EMS).to provide a safe envt during transport between health care
institution.

• EMS include all aspects of basic life support, advance life support & critical care
transport in which emergency care is provided at a scene in a vehicle

TRANSPORT ENVIRONMENT

 Both ground& air transport result in noise level that can prohibit auscultation of lungs
and heart sound.

 Vehicular motion & vibration can results in artifacts in pulse oximetry,

electrocardiography & oscillometric BP monitor.

Advantages of ground transport

o It include virtually ubiquitous access , low cost and ability to respond in most weather
condition.

o Ambulance are more spacious than biomedical transport vehicle and provide option to
perform procedures/clinical intervention.

o Disadvantage

o It include severe winter weather, traffic congestion and crowd & highway condition

 The use of sirens to facilitate the navigation of traffic.

AEROMEDICAL TRANSPORT
It is widely available in the and other developed countries.both rotor wing(US helicopter) &
fixed wing (airplane) aircraft can be adapted for use a critical care transport vehicle.

PRINCIPLE OF TRANSPORTING NEONATE

 Correct assessment of the baby should be done to justify indication of transport &
referral.

 Baby condition should be stabilized & hypothermia should be corrected before

transporting.

 Record case history ,need for referral & treatment given in the referral case sheet.

 Mother should accompany the baby at the time of transport.

 A doctor or nurse should accompany the neonate to provide necessary care on the way to
referral centre.

 Ensure warmth of baby on the way to maintain warmth chain. The best method to keep
baby warm is skin-skin contact with mother as(KMC).

 Mother should be instructed to give breast milk if possible, otherwise expressed breast
milk to be given on the way.

 Nearest referral facilities to be available by shortest route & using fastest ,possible &
available mode of transport.
SUMMARY
Neonatal intensive care unit (NICU) are highly specialist area An a hospital that caters to the
need of all types of sick newborn baby. Planning an NICU involves a multidisciplinary team
comprising of hospital planners, architects, biomedical engineers, neonatal staff and nurses.
 CHILD HEALTH NURSING
ASSIGNMENT
ON
NICU

SUBMITTED TO SUBMITTED BY
MS. VARSHA PRIYANKA DAS MS. VEENA

ASSOCIATE PROFESSOR M.Sc NURSING I st YEAR

M.Sc (N) CHILD HEALTH NURSING CHILD HEALTH NURSING
RITCON , RAIPUR ,C.G RITCON , RAIPUR , C.G