Advanced technology in neonatal care.pptx

Dr Rajathi Sakthivel

1. Advanced Technologies in Neonatal Care Dr. Rajathisakthivel RNM, M.Phil., Ph.D. Vice-Principal / HOD Child Health Nursing Hindu Mission College of Nursing West Tambaram, Chennai

2. At the end of this session, the participants will be able to , synopsis define and categorization of Newborn significance for normal Newborn Care need for transformation toward neonatal care history of NICU objectives of intensive Newborn care advanced modalities in neonatal care - Viewpoints conclusion

3. Introduction….. Cries vigorously establishes independent rhythmic respiration Active Warm and pink palms & soles Good reflexes Feeds well on the breast Newborn Quickly Adapt Changes - External Environment “Healthy Newborn ”

4. The first 28 days of life is called as Newborn / Neonate. NEW BORN - Definition Post Neonatal Period After 28 days - Up to 1 year WHO-SEAR - 2018

5. Classification of newborn Preemie < 750g Micro preemie < 500g M oderate preterm  ( 32 to 37 weeks ) Early moderate preterm (32-34 weeks) Late moderate preterm (34 -37 weeks ) Very preterm  ( 28 to 32 weeks ) Extremely preterm  ( less than 28 weeks ) . Ideal 2500 to 3500 grams WHO-SEAR - 2018

6. Significance of NEWBORN CARE The very first minute, hours, and days of babies’ lives set the tone for rest of their lifetime. High-quality universal newborn health care is right of every newborn everywhere.  Babies have right to be protected from injury and infection, to breathe normally, to be warm, and to feed. Current trends emphasize the institutional delivery to reduce mortality and provision of newborn care

7. Newborn Care Time Bound Non Time Bound CATEGORIZATION OF Newborn care Care Transitional Essential New born care

8. Should be performed first. Time – 1 st 30 sec to 90 mts of age followed by 1 and 5 minutes APGAR. Time Bound / Immediate Care Follow 4 core steps . Immediate drying and assessment of breathing Skin-skin contact Clamping & cutting the Cord after 1-2minutes Rooming in & breast feeding .

9. Next to immediate care From 90 mts to 6 hrs of age. Non- Time Bound care 2. Physical / Neuro Examination 4. Immunization 1.Physical parameters 3. Inj.Vitamin . K 4 Core steps

10. New born Transitional care (NTC) It’s is new concept ,(1990) baby is well enough to stay with mother, either in the postnatal ward or a room with support from the hospital staff. NTC supports a resident mother to be the primary care provider for her baby but does not require continuous monitoring . NTC suitable for : Term newborn baby requiring support or surveillance. Late preterm infants (32 to 37 weeks) with moderate additional care needs preparing for discharge.

11. Core steps OF Transitional NEWBORN CARE (NTC) 1. Thermoregulation. 2. kangaroo Mother care 3. Breast feeding 4. Elimination 5. Care of umbilical stump 6. Care of E ye and S kin 7. Prevention of I nfections

12. New born Danger signs Indicating Referral Elimination Not passed Urine and stool for 24 to 48 hours District Hospitals - Need for special / Intensive care

13. ( Skin colour ) Reflex Irritability Muscle tone Minimal responses to stimulation Prompt responses to stimulation Indicators New born care - Assessment of APGAR Assess for 1 minute ( Golden minute) and 5 minute

14. APGAR - Interpretation and Interventions NICU Essential & Transitional Care NICU

15. Need for Transformation of Neonatal Care Earlier To Current period

16. Today’s healthcare system is well equipped to combat many challenges of ensuring optimal health in newborns, in the field of neonatal care . Global - 2.3 million children died in the first month of life in 2021 – approximately 6,400 neonatal deaths every day Global Analysis - WHO 2022 Need for neonatal care India, accounts for nearly 0.9 million, mortalities of newborns per year which is 30% of global neonatal mortalities

17. NEED FOR NEWBORN CARE ….. Days in life Percentage Mortalities due to Preterm, Asphyxia, Hypothermia, Congenital defects and infections Distribution of Neonatal Mortalities- Day wise

18. NEED FOR NEWBORN CARE ….. Percentage Weeks Distribution of Neonatal Mortalities- week-wise Essential and Transitional New born care NMR

19. Technology - more multifaceted & significant safety features on handle equipment, need more education training & cure critically ill children . NICU - Neonatal Intensive Care Unit C are for medically unstable and critically ill newborns requiring constant monitoring , complicated surgical procedures, or continual respiratory support . Need of NICU Mortality 1990 2021 Percentage NMR 5.2 million 2.3 million 51% (36.6 /1000 live births to 18 in 2021) T ransformations & Innovations in technology care for neonates improving Survival in the last 2 to 3 Decades

20. Neonatal Mortality Rate (NMR) Global - 18 / 1000 live births ( WHO - 2018 ) National - 19.1 / 1000 live births ( UNICEF-2021 ) State - 11 / 1000 live births ( NFW -2018) SDG -3 - Good Health & Well being 3.2 - End all preventable deaths under 5 years of age” by 2030 , Target – 2030 Global < 10 / / 1000 livebirths Single digit NMR National/ INAP 12 / 1000 livebirths or fewer NEED FOR transformation toward neonatal care T op-notch M onitoring and Quality of care

21. causes for admission - NICU Preterm Gestation < 37 weeks Low birth weight < 2.5 kg APGAR score < 7 Baby who did not cry at birth or delayed Requiring ventilator therapy Infections - Meningitis /Sepsis Newborn hypoglycemia or hypocalcemia New born Jaundice > 20mg/dl Genetic syndromes & structural disorders Neonatal seizure Inborn errors of metabolism Congenital abnormalities Autoimmune disorders Complex surgery Medication overdose Organ failure

22. History of NICU Past To Present

23. History of NICU 17 th century – Doctors & scientists began writing on the care of premature and sickly newborns. After century ago - sickly and premature infants were sent home from hospital without any special interventions; many children did not survive till first birthday . 19 th century - NICU did not even appear in American hospitals until 1922 ; the method of special care for infants began not developed. Mid-20th century- most children were sent home without medical intervention; occasionally, they would have a nurse come home with them. Late 20 th & 21 st century -Boomed the intensive care

24. The Pre-NICU Era (up to 1950's) Dr.Budin - M others about proper nutrition and hygiene for their babies, and risks of contaminated cow’s milk. U rged the use of breast milk, and believed sterilized cow’s milk should be used if breast milk was insufficient. G avage - premature infants. Pierre-Constant Budin , French obstetrician 1846 – 1907 Etienne Stephane Tarnier French obstetrician 1828-1897 History of NICU….. Dr. Budin & Dr.Tarnier - Infants that are born too early are often incapable of producing their heat. He developed a crude isolette wooden box with glass lid & hot water bottle inside - to keep premature infants inside

25. History of NICU….. contributed for 28 % decrease IMR over 3 years.

26. At the turn of the century - Many hospitals in both America and Europe did not allow technology such as incubators to be used within their walls. Dr. Couney (1903) - P otential of incubators for help premature babies & offered type of treatment free of charge ; displayed babies in a sideshow at Coney Island. History of NICU….. Dr. Martin A. Couney American obstetrician 1869 - 1950 Europe (1933) Similar sideshows were set up in Europe as parts of fairs and expositions. New York (1939) World’s Fair in Chicago. I t helped pave way for modern neonatal intensive care. Dr. Couney died in 1950 , exhibitions brought awareness to the effectiveness of incubators, and encouraged hospitals to adopt the technology after American hospitals began to use incubators

27. History of NICU…..

28. History of NICU…..

29. M id 20 th century - A fter World War II hospitals began to create Special Care Baby Units, the precursors to modern NICUs.​ Hospitals were initially reluctant to adopt incubators because of their cost , the fact that they limited access to infants, and the lack of evidence of their effectiveness. Formation of the Modern NICU (1950 -1970) Dr.Julian Hess in Chicago; he worked with nurse Evelyn Lundeen to establish the first special nursery for premature infants . in addition to heat and humidity for babies, delivered oxygen to infants. I n the 21 st century , incubators with clear plastic walls allow doctors and nurses to easily see and access the babies. He Invented the first Transport incubator. Dr. Julius H. Hess (1876-1955)

30. Formation of the Modern NICU (1950 -1970)

31. D octors realize danger that infection posed to newborns, especially premature babies. He was thought that the biggest risk to a baby was another baby in the nursery. No one thought that a baby could get sick from a healthy adult. Dr. Louis Gluck , Sumner Yaffe , Norman Kretchmer and Harold Simon -. biggest issues of visitors and staff to wash their hands; this remains one of biggest threats in NICU. Formation of the Modern NICU (1950-1970) Dr. Louis Gluck (1924-1997) - F ather of Neonatology. Dr. Gluck - R esearch - infections were caused by poor hand hygiene than by other infants, he redesigned special care in isolated cubicles. L/S ratio test ( Lecithin/Sphingomyelin) - determined maturity of infant’s lungs and therefore their chances of developing certain respiratory diseases.

32. History of NICU…..

33. ​ ​ Dr. Heidelise - Developed Newborn Individualized Developmental Care and Assessment Program, encouraged family involvement and individualized plans for each baby. It reduced the ventilator required for children and improved outcomes. In 1980 Family-centered - Parental rooming-in and even siblings spend the night in the same room as their child, it allowed whole family to help care for baby. Contemporary NICU ( 1970 0nwards ) Dr.Heidelise Als 1940 - 2022  N ext decade ( 1980-1990) – with the advent of kangaroo care skin-to-skin contact between mother and child to promote bonding, stabilize the baby’s breathing, heart rate, and body temperature, and help to gain weight and grow. Kangaroo care is now encouraged for all parents, regardless of sex. kangaroo Mother care

34. Formation of the Modern NICU (1950 -1970)

35. Contemporary NICU (1990 0nwards) In the 1990s , increase of knowledge and technology to care for premature infants gave hope to babies who in previous decades. Babies as young as 23 rd GA and as small as 500 grams were successfully treated. Improvements an new technology allowing for precise fluid delivery, nutrition management, maintenance temperature, and proper ventilation management all contributed to helping these very small infants survive. S urvival rate for babies born at 23 rd week 33%; 24 th week - 65%. With increasing technology and awareness, survival for premature and sick infants with standards of care.

36. Level of care category-wise in NICU Aim: P rovides high-quality skilled care to critically ill neonates /child by offering facilities for continuous clinical, biochemical, and radiological monitoring and use of life support systems for improving the survival of babies. Category NICU ( Gestational maturity and Weight) Level 1 Normal Neonatal Care - less than 2000 grams between 35 th and 37 th gestational week Level - ll Special care- weight less than 1500 g and greater than 30 weeks gestation. Level -III Intensive care - weight less than 1200 grams or gestational maturity of fewer than 30 weeks. Level IV Specialized Care of a Level III - Offers facilities like extracorporeal membrane oxygenation (ECMO), after surgical correction for CD.

37. Establishment of satisfactory feeding regimen Secondary - To enhance survival, augment recovery, minimize pain & mitigate any risk of disability. P rimary OBJECTIVES OF NICU

38. Evolved into highly specialized facilities equipped with advanced medical technology and a multi-disciplinary team of experts . It caters unique needs of premature and critically ill newborns, providing round-the-clock monitoring and specialized care. Advanced Technologies in NICU

39. UNICEF – working partners to improve the availability of needed technologies for essential newborn care at all health system levels and drive demand for existing & upcoming newborn product suites. Efforts are focused on identifying gaps and increasing accessibility to sustainable, affordable, and easy-to-use products suitable for low-resource settings, giving every child in every community a fair chance to survive. Advanced Technologies in NICU DREAMS  ( D evices for R apid E arly A ssessment, M anagement and S upport) Suite for Newborn Health

40. M obile resuscitation trolley- N ewly born babies can be resuscitated while still receiving oxygenated blood and the ‘ placental transfusion ’ through the umbilical cord. This would also prevent the separation of the mother and baby in the first minutes after birth. B ased on the concept of an overbed hospital table. It can be maneuvered to within 50 cm of the mother's pelvis . Umbilical cord can remain intact during resuscitation, irrespective of whether naturally, by instrumental delivery, or by caesarean section. Warmth for newborns comes from a heated mattress and the trolley has the facility to provide suction, oxygen, and air. Advanced Technologies in NICU 1. BASICS Trolley - ‘B edside A ssessment, S tabilization and I nitial C ardiorespiratory S upport’ 1 st mobile resuscitation device - facilitate newborn resuscitation at mother’s bedside

41. Infection is the leading cause of mortality events among premature infants. A Neonatal Intensive Care Unit (NICU) innovation allows NNPs to predict host infections twenty-four hours in advance. Heart Rate Observation System ( HeRO ) uses an algorithm to detect heartbeat irregularities that might indicate a major oncoming infection, a serious health threat for infants that weigh less than three pounds . It’s difficult to identify the subtle symptoms that might indicate the beginning stages of a condition . However, HeRO allows practitioners to intervene before an infection occurs.   Advanced Technologies in NICU 2. Heart Rate Observation System ( HeRO )

42. 3. BALLERINA ( B ilirubin A ssessment to initiate Light therapy) for Jaundice management Jaundice occurs in almost all newborn patients. Early screening and diagnosis are crucial for enabling effective phototherapy treatment and preventing the progression of severe cases that could lead to brain damage. It aims to introduce and increase access to innovative neonatal Transcutaneous bilirubinometers ( TcB ) d evices for early jaundice screening and detection in low-resource contexts. Hand-held and non-invasive, devices accurately measure bilirubin levels using a light-emitting sensor placed on the newborn’s skin. They can replace unreliable screening methods like visual assessment and other complex and costly blood-sampling devices. Easy to use, reliable, and affordable, Increased accessibility - G oal of universal screening for neonatal jaundice, preventing newborn mortality, and giving every child a fair chance to healthy early childhood development.   Advanced Technologies in NICU

43. Biliprobe Transcutaneous Jaundice Detector Bilirubinometer Advanced Technologies in NICU

44. 3/27/2024 44 Fibre Optic Blanket Phototherapy It’s consist of an LED pad for the treatment of neonatal jaundice (hyperbilirubinemia) in the home. Its wrapped around the baby and a pad of woven fibers is used to transport light to baby. Light emitted from a Biliblanket is used to break up bilirubin in the baby’s blood, reducing the yellowing effect in the baby’s skin and the whites of the eyes. Technology advancements have led to home phototherapy treatment. Advantage D oes not need to have eye protection when using a biliblanket . Another advantage of the biliblanket is that it can be used at home . Advanced Technologies in NICU

45. 4. fire Fighter ( Fast Identification for Glucose Healthcare and Treatment) for Hypoglycemia management Hypoglycemia occurs in 10% of healthy infants and 54% of late preterm babies. In low-resource settings, newborns often rely on cheap and non-standardized adult glucometers which fail to provide adequate, consistent monitoring of rapidly fluctuating glucose levels in newborns.   Inaccurate diagnosis and delayed treatment can cause brain damage . Advanced Technologies in NICU To prevent the risks, focus on introducing and scaling up access to newborn-appropriate, affordable, and easy-to-operate glucometers especially suitable for low-resource settings. G oal - to enable accurate, routine glucose monitoring for all newborns during the first 24 hours. Increased access to appropriate devices as the standard of care for every newborn contributes to target of improved quality of care for every child around time of birth and first week of life, allowing them to survive and thrive.

46. Advanced Technologies in NICU 5 . ASTRONAUT ( Affordable Sonographic Technology: Rapid, On-site Ultrasound) , ASTRONAUT  - to promote portable, cost-effective, and user-friendly point-of-care ultrasound devices deployed in rural and remote communities. It can be used by non-specialist healthcare providers, offering essential information to guide maternal care or facilitating potential referrals to higher levels of care . Lung USG (LUS) - Lung f or pre-mature babies, respiratory conditions like RDS. It can be used for early detection and management of respiratory complications of infants. Cranial sonography - plays a huge role in ruling out neurological complications like bleeding in ventricles and hydrocephalus.

47. 6. Family- Centered Care - Parental engagement Source: Europe PMC 2016 Advanced Technologies in NICU Family-centered care (FCC) is a crucial part of creating a healing environment . FCC - for sick newborns is emerging as a paradigmatic shift in the practice of facility-based newborn care. It has potential gains for the newborn & family members, AngelEye features an app with bedside camera, allowing parents to see their babies at any time, reducing parental anxiety. Parents average spending 3.5 minutes/ virtual visit login average 5 times / day .

48. Keeping mother and baby together right from birth with zero separation will revolutionize way neonatal intensive care is practised for babies born early or small,” 6.M- NICU Global Alliance for Newborn Care - “Zero separation. Together for better care!” campaign to encourage parental involvement. Advanced Technologies in NICU

49. Over 1.5 lakh newborn deaths prevented Advanced Technologies in NICU 6.M- NCU 6.M- NCU 6.M- NCU

50. Advanced Technologies in NICU 7 . Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy “ Therapeutic hypothermia - slowly lowers the baby’s body temperature, using a water-filled cooling blanket, to 92 degrees . The infant usually remains lying on the blanket for three days. It reduces the severity of brain injuries in term newborns. Cooling body temperature of newborns who have suffered from oxygen deprivation at birth of HIE and neonatal encephalopathy Innovative therapy - advancements represent a significant step to addressing the unique challenges faced by neonates at risk of neurological complications and improving long-term neurodevelopmental outcomes.

51. Advanced Technologies in NICU 8. Milk analysis system - Breastmilk Support Lactation Support Services – H ospital uses a “ human milk analyzer system to analyze each mom’s milk. Milk analysis system - F at, protein, and total carbohydrate content and determine told solids and energy content, It helps identify deficiencies in protein or energy levels in the mother’s milk of infants with increased need for the nutrients . H uman milk fortification - P ersonalized feeding plans for premature infants or low birth weight infants, Specialized fortification processes involve adding essential nutrients, vitamins, and minerals to human milk to meet the specific nutritional needs of neonates. This ensures optimal nutrition for growth and development .

52. Advanced Technologies in NICU ….. 9. Ex Utero Intrapartum Treatments (EXIT) EXIT procedures are used more frequently to deliver babies who need immediate surgical intervention at birth while remaining attached to the placenta during EXIT procedures, surgeons operate on the infant while he or she is still connected to the umbilical cord to intervene and treat babies with immediate, critical problems in post-delivery and unable to breathe or transition safely to human life.

53. 10. Safety and Security Advanced Technologies in NICU ….. Footprint recognition - newborn personal authentication Male child – The right and Female child from the left leg and thump impressions from the mother are taken & recorded. BioBaby – Infant Protect System - BioEnable - Infant footprint scanner and software- Create a biometric birth record. Bar code scanning- utilized in administration of medications, administration of breast milk, laboratory testing & blood transfusions to ensure the right treatment is done on the right patient.

54. 10. Safety and security…. RFID - Radio-Frequency Identification Staff ties RFID band around the hand of baby, and RFID ID card with tag - mother and attender. All information stored on a tag and sensor fixed in all main entries. A tag can be read from up to several feet away and does not need to be within direct line-of-sight of the reader to be tracked. RFID and tag removed - Before discharge the baby Advanced Technologies in NICU …..

55. Rapid advances in genetic testing have enabled early detection of inherited disorders, allowing for prompt interventions and personalized treatment plans for affected newborns. Genetic testing now enables healthcare providers to identify specific genetic markers or mutations that may contribute to a newborn's health challenges. This wealth of genetic information allows for personalized treatment plans, tailoring interventions based on the individual genetic makeup of each infant. This precision medicine approach holds the potential to optimize treatment efficacy and minimize adverse effects. Advanced Technologies in NICU ….. 11. Genetic Screening and Early Detection

56. Ongoing research & collaboration- the rapid evolution of neonatology continues to drive innovation and advancements in newborn care Nearly 30,000 infants enter the world after only twenty-six weeks. The artificial womb is a relatively recent, development in treating infants who were born too early. Researchers report - successfully nurturing eight lambs through their gestation periods, mimicking the function of a mother’s womb in an artificial environment revealed that the lambs developed properly. Researchers’ next objective is to repeat this success with premature babies to help them develop in full health . Advanced Technologies in NICU ….. 12. Research and Collaboration- Artificial Womb

57. 13. Education Training - Neonatal Nurses Simulation-based training / Case scenarios have become an integral component of neonatal care education. Healthcare providers, including physicians, nurses, and respiratory therapists, engage in realistic, scenario-based simulations that replicate various clinical situations. Hands-on training - enhances clinical skills, decision-making, and teamwork, contributing to improved patient outcomes in the dynamic and high-stakes environment of the NICU. Neonatal nurse practitioners (NNPs) deliver services and treatment to millions of newborns. Advanced Technologies in NICU …..

58. 13 months in the facility’s neonatal intensive care unit, and on “multiple treatments and machines” for survival discharged in July at a far healthier weight of 6.3 kilograms (13.9 pounds )., 58 World’s smallest known baby at birth, who weighed 7.5 ounces, leaves hospital August10, 2021   Singapore’s National University Hospital  Note : Kwek Yu Xuan, born in Singapore in June 2020, is thought to be the world's smallest baby at birth. She weighs 212 grams (7.47 ounces) and is 24 cm long, which is about the weight of an apple or softball. Advanced Technologies in NICU (Global)…..

59. she is the smallest baby ever born in India. At birth, she was just about 26 cms in length - that is about the size of your palm -- and weighed 375 grams, making her perhaps the smallest in the whole of South Asia . kept in the hospital for 128 days after her birth, under a high-end incubator and ventilator at an advanced neonatal intensive care unit. Cherry was born in 25 weeks and therefore womb-like conditions had to be created with right humidity and temperature because the skin was thin and there a was need to ensure body was adequately hydrated.She was finally discharged weighing 1.98 kg. She weighs 2.4 kg now. Advanced Technologies in NICU (National) …..

60. Conclusion INAP - Single Digit NMR – 2030 & Enhance the Quality of survival The advanced modalities in NICU are essential for reducing neonatal mortality and improving future neonatal care among the survivors. With cutting-edge technology , specialized care, and a multidisciplinary approach, neonatal healthcare is essential for standards .   Ensure sustainable access to affordable, robust healthcare makes for every newborn necessary for survive for a healthy and vibrant life.

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