Levels of Neonatal Care Units in hospital.ppt

Levels of Neonatal Care Units in hospital.ppt

1. By

Safwat M. Abdel-Aziz
Assistant professor of pediatrics
Assiut university

2. Function of the unit
Care of neonates with uncomplicated
conditions, availability of emergency
measures,and plan for transfers to Levels II
and III
Criteria for admission
-Normal, stable, full term neonate with a body
weight 2,500 gm
≥
-No risk factors

3. Physical facility
- Space allocation: rooming-in with the mother at
the post-delivery room.
-The number of bassinets (cribs) should be at
least equal to the number of obstetric
beds.
-The room temperature should be maintained at
24-º26ºC.

4. Equipment, supplies, and medications
-Resuscitation box with equipment, supplies and
medications necessary for neonatal
resuscitation
-Neonatal stethoscope
-Newborn scale
-Neonatal thermometer
-Alcohol 70%
-Antibiotic eye drops

5. Personnel
-Nurses and physicians must be trained in basic
neonatal care and resuscitation
-Staffing requirements should reflect a nurse-
infant ratio of 1:6-8

6. Function of the unit
-Management of moderately ill newborns
expected to improve rapidly
-Management of extremely ill newborns
requiring stabilization and transfer to Level III
-Management of recovering neonates
transferred back from Level III or Level IV
centers
-Risk assessment
-Continuing education

7. Criteria for admission of neonates at level II units
-Preterm infant 32 weeks' gestation (<37 weeks)
≥
-Low Birth Weight (LBW) infant 1,500 gm
≥
-Infant of a diabetic mother (IDM)
-Affected infant born to high risk pregnancy and
delivery
-Respiratory distress not needing assisted
ventilation
-Hyperbilirubinemia, needing phototherapy
-Neonatal sepsis
-Hypothermia

8. Personnel
-Resident trained in neonatology available 24
hrs/day
--Pediatrician with special neonatal training
available 24 hrs/day
--Nurse-infant ratio of 1:4 during each shift

9. Function of the unit
-Care of moderately ill and extremely ill
newborns
-Transport system
-Regional and in-house continuing education
-Assist region in assessing unmet needs in
perinatal health
-Evaluation and research

10. Criteria for admission of neonates at level III units
-Any infant whose condition is such that they cannot be
appropriately cared for in Level II
-Infant with hemodynamic compromise
-Moderate or severe respiratory distress, needing short-term
mechanical ventilation for less than 7 days
-Very low birth weight infant <1,500 gm
-Infant with an abnormal neurologic examination
-Infant with seizures or sever hypoxic-ischemic
-Infant requiring an exchange transfusion for
hyperbilirubinemia or polycythemia
--Total parenteral nutrition for less than 7 days

11. Personnel
-Nurse-infant ratio of 1:1-2
-Nurse specialized in NICU
-Resident available 24 hrs/day
-Consultant available 24 hrs/day

12. Criteria for admission of neonates at level IV
units
-ELBW infant (<1,000 gm)
-Prolonged mechanical ventilation for more than
7 days
-Surgery; pre and postoperative care
-Hydrops fetalis
-Life threatening anomalies
--Total parenteral nutrition for more than 7 days

-- Suspected metabolic or endocrine disorders

13. Personnel
-Nurse-infant ratio of 1:1
-High Institute Graduate Nurses
-Neonatologist available 24 hrs/day
-Neonatology Consultant available 24 hrs/day

14. Stabilization Guidelines

15. Definition
--Stabilization is a series of activities which begin
with resuscitation and continue through those
interventions necessary to help the infant
achieve normal transition.
-Careful stabilization of the infant prior to
transport will enhance long-term outcomes
for the infant and minimizes the risks of adverse
events occurring during transport.

16. -Normal neonatal core temperature is 36.5-
37.5°C .
-Hypothermia or hyperthermia may increase
oxygen consumption and metabolic demands .
-Sick infants, small for gestation (SGA) and
preterm infants are particularly vulnerable
to cold stress .

17. Before the delivery of the infant, neonatal
hypothermia could be prevented by:
□Closing all the doors and windows.
□Turning off all fans in the room.
□Pre-warming towels and other linens which will be used
in wrapping of the infant.
□Keeping delivery room warm using a heater (radiator),
if available .
The delivery room temperature
should be kept within 24-26°C.

18. Immediately after delivery ,
►dry the infant, and remove wet linens from around the
infant.
►The neonate should be undressed except for an diaper
and centered under pre-heated radiant warmer .
►Encourage direct skin-to-skin contact with the mother.
Wrap both mother and neonate in blankets or clothing.
►Prevent contact with cold or wet surfaces or exposure
to turbulent air currents .
►Cover infant with clear plastic sheet or acrylic heat
shield; use double-walled isolette .
►Cover infant’s head with a cap.

19. Warming the infant:
►Place under radiant warmer
►If the infant is cold, place in isolette
► Use warmed blankets, or heat lamps, and
avoid using hot water bottles.

20. Assessment of the circulatory status and
perinatal volume loss:
►Perfusion: capillary refill time (>3 seconds), pallor,
mottling, cool skin, decreased peripheral pulses
with poor peripheral perfusion.
►Heart rate: tachycardia (>170 beats/minute at
rest), or bradycardia (<100beats/minute).
►Blood pressure: may be normal or low; a fall in
blood pressure is a late sign of shock.
►Urine output.
►Blood gas analysis: evaluate for
acidosis/hypoxemia.


21. Obtain an intravenous access:
►Peripheral intravenous line: the first choice,
insert cannula under aseptic conditions.
►Umbilical vein catheter: the second choice, if
trained personnel and equipment are available.

22. Treatment for circulatory failure:
►Support oxygenation/ventilation and reverse
effects of asphyxia.
►Improve circulating blood volume by giving
normal saline, Ringer’s solution, packed RBC’s, or
whole blood 10 ml/kg over 15-30 minutes. Volume
expansion may need to be repeated up to two
times in severe shock.
►Improve myocardial contractility:
□Dopamine: 5-20μg/kg/minute via a continuous
infusion.
□Other inotropic agents can be used as
dobutamine, and epinephrine.

23. -Blood glucose levels should be monitored
regularly.
-Calculate fluid requirement according to
gestational age, day of life, hydration state and
disease state.
-When available, evaluation of blood gases for
acid-base balance.

24. Evaluation for infection requires a thorough
review for potential risk factors, including:
►Preterm labor and delivery
►Rupture of membranes ( 18 hrs)
≥
►Prolonged length of labor
►Presence of maternal fever during labor
►Elevated maternal WBCs count
►Low neonatal WBCs count

25. Obtaining CBC with differential, WBCs count,
absolute neutrophil count, immature to total
(I/T )ratio, platelet count, and blood culture.
Treating suspected infection:
►Initiate IV antibiotic therapy (ampicillin and
gentamicin) after obtaining the appropriate
cultures, and continue close observation until
results of blood culture and sensitivity are
available.

26. ----Esophageal atresia and tracheo-esophageal fistula: place
a multiple end-hole suction catheter in the proximal
pouch and put on to intermittent suction immediately
to protect lungs.
-Diaphragmatic hernia: initiate immediate endotracheal
intubation (avoid bag and mask ventilation), and then
insert a large nasogastric tube into the stomach and
aspirate its contents immediately.
-Abdominal wall defect (gastroschisis or omphalocele):
cover the sac with warm, sterile, saline soaked gauze,
and wrap with a sterile transparent plastic bag , then a
nasogastric tube is inserted to decompress the
intestine

27. -Neural tube defects (e.g., myelomeningocele):
keep the newborn in the prone position, with a
sterile saline-moistured gauze sponge placed
over the defect .
-Bilateral choanal atresia: insert an oral airway.
-Pierre Robin syndrome: place the infant in the
prone position, in more severe cases;
nasopharyngeal tubes are required .