Neonatal Intensive Care Unit

Neonatal Intensive Care Unit: Definition, objectives, major components, requirements, physical setup, admission criteria, space, location, baby care area, electrical outlet, ventilation, counselling, handwashing area, acoustic characteristics, personnel, equipments available in the NICU, services, levels of NICU

1. Organisation of NICU Presented by: Ms. Manisha Thakur Nursing Tutor Child Health Nursing

2. What is a NICU ?

3. NICU means…. Neonatal Intensive Care Unit

4. DEFINITION Newborn or neonatal intensive care unit, an intensive care unit designed for premature and ill newborn babies.

5. OBJECTIVES

6. BASIC REQUIREMENTS

7. MAIN COMPONENTS TO BE CONSIDER WHILE ORGANIZING A NICU PHYSICAL FACILITIES Space Location Floor plan Ventilation Lighting Environmental temperature & humidity Handling & social contacts Communication system Electrical outlets

8. PHYSICAL FACILITIES

9. Space Requirement as per population To serve as a referral unit for infant born outside the hospital (extra mural), additional physical facilities. Each infant to be provided minimum 100 sq. feet. Place for promotion of breast feeding. No compromise in space regarding nosocomial infection .

10. Location Close to labour room & OT Elevator in close proximity In tropical countries –located on top floor Feasibility for sunlight

11. Baby Care Area Areas and rooms for inborn or intramural babies, out born or extramural babies, examination area, mother’s area for breast feeding and expression of breast milk nurses station and charting area.

12. NICU LAYOUT Unit design may be in a square or single corridor based rectangular unit. A unit should occupy one side of corridor. The distance should ensure minimal walking distance

13. Hand Washing And Gowning Room Hand washing and gowning facilities at the entrance. Self-closure door and abundant space provided. Positive air pressure is maintained in SNCU, so that corridor air does not enter. Hand free elbow operated hand washing taps. Sink or wash basins are of porcelain or stainless steel. Pictorial presentation of hand washing steps near hand washing area. Single use disposable napkins or hand dryer should be provided in hand washing area.

14. Examination Area Small comfortable room with examination table, comfortable seating, sufficient light and warmth .

15. Mother Area Comfortable seating and privacy to mother to express breast milk with the help of lactation nurse.

16. COUNSELLING ROOM Separate counseling room should be there in the NICU where doctors can counsel parents regarding the babies condition, prognosis, treatment, home care and follow-up care.

17. NURSES STATION Central area Newborn charts, hospital forms, computer terminals, telephone lines should be located in this area.

18. Clean Utility and Soiled Utility Holding Rooms Stocking clean utility items and sterile disposables, and for disposal of dirty linen and contaminated disposables.

19. Staff Rooms A comfortable room with intercom, telephone, computer facility It is the space provided within the NICU. Nurses staff room Residents duty room Nurses changing room

20. VENTILATION Effective air ventilation of nursery. Provision of exhaust fan. Do not use chemical air disinfection and ultra-violet lamps.

21. LIGHTING Well illuminated & painted white/off white. Cool white fluorescent tube to provide at least 100 foot candle illumination at infant’s level. Spot illumination – portable angle poise lamp with two 15 watt fluorescent bulb provide 100 foot candle at a distance of 1 foot from infant. GENERATOR: 24X 7 hours electrical facility.

22. ENVIRONMENTAL TEMPERATURE AND HUMIDITY Temperature of NICU is maintained between 26-28 o C. Rooms’ temperature should be maintained by radiant heaters and hot air blowers in winters. External windows of nursery should be glazed to minimize heat gain or loss. Baby should be located at least 2 feet away from walls.

23. ACOUSTIC CHARACTERISTICS The ventilation system, incubators, air compressors, suction pumps and many other devices used in the nursery produce noise. Sound intensity in the unit should not be exceed 75 decibels. Telephone rings and equipment alarms should be replaced by blinking lights.

24. ELECTRICAL OUTLETS 8-12 electrical points at 4-5 feet height of 5 amperes and 15 amperes electrical points. Each infant should be allotted with 8 electrical sockets, 4 of each ampere. No extension board or adapter should be used. Electrical equipment should be checked once a month. Round the clock uninterrupted servo supplied power supply and power back up.

25. PERSONNEL Availability of sufficient number of adequately trained personnel. Nurse patient ratio in special care and NICU.

26. PERSONNEL Availability of sufficient number of adequately trained personnel. Nurse patient ratio in special care and NICU.

27. STAFF One neonatal physician is required for every 6-10 patients . One resident doctor should be present in the unit round-the-clock. Anesthetist - pediatric surgeon and pediatric pathologist are essential persons in establishment of a good quality NICU

28. NURSES According to National Neonatology Forum of India: 1 trained nurse: 4 babies If 8 bedded NICU, 8nurses should be sanctioned to ensure availability of 2 nurses in each shift along with sister In charge in the morning.

29. HANDLING AND SOCIAL CONTACTS Minimal and gentle handling Soothing words gentle stoking and rocking after painful procedures Gentle and soothing tactile stimulation.

30. COMMUNICATION SYSTEM NICU should have intercom system. Direct lines should be made available with external telephones. No mobile phones should be allowed in the inborn and out born area.

31. EQUIPMENTS

32. NURSING care and nursing services in NICU Assessment Monitoring physiological data Safety measures Respiratory support Thermoregulation Protection from infection Hydration Nutrition Feeding resistance Skin care

33. Cont … 11. Administration of medication 12. Developmental outcome 13. Facilitating parent-infant relationship 14. Discharge planning and home care

34. Laboratory facilities Lab for routine analysis of blood, urine , amniotic fluid, gastric aspirate for shake test , blood gases and acid base parameters should be available. Portable X- Ray machine

35. TRANSPORT OF SICK NEONATES The short distance transport within the hospital can be accomplished in a transport incubator. The use of plastic basket with perforated sides coupled with careful placing of hot water bottles is recommended for use in the rural setting. The baby can be wrapped in tin foil or covered with several layers of cotton. Themocele (polystyrene) box is an effective insulator and can be used in community. Skin to skin contact with mother or a care taker is a useful modality of transport in rural areas or resource poor settings.

36. INDICATIONS FOR THE ADMINSSION TO NICU   Birth weight less then 1800 gram. Gestational age less than 34 weeks. Neonates with postnatal age less than 14 days. Moderate to severe asphyxia. Respiratory distress at birth. Rh isoimmunization . Maternal insulin dependent diabetes mellitus. Neonatal and major congenital malformation. Suspected inborn error of metabolism. Unwell baby from maternity ward. Sick neonate referred from peripheries to the hospital.

37. GRADE OF NEONATAL CARE

38. LEVEL I CARE The minimal care Provided by the mother under the supervision of basic health professionals. Neonates weighting more than 2000 gm or having gestational age maturity of 37 weeks or more belong to this care. This care can be includes care of delivery, provision of the warmth, maintenance of asepsis, and promotion of breast feeding.

39. LEVEL II CARE This care includes requirement for resuscitation, maintenance of thermo neutral temperature, intravenous infusion, gavage feeding phototherapy and exchange transfusion. 10-15 percent of the newborn require this care This care is anticipated for the infants weighing in between 1500 & 1800 gm or having gestational age maturity of 32 to 36 weeks.

40. LEVEL III CARE This care includes life saving support system like ventilator and best suited special intensive neonatal care. Three to five percent of newborn require care of this level. This level of care is for critically ill babies, for those weighing less than 1500 gm or having gestational age maturity of less than 32 weeks. The care is provided at apex institutions and regional perinatal centers 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.

41. SUMMARY So far we have seen about neonatal intensive care unit, its organization, physical facilities, personnel, equipment necessary, laboratory facilities and level of neonatal care etc.

42. CONCLUSION Thought NICU services require high technology input and expensive one should not lose sight of the human approach towards the fragile and sick babies & their anguished parents. To obtain best results from neonatal intensive care we need a well equipped unit.

43. references Singh Meharban ; medical emergencies in children 5 th ed. New Delhi; Sagar Publication 2012; 13-31.