NEONATAL INTENSIVE CARE UNIT

PHYSICAL INFRASTRUCTURE OF NICU

1. ORGANIZATION OF NEONATAL INTENSIVE CARE UNIT

2. INTRODUC T ION

3. What is a NICU ? NICU means….

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

5. A neonatal intensive care unit,is an intensive care unit specializing in the care of ill or premature newborn infants. wikipedia

6. AIM OF THE ORGANIZATION OF A NICU Reducing the neonatal mortality and improving the quality of life among the survivors

7. OBJECTIVES To save the life of the sick new born To prevent damage in infants with problems at birth and also reduce morbidity in later life

8. To monitor high risk newborns so as to reduce mortality and morbidity in these babies

9. BASIC REQUIREMENTS Adequate space Availability of running water round the clock Centralized oxygen and suction facilities

10. Maintenance of thermo neutral environment Availability of plenty of linen and disposables Facilities for availability to treat common neonatal problems

11. MAIN COMPONENTS TO BE CONSIDER WHILE ORGANIZING A NICU PHYSICAL FACILITIES PERSONNEL EQUIPMENTS LABORATORY FACILITIES

12. PROCEDURE MANUAL TRANSPORT OF SICK INFANTS COOPERATION BETWEEN THE OBSTETRICIAN AND NEONATOLOGIST

13. 1.Physical facilities Location Space Floor plan Ventillation

14. Lighting Environmental temperature and humidity Acoustic characteristics

15. Handling and social contacts Communication system Electrical outlets

16. location located as close possible to the labor rooms and obstetric operation theatre should not be located on the top floor brightness and provide ultra violate rays to augment asepsis.

17. space 500-600 Gross square feet per bed. Space includes patient care area, storage area, space for doctors, nurses, other staff, office area, seminar room area, laboratory area and space for families 6 Feet gap between two incubators for adequate circulation and keeping the essential lifesaving equipment

18. FLOOR PLAN Open encumbered space The walls should be made of washable glazed tiles and windows should have two layers of glass panes. Wash basins with elbow or floor operated taps facility having constant round-the- clock water supply should be provided. The doors should be provided with automatic door closers. Isolation room

19. Baby Care Area Areas and rooms for inborn or intramural babies, Examination area Mother’s area for breast feeding and expression of breast milk Nurses station and charting area.

20. Hand Washing And Gowning Room Should be located at the entrance. self closing doors.

21. Examination Area

22. Mother Area

23. Nurses Stations Central area Newborn charts, hospital forms, computer terminals, telephone lines should be located in this area.

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

25. Staff Rooms

26. LIGHTING Well illuminated and painted while or slightly off Cool white fluorescent tubes The number and exact location of fixtures can be worked out taking into account size of the nursery, height of ceiling, and availability or otherwise of sunlight.

27. ventilation Effective air ventilation of nursery Provision of exhaust fan Do not use chemical air disinfection and ultraviolet lamps

28. ENVIRONMENTAL TEMPERATURE AND HUMIDITY 26-28°C in order to minimize effect of thermal stress on the babies. The external windows of nursery should be glazed to minimize heat gain and heat loss and baby beds should be located at least 2 feet away from the wall and windows.

29. 2.Personnel Skilled nurses Neonatologists Lab technician Biomedical technician Respiratory therapists pathologists

30. ST A FF A direct who is a full time neonatologist 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

31. NU R SES A nurse : patient ratio of 1:1 maintained thought out day and night is absolutely essential for babies on multi system support including ventilatory therapy. For special care neonatal unit and intermediate care, nurse to patient ratio of 1:3 is ideal but 1:5 per shift is manageable. Head nurse is the overall in-charge In addition to basic nursing training for level-II care, tertiary care requires, staff nurse need to be trained in handling equipment, use of ventilators and initiation of life-support like use of bag and mask resuscitation, endotracheal intubations, arterial sampling and so-on. The staff must have a minimum of 3 years work experience in special care neonatal unit in addition to having 3 months hand-on-training in an intensive care neonatal unit.

32. 3 . Equipm e nts Resuscitation equipment Bag and mask resuscitator Oxygen and suction facilities Catheter,syringes and needles

33. Feeding equipment Laminar flow system Weighing machine Bassinets

34. Incubators Radiant heat warmer Thermometer Oxygen analyzer

35. Oxygen concentrator Perpex heat shield Photherapy unit Heartrate monitor

36. Respiratory rate and apnea monitor Blood pressure monitor Multi channel vital sign monitor Infusion pump

37. Bilirubin analyzer T ranscutaneous bilirubinometer Transcutaneous blood gas monitor Pulse oximeter

38. Capnography or end tidal co2 Neonatal ventilators Neonatal pulmonary function tests Cranial ultrasonogram

39. Intracranial pressure monitor Extracorporeal membrane oxygenator Placenta prototype

40. 4.Laboratory facilities 5.Transport of sick infants 6.Procedure manual

41. 7.Cooperation between the obstetrician and neonatologist Antenatal care and foetal diagnosis Perinatal hypoxia Promotion of feeding with human milk Supervised care of low birth weight babies

42. INDICATIONS FOR THE ADMISSION TO NICU Babies less then 30 weeks Very low birth weight baby of less then 1500 gms Cardiopulmonary monitoring Surfactant therapy Convulsions Severe birth asphyxia Assisted ventilation Total parenteral nutrition Major surgery

43. LEVELS OR GRADES OF NEONATAL CARE Level I Level II Level III

44. LEVELS OF NEONATAL CARE 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.

45. LEVELS OF NEONATAL CARE 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 s is anticipated for the infants weighing in between 1500 & 1800 gm or having gestational age maturity of 32 to 36 weeks.

46. LEVELS OF NEONATAL CARE 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.

47. EQUIPMENT FOR LEVEL III NURSING – 6 BED Sl.No Item Nos 1 Resuscitation set 6 2 Open care system 4 3 Incubators 2 4 Infusion pumps 12-18 5 Positive pressure ventilators 6 6 Oxygen hoods, oxygen analyzers 6 7 Heart rate – apnea monitors with scope 6 8 Phototherapy unit 6

48. EQUIPMENT FOR LEVEL III NURSING – 6 BED 9 Electronic weighting scale 1 10 Pulse oxymeters 6 11 End tidal CO 2 monitor 6 12 Transcutaneous PO 2 & PCO 2 2-3 13 Noninvasive Bp monitors 1-2 14 Invasive Bp monitors 1-2 15 ECG monitor with defibrillator 1 16 Intra cranial pressure monitor 1 17 Portable radiographic machine 1 18 Portable ultrasound machine 1 19 Blood gas analyzer 1