ORGANIZATION & LEVELS OF NICU.pptx

ORGANIZATION & LEVELS OF NICU.

1. ORGANIZATION & LEVELS OF NICU Amy Lalringhluani consh

2. DEFINITION “Neonatal intensive care unit is designed for treatment of premature and ill newborn babies”

3. NEONATAL INTENSIVE CARE The NICU is specially designed for management of life threatening diseases, continuous intensive monitoring and to provide life saving therapies in an organized manner to a critically ill child

4. INDICATIONS FOR ADMISSION TO NICU ◈Babies less than 30 weeks and very low birth weight baby less than 1500gm. ◈Cardiopulmonary monitoring ◈Surfactant therapy ◈Convulsion ◈Birth asphyxia ◈Assisted ventilation ◈Total parenteral nutrition ◈Major surgery

5. AIMS OF NICU ◈ To reduce neonatal mortality and morbidity ◈ To improve the quality of life among the survivors

6. OBJECTIVES To save the life of the critically ill new born To prevent damage in babies who born with problems and also reduce morbidity in later life To monitor high risk newborns to reduce mortality and morbidity

7. BASIC FACILITIES Facilities to treat common neonatal problems Adequate space Continuous supply of running water and electricity Centralized oxygen and suction facilities Maintenance of environmental temperature Availability of sufficient linen and equipment

8. PHYSICAL FACILITIES

9. Location ◈ Located close to labour room and obstetric care unit ◈ Adequate sunlight for illumination ◈ Proper ventilation for fresh air

10. Space ◈ Each infant should be provided with 100 sq. ft. or 10sq. meter area. 500-600 square feet per bed. ◈ Space for promotion of breast feeding, patient care area, storage area, space for doctors, nurses, other staff, office area, seminar room area, laboratory area and space for families.

11. Space ◈ 6 Feet space between two incubators for adequate circulation and keeping the essential lifesaving equipment ◈ Isolation room ◈ Examination area ◈ Hand washing and gowning room should be located at the entrance

12. Floor Plan ◈ The walls should be made of washable glazed tiles and windows should have two layers of glass. ◈ Wash basins with elbow operated taps facility having continuous water supply should be provided. ◈ The doors should be provided with self closing doors.

13. Ventilation ◈ Adequate air ventilation ◈ Whole NICU should have central air conditioning

14. Lighting ◈ The NICU must be well illuminated and wall should be painted white. ◈ There should be uniform shadow free lighting and 100 foot candles lighting at the baby’s level ◈ Avoid excess of light

15. Temperature & Humidity ◈ The temperature inside the NICU should be maintained at 28 – 30 °C, while the humidity must be above 50%. ◈ Portable radiant heater, infra red lamp can be used.

16. Acoustic Characteristics ◈ Many devices used in NICU such as ventilator, incubators, air compressors, suction pumps etc. produce noise. ◈ Sound intensity in the unit should not be more than 75 decibels. ◈ Telephone rings and equipment alarms should be replaced by blinking lights.

17. Electrical outlets ◈ Each bed should have 12 to 16 central voltage – stabilized electrical outlets sufficient to handle all pieces of equipment and some extra power plugs should be there. ◈ There should be continuous power back up

18. DOCTORS ◈ A full time neonatologist ◈ One neonatal physician is required for every 6-10 patients ◈ One resident doctor should be present in the unit 24 hours

19. NURSES ◈ A nurse : patient ratio of 1:1 maintained through out day and night is absolutely essential for babies on multi system support including ventilatory therapy. ◈ For intermediate care nurse to patient ratio is 1:3 but 1:5 per shift is manageable. ◈ One nurse in-charge

20. OTHER STAFF ◈ Respiratory therapist ◈ Laboratory technician ◈ Public health nurse or social worker ◈ Biomedical engineer ◈ Clark

21. LEVELS OF NEONATAL CARE ◈ Level I ◈ Level II ◈ Level III ◈ Level IV

22. Level I-Basic neonatal care At home, subcenters, PHC Postnatal care to stable term newborn born at 35 – 37 wks Provide neonatal resuscitation at every delivery Stabilize newborn infants (born at <35wks) who are ill until transfer to higher levels of care

23. Level II-Special Care Nursery At district hospitals Provide care for Infants born ≥ 32wks/ ≥1500gm who are moderately ill and not anticipated to require subspeciality on an urgent basis Convalescing newborn after intensive care Neonate on mechanical ventilation Stabilize infants born ≥ 32wks/ ≥ 1500gm until transfer to higher levels of care

24. Level III-NICU At Tertiary level care centres Provide care for Infants born < 32wks/ <1500gm with critical illness Sustained life support Neonate on mechanical ventilation Provide subspeciality care, full range and avanced care with investigations

25. Level IV- Regional NICU At tertiary level care centres Manage complex conditions Facilitate transport Provide outreach education All specialities and subspeciality care

26. THANK YOU