Organization of neonatal care, services,transport,nicu,organization and management

introduction
purpose
examples
equipments

1. ORGANIZATION OF NEONATAL CARE, SERVICES,TRANSPORT,NICU,ORGANIZATION AND MANAGEMENT OF NURSING SERVICES IN NICU

2. INTRODUCTION The infant mortality rate and neonatal mortality rate is very high in India. The organization of a good quality special care unit and paediatric ward is essential for reducing the high mortality and improving the quality of care being given to children. Neonatal intensive care units(NICU) are highly specialized areas in a hospital that cater to the needs of all types of sick newborn babies.

3. PURPOSES To document the need for such unit in a given set-up Assessment of need based on the existing patient load and type of illness cared for in the set-up To determine the availability of committed and appropriately trained staff, adequate financial resources and other important considerations.

4. I-NORMAL NEONATAL CARE(LEVEL-1)- This is care given, usually by the mother in a postnatal ward, supervised by the nurse and doctor but requiring minimal medical or nursing advice. II-SPECIAL CARE NURSERY(LEVEL-2)- Care given in a special care nursery which provides observation, treatment and monitoring falling short of intensive care but exceeding normal routine care.

5. III-INTENSIVE NEONATAL (LEVEL-3)- Care given in an intensive care nursery for seriously ill neonates who require intensive skilled management by nursing and medical staff.        

6. EXAMPLES OF LEVELS OF NEONATAL CARE 1.NORMAL NEONATAL CARE(LEVEL-1) Babies with mild medical conditions who can be observed in level-1 neonatal care include babies with G6PD deficiency, babies of hepatitis B carrier mothers, babies with mild congenital malformations( eg-polydactyly ,pre-auricular tags, hydrocele etc) and babies receiving phototherapy, at the discretion of the specialist in charge.

7. Babies born to mothers with maternal complications like DM, pyrexia, prolonged rupture of membrane, mild meconium staining, but who are free from all clinical manifestations of illness are also included. The emphasis is to provide mother craft and the encouragement of breastfeeding.

8. 2.SPECIAL CARE NURSERY(LEVEL-2) All low birth weight infants 2000gm and below. All preterm deliveries 35wks and below Neonates with Apgar score of 4-6 at five minutes,and /or requiring any form of resuscitation at birth Babies who require continous monitoring of respiration or heart rates by apnoea monitor, pulse oximetry Babies who are receiving additional oxygen

9. Babies who are receiving intravenous glucose, electrolyte solutions, antibiotics. Babies who are being tube feed Babies receiving phototherapy Babies with persistent hypothermia of 36c and below Babies with congenital malformations that require special care

10. 3. NEONATAL INTENSIVE CARE UNIT(LEVEL-3) Critically ill babies receiving assisted ventilation Recurrent apnea Who have had major surgeries like PDA Perinatal asphyxia( Apgar score of 3 or less at 5 minute) Severe meconium aspiration syndrome

11. Infant weighing less than 1250gms or preterm deliveries below 30wks Babies with convulsions Partial or total parenteral nutrition

12. EQUIPMENT RECOMMENDED FOR DIFFERENT LEVELS OF NEONATAL INTENSIVE CARE 1. Special care nursery level-2 Incubator or cot adequate for temperature control Oxygen analyzer Apnoea alarm Infusion pump Phototherapy unit Facilities for frequent ABG monitoring Access to equipment for radiological examination

13. NICU NICU stands for neonatal intensive care unit also called a special care nursery. These nurseries care for babies who born early, who have problems during delivery, or who develop problems while still in the hospital.

14. 1.PERSONNEL- Doctor incharge of NICU- The neonatal intensive care unit shall be under the charge of an accredited paediatrician who has the necessary training and experience in neonatal intensive care or its equivalent. Nurses in NICU-

15. At least 60% of the total nursing complement Level-3- the minimum ratio of nurse to baby shall be 1:1.at least 50% of registered nurses on duty each shift shall have the relevant training in neonatal care. Level-2- the minimum nurse to baby ration shall be 1:2. There shall be at least one registered nurse with the relevant training on duty.

16. Patients- an admitting paediatrician is designated to be responsible for each neonate admitted to the NICU Others- At least 1 sweeper and one helper should be available A medico-social worker who can talk parents, ensure bills are paid, fix appointment for varies check-up

17. A biomedical engineer should be available on call for uninterrupted functioning of all equipment A ward clerk will be helpful in maintaining store and patient records, corresponding with referring doctors and help in other administrative work.

18. 2. PHYSICAL FACILITY- Space- Each infant should be provided with a minimum area of 100sq ft or 10metersq. However additional space would be needed to provide for special facilities.

19. Location- The neonatal unit should be located as close as possible to the labour room and obstetric operation theatre, to facilitate prompt transfer of sick and high risk infants. The nursery should not be located on the top floor of the hospital, there should be adequate sunlight to enhance brightness and provide UV rays to augment asepsis.

20. Floor- The unit facility should preferably be in a square space so that abundant open berred space is available. The walls should be made of washable tiles and windows should have two layers of glass pares to ensure some measure of heat and sound insulation. Adequate wash basins having constant water supply should be provided.

21. Ventilation- Effective air ventilation is essential to reduce nosocomial infection. The most satisfactory ventilation is achieved with laminar air flow system Lighting- Nursery must be well-illuminated and painted white or off-white to permit prompt detection of jaundice or cyanosis. It can be best achieved by cool, fluorescent tubes. Spot lights should be present for performing various procedures.

22. Environmental temperature and humidity- The temperature in the nursery must be maintained around 26c in order to minimize the effects of thermal stress on the babies. The air movements should be so designed that drought is minimized.

23. Communication system- The nursery should be provided with an intercom system so that additional can be called for helping case of an emergency without leaving the sick infant. Electrical outlets- There should be adequate number of electrical sockets at a height of 4-5ft attached to a common ground. Each infant must be provided with at least 8 electrical outlets.

24. 3. GENERAL SUPPORT SPACE- Clean utility/ soiled utility area- It should be designed for storage of supplies frequently used in care of newborn such as diapers, linen, charts and gowns. Soiled utility space is essential for storing used and contaminated material before its removal from the care area.

25. Nursing station- Charting space at each bedside should be provided An additional separate area or desk for tasks. Such as compiling detailed records, completing requisitions and telephone communication should be provided.

26. EQUIPMENTS FOR NICU

27. NEONATAL TRANSFER SERVICES A transfer service is concerned with organizing and implementing the transfer of babies and or mothers from within a defined geographical area. TYPES OF TRANSFER SERVICES- Inutero transfer Exutero transfer

28. 1.INUTERO TRANSFER- (based on clinical and operational patient priority) Unplanned(time-critical) transfer- Transfer of babies from units in the network inorder to access intensive care or specialist services. Unplanned (emergency/urgent) transfer- Transfer of babies from units in the network in order to access intensive care or specialist services

29. Planned (next few days) transfer- Transfer of babies from units in the network for investigation and treatment or continuing intensive care, either to other units in the network or to units outside the network.

30. 2. EX UTERO TRANSFER(based on clinical priority)- Unplanned acute transfers of mothers for specialist maternal or anticipated neonatal care which cannot be provided locally, either to other units in the network or to units outside the network(e.g. other designated tertiary center)