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ORGANIZATION OF A NEONATAL INTENSIVE

CARE UNIT

INTRODUCTION

Neonatal considered

intensive synonymous

care with

is

also

providing

advanced life support (ALS) to critically sick babies with multisystem organ dysfunction.

Those who weigh < 1500gms or <32 wks


of gestation.

3 5 % of newborns would need these


services depending upon conditions .

GOALS

To improve the clinical care of the critically ill neonate.

To reduce the neonatal morbidity & mortality.

To provide continuing in- service training of medical & nursing personnel in the care of newborn.

LEVELS 0F NEONATAL CARE

Level I neonatal care (Basic)


Well newborn nursery LEVEL II neonatal care( speciality) special care nursery LEVEL II A LEVEL IIB LEVEL III NICU(SUB SPECIALITY) LEVEL III A NICU LEVEL III B NICU LEVEL III C NICU

TYPES OF ENVIRONMENT

Physical : Design

Social : Staff & Parents

PHYSICAL FACILITIES

PHYSICAL FACIITIES LOCATION

Should be located as close as possible to the labor room & obstetrics OT.

Elevator should be available in close proximity Transport of sick out born babies.

SPACE
NICU design should allow 500 600
gross sq.ft per bed.

For patient care, 100 sq.ft is required for each baby.

SETTING
Unit facility preferably in square space. Adequate taps Elbow & foot operated. Built-in purpose. wooden cabinets for stocking

Isolation room for infected babies.

VENTILATION
ventilation To reduce

Effective

nosocomial infections. When centralized air conditioning is

used minimum of 12 changes of air


room per hour.

Provision of exhaust fan in reverse


direction.

LIGHTING
Well shadow-free illuminated(100 foot candles) at babys level.

Painted white or slightly off white- early


detection of jaundice & cyanosis.

ENVIRONMENTAL HUMIDITY

TEMPERATURE

&

Temperature must be maintained around 28 +/- 2 degree C To minimize thermal stress. Humidity must be above 50%

WATER
o

Uninterrupted clean water supply ,& each patient care area must have a washbasin with foot, elbow, or sensor operated water taps.

ACOUSTIC

CHARECTERISTICS

In critical care area 64-66 db. IN growing nursery 50-60 db.

ELECTRICAL OUTLETS

Each patient station should 12-16 have central voltage-stabilized electrical outlets sufficient to

handle all equipments.

2 oxygen outlets, 1 compressed air outlet & 2

suction outlets.

Voltage supply Stabilized with Voltage ServoStabilizer.

COMMUNICATING SYSTEM

Nursery complex should be provided

with an intercom system &

Direct

line

external

telephone

is

mandatory Parents have an easy


access.

PERSONNEL

According to bed occupancy


Medical

Nursing
Paramedical staff are allotted in

neonatal unit.

Medical

A Director Full time neonatologist with special qualification & training in neonatal medicine should head the unit.

One Neonatal Physician - for every 6 to 10 patients in the continuing care, intermediate care and intensive care areas.

One Resident Doctor should be present in


the unit round the clock.

For special care and intermediate care neonatal units will be same. number of senior doctor

One Resident Doctor in each shift for 8 to


10 beds with one reliever.

Nurses

A nurse : patient ratio of 1:1 in all shifts

for

babies

on

multisystem

support

including ventilatory therapy.

A ratio of 1 : 2 for sick babies not


requiring ventilatory support.

For special care neonatal unit (SCNU) and intermediate care, 1:3 is ideal but 1:5 per shift is manageable.

In addition, 30 % provision should be made


for day off, leaves and other emergencies.

Desirable to have atleast 2/3 rd of the staff


nurses fully trained and permanent in the unit at any given time.

EQUIPMENTS

NEEDED EQUIPMENTS
o o o o o o o

Resuscitation Equipment Oxygen & Suction Facilities Catheters, Syringes & Needles Drugs Needed Feeding Equipments Weighing Machines Bassinets

o o o o o

Incubators Thermometers Oxygen Hood Radiant Heat Warmer Phototherapy Unit

o
o

Oxygen Analyzer
Heat Rate Monitor

o
o

Respiratory Rate & Apnea Monitor


Blood Pressure Monitor

o o o o o

Infusion Pump Transcutaneous Bilirubin Meter Transcutaneous Blood Gas Monitor Vein Viewer Pulse Oximetry

o
o

Ventilators
Intracranial Pressure Monitor

Extracorporeal Membrane Oxygenator


(ECMO)

documentation

INFECTION CONTROL & SURVEILLANCE

Follow up program