NEONATAL

INTENSIVE CARE
UNIT (NICU)

By:- firoz qureshi

Dept. psychiatric
nursing
 I C U
N
Steps organization of
Neonatal Intensive Care

Reorganization of existing neonatal

care facilities
Developing the units should be
Basic level I
High level II
Level III
PHYSICAL FACILITIES

The neonatologist and the

nurse in charge must be
involved while planning the
unit.
LOCATION

Neonatal unit should be located as close as

possible to the labour rooms and obsteric
operation theatre
Adequate sunlight for illumination

Fair degree of ventilation of fresh air

 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
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
VENTILATION

Effective air ventilation

Central air conditioning

LIGHTING

The whole unit must be well

illuminated and painted white
The lighting arrangement should
provided uniform shadow-free,
illumination of 100 foot candles
at the babys level
ENVIRONMANTAL TEMPERATURE
AND HUMIDITY

The temperature inside the unit should be

maintained at 28 +_2C, while the humidity
must be above 50%.

Portable radiant heater, infra red lamp can

be used
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 be
exceed 75 decibels.
Telephone rings and equipment alarms
should be replaced by blinking lights.
COMMUNICATION SYSTEM

The unit should also have an

intercom & a direct outside
telephone line
ELECTRICAL OUTLETS

Each patient station should have 12 to 16

central voltage stabilized electrical outlets
sufficient to handle all pieces of equipment
An additional power plug point
There should be round-the-clock power
back up including provision of UPS system .
STAFF

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
 NURSES
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.
OTHER STAFF

Respiratory therapist
Laboratory technician
Public health nurse or social worker
Biomedical engineer
Clark
EQUIPMENT
Equipment and supplies should including all
that is necessary for resuscitation and
intermediate care areas.
Supplies should be kept close to the patient
station so that nurses do not have to go
away from the neonate unnecessarily and
nurses time & skills are used efficiently.
There should be servo-controlled
incubators and open care systems for
providing adequate warmth
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 6
scope
8 Phototherapy unit 6
EQUIPMENT FOR LEVEL III NURSING 6 BED
9 Electronic weighting scale 1
10 Pulse oxymeters 6
11 End tidal CO2 monitor 6
12 Transcutaneous PO2 & PCO2 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
 DISPOSABLE ARTICLES REQUIRED FOR THE
NICU
IV Catheters
IV sets
Micro burette sets
Bacterial filters
Feeding tubes
Endotracheal tubes
Suction catheters
Three-way stopcocks
Extension tubing
Umbilical arterial and venous catheters
Syringes, needles
Trocar and cannula
LABORATORY FACILITIES

Microchemistry laboratory
Well equipped to provide
quick and reliable
Facilities for creative
protein, total leukocyte
counts and microscopic
examination of peripheral
blood
TOWARDS A GENTLE AND FRIENDLY NICU ENVIRONMENT

It has been realized that physical and social

environment of nursery affect the recovery and
long term morbidity of the neonate.
Attempts should be made to reduce unnecessary
noise and light.
Avoid excess of light
Handling should be gentle
Neonates including pre terms feel pain and painful
stimuli can cause deleterious physiological
responses. Analgesia should be provided during
all procedure including ventilation.
Parent should be allowed unrestricted entry to the
nursery,
They should be explained about various tubing
and attachments to the baby and should be
involved in care of their baby.
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
 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,
 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.
 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.
 OUTLINE OF MCH SERVICES
LEVEL FOR WHERE BY WHOM COMPONENTS
I 75% Home Basis care
(at village) Sub-centre Mother
for low PHC Trained birth attendant
risk Multipurpose worker
mother or ANM
and Doctors
neonate. Anganwadi workers.
II (at sub- 20% Upgraded First referral
district) PHC, Trained nurses units
for Sub-district Resident doctors Special
higher District Trained in obstetrics neonatal
risk hospital Neonatology and care
mothers s, anesthesia
and nursing
neonates homes,
. medical
college
hospital
s
 OUTLINE OF MCH SERVICES

III (in 5% Large Sophisticated care

metropolit hospitals Specialists given by trained
an centers Medical nurses, resident
for still college doctors,
higher risk hospitals obstetrician
mothers & and neonatologist,
infants) institutes. pediatric surgeon,
haematologist,
radiologist,
ultrasonologist &
well equipped
laboratories.
 THE MCH SERVICES
DIFFERENT LEVELS

Level I Care:
Prenatal care:

Early detection of pregnancy.

Identification of high risk pregnancy.
Immunization against tetanus.
Nutrition supplements with iron & folic
acid.
Antenatal assessments at 20,30,34 & 38
weeks of pregnancy.
Assessment of pelosis.
Early detection of fortal growth failure.
 THE MCH SERVICES
DIFFERENT LEVELS

INTERNAL CARE :

Proper management of labour and delivery.

Adequate support of establishment of
respiration oropharyngeal suction and
warmth.
Identification of low birth weight, preterm
birth & malformations requiring immediate
correction and their referral.
 THE MCH SERVICES
DIFFERENT LEVELS
LEVEL II CARE:

Prenatal care:

This must be offered to mothers at risk identified

through the high risk approach or mothers developing
complications during pregnancy and / or labour.

Intranatal and neonatal care:

Deliveries of all at risk mothers must be attended

by a trained obstetrician and neonatologist at first
referral units. The new-born are expected to get
special care for anoxia hyperbilirubinaemia, respiratory
distress syndrome and septicaemia.
 THE MCH SERVICES
DIFFERENT LEVELS
LEVEL III CARE:

This level of care is meant for high risk pregnant

women & neonates.
Low birth weight babies
Severe respiratory distress
Serve anoxia at birth
Shock & metabolic problems

Intensive neonatal care unit having a full time

neonatologist, trained nursing staff and resident
doctors, equipped with biochemical laboratory support,
ultra sound, electronic monitory of foetal condition,
ventilation and respiratory support, blood transfusion
arrangement & monitoring.
 SUMMARY

So far we have seen about neonatal

intensive care unit, its organization, physical
facilities, personnel, equipment necessary,
laboratory facilities and level of neonatal are
and MCH services available at different level.
 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.
THANK YOU