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
