ORGANIZATION OF

NEONATAL INTENSIVE CARE

UNIT
 INTRODUCTION

Newborn intensive care approach developed from the concept that a more intensive

approach to neonates who require special care would result in a significant decrease in

neonatal mortality and morbidity. A neonatal intensive care unit (NICU) is an intensive

care unit specializing in the care of ill or premature newborn infants. The first official ICU

for neonates was established in 1961 at Vanderbilt University Mildred Stahlman, officially

termed a NICU when Stahlman used a ventilator off-label for a baby with breathing

difficulties, for the first time ever in the world.

DEFINITION OF NICU

It is very specialized unit where critically ill neonates are cared to reduce the neonatal

morbidity and mortality.

INDICATIONS FOR ADMISSION IN NICU

 Low birth weight

 Large babies

 Birth asphyxia(APGAR score less than or equal to 6)

 Me conium aspiration syndrome

 Severe jaundice

 Infants of diabetic mother

 Neonatal sepsis/meningitis
  Neonatal convulsions

 Severe congenital malformation

 O2 therapy/parenteral nutrition

 Immediately after surgery

 Cardio respiratory monitoring

 Exchange blood transfusion

 PROM/foul smelling liquor

 Mother of Hepatitis B carrier

 Injured neonate.

AIMS /GOALS OF NICU

The goals of neonatal intensive care unit are

 To improve the condition of the critically ill neonates keeping in mind the survival of

neonate so as to reduce the neonatal mortality and morbidity

 To provide continuing in-service training to medicine and nursing personnel in the

care of newborn.

 To maintain the function of the pulmonary ,cardiovascular, renal and nervous system
 To monitor the heart rate, body temperature, blood pressure,central venous pressure

and blood by non invasive techniques.

 To measure the oxygen concentration of the blood by oxygen analysers

 To check/observe alarms systems signal ,to find out the changes beyond certain fixed

limits sets on the monitors.

 To administer precise amounts of fluids and minute quantities of drugs through I.V

infusion pumps.
CATAGORIES OF NICU:- LEVEL 1
  Evaluation and postnatal care of healthy newborn infants;

 Phototherapy

 Care for infants with corrected gestational age greater than 34 weeks or weight greater

than 1800 g who have mild illness expected to resolve quickly or who are

convalescing after intensive care

 Ability to initiate and maintain intravenous access and medications

 Nasal oxygen with oxygen saturation monitoring (e.g., for infants with chronic lung

disease needing long-term oxygen and monitoring

 Normal new born care

LEVEL 2
  Care of infants with a corrected gestational age of 32 weeks or greater or a weight of

1500 g or greater who are moderately ill with problems expected to resolve quickly or

who are convalescing after intensive care

 Peripheral intravenous infusions and possibly parenteral nutrition for a limited

duration

 Resuscitation and stabilization of ill infants before transfer to an appropriate care

facility

 Mechanical ventilation for brief durations (less than 24 h) or continuous positive

airway pressure. Intravenous infusion, total parenteral nutrition, and possibly the use

of umbilical central lines and percutaneous intravenous central lines

 Mild to moderate respiratory distress syndrome

 Suspected neonatal sepsis

 Hypoglycemia

 Infants of diabetic mother

LEVEL 3
  Care of infants of all gestational ages and weights; Mechanical ventilation support,

and possibly inhaled nitric oxide, for as long as required immediate access to the full

range of subspecialty consultation

 Comprehensive on-site access to subspecialty consultants; Performance and

interpretation of advanced imaging tests, including computed tomography, magnetic

resonance imaging and cardiac echocardiography on an urgent basis Performance of

major surgery on site but not extracorporeal membrane oxygenation, hemofiltration

and haemodialysis, or surgical repair of serious congenital cardiac malformations that

require cardiopulmonary bypass.

 Severe respiratory distress syndrome

 Persistent pulmonary HTN

 Sepsis

 Prematurity at<32 weeks

Major congenital malformations

ORGANISATION OF NICU

 Physical Organization

 Personal Organization

 Equipment Organization

PHYSICAL ORGANISATION

The neonatologist and nurse incharge must be involved while planning the unit. The intensive

area should be localised preferably next to labour ward and delivery rooms. For economising

costs it would be preferably to have combined with level 2 facilities, through both the areas
there must have separate and adequate staff and single administrative control. the neonatal

unit can be conceptualised in terms of four elements which exist in a concentric layering

inside outwards with designed work traffic flow pattern.

a) Clinical care areas

b) Clinical support areas

c) Administrative zones

d) Family support area

a) Clinical care areas

 Scrubbing areas

 Storage spaces

 Hand washing scrub zones

b)clinical support areas

 Laboratory

 X ray machine

 Formula preparation

 TPN preparation

 Breast milk expression

 Equipment storage

 Clean and dirty utility areas

c)Administrative and staff support areas

 Central reception area

 Separate unit office for ward master, resident doctor,and nursing staff

 Staff changing room

 On call duty doctor room

 Staff rest room

 Counselling room

 Seminar rooms

 Library

1. Family support area

  Children play area

 Nourishment area

 A lounge

 Lockable storage

 Education area

PHYSICAL ENVIRONMENT CHARACTERSTICS:

1. Bed strength

The NICU can be in a single area or it can be in multiple rooms with a capacity of 2-4

infants each..one intensive care bed is generally required for 100 deliveries provided the

prematurity ratio is around 8 percent and hence for a population of one million,30 intensive

care beds would be required for our country. It would be uneconomical to have a NICU of

less than 6-8bed.

2. Space between the patient

 For the patient care,100 square feet is required for each baby as it is true for any adult

bed

 There should be a gap of about 6 feet between two incubators for adequate circulation

and keep the essential life saving equipments,space needed about 120 square feet.

 Each patient station should have 12-16 central voltage stabilised electrical outlets

 2-3 oxygen out lets

 2 compressed air outlets

 2 compressed air outlets

 2-3 suction outlets

  Additional power plug point would be required for the portable x-ray machine close

to the patient care area

3. TEMPERATURE AND HUMIDITY CONTROL OF THE UNIT

 In case of controlling the environmental temperature, the NICU should not be

located on the top floor, but there must be adequate sunlight for illumination

 The unit must have a fair degree or ventilation of fresh air through central air

conditioning is must. The temperature inside the unit should be maintained at

28+_2deg c while the humidity must be above 50%.

4. WATER-HAND WASHING

 The unit must have an uninterrupted clean water supply and each patient care area

must also have a wash basin with foot or elbow operated tapes. Neat wash basin,

placing paper towel and receptical.

 The unit should be equipped with laminar air flow system, however alternatively air

conditioned with multipore filters and fresh air exchange of 12 per hours should be

provided.

5. COLOUR

The walls of the whole unit should be washable and have a white or slightly off white colour

for better colour appreciation of the neonates.

6. LIGHTING
The lighting arrangement should provide uniform, shadow free illumination. In addition spot

illumination should be available for each baby for any procedure. A generator back up is

mandatory where there is frequent power fluctuations or power failures.

7. SOUNDS

The acoustic characteristics should be such that the intensity of light kept below 75 decibels.

The unit should also have an intercom and a direct outside telephone so that the parent of the

patient can have an easy access to the medical personnels in case of an emergency

8. ROOMS

Apart from the patient care area including rooms for isolation and procedures, her e is need of

space for certain essential functions, like a room for scrubbing and gowning near the

entrance, a side laboratory mothers room, adequate stores for keeping consumable and non-

consumable articles

 A room for keeping x-ray and ultrasound machines

 One or two rooms each would be needed for doctors and nurses on day and night

duties

 There is space available for a biomedical engineer to provide essential periodic

preventive maintenance of costly equipments.

 Additional space will be required for educational activities and storing of data

9. VENTILATION
Minimum of six air changes,2 air changes should be outside for filtering the inner air.

 Effective air ventilation of nursery is essential to reduce nasocomial infections

 The air conditioning ducts must be provided with Millipore filters(0.5H) to restrict

passage of microbes

10. ENVIRONMENTAL DESIGN:

WALL SURFACES

 Easily cleaneable, protect at point with moveable equipment, made with sound

absorbable material

FLOORS

 Easily cleanable with out use of hazardous material, minimize microbial growth

CEILINGS ;

 Easily cleanable, noise reduction

11.COMMUNICATION:

 One emergency call bell in each room connected to doctors room

12.DATABASE AND RESEARCH ENVIRONMENT:

 Computer ports with internet access should be readily available to maintain database

and data analysis.

  Database of all NICU information, teaching aids like X rays, ECG, and ABG reports

must be maintained for future training and research.

13.SEPTIC NURSERY

14.SECURITY

15.HEAD WALL SYSTEM

Refers to the array of the medical gas outlet+electrical+data outlet at each patient care station

 Electric environment

 Medical gases

 Data outlets

16. Toilets

It is important to plan the number and position of water closets in the Neonatal Unit. Parents’

bedrooms, Transitional Care, medical on-call rooms, and the area dedicated to counselling

(Parents’ Quiet Rooms) should all have separate toilet facilities. In a large Neonatal Unit

there should be at least 3 further toilets for staff and the general public.

17. Transport incubator store

Transport incubators are bulky and should not be stored in public corridors. There should be a

designated area for storing them within the Equipment Store

18.Pneumatic tube system

Careful thought should be put into how specimens can be transferred urgently to central

laboratories in the Hospital. If a pneumatic tube system is chosen, it should be easily

accessible, robust and reliable. The outlet might be best positioned at the central station next

to the Unit Office. Readily available personnel can then identify problems if the system were

to fail to send an urgent specimen

19. Stationery
Although some NNUs are striving towards becoming paperless, most will not achieve this in

the next five years. There should therefore be a room of 12 sqm with extensive shelving for

storage of all the paper sheets and forms necessary for the efficient running of the NNU.

20. CLINICAL

Pendants, gantries, cabinetry or head-rails?

Choosing to equip the rooms with pendants, gantries or cabinetry is a crucial early decision.

Pendants descend from the ceiling and are single-armed or double-armed. The pendants

contain intensive care facilities including electrical outlets, oxygen and air pipes and a

vacuum facility for suction. The clinician has the opportunity of specifying the number of

electric sockets, and the number of shelves which are fixed to the pendant arms. These

shelves can hold ventilators, monitors, syringes drivers, and indeed any intensive care

equipment required to service the infants in the incubator.

Gantries

Gantries have many of the advantages of pendants containing internally all the pipin and

wiring required to provide the oxygen, air, vacuum and power points as well as the computer

networks. The clinicians again have the opportunity of specifying the number of sockets and

the number of shelves. Many of the gantries allow movement laterally of the hangars and

ventilators, monitors and syringe drivers can all be attached to the gantry.

Cabinetry

If designed carefully, cabinetry is fully consistent with the demands of intensive care. All

intensive care and high dependency cots can be contained in spacious bays. Electric sockets,

computer and piped gas outlets can all be positioned so that there is no interference with the
movement of staff caring for the infant. It is recommended that all such bays be identical in

the Unit, so that staff can be familiar with the work area no matter which room or cots have

been allocated to them. The size of the bays is critical. Each must accommodate an incubator,

a mother and father with comfortable seating, two members of nursing staff, and it should be

possible to manoeuvre all machinery (e.g. for taking X-rays) within the allocated space. Such

bays should be at least 3.2m wide and the bay walls may extend 2-3 cm in room

Head-rails

It is possible to combine cabinetry systems with horizontal rails at the head of the incubator.

These rails then carry most of the intensive care monitoring equipment

WORK FLOW PATTERN AND ATMOSPHERE

The NICU should be designed to allow efficient patient and staff movements within the unit.

The following should be included.

• Ready access of the NNU to Labour Suite including Operating Theatres

• All doors between Labour Suite and NNU, and also those within NNU, should be designed

to maximise safety and convenience. Automatic opening, push pad opening, swipe-card

access, punch-code access and manual opening may all be appropriate in individual

circumstances

• Positioning of Neonatal intensive care cots closest to the Labour Suite

• Access for mothers on trolleys or in wheelchairs. Widths of doors, corridors and corners

should be considered so that mothers have access to all clinical areas

• Access to all cots in all clinical areas for X-ray, ultrasound and other mobile equipment. An

MRI scanner ideally should be available nearby on the same floor

• Clinical support areas should be as close as possible to clinical care areas. Such supports

include near patient testing laboratory, pharmacy, equipment storage, milk storage, clean and

dirty linen store

• Family access to the waiting area, counselling rooms, support services (e.g. social work and

community neonatal nursing) and recreational facilities

• Positioning of the Clinical Manager’s office on the NNU floor, easily available to all staff

and, by arrangement, to families

• Attending consultant’s office should be in the NNU so that family interviews and staff

interviews can take place readily

• Doctors’ on call rooms should be in the NNU, sound-proofed, and sufficiently distanced

from busy corridors and extraneous noises to allow adequate rest opportunities

• Consultant and research offices can be positioned further away from the clinical care area

• Ideally there should be ready access to the mortuary, a viewing area for the bereaved, and

to the autopsy suite.

Atmosphere

The NNU should be thought of as “baby’s first home”. It must have a welcoming

atmosphere. This is achieved by thinking of the comforts of the infant and family. Natural

lighting and where possible views of the surroundings outside are beneficial. Internal
decoration can convert a clinical area into a room which is appealing to families, and

encourages all members of staff to treat the care area as the infant bed room

PERSONAL ORGANISATION

MEDICAL STAFF-The unit should be headed by a director who is full time neonatologist

with special qualification and training in neonatal medicine.

 He should be responsible for maintenance of standard of patient care

 Development of operating budget

 Equipment evaluation and purchase

 Planning and development of education programme

 Evaluation of effectiveness of perinatal care in the area

 He should devote time to patient care services,research and teaching as well as co-

ordinate with level 1 and level 2 hospital in the area .

STAFF REQUIREMENTS

 Neonatal physician 6-12 in the continuing care, intermediate care and intensive care

areas.

 He should be available for 24 hrs basis for consultation

  A ratio of one physician in training to every 4-5 patient who requires intensive care

ideal round the clock

 Services of other specialists like micro biologists, hemtologists, radiologists

cardiologists and should be available on call.

 An anaesthetist capable of administering anaesthesia to neonate

 Paediatric surgeon and paediatric pathologists should be available

NURSES RATIO

 Nurse patient ratio of 1:1 maintained throughout the day and night

 A ratio of one nurse for two sick babies not requiring ventilator support may be

adequate

 For an ideal nurse patient ratio, four trained nurses per intensive care bed are needed

 Additional head nurse who is the overall incharge

 In addition to basic nursing training for level 2 carer, tertiary care requires dedicated

committed and trained staff of the highest quality

 The training must include training in handling equipment, use of ventilators and the

use of mask resuscitations and even endotracheal intubation, arterial sampling and so

on

EXPERIENCE
The staff nurse must have a minimum of three 3yrs experience in special neonatal care unit in

addition to having three months training in a intensive care unit.

OTHER STAFF

 One sweeper should be available round the clock

 Laboratory technician

 Public health nurse/social workers

 Respiratory therapist

 Bio medical engineer

 Ward clerk can help in keeping track of the stores

EQUIPMENT ORGANISATION

 Equipment and supports should include all that is necessary to resuscitation and

intermediate areas

 Supply should be kept to the patient station so that nurse does not have to go away

from the neonate unnecessarily and nurses time and skills are used efficiently

 There should be controlled incubators and open air system for providing adequate

warmth

 Adequate number of infusion pumps for giving fluid and parenteral nutrition solutions

and drugs should be available

  Infant ventilators capable of giving pressure ventilation and various cardiopulmonary

monitor.

EQUIPMENT REQUIRED FOR ANY NEONATAL ICU

1. Radiant warmer

2. Incubator

3. Radiography

4. Oxygen catheter

5. Infusion pumps

6. Positive pressure ventilator

7. Oxygen analyser

8. Phototherapy

9. Electronic weighing machine

10. Transcutaneous PO2 and PCO2 monitor

11. Non invasive BP monitor

12. Invasive BP monitor

13. Intracranial pressure monitor.

 14. Microdrips

15. Suction apparatus

16. Open care system

17. ECG monitor

18. Pulse oxymeter

19. Resuscitation set

20. Oxyhood

Disposable articles

21. Nasogastric tubes

22. Feeding bottles and cups.

23. Diapers.

24. Specimen bottles

25. I.V catheter

26. IV set,

27. Bacterial filters.

28. Three way stop cocks,

29. umbilical arterial and venous catheter,

 30. syringes, needles,

31. ventilator tubes,

32. Canula,

33. Catheters suction, urinary ET tube, nasal catheters.

DOCUMENTATION IN NICU

The unit should have printed problem oriented stationary for maintaining records, admission

and discharge slips

Record of all admission should be maintained in a register or on a computer

The information should be analyzed and discussed at least once a month to improve the

effectiveness of the nicu in providing the services

EDUCATION PROGRAMME AT NICU

 There should be continuing medical education programmes for physicians and nurses

in the form of lectures, demonstrations and group discussions.

 This should cover important issues like resuscitation, steralisation to be maintained

for critically ill babies, putting in arterial catheters, conducting exchange transfusions,

maintenance of ventilators.

 Educational programmes covering the nurses and physicians in the community should

be developed.

 There should be regular discussion with the obstetrician to discuss the perinatal care

and condition Individual high risk cases

 Education and follow up is necessary

ROLE OF A NURSE IN NICU

A Neonatal nurse job role involves working in a specialist neonatal baby care unit (within

maternity or children’s hospitals) or in the local community.

Neonatal nurses care for new-born babies who are premature or are born sick. There are a

vast number of conditions that can affect a new-born baby and require treatment from

specialists within the healthcare team.

As a neonatal nurse its important to be sensitive to the needs of others, have a caring attitude.

As a neonatal nurse has an important role of supporting  parents of the sick baby at a time

when they themselves are frightened of losing their child, very anxious and stressed or upset

seeing baby coupled up to wires and monitors. As far as possible, the parents and

occasionally other family members are encouraged to take an active role in the care of the

baby.

ESSENTIAL DUTIES:

 Managing patient care of newborns and pediatrics, assisting with the admission assessment

discharge of these patients;

 Providing health education and counselling to patients;

 Maintaining medical records

 Participating in nursing and unit staff meetings and patient care conferences;

 Performing other related duties as assigned/required.

 Provides and/or manages the nursing plan of care for neonates with complex problems;

 Provides education, training, information, and consultation services to physicians,

registered nurses, and other members of the clinical team;

 Interprets, coordinates, and implements new and existing policies, methods and procedures

for neonatal nursing in the Perinatal areas;

 Keeps informed of current practices and trends and incorporates them into practice

 Works in cooperation with other members of the multidisciplinary health teams;

 Makes professional contacts with a variety of public, private and professional

institutions/organizations;

 Performs other related duties as assigned/required.

 The duties for a neonatal nurse may vary slightly at each hospital, but overall their care

tasks are the same. A neonatal nurse is one of the primary caregivers of a baby in the

intensive care unit, and often becomes the saving grace to worried parents who have plenty

of questions and few answers about their situation.

General Care

One of the main duties for a neonatal nurse is the general care of the infant. Babies, even tiny

ones or those with physical ailments, need regular changes, feedings and cuddles.

Customarily, the NICU will assign each baby "care times" throughout the day and night,

usually about 3 or 4 hours apart from each other. At each care time, the nurse will change the

baby's diaper, take his temperature, and feed him breast milk or formula. If a baby is

receiving any medications, these may also be administered during these times.

If the parents of an infant are able to visit regularly, a neonatal nurse will teach them how to

perform these basic cares. With time, nurses will help parents to feel equipped in all aspects

of meeting their little one's needs and will continue to serve as a basic support system during

the hospitalization.

Special Needs

Sometimes babies are too fragile or small to eat directly from breast or bottle. When this is

the case, they are fed either intravenously, or through a gavage tube, which is a small tube
that goes from the nose or mouth into the stomach. Nurses will carefully place the correct

amount of formula or dietary supplementation if a baby is not yet eating, into either of these

methods of nutrition, and monitors the baby for any positive or negative changes in the

infant.

The duties for a neonatal nurse also include inserting and changing IVs, administering blood

transfusions when necessary, and drawing blood for various testing. Nurses are able to

perform many other procedures as well, and it fully depends upon each hospital's individual

protocol, as well as the nurse's experience level and staff rating.

Technical Duties for a Neonatal Nurse

Regardless of their other responsibilities, all neonatal nurses do a fair bit of charting on each

of their patients. This may be on a paper sheet, or more commonly every year, completed

electronically via a special hospital computer system. The details logged into the online chart

allow doctors, other nurses, and anyone else within the baby's medical care team to view a

baby's updated health records.

A nurse may also be responsible for emailing the neonatologist (NICU doctor) or calling the

parents with specific requests or information. While a neonatal nurse's priorities are found in

caring for the child assigned to them, they often also spend a large portion of their shift

charting and getting messages out to those who need to receive them.

Emotional Support

A neonatal nurse often gets to know the families of infants very well, especially if they

happen to have a primary baby they take care of. A primary nurse will care for the same

infant for the duration of his hospital stay, whenever he/she is on shift. This works well, as
the nurses become very familiar with their babies and can in turn provide them with the best

care possible.

In building relationships with these families, they can often provide emotional support and

comfort during scary times. If a baby has to go through surgery or is exceptionally ill, nurses

are great for reassuring the parents and providing as concrete of answers as they are permitted

to.

Neonatal nurses are often the unsung heroes to families and able to give the earliest of lives a

fighting chance. Their daily duties add up to countless miracles and a rewarding career at the

same time.

CONCLUSION

A neonatal intensive-care unit (NICU), also known as an intensive care nursery

(ICN), is an intensive-care unit specializing in the care of ill or premature newborn infants. A

NICU is typically directed by one or more neonatologists and staffed by nurses, nurse

practitioners, pharmacists, physician assistants, resident physicians, and respiratory

therapists, dietitians. Many other ancillary disciplines and specialists are available at larger

units. Neonatal intensive care is costly not only to the individual but also to the family. These

cost increase with decreasing birth weight and gestational age. Therefore neonatologists must

include parents in any discussion about whether to continue the extreme measures being

provided to their extremely low birth weight preterm infants. Development of neonatal

intensive care unit requires careful planning with the joint efforts of physicians, nurses and
architects. The plan should be based on functional efficiency. Neonatal intensive care unit

ideally should be next to the obstetric suite.

RESEARCH PUBLICATIONS:

Journal of Health Population & Nutrition. 2011 Oct;29(5):500-509

(1) Assessment of special care newborn units in India.

The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units
(SCNUs) have been set up to provide quality level II newborn-care services in several district
hospitals to meet this challenge. The units are located in some remotest districts where the
burden of neonatal deaths is high, and access to special newborn care is poor. The study was
conducted to assess the functioning of SCNUs in eight rural districts of India. The evaluation
was based on an analysis of secondary data from the eight units that had been functioning for
at least one year. A cross-sectional survey was also conducted to assess the availability of
human resources, equipment, and quality care. Descriptive statistics were used for analyzing
the inputs (resources) and outcomes (morbidity and mortality). The rate of mortality among
admitted neonates was taken as the key outcome variable to assess the performance of the
units. Chi-square test was used for analyzing the trend of case-fatality rate over a period of 3-
5 years considering the first year of operationalization as the base. Correlation coefficients
were estimated to understand the possible association of case-fatality rate with factors, such
as bed:doctor ratio, bed:nurse ratio, average duration of stay, and bed occupancy rate, and the
asepsis score was determined. The rates of admission increased from a median of 16.7 per
100 deliveries in 2008 to 19.5 per 100 deliveries in 2009. The case-fatality rate reduced from
4% to 40% within one year of their functioning. Proportional mortality due to sepsis and low
birth weight (LBW) declined significantly over two years (LBW <2.5 kg). The major reasons
for admission and the major causes of deaths were birth asphyxia, sepsis, and
LBW/prematurity. The units had a varying nurse:bed ratio (1:0.5-1:1.3). The bed occupancy
rate ranged from 28% to 155% (median 103%), and the average duration of stay ranged from
two days to 15 days (median 4.75 days). Repair and maintenance of equipment were a major
concern. It is possible to set up and manage quality SCNUs and improve the survival of
newborns with LBW and sepsis in developing countries, although several challenges relating
to human resources, maintenance of equipment, and maintenance of asepsis remain.

- By Malhotra S & Mohan P.

(2) Challenges in scaling up of special care newborn units--lessons from

India.

Indian Journal of Pediatrics. 2011 Dec;48(12):931-935.

Neonatal mortality rate in India is high and stagnant. Special Care Newborn Units

(SCNUs) are being set up to provide quality level II newborn care services in district

hospitals of several districts to meet this challenge. The units are located in some of the

remotest districts where the burden of neonatal deaths and accessibility to special care is a

concern. A recently concluded evaluation of these units indicates that it is possible to provide

quality level II newborn care in district hospitals. However, there are critical constraints such

as availability and skills of human resources, maintenance of equipment and bed occupancy.

It is not the SCNU alone but an active network of SCNU (level II care), neonatal stabilization

units (level I care) and newborn care corners can impact neonatal mortality rate reduction
higher. Number of beds is also not sufficient to cater to the increasing demand of such

services. Available number of nurses is a problem in many such units. An effective and

sustainable system to maintain and repair the equipment is essential. Scaling up these units

would require squarely addressing these issues.

- By Neogi S & Zodpey S

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13.  http://daten.digitale-sammlungen.de/bsb00027988/image_1

14.  http://www.neonatology.org/classics/cadogan.html

15.  http://www.neonatology.org/pdf/arrault.pdf