RAJKUMARI AMRIT KAUR COLLEGE OF NURSING

LAJPAT NAGER NEW DELHI

ORGANIZATION OF NICU AND SERVICES

SUBMITTED TO :- SUBMITTED BY :-

Mrs. S. Geetha Rajkumar Ms. Shilpa Joshi

H.O.D. Child health nursing M. Sc. Nursing 1st year
R.A.K.C.O.N. R.A.K.C.O.N.
 Subject :- Child Health Nursing

Name of the Presenter :- Ms. Shilpa Joshi

Qualification :- M.Sc. Nursing 3rd semester

Topic :- Organization of NICU and services

Date & Time :-

Duration :-

Place :- Class Room, R.A.K. C.O.N.

Group of People :- Classmates

Moderator :- Mrs. S. Geetha Rajkumar

Method of Learning :- Lecture cum discussion

A.V. AID :- PPT

General Objective :- On the completion of the class classmates will be able to acquire knowledge about how to setup neonatal intensive care units and
services provided in NICUs.

Specific Objectives :- On the completion of the class classmates will be able :-

S.No. Time Specific Content Teaching Learning Activity A.V. Evaluation
Objective aid
INTRODUCTION
1.
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 . Dr. Stahlman, officially termed a
NICU when she used a ventilator off-label for a
2 To explain DEFINITION OF NICU baby with breathing difficulties, for the first PPT What are the
indications for It is very specialized unit where critically ill neonates are time ever in the world. indications
NICU cared to reduce the neonatal morbidity and mortality. for admission
admission. in NICU.
INDICATIONS FOR ADMISSION IN NICU
• Low birth weight
• Large babies
• Birth asphyxia(APGAR score less than or equal to 6)
• Meconium aspiration syndrome (MAS)
• 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
• Injured neonate.
3 To describe AIMS /GOALS OF NICU Lecture cum discussion
goals of NICU. The goals of neonatal intensive care unit are Describe
• To improve the condition of the critically ill neonates goals of
keeping in mind the survival of neonate so as to reduce the NICU.
neonatal mortality and morbidity
• To provide continuing in-service training to medicine
and nursing personnel in the care of newborn.
• To maintain the functions of the
pulmonary ,cardiovascular, renal and nervous system.
• To monitor the heart rate, body temperature, blood
pressure, central venous pressure 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.

4 To explain CATAGORIES OF NICU:-

about LEVEL 1 Lecture cum discussion PPT Explain about
categories of various
NICUs • Evaluation and postnatal care of healthy newborn categories of
infants. NICUs.
• 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
 Elaborate on
5 To elaborate ORGANIZATION OF NICU Lecture cum discussion PPT physical,
physical, • Physical Organization personal and
personal and • Personal Organization equipment
equipment • Equipment Organization organization
organization of of NICUs.
NICU. PHYSICAL ORGANIZATION
The neonatologist and nurse in charge must be involved
while planning the unit. The intensive area should be
localized preferably next to labor ward and delivery rooms.
For economizing 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
conceptualized 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
 Feed preparation room
 Clean and dirty utility areas
 c)Administrative and staff support areas
 Central reception area
 Separate unit office for ward in charge, resident
doctor, and nursing staff
 Staff changing room
 On call duty doctor room
 Staff rest room
 Counselling room
 Seminar rooms
 Library

D ) Family support area

 Children play area
 KMC area
 A lounge
 Lockable storage
 Counselling 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 receptacle.
• The unit should be equipped with laminar air flow
system, however alternatively air conditioned with multiple
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 color for better color 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, here is need of space for certain
essential functions, like a room for scrubbing and gowning
near the entrance, a side 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 should be 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 nosocomial infections.
• The air conditioning ducts must be provided with
Millipore filters(0.5H) to restrict passage of microbes.

10. ENVIRONMENTAL DESIGN:

WALL SURFACES
• Easily cleanable, protect at point with moveable
equipment, made with sound absorbable material.
FLOOR
• 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. Readily available personnel
can then identify problems if the system were to fail to send
an urgent specimen.

19. Stationery
Although some Nicus are striving towards becoming
paperless, most will not achieve this in the next five years. it
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 NICU.

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 piping 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 man oeuvre 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.

7 to describe WORK FLOW PATTERN AND ATMOSPHERE

workflow The NICU should be designed to allow efficient patient and Lecture cum discussion PPT Describe the
pattern of staff movements within the unit. The following should be workflow
NICU. included. pattern of
• Ready access of the NICU to Labor Suite including NICU.
Operation Theatres
• All doors between Labor Suite and NNU, and also those
within NNU, should be designed to maximize 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
Labor 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 .
• Attending consultant’s office should be in the NICU so that
family interviews and staff interviews can take place readily.
• Doctors’ on call rooms should be in the NICU, 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 NICU 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 ORGANIZATION
8
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,
hematologist, radiologists cardiologists 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.
• 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 3yrs
experience in special neonatal care unit in addition to having
three months training in a intensive care unit.
OTHER STAFF
• One sweeper and one nursing orderly 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.

9 To enlist EQUIPMENT REQUIRED FOR ANY NEONATAL ICU

equipment’s 1. Radiant warmer Lecture cum discussion
required for 2. Incubator
any NICU. 3. Radiography
4. Oxygen catheter
5. Infusion pumps
6. Positive pressure ventilator
7. Oxygen analyzer
8. Phototherapy device
9. Electronic weighing machine
10. Transcutaneous PO2 and PCO2 monitor
11. Non invasive BP monitor
12. Invasive BP monitor
13. Intracranial pressure monitor.
14. Microdrip sets
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 circuits,
32. Cannulas of different sizes,
33. Catheters suction, urinary ET tube, nasal catheters.

10 To explain DOCUMENTATION IN NICU

documentation The unit should have printed problem oriented stationary for
and maintaining records, admission and discharge slips. Lecture cum discussion
educational Record of all admissions, deaths, LAMA, discharges and refer
programme at should be maintained in a register or on a computer.
NICU. 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,
sterilization 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

11. To elaborate A Neonatal nurse’s job role involves working in a specialist Lecture cum discussion PPT What are the
role of nurse in neonatal baby care unit (within maternity or children’s roles of nurse
NICU. hospitals) or in the local community. in NICU.
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 feed directly
from breast or palada. 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
feeding, into either of these methods of nutrition, and
monitors the baby for any positive or negative changes in
the neonate.
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 information 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.

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. SUMMARY AND CONCLUSION :-
Number of beds is also not sufficient to cater to the NICUs provide around the clock care to sick or
increasing demand of such services. Available number of premature babies . it has health care providers
nurses is a problem in many such units. An effective and who are specially trained to give the neonates
sustainable system to maintain and repair the equipment is best possible care needed .NICUs have greately
essential. Scaling up these units would require squarely increased the survival of very low birth weight
addressing these issues. and extremely premature infants. In the era
- By Neogi S & Zodpey S before NICUs , neonates birth weight less than
1400 gm rarely survived. Today , neonates of
500 gms at 26 weeks have a fair chance of
survival.

REFERENCES:

1. Gupte Suraj “the short textbook of pediatrics’ twelfth edition,2016, Jaypee publishers, page no. 271-291.

2. Achar’s “Text Book Of Pediatrics” ,Fourth Edition,2002 ,University Press Publication, Page No.13-15.

3. Wong’s “Nursing Care Of Infants And Children”,7th Edition, Mosby Publication,2002 Edition, Page No.20-22.

4. Beevi Assuma,” Text Book Of Pediatric Nursing”,1st Edition, Elsevier Publication, Page No.12-18.

5. "Neonatal Nurse". Nurses For A Healthier Tomorrow. Nurses For A Healthier Tomorrow. Retrieved may 6 2022..

6. "Neonatal Nurse". Nurses for a Healthier Tomorrow. Nurses for a Healthier Tomorrow. Retrieved May 5 2022.

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