Class Notes: NICU (Neonatal Intensive Care Unit)
1. Introduction to NICU
• Definition: A specialized unit that provides intensive medical care to newborns who are
premature, ill, or have congenital disorders.
• Levels of Care:
o Level I: Basic newborn care
o Level II: Special care nursery (moderate preterm or sick newborns)
o Level III: NICU with advanced respiratory and life support
o Level IV: Regional NICU with the highest level of surgical and critical care
2. Common Reasons for NICU Admission
• Prematurity (born before 37 weeks)
• Low birth weight (< 2500g)
• Respiratory distress
• Birth asphyxia
• Sepsis or infections
• Jaundice requiring phototherapy
• Congenital anomalies (e.g., cardiac defects, neural tube defects)
• Hypoglycemia
• Neonatal abstinence syndrome (drug withdrawal)
3. NICU Environment
• Controlled Conditions:
o Temperature (incubators, radiant warmers)
o Humidity
o Noise and light reduction for neuroprotection
• Monitoring Devices:
o Cardiac monitor
o Pulse oximeter
o Blood pressure monitor
o Apnea monitors
4. Roles of the NICU Nurse
• Monitor vital signs and development
• Administer medications and fluids
• Support respiratory needs (oxygen, ventilation)
• Educate and support parents
• Coordinate multidisciplinary care (neonatologists, lactation consultants, physical
therapists)
5. Essential Equipment in NICU
• Incubators and radiant warmers
• Ventilators and CPAP machines
• IV pumps and syringe drivers
• Phototherapy units
• Blood gas analyzers
6. Key Neonatal Conditions and Nursing Care
A. Respiratory Distress Syndrome (RDS)
• Common in preterm infants due to surfactant deficiency
• Treatment: Surfactant therapy, oxygen, mechanical ventilation
B. Neonatal Jaundice
• Caused by high bilirubin
• Management: Phototherapy, exchange transfusion (in severe cases)
C. Neonatal Sepsis
• Signs: Temperature instability, lethargy, apnea, feeding issues
• Treatment: Antibiotics, supportive care
D. Hypoglycemia
• <40 mg/dL in term infants
• Care: Dextrose administration, frequent feeding
E. Intraventricular Hemorrhage (IVH)
• Common in very low birth weight infants
• Prevention: Gentle handling, head positioning
7. Feeding in NICU
• Types:
o Gavage (tube feeding)
o Parenteral nutrition (IV)
o Breastfeeding (when stable)
• Support:
o Lactation consultation
o Use of breast pumps
o Fortification of breast milk
8. Infection Control
• Hand hygiene
• Sterile procedures
• Limiting visitors
• Equipment sterilization
• Antibiotic stewardship
9. Family-Centered Care
• Parental Involvement: Kangaroo care, feeding support
• Psychological Support: NICU stay is stressful; nurses play a key role in emotional support
• Discharge Planning: Teaching parents about feeding, medications, follow-up care
10. Developmental Care in NICU
• Minimizing stress (noise/light)
• Positioning (nesting)
• Skin-to-skin contact
• Gentle handling and clustering care activities
11. Common Medications in NICU
• Surfactant (for RDS)
• Antibiotics (ampicillin, gentamicin)
• Caffeine (for apnea of prematurity)
• Vitamin K (bleeding prevention)
• Anticonvulsants (e.g., phenobarbital)
12. Ethical and Legal Considerations
• Informed consent for procedures
• End-of-life care and palliative support
• Parental rights and decision-making
• Privacy and confidentiality
13. Recent Advances in NICU Care
• Use of NIRS (near-infrared spectroscopy) for brain oxygen monitoring
• Family-integrated care models
• Artificial womb research (EXTRA-uterine support)
• Non-invasive respiratory support (e.g., high-flow nasal cannula)
14. Documentation and Charting
• Accurate recording of vital signs, feeding, weight, and outputs
• Incident reporting
• Growth monitoring charts
• Medication administration logs
