1. 1.

Neonatal transport
2. 2. Definition • Newborn transport is used to move premature and other sick infants
from hospitals without specialist, intensive care facilities require for optimal care of the
baby to hospitals with neonatal intensive care and other specialist services.
3. 3. Out born newborns • A significant number of neonates require emergent transfer to
a tertiary care center, often because of medical, surgical, or rapidly emerging postpartum
problems. These are termed “outborn” neonates, because they have been born somewhere
besides the facility to which they’ve been transferred.
4. 4. TRANSFER • Transfer can be within the hospital; to ICU • Transfer can be to other
hospital
5. 5. Neonatal transfer types • Emergency: unplanned • Elective : planned and informed
6. 6. How can we transfer? • The short distance transport within the hospital can be
accomplished in a transport incubator. • The use of plastic basket with perforated sides
coupled with careful placing of hot water bottles is recommended for use in the rural
setting.
7. 7. • The baby can be wrapped in tin foil or covered with several layers of cotton. •
Themocele (polystyrene) box is an effective insulator and can be used in community. •
Skin to skin contact with mother or a care taker is a useful modality of transport in rural
areas or resource poor settings.
8. 8. Indications of neonatal transport • Preterm infant with a birth weight <1500g or
gestation <32 weeks • Respiratory distress requiring CPAP or assisted ventilation • Severe
hypoxic-ischemic encephalopathy • Life threatening sepsis • Intractable seizures •
Bleeding neonate
9. 9. • Congenital anomalies or surgical neonate • Inborn errors of metabolism • Severe
jaundice • Procedures or diagnostic facilities unavailable at parent hospital.
10. 10. Transport equipments 1. Transport incubator with multi channel vital signs
monitor for recording temperature, heart rate, NIBP, oxygen saturation 2. CPAP facility
with nasal prongs and portable ventilator 3. Airway equipment: suction devices, oral
airways, bag and mask, laryngoscopes (size 00,0 and 1 blades)
11. 11. 4. Infusion facilities: infusates, infusion pumps, glucometer 5. oxygen,
compressed air cylinder, oxygen mask, hood, heat and light, sources of electric powers
and adapters. 6. disposables: catheters (5,6,7,8,10,12Fr), syringes, needles, feeding tubes
(8 & 10Fr), alcohol, betadine swabs, micropore tape, gloves etc.
12. 12. 7. Instrument tray for ET intubation, vascular access, insertion of chest tubes, NG
tube etc 8. Life saving drugs
13. 13. Note • All the equipment should have a battery back up and should be kept fully
charged all the time. • Enough O2 supply should be carried which should last during the
period of journey.
14. 14. Transport team • The neonate needing special or intensive care should be
transported by a skilled transport team. • Teams include at least, a) One senior resident b)
One specially trained neonatal nurse
15. 15. Principles of safe transport • Sugar • Temperature • Airway • Blood pressure • Lab
work • Emotional support
16. 16. • Sugar • Arterial circulatory support • Family support • Environment •
Respiratory support
17. 17. • Temperature • Oxygenation (airway and breathing) • Perfusion • Sugar
18. 18. Protocols i. Maintain airway, oxygenation, thermal stability and tissue perfusion
ii. Stop oral feeding and start parenteral feeding with 10% of dextrose. iii. Ensure
umbilical or peripheral venous access iv. Insert an NG tube and decompress the stomach
v. Maintain adequate blood glucose level
19. 19. vi. Obtain culture samples and administer first dose of antibiotics. vii. Obtain a
recent chest skiagram as a base line and to check the position of catheters and tubes. viii.
Take the family member or parents along with the baby whenever feasible. ix. When
required transport team should undertake life saving procedures (like ET tube insertion,
chest tube insertion etc)
20. 20. x. administer life saving drugs like surfactant and prostaglandins xi. The referring
hospital should prepare a detailed transport note including copies of obstetric and neonatal
charts for the transport team. xii. Monitor the baby’s color and temperature.
21. 21. Arrival at the receiving NICU • The transport team should remain in constant
touch with the referral NICU during the course of journey. • The team should brief the
NICU care givers regarding the status of the baby and immediate clinical concerns. • Hand
over all the documents.
22. 22. • The referring hospital and parents should be informed about the safe arrival and
latest condition of the baby. • The inventory of transport equipment should be checked,
medications and essential supplies should be restocked for the next transport service.

Neonatal intensive care unit (nicu)

1. 1. NEONATAL INTENSIVE CARE UNIT (NICU) By:- firoz qureshi Dept.
psychiatric nursing
2. 2. 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
3. 3. PHYSICAL FACILITIES The neonatologist and the nurse in charge must be
involved while planning the unit.
4. 4. 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
5. 5. 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
6. 6. 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
7. 7. VENTILATION Effective air ventilation Central air conditioning
8. 8. 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 baby’s level
9. 9. ENVIRONMANTAL TEMPERATURE AND HUMIDITY • The temperature
inside the unit should be maintained at 28’ +_2’C, while the humidity must be above 50%.
• Portable radiant heater, infra red lamp can be used
10. 10. 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.
11. 11. COMMUNICATION SYSTEM • The unit should also have an intercom & a
direct outside telephone line
12. 12. 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.
13. 13. 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
14. 14. 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.
15. 15. OTHER STAFF • Respiratory therapist • Laboratory technician • Public health
nurse or social worker • Biomedical engineer • Clark
16. 16. 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
17. 17. 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 scope 6 8 Phototherapy unit 6
18. 18. 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
19. 19. 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
20. 20. LABORATORY FACILITIES •Microchemistry laboratory •Well equipped to
provide quick and reliable •Facilities for creative protein, total leukocyte counts and
microscopic examination of peripheral blood
21. 21. 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.
22. 22. 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
23. 23. 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, maintenance of
asepsis, and promotion of breast feeding.
24. 24. 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.
25. 25. 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.
26. 26. OUTLINE OF MCH SERVICES LEVEL FOR WHERE BY WHOM
COMPONENTS I (at village) for low risk mother and neonate. 75% Home Sub-centre
PHC  Mother  Trained birth attendant  Multipurpose worker or ANM  Doctors 
Anganwadi workers. Basis care II (at sub- district) for higher risk mothers and neonates.
20% Upgraded PHC, Sub-district District hospitals, nursing homes, medical college
hospitals  Trained nurses  Resident doctors  Trained in obstetrics  Neonatology and
anesthesia First referral units Special neonatal care
27. 27. OUTLINE OF MCH SERVICES III (in metropolitan centers for still higher risk
mothers & infants) 5% Large hospitals Medical college hospitals and institutes.
Specialists Sophisticated care given by trained nurses, resident doctors, obstetrician
neonatologist, pediatric surgeon, haematologist, radiologist, ultrasonologist & well
equipped laboratories.
28. 28. 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.
29. 29. 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.
30. 30. 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.
31. 31. 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.
32. 32. 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.
33. 33. 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.

Nicu management
1. 1. INFECTION & ANTIBIOTIC
What is NICU?  Neonatal intensive care unit, (NICU) and also called a Special Care
Nursery, newborn intensive care unit, intensive care nursery (ICN), and special care baby
unit (SCBU) is a unit of a hospital specializing in the care of ill or premature newborn
infants
2. 3. History of modern NICU  Mid 1800, Dr. Stephane Tarnier invented the incubator
 Dr.Pierre Budin is known as the father of modern perinatology, and his seminal work
The Nursling (Le Nourisson in French) became the first major publication to deal with the
care of the neonate  Dr. Martin Couney and his permanent installment of premature
babies in incubators at Coney Island
3. 4. Cont….  1970s NICUs were an established part of hospitals in the developed
world.  1980s, over 90% of births took place in hospital . The emergency dash from
home to the NICU with baby in a transport incubator had become a thing of the past, 
1979 study showed that 20% of babies in NICUs for up to a week were never visited by
either parent. Centralized or not,  1980s few questioned the role of NICUs in saving
babies. Around 80% of babies born weighing under 1.5 kg now survived, compared to
around 40% in the 1960s.  1982 in Britain pediatricians could train and qualify in the
sub-specialty of neonatal medicine.
4. 5. Common diseases in a NICU  prematurity and extreme low birth weight, 
Perinatal asphyxia,  Major birth defects,  Sepsis,  Neonatal Jaundice,  Respiratory
 distress Syndrome  The leading cause of death in NICUs is generally Necrotizing
Enterocolitis.  Intracranial Hemorrhage  chronic bronchopulmonary dysplasia
5. 6. Major challenges in NICU  Nosocomial infection in the neonatal intensive care
unit  Risk factors for nosocomial infection (Host, Nursury environment, invasive
procedures  Indiscriminate uses of Antibiotic at NICU leads to resistance of Antobiotic 
Prevention & Control  Policies & procedures
6. 7. Nosocomial infections  Nosocomial infections are infections that are a result of
treatment in a hospital or a healthcare service unit. Infections are considered nosocomial if
they first appear 48 hours or more after hospital admission or within 30 days after
discharge.  Nosocomial comes from the Greek word nosokomeio (νοσοκομείον)
meaning hospital (nosos = disease, komeo = to take care of).  This type of infection is
also known as a hospital- acquired infection
7. 8. Epidemiology of N.I. in the New Born  Not well understood  Definitions are not
standardized  Intrapartum vs PeriPartum vs. Postpartum acquisition of Pathogen 
Maternal vs. Hospital acquired infections  Short Hospital Stay of the normal New born 
Early Onset vs. Late Onset vs. very Late Onset of Infections
8. 9. Present of scenario NI  In the US, the CDC & P estimate that roughly 1.7 million
hospital-associated infections, from all types of microorganisms, including bacteria,
combined, cause or contribute to 99,000 deaths each year.  In Europe, the category of
Gm -ve infections are estimated to account for two-thirds of the 25,000 deaths each year.
 Nosocomial infections can cause severe pneumonia and infections of the UTI,
bloodstream and other parts of the body. Many types are difficult to attack with
antibiotics, and anti biotic resistance is spreading to Gm -ve bacteria that can infect people
outside the hospital
9. 10. Etiology of NICU Acquired Infection Changing Etiology over the time  1950’s
S.aureus  1960’s Gram negative bacteria  1970’s Group B Streptococci  1980’s
MRSA & CONS  1990’s Enterococci, Resistant gm –ves , MRSA, CONS
10. 11. Risk Factors for N.I. in NICU  Birth weight  Length of stay to NICU 
Duration of exposure of devices 1. Central venous catheters 2. Mechanical Ventilations 
Over crowding & Understaffing  Lipid therapy (risk of CONS)  Prolonged therapy with
antibiotics & steroids
11. 12. Clinical characteristics of nosocomial infections A retrospective cohort study on
nosocomial infections (NI) in the NICU was performed in the Children's Hospital of
Zhejiang University,  The most common infection site was pneumonia and bloodstream
infection. Low admission age, long NICU stay, and mechanical ventilation were risk
factors for NI.  Klebsiella pneumonia was the most common pathogen, followed by
Acinetobacter baumannii,  Staphylococcus epidermidi,  Pseudomonas aeruginosa, 
Enterobacter cloacae,  Stenotrophomonas maltophilia.
12. 13. Gm+ve Infection in NICU Prevention  Coagulase –ve Staphylococci 1. Aseptic
technique for insertion and handling of devices 2. Prevention of contamination during
surgery  MRSA outbreak (include infections in NICU patients with CA--MRSA strains)
 1. Cultures of nacres & skin lesions of infants - HCW 2. Improve under staff & over
crowding 3. Contact precautions for known or suspected infected infants 4. Cohorting 5.
Attempt to eliminate neonatal colonization
13. 14. Gm+ve Infection in NICU Prevention…..  Vancomycin resistant enterococci 1.
Contact precautions for colonized or infected infants 2. Judicious use of antibiotics
14. 15. Gm-ve bacteria in NICU Prevention  E.coli , Klebsiella sp, Enterobactor sp.  18
– 19% of BSI  30% Nosocomial Pneumonia Prevention:  Elimination of standing water
 Disinfection of shared equipments  Appropriate handling of devices  Sterile water in
nebulizer & humidifiers  Contact precautions for colonized or infected infants
15. 16. Causative pathogens of bacterial infections : NICU  Common organisms
Klebsiella, Escherichia coli (E. coli), Pseudomonas and Staphylococcus aureus (S.aureus).
 Less common organisms Enterobacter, Citrobacter, Salmonella and Streptococcus
groups B and D  Uncommon organisms Group B streptococcus (common cause of
neonatal sepsis in the West, but infrequent in India)  Organisms in EOS Streptococcus
agalactiae, E. coli, Haemophilus influenza and Listeria monocytogenes.  Organisms in
LOS Coagulase-negative Staphylococcus (CoNS), S. aureus, E. coli, Klebsiella species,
Pseudomonas aeruginosa, Enterobacter species, Candida species, Streptococcus
agalactiae, Serratia species, Acinetobacter species and anaerobes.  Organisms in LBW
neonates with sepsis : Coagulase- negative Staphylococcus (CoNS) and Acinetobacter
16. 17. Fungi in NICU  Very Important cause of Infection  7 – 13% of BSI in NICU 
3rd Most common cause of late onset of sepsis in VLBW infants  Candida spp most
common & C.albicans & C. tropicalis also common  Other yeasts : Malassezia furfur ,
aspergillis
17. 18. Fungi Prevention in NICU  Prevention is a challenge  Fluconazole prophylaxis
 Removal of intra vascular infected catheters  NICU air & equipments should be free
from dust
18. 19. Nosocomial infection in a NICU – A Study  Among 528 infants enrolled, 60
(11.4%) had 97 nosocomial infections.  The survival rate was 92%.  The prevalence of
nosocomial infections was 17.5%:  bloodstream infection, 4.7%,  clinical sepsis, 6.3%,
 pneumonia, 5.1%,  urinary tract infections (UTIs), 0.7%,  surgical site infection,
0.7%.  Intervention-associated infection rate: central intravascular catheter– associated
bloodstream infection, 13.7%,  TPN-associated bloodstream infection,  15.8%,
ventilator-associated pneumonia,  18.6%, surgical site infection 13.7%,  urinary
catheter–associated UTI 17.3%.  Patients with a birth weight <1000 g (relative risk, 11.8,
95% confidence interval, 7.66-18.18; P < .001) were at the greatest risk for nosocomial
infection. AJIC, APRIL2007 PAGE 190-195 - TAIWAN
19. 20. Antibiotic usage in neonates  Antibiotics are one of the most abused drugs in the
neonatal unit.  While appropriate usage is definitely helpful, indiscriminate use of
antibiotics could lead to emergence of multidrug resistance in previously susceptible
isolates.  Adopting and implementing a rational antibiotic policy would help alleviate
this problem to a significant extent.
20. 21. Antibiotic Usage in the NICU  Antibiotic Use in Neonatal Intensive Care Units
and Adherence with Centers for Disease Control and Prevention 12 Step Campaign to
Prevent Antimicrobial Resistance  The CDC 12-Step Campaign can be modified for
neonatal populations. Inappropriate antibiotic prescribing was common in the study
NICUs. Improvement efforts should target antibiotic use 72 hours after initiation,
particularly focusing on narrowing therapy and instituting protocols to limit prophylaxis.
21. 22. Rational antibiotic usage in neonates The various issues related to the use of
antibiotics In NICU can be discussed under the following headings:  A. When to start? 
B. What to start?  C. When to stop?  D. What’s the optimum route and dose?  E.
Special situations
22. 23. When to start antibiotics? The decision to start antibiotics is usually dependent
upon two factors: 1. The infant is symptomatic 2. At-risk for sepsis and if the diagnostic
tests suggest an infectious etiology
23. 24. Existing practice in major neonatal units 3RD GEN CEPH+AMINO Piperacillin
tzobactam+ amino Fluoroquin ol.+amino OTHERS First line (n=16)* 5 (31.2%) 1 (6.2%)
1 (6.2%) Ampicillin+ Aminogly.:3 (18.8%); Co-amoxiclav+ Aminogly.:3 (18.8%) Second
line (n=16)* Third line (n=16)* 1 (6.2%) 0 7 (43.8%) 3 (18.8%) 3 (18.8%) 1 (6.2%)
Cefoperazone- sulbactum: 1 (6.2%); Netilmycin*: 2 (12.5%) Meropenem: 6
(37.5%);Vancomyci n: 8 (50.0%); Fluconazole: 1 (6.2%) Reserve (n=16) * 1 (6.2%) 1 (6.
2%) Meropenem: 8 (50.0%); Cefoperazone- sulbactum: 2 (12.5%)
24. 25. Antibiotic policy in neonatal units - NICU of India:  A combination of third
generation cephalosporin with an aminoglycoside (mostly amikacin) is used as the first
line of antibiotic therapy in about one third of the units surveyed (6/17; 35..3%).  About
half of the units use piperacillin-tazobactam as the second line agent (8/17; 47.0%), 
vancomycin as third line, and meropenem as the reserve drug (8/17 each; 47%)
JOURNAL OF NEONATOLOGY VOL-23 JAN - MARCH 2009
25. 26. Choice of antibiotics  Early and late onset sepsis: ampicillin plus gentamicin 
Early onset meningitis: ampicillin plus gentamicin  Late onset meningitis: ampicillin,
gentamicin (or amikacin), and/or cefotaxime  Suspected staphylococcal sepsis, focal
skin, bone, joint infections, omphalitis: methicillin/nafcillin plus gentamicin  For sepsis
of suspected GI origin: ampicillin, gentamicin/amikacin, plus clindamycin (or piperacillin)
 Nosocomial infection in setting with MRSA: vancomycin plus gentamicin (and/or
ceftazidime, if high prevalence of  pseudomonas)
26. 27. How to restrict antibiotic usage in NICU  Don’t use prophylactic antibiotics 
Consider carefully whether antibiotics are needed  Avoid broad spectrum antibiotics 
Avoid cefotaxime and other beta-lactam drugs  Always do a blood culture  Obtain
blood culture report at 36-48 hours  Shorten duration of treatment  Stop antibiotics
when no infection evident at 36-48 hours  Treat LOS for gram negative infections and
wherever possible wait for culture before treating gram positive infection
27. 28. NICU Infection Control Polocies  Isolation Precautions : single use items , 
skin & cord care : Topical ointment Therapy  Insertion & Maintenance of Devices :
 PICC, CVC, Ventilator  Hand Hygiene : Waterless hand rub, Artificial nails  Special
Attire  Visitor control  Co bedding  Ventilator tube change
28. 29. Reference Page  N. B. Mathur, ECAB Clinical Update: Pediatrics; Neonatal
Sepsis, Elsevier, 2009  Indian J Pediatr 2008; 75 (3):261–266  Journal of Neonatology
Vol. 23, No. 1, January–March 2009  Eastern Journal of Medicine 15 (2010) 133-138 
Clark R, Powers R, White R, et al. Prevention and treatment of nosocomial sepsis in the
NICU. J Perinatol 2004; 24: 446-453  Unique aspects of Infection control in NICU –
Dr.Jo Ann Harris : sep 2007