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Organization of NICU Notes
Organization of NICU Notes
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
DEFINITION OF NICU
It is very specialized unit where critically ill neonates are cared to reduce the neonatal
Large babies
Severe jaundice
Neonatal sepsis/meningitis
Neonatal convulsions
O2 therapy/parenteral nutrition
Injured neonate.
To improve the condition of the critically ill neonates keeping in mind the survival of
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
To check/observe alarms systems signal ,to find out the changes beyond certain fixed
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
Nasal oxygen with oxygen saturation monitoring (e.g., for infants with chronic lung
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
duration
facility
airway pressure. Intravenous infusion, total parenteral nutrition, and possibly the use
Hypoglycemia
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
Sepsis
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
c) Administrative zones
Storage spaces
X ray machine
Formula preparation
TPN preparation
Equipment storage
Separate unit office for ward master, resident doctor,and nursing staff
Counselling room
Seminar rooms
Library
Nourishment area
A lounge
Lockable storage
Education area
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
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
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
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,
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
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
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
One or two rooms each would be needed for doctors and nurses on day and night
duties
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.
The air conditioning ducts must be provided with Millipore filters(0.5H) to restrict
passage of microbes
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 ;
11.COMMUNICATION:
Computer ports with internet access should be readily available to maintain database
13.SEPTIC NURSERY
14.SECURITY
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.
Careful thought should be put into how specimens can be transferred urgently to central
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
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
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
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
The NICU should be designed to allow efficient patient and staff movements within the unit.
• 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
• Access for mothers on trolleys or in wheelchairs. Widths of doors, corridors and corners
• 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
• Family access to the waiting area, counselling rooms, support services (e.g. social work and
• Positioning of the Clinical Manager’s office on the NNU floor, easily available to all staff
• Attending consultant’s office should be in the NNU so that family interviews and staff
• 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
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
He should devote time to patient care services,research and teaching as well as co-
STAFF REQUIREMENTS
Neonatal physician 6-12 in the continuing care, intermediate care and intensive care
areas.
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
In addition to basic nursing training for level 2 carer, tertiary care requires dedicated
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
OTHER STAFF
Laboratory technician
Respiratory therapist
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
monitor.
1. Radiant warmer
2. Incubator
3. Radiography
4. Oxygen catheter
5. Infusion pumps
7. Oxygen analyser
8. Phototherapy
20. Oxyhood
Disposable articles
23. Diapers.
26. IV set,
32. Canula,
DOCUMENTATION IN NICU
The unit should have printed problem oriented stationary for maintaining records, admission
The information should be analyzed and discussed at least once a month to improve the
There should be continuing medical education programmes for physicians and nurses
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
A Neonatal nurse job role involves working in a specialist neonatal baby care unit (within
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
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
Participating in nursing and unit staff meetings and patient care conferences;
Provides and/or manages the nursing plan of care for neonates with complex problems;
Interprets, coordinates, and implements new and existing policies, methods and procedures
institutions/organizations;
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
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
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
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
(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
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
RESEARCH PUBLICATIONS:
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.
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
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