ORGANIZATION AND

MANAGEMENT OF SERVICES
IN NICU

Presented by:
Lamnunnem Haokip
Msc (N) 2nd Year
Under the supervision of
Ms. Aastha Singh
Asst. Prof (OBG)
 INTRODCUTION

New-born babies who need intensive medical

care are often put in a special area of the hospital
called Neonatal Intensive Care Unit (NICU). The
NICU has advanced technology and trained
health care professionals to give special care to
the tiniest patients.
 DEFINITION
• Neonatal Intensive Care Unit (NICU) is an intensive
care unit designed for premature and ill new-born
babies.
-Andria Santiago
• A neonatal intensive care unit is an area of care
unit specializing in the care of ill and premature
babies or new-born infant.
• Neonatal care

The management of complex life threatening

diseases, provision of intensive monitoring and
institution of life sustaining therapies in an
organized manner to critically ill children in a
Neonatal Intensive Care Unit in the particular
Hospital.
 GOALS OF NICU
The goals of a 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

morbidity and mortality.

• To provide continuing in-service training to medicine and nursing

personnel in the care of the new born.

• To maintain the function of the pulmonary, cardio-vascular,

renal and nervous system.

• 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 set on the
monitors.
• To administer precise amounts of fluids and minute
quantities of drugs through I.V. infusion pumps
LIFE THREATENING CONDITION WHICH REQUIRE NICU

CHART
LEVELS OF SERVICES IN NICU

Level Level Level

I II III
 Level – I Neonatal Care (Basic)
This is a well new-born nursery and it has the capability to:
• Provide neonatal resuscitation

• Postnatal care to healthy new-born infants.

• Apgar score < 6

• Stabilize and provide care for infants born > 34 weeks'

gestation who remain physiologically stable.
• Stabilize and provide care for infants born > 34 weeks'
gestation <   2   k g 
• Birth weight <   2   k g
 LEVEL II NEONATAL CARE
(SPECIALITY)

Special care nursery

• The level II units are subdivided into 2
categories based on their ability to provide
assisted ventilation including continuous
positive airway-pressure.
 Level II (A)

• Resuscitate and stabilize preterm and/or ill infants.

• Provide care for infants born at >30 weeks' gestation and

weighing </= 1500 g.
• Apgar score 4 to 6

• Who have physiologic immaturity.

• Provide care for infants who are convalescing after intensive
care
 Level II (B)

• Has the capabilities of a level IIA nursery and

the additional capability to provide mechanical
ventilation for brief durations (<24 hours) or

continuous positive airway pressure.

 LEVEL III (SUBSPECIALITY)
3 sub categories
Level III A: It has the capabilities to
• Infants born at >28 weeks' gestation and weighing >1000 g

• Apgar Scores 3 and below.

• Provide sustained life support limited to conventional

mechanical ventilation
• Perform minor surgical procedures such as placement of
central venous catheter or inguinal hernia repair.
Level III B NICU: It has the capabilities to provide

• Comprehensive care or extremely low birth weight infants.

• Advanced respiratory support.

• Prompt and on-site access to a full range of paediatric medical

subspecialists.

• Advanced imaging.

• Perform major surgery such as ligation of patent ductus arteriosus and

repair of abdominal wall defects, necrotizing enterocolitis with bowel

perforation, tracheoesophageal fistula and/or oesophageal atresia, and

myelomeningocele.
• Level III C NICU: It has the capabilities of a level IIIB
NICU and is located within an institution that has the
capability to provide Extracorporeal membrane
oxygenation and surgical repair of complex congenital
cardiac malformations that require cardiopulmonary
bypass surgery.
 TRANSPORT SYSTEM

• The Transport Team functions as a complete

mobile ICU, utilizing a specialized portable
incubator with integrated ventilator and monitor,
so that the patient remains fully supported
throughout the transport process.
• A transport team comprised of a neonatologist, a NICU
transport nurse and a NICU respiratory therapist who
accompany the new-born on critical transports.
• Ambulance or helicopter transportation, based on the
patient's need, distance and the referring facility's ability
to manage the new-born until the transport team arrives.
• A medical director and a transport coordinator who
ensure clinical practice compliance and oversee the daily
operations of the program.
• Transport incubators with self-contained power supplies
to maintain neutral thermal environment, continuous
cardiopulmonary monitoring, mechanical ventilation,
blended oxygen, suction devices, and infusion pumps
PHYSICAL LAYOUT OF
NICU
 LOCATION

 It should be as close as to
the labour room and
obstetric care unit.
 There should be adequate
sunlight for illumination.
 The ventilation should be
properly placed in order to
get fresh air.
 SPACE
 It serves as a referral unit for the infants born
outside the hospital.
 Each infant should be provided with a
minimum area of 100 sq. Ft. Or 10sq.metre.
 There should be a breast feeding room.
 500 – 600 Gross sq.ft. per bed.
 FLOOR PLAN
 It should be open encumbered space.
 The walls should be made of washable glass
tiles and window should have two layers glass
panes.
 Water supply should be adequate and accessible.
 There should be isolation room.
 The door should be automatic.
 LIGHTING

 The whole unit should be

fresh and the wall of the room
should be painted white.
 It should provide uniform
shadow free, illumination of
100 foot candles at the baby’s
level.
 TEMPERATURE AND HUMIDITY

 The temperature inside the room

should be maintained at 28 degree
Celsius, while the humidity must be
above 50 %.
 There should be portable radiant
warmer; intra red lamp can also be
used.
 ELECTRICAL OUTLET

 Each patient should have 12 to 16 central voltage-

stabilized electrical outlets sufficient to handle all those
pieces of equipment’s.
 An additional power point should be there.
 There should be around the clock power back up including
provision of UPS(Uninterruptible Power Supply)
system.
 COMMUNICATION SYSTEM

• The unit also should have an

intercom and a direct outside
telephone line to connect
with the other health teams
as in emergency cases.
 VENTILATION

• There should be effective ventilation in the unit and

Central Air conditioning should be placed in the unit for
further purposes.
PERSONNEL’S
IN NICU
Neonatologist Neonatal Nurse

Respiratory
Therapist

Paediatrician
Physical, occupational, and Dietician
speech therapists

Pharmacist

Lactation Consultant
 SOCIAL
WORKERS
EQUIPMENTS
IN
NICU
 Laminar Flow System

Oxygen Hood

Phototherapy machine

Radiant Warmer
 Pulse rate monitor

Infusion Pump

Feeding Set

Incubator
 Bilimeter

Neonatal ventilator

Mucus Extractor
 ARTERIAL LINE

CPAP
ECMO

PERIPHERALLY INSERTED
CENTRAL
CATHETERIZATION
 NURSES
RESPONSIBILITIES

PAMPHLETS
 SUMMARY
&
CONCLUSION
 BIBLIOGRAPHY / REFERENCE
• Vinod K Paul, Arvind bagga. Ghai Essential Pediatrics,
Ninth Edition, page no 223 – 227.
• Nursing, Manoj Yadav, A textbook of Child Health, Pee
Vee 3rd edition.page no. 312 – 319.
• Internet sources :
• Youtube : https://youtu.be/-f4s3XoQQms &
https://youtu.be/6kNfB3VQ2CA
• Browser :
https://www.stanfordchildrens.org/en/topic/default?id=th
e-neonatal-intensive-care-unit-nicu-90-p02389
• http://www.slideshare.net/mannparashar/organization-of-
nicu-91955908?from
• https://www.cedars-sinai.org/programs/neonatal-intensiv