Introduction
Neonatal intensive care is also considered synonymous with providing advanced life support (ALS) to critically sick babies with multisystem organ dysfunction.1
Those who weigh < 1500 gms or <32 wks of gestation
3 – 5 % of newborns would need these services depending upon conditions.
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 separate pediatric intensive care unit.
Baby care area
Areas and rooms for inborn or intramural babies,
Examination area
Mother’s area for breast feeding and expression of breast milk2
Nurses station and charting area
Personnel
Availability of sufficient number of adequately trained personnel
Nurse patient ratio in special care and NICU3
Nursing staff
The nurse to patients ratio should be 1:4 -5 per shift in SICU. While in more intensive care area providing mechanical ventilation support, nurse: baby ratio should be 1:1-2 per shift.4
Para medical personnel
1 Respiratory therapist
Nurse: patient ratio: 1:1 in special care units and in PICU, the ratio is 1:3 and Nurse should have specialized degree in neonatal care.5
Other Staff
Maintenance staff: 1 sweeper should be there for 24 hrs and 1 laundry boy
1 Lab technician
1 Social worker attached to NICU care6
Equipment’s
Thermometer
Stethoscope
Electronic Baby weighing scale
Incubator
Over head radiant warmers
Resuscitation equipment
Heart rate monitor
Respiratory support equipment
Suction facilities
Suction facilities and needles7
Management of nursing care
Assessment
Monitoring physiological data
Safety measures
Respiratory support
Thermoregulation
Protection from infection
Hydration
Nutrition
Feeding resistance
Skin care
Administration of medication
Developmental outcome
Facilitating parent-infant relationship
Discharge planning and home care8
Neonatal loss
Transport of sick neonates
The goal of every transport is to bring a sick neonate to specialized neonatal center in a stable condition.
To avoid complications during transport, the infant should be as stable as possible before leaving the referring hospital and warm chain should be maintained. 9
The transport service gives high — risk patients timely access to the appropriate services without interrupting their care.10
Transfer patterns in regional system
Level I [Basic Care] — Relatively minor problems
Level II [Speciality Care] — Low birth weight babies (1500 to 2500 gm, 32 to 36 weeks of gestation)
Level III [Subspeciality Care] — Maternal and Neonatal those at high risk (less than 1500 gm birth weight or less than 32 weeks gestation)
Level I to Level II: Complicated cases not requiring intensive care.
Level II to Level III: Complicated cases requiring intensive care. Labor less than 34 weeks gestation.11
Reasons for transport
Commonest reason is transport for advanced level of care such a situation may arise due to non availability of:
Pediatric subspecialty (Neurology, nephrology
Specific investigation (MRI, 24 hours EEG etc), specific facility (Advanced ventilation, plasmapheresis or it may be due to non availability of continuous monitoring in the referring hospital).12
Preparation for transport
1. Each hospital should be ready with plan for transport of critical child long before such need arises.
2. Each institute should have list of hospitals in the surrounding area which offer specialized facility.13
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