NEONATAL INTENSIVE CARE UNIT (NICU)

Introduction:
NICU is a very specialized unit where critically ill neonatal cared to
reduce the neonatal morbidity and mortality.
The admission to neonatal special care unit or intensive care unit has
some can. If the child is neonatal in the critical condition, the neonate needs
the care of interer unit. Mostly from the labour wards, operation theatre and
hospital or any other referred they will be send to intensive care unit (ICU)

CRITIRIA FOR ADMISSION IN NICU:

Indications for admission to the neonatal intensive care unit are as follow.
 Low birth weight(2000gm)
 Large babies(more than or equal to 4kg)
 Birth asphyxia(apgar score less than or equal to 6)
 Meconium aspiration syndrome. If symptomatic/ thick meconium seen in
lab
 Sever jaundice
 Infants of diabetic mother
 Neonatal sepsis/meningitis
 Neonatal convulsions
 Severe congenital malformation/cyanotic congenital heart disease
 O2 therapy/parentral nutrition
 Immediate after surgery/cardiological investigayion
 Cardio respiratory monitoring, if heart Rate and respiratory rate are
unstable
 Exchange blood transfusion
 PROM/foul smelling liquor
  Mother of hepatitis ‘B’ carrier
 Injured neonate
 Intensive care needs highly trained personnel including the intensive care
specialist,and nurses and techniques. Sophisticated equipment for the
monitoring and if vital functions and the availability for continuous
laboratory support are in the intensive care.

AIMS/GOALS OF NEONATAL INTENSIVE CARE UNIT

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 inservice 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 monitor the heart rate, body temperature, blood pressure, central venous
pressure and blood by non-invasive techniques.
 To measure the oxygen concentration of the blood is by oxygen analyzers.
 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.

PREPARATION OF NICU

 Warm (33-36°C) incubator

 Adequate light source
 Resuscitation and treatment trolly stocked.
 History, continuation sheet treatment and diet sheet, problem list
 and flow charts.
 Oxygen air and suction apparatus (as available in the unit).
 Oxygen line connected to oxygen and air flow meter.
 Suction - complete suction unit tubing and various sizes of suction
catheters. Ventilation bag and mask of appropriate sizes,
 Vital signs monitors.
 Specific equipment as indicated by diagnosis.

ADMISSION PROCEDURE IN NICU

All babies admitted to the neonatal unit. Should have the following data
recue carefully within 24 hours of admission (if possible much sooner).

History and examination

 Maternal history
 Paternal history
 Previous obstetric history
 Details of present pregnancy
 Labour.
 Delivery
 Apgar score

On admission
 Notify the doctor and the nurse in charge.
 Resuscitate infant as necessary and maintain warmth.
 Check infant identification label.
 Quickly examine the infant from head to toe for obvious abnormalities
condition permits.
 Record Weight, length and head circumference as soon as possible.
 Transfer to warm environment as soon as. Possible.
  Cornrnonest observations are :-
(a) Temperature - Infant normal temperature range 36°C to 37°C
- Environment - See natural thermal environment charts.
(b) Heart rate.
(c) Respiration
(d) Colour,
(e) Activity.
- Explain to parents
- Hand over from transferring unit staff

Record keeping:
- Birth history : Done in labour ward.
History
A. Ward history contains
- Apgar score and examination of new born infant, sheet.
- Neonatal weight and feed sheet, progress chart.
B. Compiled history contains
- Patient registration form.
- Progress 'sheet.
- intra uterine growth chart.
- 02 flow sheets, fluid balance sheet etc.

LIFETHREATENING CONDITIONS WHICH REQUIRE NICU

The following are the life threatening conditions in neonates :
- Apnea
- Baby with respiratory distress
- Birth asphyxia.
- Convulsions.
- Low birth weight babies (less than 1500 gm requiring intensive care.)
 - Neonatal jaundice requiring exchange blood transfusion.
- Sepsis and meningitis.

HOW TO MAKE ROUND WITH THE CONSULTANT IN NICU

The nurse should have the following recording and reporting while round with
cons ultant.
A. Examine and evaluate assigned patients (neonate)
each day.
B. Record keeping.
1) Progress notes - it should reflect present status of infants and new or
ongoing problems
2) Problem list - a coniplete problem list is kept at the front of the progress
notes.
- This must be kept current, new problems listed and resolved problem also
noted.
- The number of the problems in the progress chart should be consistent
with the problem list.
- Only active problem needs to be discussed. The problems should be
collected from folowing areas :-
a. general status :-
- Better ? Worse ? No change ?
- Pertinent physical findings.
b. nutrition ;-
- Weight, change appropriate ?, inappropriate
- Caloric status, source.
- Plan of nutrition (feeding)
c. Respiratory problems :-
- Present status, pertinent physical findings, laboratory findings.
d. infection :-
 - If suspected or present, pertinent findings.
- cultural• results.
- Plan of therapy e.g., how long antibiotic treatment is planned ?
e. Apnea :-
- Number and severity of apneas/bradycardia.
- Treatment (ventilation),
- Caffeine or theophyline levels.
f. Cardiovascular
- Physical findings
- Blood pressure
- Results of test such as echo,
- Treatment plans
g. Fluids and electrolytes :-
- Intake and output, electrolytes
- Problems and plan,
h. Metabolic :-
- Glucose, calcium, phosphorusim balance or any problems
- Assessment and plan.
i. Neurological :-
- Problems, changes, meditation, plans.
- Seizures, medications, blood levels, ECG results.
j. Hematological :-
- Anemia/coagulopathy, neutropenia etc.
- Transfusions and plans.
k. Hepatic
l. Renal problems
m. Eyes when examined and results
(3) Discharge - Summaries/transfer summaries must be done prior to discharge
patient.