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1. Struktur Fisik
1.1 Spesifikasi area
" Lokasi strategis dekat di sekitar pintu masuk ruang rawat atau tindakan neonatus,
mudah dijangkau tetapi tidak mengganggu lalu lintas baik pasien, petugas dan
pengunjung.
" Ruang rawat atau tindakan neonatus di rumah sakit: IGD, kamar bersalin, kamar
operasi, ruang transisi, ruang rawat gabung.
1.2 Kebersihan harus terjaga dengan struktur yang mudah dibersihkan.
1.3 Pencahayaan terang dan nyaman
1.4 Ventilasi optimal dengan aliran udara bebas yang maksimal
1.5 Wastafel
Ukuran besar untuk menampung cipratan air saat melakukan cuci tangan, dengan
aliran air limbah yang lancer, memiliki kran yang dioperasikan dengan siku atau
lengan.
2. Mebel
2.1 Rak sepatu
2.2 Wadah sampah tertutup dengan kantung plastik, terpisah antara limbah organik, non-
organik, infeksius.
3. Bahan-bahan
3.1 Sabun
Tersedia sabun dalam jumlah cukup, dianjurkan sabun cair antibakteri dalam
dispenser dengan pompa.
3.2 Pengering
Harus tersedia pengering minimal kertas tisu habis pakai
Tidak dianjurkan pengering handuk
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1. Struktur Fisik
1.1 Spesifikasi area
- Harus tersedia di IGD, ruang bersalin, ruang kamar operasi.
- Di ruang rawat neonatus, menyatu dalam unit layanan neonatus baik di tingkat II
maupun tingkat III.
- Lokasi di area yang tidak mengganggu lalu lintas baik pasien, petugas dan
pengunjung. Di kamar bersalin dan kamar operasi harus terletak dekat dengan
tempat menolong ibu.
" Ukuran luas minimal 4 m2 untuk posisi meja resusitasi, di luar kebutuhan untuk meja
alat, sumber oksigen dan sumber udara serta peralatan lainnya.
1.2 Kebersihan terjaga setiap waktu dan siap pakai

1.3 Pencahayaan optimal menerangi area resusitasi
1.4 Ventilasi baik, dihindari adanya aliran udara.
1.5 Suhu ruangan dapat diatur sekitar 24-28ºC dengan kelembaban udara optimal
1.6 Steker listrik
Ruang harus dilengkapi paling sedikit enam steker yang dipasang de ngan tepat untuk
peralatan listrik. Steker harus mampu memasok beban listrik yang diperlukan, aman
dan berfungsi baik.
2. Mebel
2.1 Meja resusitasi dengan penghangat (radiant warmer ) lengkap, minimal memiliki:
" Lampu atau alat penghangat area resusitasi yang dapat diatur suhunya.
" Matras yang cukup keras, bersih, kering dan mudah menyerap panas.
" Selimut alas yang bersih kering dan hangat
" Mudah dibersihkan dan dikeringkan, dengan bagian logam bebas berkarat.
2.2 Jam dengan fasilitas stop watch sebagai penunjuk waktu yang tepat dan berfungsi baik.
2.3 Selimut penghangat bayi atau plastik pembungkus bayi prematur lengkap dengan
topinya, kering, bersih dan hangat.
3. Fasilitas, alat dan obat-obatan
3.1 Meja untuk meletakan alat resusitasi dan obat-obatan
3.2 Perlengkapan jalan napas (air way ):
" Alat penghisap lendir harus ada minimal alat hisap lendir dinidng atau portable
dengan segala kelengkapannya
3.3 Pasokan oksigen dan udara
" Sumber oksigen dapat berasal dari dinding atau tabung portable, dilengkapi selang
atau pipa aliran menuju blender pencampur dengan udara agar didapat persentase
kadar oksigen yang optimal diinginkan.
" Persediaan oksigen tidak dapat terputus, harus tersedia terus menerus.
" Sumber udara juga dapat berasal dari dinding atau tabung portable yang tersambung
langsung ke blender.
" Persediaan udara juga tidak dapat terputus, harus tersedia terus menerus.
" Blender lengkap dengan regulator persentase oksigen dan selang menuju bayi.
Sumber oksigen dan udara yang tercampur dengan konsentrasi optimal dialirkan dan
diberikan ke neonatus melalui:
" Alat ventilasi non-invasif
" Kanul nasal dengan regulator oksigen aliran rendah dan tinggi
Sumber oksigen dan udara yang tercampur dengan konsentrasi optimal dialirkan dan
diberikan ke neonatus melalui:
" Alat ventilasi invasif
" Alat ventilasi non-invasif
" Kanul nasal dengan regulator oksigen aliran rendah dan tinggi
3.4 Alat bantu ventilasi:
Ventilasi non-invasif dengan segala kelengkapannya:

" t-piece resuscitator
" CPAP
Ventilasi invasif dengan segala kelengkapannya:

" Ventilator konvensional (tingkat IIIA)
" High frequency ventilator (HFV)(tingkat IIIB, IIIC, IIID)
" High frequency oscillator (HFO)(IIIB, IIIC, IIID)
3.5 Troley emergency atau kotak resusitasi harus berisi perlengkapan berikut:
3.5.1 Alat pembebas jalan napas:
" Harus ada kateter penghisap lendir no 6FR, 8FR
" Harus ada balon penghisap lendir atau mucous ectractor untuk penghisapan lendir
sederhana dan reservoir cairan lambung apabila diperlukan
" Harus ada kateter oro-gastrik untuk mengurangi tekanan dalam lambung ukuran 5FR
dan 8FR.
" Alat laringoskop neonatus yang berfungsi baik dengan baterei AA siap pasang dan
digunakan.
" Bola lampu laringoskop cadangan
" Bilah laringoskop (Miller, lurus panjang) ukuran 00, 0 dan 1
3.5.2 Alat pemberi oksigenisasi:
" Balon mengembang sendiri dengan perlengkapannya yang berfungsi baik
" Sungkup oksigen berbagai ukuran untuk bayi prematur dan cukup bulan
" Nasal kanul oksigen untuk pemberian ventilasi non-invasif.
" Pipa endotrakeal ukuran 2,5; 3,0; 3,5; 4,0. Dengan perlengkapan plester dan
guntingnya untuk melakukan fiksasi untuk pemberian ventilasi invasif.
3.5.3 Alat monitor
" Alat pengukur saturasi oksigen (pulse oximeter ) dan frekuensi jantung portable.
" Stetoskop bayi
3.5.4 Obat-obatan:
" Alat suntik /spuit 1cc; 2,5 cc; 3 cc; 5 cc; 10 cc; 20 cc; 50cc
" Obat Epinefrin dalam ampul (1:1000)
" Nalokson HCL (1mg/ mL atau 0,4mg/ mL)
3.5.5 Alat penunjang sirkulasi dan cairan:
" Set alat insersi kateter vena umbilikalis steril lengkap
" Kateter vena umbilikalis ukuran 3,5FR; 5FR atau pipa orogastrik ukuran 5FR
" Three-way stopcock
" Cairan NaCl 0,9% atau Ringer Lactate
3.6 Alat pelindung diri:
" Topi
" Masker
" Kaca mata google
" Sarung tangan steril lengan pendek dan lengan panjang
" Gaun plastik
" Sepatu pelindung
3.7 Pengatur suhu ruangan dan penghangat meja resusitasi:
" AC yang siap pakai suhu diatur antara 24-28ºC
" Termometer ruangan
" Penghangat (Radiant warmer ) yang berfungsi dengan baik
" Topi bayi, selimut untuk pembungkus bayi, selimut untuk pembersih dan selimut
untuk alat, serta plastik untuk penghangat b ayi prematur
3.8 Inkubator transport atau kain/ gaun metode kanguru
3.9 Laboratorium penunjang:
" Pemeriksaan laboratorium darah lengkap sederhana
" Pemeriksaan laboratorium gula darah
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1. Struktur Fisik
1.1 Spesifikasi ruang
" Lokasi ruang harus berdekatan dengan kamar operasi, dan merupakan bagian atau
bersebelahan dengan kamar bersalin.
" Alur transport bayi tidak melalui ruang yang menjadi lalu lintas pengunjung rumah sakit,
terutama untuk menuju ruang perawatan neonatus maupun ruang rawat gabung
(ruang rawat bayi sehat gabung dengan perawatan ibu pasca lahir).
" Ukuran ruang disesuaikan dengan kebutuhan minimal 4m2 untuk setiap inkubator
pasien dan perlengkapannya.
" Lokasi tersendiri, tetapi mudah dijangkau oleh keluarga yang ingin menjenguknya.
" Prosedur menjenguk hanya dapat melalui jendela kaca. Struktur fisik didisain
sedemikian rupa menyerupai aquarium, karena yang dapat masuk ruangan hanya
ayah bayi baru lahir pada saat melaksanakan komunikasi, informasi edukasi tentang
bayinya segera setelah lahir.
1.2 Pencahayaan
Secara umum nyaman dan terang sehingga pengunjung dapat melihat dari luar ruang
ke segala arah.
1.3 Ventilasi
Aliran udara bebas dengan sirkulasi optimal.
Suhu ruangan dan kelembaban
Suhu ruangan sekitar 24-28ºC dengan kelembaban optimal
1.4 Sumber listrik:
Minimal tiga steker untuk setiap inkubator dengan kemampuan bebas yang sesuai
untuk kebutuhan alat, aman dan berfungsi baik.
1.5 Tersedia sumber oksigen dan udara yang siap pakai apabila terjadi kegawatan pada
neonatus
1.6 Tersedia sumber tekanan negatif untuk alat hisap lendir yang siap pakai apabila terjadi
kegawatan pada neonatus
1.7 Kebersihan terjaga setiap waktu
1.8 Lampu darurat
1.9 Memiliki area cuci tangan yang memenuhi kebutuhan dan siap pakai.
2. Mebel
2.1 Lemari instrumen
Tersedia dua:
" Lemari linen, set alat steril.
" Lemari alat kedokteran, bahan habis pakai dan obat-obatan untuk pelayanan neonatal
esensial.
2.2 Meja
Tersedia tiga meja:
" Meja trolley pertama untuk meletakkan kotak resusitasi dan kelengkapannya.
" Meja trolley kedua untuk meletakkan perlengkapan antropometri (timbangan berat
badan digital, alat pengukur panjang badan, pita pengukur lingkar kepala), alat untuk
pemeriksaan laboratorium pada pelayanan neonatal esensial.
" Meja ketiga di area administrasi, selain untuk keperluan administrasi juga untuk
melakukan komunikasi, informasi dan edukasi kepada keluarga pasien.
2.3 Kursi
- Harus ada tiga kursi di area administrasi dan edukasi yang berfungsi baik.
2.4 Wadah sampah tertutup dengan kantong plastik, terdiri dari sampai organik, non-
organik dan sampai infeksius.
2.5 Jam dinding
- Harus menunjukkan waktu yang tepat dan berfungsi baik.
3. Fasilitas, alat kedokteran dan obat-obatan
3.1 Alat periksa:
" Stetoskop
" Termometer
" Alat pengukur saturasi oksigen (oximeter)
Alat dan jarum suntik serta swab alkohol untuk memberikan:
" Vitamin K1
" Imunisasi Hepatitis B
" Pengambilan darah untuk pemeriksaan golongan darah/ Rh, darah rutin lengkap,
gula darah
3.2 Inkubator, asuhan normal
- Paling sedikit harus ada 2 inkubator yang berfungsi baik.
- Jarak satu inkubator dengan yang lain minimal 1m2
" Inkubator transport
3.3 Penghangat (Radiant warmer )
- Paling sedikit harus ada satu penghangat yang berfungsi baik.
3.4 Cairan pencuci tangan
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1. Struktur Fisik
" Lokasi ruang harus bersebelahan dan satu lantai dengan kamar bersalin dan kamar
operasi.
" Alur transport bayi tidak melalui ruang yang menjadi lalu lintas pengunjung rumah
sakit, terutama untuk menuju ruang rawat gabung (ruang perawatan ibu pasca
lahir).
" Ukuran ruang disesuaikan dengan kebutuhan minimal 4m2 untuk setiap inkubator
pasien dan perlengkapannya.
" Ruang terdiri dari:
! Area perawatan
! Ruang peracikan obat/ ruang obat
! Ruang tindakan
! Ruang perah ASI/ Area laktasi
! Area konsultasi
! Ruang administrasi
! Ruang pencucian inkubator
1.2 Pencahayaan
Secara umum nyaman, pencahayaan terang hanya disekitar inkubator untuk
melaksanakan prosedur klinis pada bayi
1.3 Ventilasi
Aliran udara bebas dengan sirkulasi optimal.
Suhu ruangan dan kelembaban
Suhu ruangan sekitar 24-28ºC dengan kelembaban optimal
1.4 Sumber listrik:
Minimal enam steker untuk setiap inkubator dengan kemampuan bebas yang sesuai
untuk kebutuhan alat, aman dan berfungsi baik.
1.5 Sumber oksigen dan udara pada dinding untuk satu inkubator
1.6 Sumber tekanan negatif untuk alat hisap dinding untuk satu inkubator
1.7 Kebersihan selalu terjaga setiap waktu
1.8 Lampu darurat
1.9 Jam dinding
- Harus menunjukkan waktu yang tepat dan berfungsi baik.
1.10 Area cuci tangan di pintu masuk ruang perawatan neonatus
1.11 Generator listrik darurat
- Harus ada generator listrik cadangan yang dioperasikan jika pasokan listrik utama
tidak ada.
2. Area perawatan: memiliki unit layangan neonatus tingkat II dan III.
Satu unit layanan neonatus tingkat III, terdiri dari:
2.1 Perlengkapan menjaga jalan napas.
Minimal dua alat penghisap lendir dinding atau portable lengkap dengan:
" Regulator pengukur tekanan negatif
" Selang penghisap
" Kateter penghisap nomor 6FR, 8FR
2.2 Pasokan oksigen dan udara
" Minimal dua sumber oksigen dapat berasal dari dinding atau tabung portable,
dilengkapi selang atau pipa aliran menuju blender pencampur dengan udara agar
didapat persentase kadar oksigen yang optimal diinginkan.
" Persediaan oksigen tidak dapat terputus, harus tersedia terus menerus.
" Setiap sumber oksigen dilengkapi dengan regulator aliran rendah dan alirang
tinggi.
" Minimal dua sumber udara yang dilengkapi dengan selang menuju alat pencampur
udara (blender ).
" Persediaan udara tidak boleh terputus, harus tersedia terus menerus.
" Minimal satu alat pencampur oksige (blender oxygen) dengan regulatornya.
2.3 Alat bantu ventilasi:
Harus ada alat ventilasi non-invasif (untuk unit layanan neonatus tingkat IIA):
" t-piece resuscitator
" CPAP dengan segala perlengkapannya.
Harus ada alat bantu ventilasi non -invasif (untuk unit layanan neonatus tingkat IIB):
- Ventilator mekanik konvensional.
- High Frequency Ventilatior
- High Frequency Oscillator
2.4 Inkubator
2.5 Radiant warmer
2.6 Monitor bed-side
2.7 Infusion pump
2.8 Syringe pump
2.9 Kursi kangaroo care dan perlengkapannya
2.10 Unit terapi sinar
- Paling sedikit harus ada satu unit terapi sinar yang berfungsi baik untuk setiap tiga
inkubator atau tempat tidur bayi
2.11 Timbangan bayi
- Paling sedikit harus ada satu timbangan bayi yang berfungsi baik di setiap
ruangan.
2.12 Stetoskop
- Harus ada stetoskop yang berfungsi baik untuk setiap tiga inkubator atau tempat
tidur bayi
organik, infeksius.
3. Area tempat meletakkan troley emergency dengan segala kelengkapan yang siap
pakai
4. Ruang penyimpanan dan peracikan obat
Memiliki lemari instrument tempat menyimpan bahan-bahan habis pakai dan obat-
obatan
4.1 Gaun
4.2 Masker
4.3 Sarung tangan
4.4 Alat suntik /spuit 1cc, 2,5 cc, 3 cc, 5 cc, 10 cc, 20 cc, 50cc
4.5 Pipa minum, ukuran 5 Fr dan 8 Fr
4.6 Pipa penghisap lendir, ukuran 6 dan 8 Fr
4.7 Kanula, ukuran 22 dan 24
4.8 Kateter umbilikus, ukuran 3 !, 5, 8
4.9 Masker oksigen neonatus
4.10 Head box / t-piece reuscitator
4.11 Penutup mata untuk terapi sinar
4.12 Popok sekali pakai (Pampers)
4.13 Penutup sepatu sekali pakai
4.14 Betadine/alkohol untuk disinfeksi
4.15 Kantung plastik untuk wadah sampah besar
4.16 Cairan infus
" Dextrose 5%, 10%, 40%
" NaCL 0,9%; NaCl 3%
" KCl 7,4%
" Ca glukonas 10%
" Ringer Lactate
4.17 Cairan nutrisi parenteral
" Solusio asam amino 6%
" Intralipid 20%
4.18 Antibiotik
" Ampisilin
" Gentamisin
4.19 Obat respirasi
" Aminofilin
4.20 Kardiotonik
" Dopamin
" Dobutamin
" Epinefrin
4.21 Lemari es
5. Ruang tindakan memiliki perlengkapan:
5.1 Meja atau tempat tidur untuk melakukan tindakan
5.2 Lampu tindakan
organik, infeksius.
6. Ruang konsultasi
Mebel
6.1 Meja
" Untuk keperluan komunikasi informasi dan edukasi
- Harus dicat dengan bahan yang bisa dibersihkan.
6.2 Kursi
- Harus ada tiga kursi yang berfungsi baik.
7. Ruang administrasi
7.1 Meja
" Untuk keperluan administras
- Harus dicat dengan bahan yang bisa dibersihkan.
7.2 Kursi
- Harus ada kursi yang berfungsi baik.
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1. Struktur Fisik
- Paling kecil, ruangan berukuran 6 m2.
1.2 Kebersihan
1.3 Pencahayaan
1.4 Ventilasi
1.5 Wastafel
2. Mebel
organik, infeksius.
2.2 Kursi (1-3)
-Harus mudah dibersihkan dan di disinfeksi.
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1. Struktur Fisik
-Paling kecil, ruangan berukuran 6-8 m2.
1.2 Kebersihan
1.3 Pencahayaan
1.4 Ventilasi
1.5 Wastafel
organik, infeksius.
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1. Panduan prosedur klinik
1.1 Panduan prosedur klinik, harus ada di unit perawatan neonatus, dan selalu di revisi minimal
satu tahun sekali.
Uraian secara rinci panduan klinis neonatologi diuraikan pada bab II.
2. Perangkat registri pasien, sistem informasi pasien
2.1 Perangkat registri pasien meliputi:
• Buku register masuk dan keluarnya pasien lengkap dengan data mortalitas dan
morbiditas.
• Catatan medik pasien yang menggambarkan:
! Alur pelayanan pasien menurut unit perawatan atau DPJP
! Proses tatalaksana pasien lengkap mulai dari penegakkan diagnosis
sampai pada tindakan prosedur yang diberikan.
! Ringkasan akhir pasien yang menggambarkan diagnosis akhir pasien
selama dirawat dan sebab kematian pasien apabila pasien meninggal
! Ssurat rujukan pasien yang menyebutkan:
▪ Keadaan terakhir pasien, tunjangan yang diberikan untuk
menjaga stabilisainya dalam proses rujukan
▪ Rumah sakit rujukan yang dituju
• Rekapitulasi pencatatan dan pelaporan bulanan pasien di unit pelayanan neonatus.
2.2 Sistem database catatan medis pasien yang dapat diakses dan disimpan kembali setiap
waktu
3. Aset tenaga manusia
3.1 Jumlah, gambaran tugas dan pembagian waktu
3.1.1 Pelayanan neonatus tingkat I di fasilitas kesehatan primer : seorang dokter sebagai DPJP
yang bertanggung jawab selain untuk tatakelola klinis, jug a memiliki tugas pokok dan fungsi
untuk tatakelola manajemen dan program lintas sekoral berhubungan dengan sistem rujukan
Pelayanan neonatus tingkat IIA, di rumah sakit tipe Ddan tipe C: minimal seorang dokter
spesialis anak yang dibantu oleh dokter, perawat dan bidan.
• Tata kelola klinis: 100% menjadi kewenangannya yang disupervisi oleh komite
medik:
! Gambaran tugas sesuai tingkat kompetensi tingkat II (pelayanan neonatal
spesialistik)
! Waktu kerja minimal 6 jam kerja on-site, 18 jam kerja on-call dengan
pendelegasian kewenangan kepada dokter jaga.
• Tata kelola manajemen: koordinasi dan kolaborasi interprofesi dalam struktur
manajemen rumah sakit, disupervisi oleh komite mutu dan difasilitasi oleh jajaran
direktur rumah sakit
• Tata kelola program: koordinasi dan kolaborasi dalam sistem rujukan antar fasilitas
kesehatan yang difasilitasi oleh manajemen rumah sakit, dinas kesehatan setempat
dan jajaran lintas sektoral terkait.
Pelayanan neonatus tingkat IIIA, IIIB di rumah sakit tipe B: minimal seorang dokter
spesialis anak dengan kompetensi tambahan dari pelatihan perawatan intensif neonatus
yang dibantu oleh dokter, perawat dan bidan.
medik:
! Gambaran tugas sesuai tingkat kompetensi tingkat III minimal didapat dari
pelatihan tambahan pelayanan neonatus subspesialistik atau yang
setingkat)
! Idealnya ada DPJP dengan waktu kerja 24 jam on-site. Apabila jumlah
tenaga tidak memadai dapat disesuaikan dengan kondisi setempat yang
disetujui oleh komite medik dan disahkan oleh direktu RS setempat dengan
adanya konsulen jaga on-call dengan pendelegasian kewenangan kepada
dokter jaga.
Pelayanan neonatus tingkat IIIC, IIID di rumah sakit tipe A: minimal seorang dokter
spesialis anak konsultan neonatologi yang dibantu oleh dokter spesialis anak, dokter,
perawat dan bidan.
medik:
! Gambaran tugas sesuai tingkat kompetensi tingkat III yang didapat dari
pendidikan subspesialistik/ konsultan neonatologi.
! Idealnya ada DPJP dengan waktu kerja 24 jam on-site. Apabila jumlah
tenaga tidak memadai dapat disesuaikan dengan kondisi setempat yang
disetujui oleh komite medik dan disahkan oleh direktu RS setempat dengan
adanya konsulen jaga on-call dengan pendelegasian kewenangan kepada
dokter jaga.
3.1.2 Dokter yang melaksanakan tugas jaga dengan mendapat pendelegasian kewenangan dari
DPJP /shift *
3.1.3 Proporsi perawat di pelayanan neonatus tingkat II:
Satu perawat/ 3-4 inkubator/ shift
Porporsi perawat di pelayanan neonatus tingkat III:
Satu perawat/ 2 inkubator/ shift
3.2 Berikut ini adalah kompetensi minimal yang harus dimiliki oleh petugas di pelayanan
neonatus tingkat I, II dan III
3.2.1 Pelatihan manajemen neonatus tingkat II untuk dokter, dokter spesialis anak
Pelatihan manajemen neonatus tingkat II untuk perawat
3.2.2 On the job training manajemen neonatal tingkat II untuk dokter, dokter spesialis anak
On the job training manajemen neonatal tingkat II untuk perawat
3.2.3 Pelatihan manajemen neonatus tingkat III untuk dokter, dokter spesialis anak
Pelatihan manajemen neonatus tingkat III untuk perawat
3.2.4 On the job training manajemen neonatal tingkat III untuk dokter, dokter spesialis anak
On the job training manajemen neonatal tingkat III untuk perawat
3.2.5 Program pendidikan subspesialistik/ konsultan di bidang neonatologi
3.3. Program pendidikan kedokteran berkelanjutan di bidang neonatologi secara periodik
4. Manajemen perencanaan, pemeliharaan dan penggantian fasilitas kesehatan, alat
kedokteran dan obat-obatan
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