ORGANIZATION OF NICU

Intensive care unit, also known as an intensive care nursery (ICN) is an intensive care
unit specializing in the care of ill or premature new born infants. The first American new
born intensive care unit, designed by Louis Gluck was opened in October 1960 at Yale- New
Heaven hospital.
The management of complex life threatening diseases, provision to intensive monitoring
and institution of life sustaining therapist in an organized manner to critically ill children
need separate paediatric intensive care unit. The concept of designations for hospital facilities
that care for new born infants according to the level of complexity of care provided.
LEVELS OF CARE
India has weighing more than 1800 grams or having gestational maturity of 34 weeks or
more are categorized under level 1 care. The care consists of basic care at birth, provision of
warmth, maintaining asepsis and promotion of breast feeding. This type of care can be given
at home, subcenter and primary health care.
 Level II care
Neonates weighing 1200-1800 grams of having gestational maturity of 30-34 weeks are
categorized under level II care and are looked after the trained nurses and paediatrician. The
equipment and facilities need for this level of care are include equipment for resuscitation,
maintenance of thermo neutral environment, intra venous infusion, gavage feeding, photo
therapy, and exchange transfusion. This type of care can be given at first referral unit, district
hospitals and teaching institutions and nursing homes.
 Level III care.
Neonates weighing less than 1200 grams and having gestational maturity of less than 30
weeks are categorized under level III care. The care is provided apex institutions and regional
perinatal centres equipped with centralized oxygen and suction facilities, servo controlled
incubators, vital signs monitors, ventilators, infusion pump etc. This type of care is provided
by skilful nurses and neonatologists.
LOCATION NEONATAL UNIT
Neonatal unit should be located as close as possible to the labour room and operation
theatre. Adequate sunlight for illumination and fair degree of ventilation of fresh air is
necessary.
SPACE
500-600 gross square feet per bed. Space includes patient care area, storage area, space
for doctors, nurses, other staff, office area, seminar room area, laboratory area & space for
families. 6 feet gap between two incubators for adequate circulation and keeping in essential
life saving equipment’s.
FLOOR PLAN
Should be open space. The wall should be made of washable glazed tiles and windows
should have two layers of glass panes. Wash basins with elbow or floor operated taps facility
having constant round the clock water supply should be provided. The door should be
provided with automatic door closers.
CONCEPTUAL LAYOUT FOR A SINGLE CORRIDOR SPECIAL CARE
NEONATAL UNIT FOR 24 INFANTS.
The unit facility should preferably be in a square space so that abundant open space is
available. In addition to the special care area, minimal care and isolation rooms, x ray room
laboratory and a procedure room. The nursery is used with advantages for education of
mothers in child craft activities and promoting the practice of breast feeding. The cleaning
area is used for sterilization of equipment and for fumigation of incubators in a specially
designed. Isolation room is used to care potentially infected infants with open sepsis
(especially those with diarrhoea and abscess.) The septic nursery must be located away from
the special care neonatal unit and maintained by resident staff.
Store
Doctor’s room

room
Procedure

Growing

Feeding

Waiting
nursery
X-ray

room

area
Lab
Nurse’s room

Nursing station (Bay)

Minimal care room

Isolation room
area
Fumigation

chamber

Scrub
room

VENTILATION
Effective air ventilation – central air conditioning should be there.
LIGHTING
The whole unit must be well illuminated and painted white. The lighting arrangement should
provide uniform shadow free illumination of 100 foot candles at the baby’s level.
ENVIRONMENTAL TEMPERATURE AND HUMIDITY
The temperature inside the unit should be maintained at 28 degree Celsius+\-2 degree
Celsius, while the humidity must be above 50%. Portable radiant heater, infra-red lamp can
be used.
ACOUSTIC CHARACTERISTICS
The ventilation system, incubators, air compressor, suction pumps and any other devices used
in the nursery produce noise. Sound intensity in the unit should not exceed 15 decibels.
Telephone rings and equipment alarms should be replaced by blinking lights.
COMMUNICATION SYSTEM
The unit should also have an intercom and a direct outside telephone line.
ELECTRICAL OUTLET
Each patient station should have 12 to 16 central voltage stabilized electrical outlets sufficient
to handle all pieces of equipment with additional power pug points. There should be round
the clock power back up including provision of UPS system.
STAFF
Full time neonatologist is the in charge of NICU. One neonatal physician is required for
every 6-10 patients. One resident doctor should be present in the unit round the clock.
Anaesthetist- Paediatric surgeon and Paediatric pathologist is essential in establishment of a
good quality of NICU.
 Nurses
A nurse patient ratio of 1:1 maintained throughout day and night is absolutely essential for
babies on multi system support including ventilatory therapy. For special care neonatal unit
and intermediate care, nurse to patient ratio is 1:3 is ideal but 1:5 per shift is manageable.
Head nurse is the over in charge. In addition to basic nursing training for level II care, tertiary
care requires staff nurse trained in handling equipment, use of ventilators and initiation of life
support like use of bag and mask resuscitation, endotracheal incubators, arterial sampling and
so on. The staff must have a minimum of 3 years work experience in special care neonatal
unit in addition to having 3 months hand on training in an intensive care neonatal unit.
 Other staffs
o Respiratory therapist o Housekeeping staff
o Laboratory technician o Clerk
o Public health nurse or social o Dietician
worker
 o Bio medical engineer

BED STRENGTH
For the total NICU ward 1-2 % of the hospital beds, at the most 6% is what is recommended.
EQUIPMENTS REQUIRED
 Resuscitation set  Phototherapy unit
 Open care system  Electronic weighing scale
 Incubators  Pulse oxymeter
 Infusion pumps  End tidal invasive BP monitor
 Positive pressure ventilators  12 lead ECG monitor with
 Oxygen hoods defibrillator
 Oxygen analyser  Intra cranial pressure monitor
 Heart rate apnoea monitor  Portable radio graphic machine
 Blood gas analyser.
Disposable articles required
 IV catheters  Extension tubing
 IV set  Umbilical arterial and venous
 Bacterial filters catheters.
 Feeding tubes  Syringes
 Endotracheal tubes  Needles
 Suction catheters  Troch
 3 way stop clocks  Cannula
Services that should be available
 Monitors for:  Incubators
 Cardiac and hemodynamic indices  Oxygen hood box
 Respiratory functions  Oxygen analyser

 Temperature including core  Photo therapy unit

temperature  Respiratory rate and apnoea monitor

 Cerebral functions.  Infusion pump

 Equipment for resuscitation  Bilirubin analyser

 Open care system  Transcutaneous bilirubinometer

 Thermometer  Pulse oxymeter

 Feeding equipment  Neonatal ventilators

 Laminar flow system  Intra cranial pressure monitor

 Weighing machine
SUPPORT SERVICES NECESSARY FOR NICU
 Radio diagnosis and imaging facility
 Laboratory services 24 hours a day
 Centralized oxygen, compressed air and suction facility
 Blood bank and pharmacy
 Physiotherapy
 Transport system
 Equipment maintenance and care
ANCILLARY SERVICES
1. Housekeeping related to cleaning, water, electrical, air conditioning, linen cleaning,
and central sterilization services.
2. Communication within ICU and outside through telephone, paging and intercom
system. A direct outside telephone line should be available in NICU
3. Computerized record keeping is desirable
4. Social services.
Conclusion
It is concluded that a properly organized neonatal unit is essential for providing with
adequate space, should have proper floor plan. The unit should have proper location and
should have a proper floor plan. The unit should have all the equipment such as resuscitation
equipment, oxygenation and catheter, syringes etc. And the maintenance of equipment’s in
proper working condition is also very important.