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What is the neonatal intensive care unit (NICU)?

A neonatal intensive care unit (NICU) is a specialised unit for care of ill or premature newborn infant needs intensive care. The NICU combines advanced technology and skilled health care professionals to provide specialized care for babies. NICUs may also specialised areas for babies who are not as sick but do need specialized nursing care. In NICU newborn will stay for days, weeks, or possibly longer, depending on the baby’s degree of prematurity and severity of illness. When babies need NICU admission, it can be an overwhelming experience. Very next moment, the excitement and happiness about the birth of your new baby can change to fear and anxiety. You may feel angry or nervous or find yourself questioning whether anything is really wrong with your baby. Even though all of these emotions are normal, knowing what to expect can help to overcome some of the fear and balance the emotions.

Different level of NICU

A Level 1 NICU or Level 1 Nursery is defined by two different sources as follows: Level 1 nurseries care for healthy, full-term babies. They are able to stabilize babies born near term to get them ready to transfer to facilities that offer special care.” Level 2, or specialty care nurseries, in addition to providing basic care, can provide care to infants who are moderately ill with problems that are expected to resolve rapidly or who are recovering from serious illness treated in a level 3 (subspecialty) NICU. The Level 3 NICU, is a neonatal intensive care unit that is capable of caring for very small or very sick newborn babies. Level 3 NICUs have a wide variety of staff on site, including neonatologists, neonatal nurses, and respiratory therapists who are available 24 hours a day. Baby’s condition requiring special care is premature or critically ill, NICU is the right place for the baby care.

Which babies need special NICU care?

Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birth weight (less than 2500 gm), or have a medical condition that requires special care. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. The following are some factors that can place a baby at high risk and increases the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following:

Maternal factors:

  • Age younger than 16 or older than 40 years.
  • Drug or alcohol exposure.
  • Diabetes
  • Hypertension (high blood pressure)
  • Bleeding
  • Sexually transmitted diseases.
  • Multiple pregnancy (twins, triplets, or more)

Delivery factors:

  • Foetal distress/birth asphyxia (changes in organ systems due to lack of oxygen)
  • Breech delivery presentation (buttocks delivered first) or other abnormal presentation
  • Meconium stained amniotic fluid / meconium aspiration
  • Nuchal cord (cord around the baby’s neck)
  • Forceps or caesarean delivery.

Baby factors:

  • Pre or post term deliveries (less than 37 weeks or more than 42 weeks).
  • Birth weight less than 2,500 grams  or over 4,000 grams.
  • Small for gestational age.
  • Medication or resuscitation in the delivery room.
  • Birth defects
  • Respiratory distress including rapid breathing, grunting, or apnea (stopping breathing)
  • Infection such as herpes, group B streptococcus, Chlamydia.
  • Seizures
  • Hypoglycemia (low blood sugar)
  • Need for extra oxygen or monitoring, intravenous (IV) therapy, or medications.
  • Requiring blood transfusion

Baby’s caregivers at NICU

Your baby will be cared for by a team of well-trained, diversely skilled staff members – any of whom will be glad to answer your questions at any time. However, it may be difficult at first to figure out who everyone is and the role they play in your newborn’s care.

Doctors

Neonatologist – This is a doctor specially trained in newborn intensive medicine who leads the caregiver team in the NICU. All major decisions concerning your child are cleared first through this doctor. Your neonatologist may consult with surgeons and other doctors who are specialists in other areas. Pediatrician – The doctor who specializes in the care of infants and children) and oversees your baby’s care in the hospital. You will contact your pediatrician for care (other than emergencies) after you go home.

Nurses

Staff nurses – These providers, are the caregivers you’ll see most during your baby’s stay in the NICU. They have been specially trained to care for babies including babies born premature and those having medical or surgical problems needs intensive care. They will deliver the care to your baby according to doctor’s order. Staff nurses closely monitor your baby and usually have the most recent information about your baby’s progress. Nurse in charge – This nurse has the same special training in infant care as the staff nurses and supervises other nurses. They assign care tasks to staff nurses and help resolve problems. The charge nurse also coordinates the flow of patients in and out of the unit.

Other healthcare professionals

In addition to the doctors and nursing staff, there are a variety of other specialized professionals involved in your baby’s care.

  • Pharmacist – This is a professional who specializes in preparing and delivering medicines.
  • Developmental team – This group may include physical therapists, occupational therapists, and speech therapists can help your baby with movement, feeding, and other developmental issues.
  • Audiologist – Does hearing screening for all babies.
  • Ophthalmologist – Does eye checkup for all preterm babies .

CIMAR Hospital NICU

The CIMAR hospital neonatal unit (NICU) has adequate space, controlled access, nominated sterile areas, uninterrupted power supply, efficient medical gas distribution systems and modern medical infrastructure in an environment that is sensitive to the needs of the baby and the family. Facilities exists in the unit for providing the safest critical care to the premature babies including the ELBWs (extremely low birth weight babies weighing less than 1000 grams) and those newborns with a wide variety of complex medical, cardiac and surgical problems. The unit is constructed scientifically as per the current recommendations and follows open care system with state of the art radiant warmers for the babies.

  • The unit has bed strength of 23 as detailed below:
  • Level III Neonatal Intensive Care Unit (NICU) – 4 ventilated beds
  • Level IIB Special Care Baby Unit- intermediate dependency care – 14
  • Level IIA Special Care Baby Unit – low dependency care – 5

The unit is run by a team of neonatologists, paediatricians and senior nursing staff trained in neonatal care. The unit has 1:1 nurse patient ratio in the level III section and comparable staff strength in the other two sections. The unit seeks to continuously improve the quality of care by using evidence-based treatment and regular audit of health outcomes.

Advanced Neonatal intensive care (NICU) at CIMAR hospital

The unit provide best and up to date advanced care included

  • High-frequency ventilation (HFO)- using two Drager VN 500
  • Conventional mechanical ventilation.
  • Non Invasive Ventilation.
  • Exchange transfusion
  • Surfactant replacement therapy.
  • Neonatal Partial Parenteral nutrition.
  • Umbilical catheter and PICC insertion.

Perinatal Care

  • Prenatal consultation and counselling for parents.
  • Foetal medicine services.
  • Genetic counselling.
  • Attendance at all deliveries including high-risk or potentially complicated deliveries

 Other Services

  • Comprehensive  management of neonatal hyperbilirubinemia warranting intensive phototherapy and exchange blood transfusion.
  • Bed side Early Intervention Program for neuro development of High Risk newborns (once they are haemodynamically stable).
  • Lactation counselling, breast feeding support and Kangaroo Mother Care Support by doctors, lactation counsellors and nurses.
  • 24-hour consultation and advice on neonatal problems to paediatricians in the periphery.

Newborn Screening Programs

The following screening programs are carried out in the department:

  • Universal Clinical screening for anomalies.
  • Universal Pulse Oximetry Screening for Congenital Heart Disease
  • Universal Newborn Hearing Screen by OAE Test.
  • Universal Thyroid screening programme.
  • Metabolic, Endocrine and Genetic Screening by TMS and GCMS- for high risk cases
  • Preterm Screening Program for Retinopathy of Prematurity.

Newborn OP Clinics

The department has a well designed follow up program

  • Well Baby and Immunisation Clinics: 8 am – 4pm (Daily)
  • Neonatal follow-up clinic: 11 am – 2 pm (Daily)