A neonatal intensive care unit ( NICU ), also known as intensive nursery care ( ICN ), is a treatment unit intensive specializing in the care of a newborn who is sick or premature. Neonatal refers to the first 28 days of life. Neonatal treatments, known as special nurseries or intensive care, have been around since the 1960s.
The first American intensive care unit for the first time designed by Louis Gluck, opened in October 1960 at the Yale-New Haven Hospital.
NICU is usually directed by one or more neonatologists and administered by nurses, nurse practitioners, pharmacists, physician assistants, resident doctors, respiratory therapists, and dietitians. Many other disciplines and additional specialists are available in larger units.
The term neonatal comes from neo , "new", and christmas , "related to birth or origin".
The neonatal nurse practitioner is a follow-up care nurse who cares for premature babies and sick newborns in intensive care units, emergency rooms, delivery rooms, and specialized clinics. Prematurity is a risk factor that follows early labor, a planned cesarean section, or pre-eclampsia.
Video Neonatal intensive care unit
Nursing and the neonatal population
Health care institutions have various entry-level requirements for neonatal nurses. The neonatal nurse is a registered nurse (RN), and must therefore have an Associate of Science in Nursing (ASN) or Bachelor of Science in Nursing (BSN) degree. Some countries or institutions may also require midwifery qualifications. Some institutions may receive a newly graduated RN after passing the NCLEX exam; others may require additional experience working in adult-health or medical/surgical nursing.
Some countries offer postgraduate degrees in neonatal nursing, such as the Master of Science in Nursing (MSN) and various doctorates. A nurse practitioner may be required to hold a postgraduate degree. The National Association of Neonatal Nurses recommends a two-year experience working at the NICU before taking the graduate class.
As well as registered nurses, local licensing or certification bodies as well as employers may set requirements for continuing education.
There is no mandatory requirement to become an RN in the NICU, although neonatal nurses must be certified as providers of neonatal resuscitation. Some units prefer new graduates who have no experience in other units, so they can be specially trained specifically, while others prefer nurses with more experience already under their belts.
Intensive care nurses undergo an intensive, didactic and clinical orientation in addition to their general nursing knowledge to provide highly specialized care for critical patients. Their competence includes high-risk drug delivery, high-purity patient management requiring ventilator support, surgical treatment, resuscitation, advanced interventions such as extracorporeal membrane oxygenation or hypothermia therapy for neonatal encephalopathy procedures, as well as management of chronic or lower care. sharpness associated with premature infants such as eating intolerance, phototherapy, or antibiotic administration. NICU RN is undergoing annual skills tests and is subject to additional training to maintain contemporary practice.
Maps Neonatal intensive care unit
History
The problem of premature and congenital babies is not new. In the early seventeenth and eighteenth centuries, there were published scientific papers that sought to share knowledge about the intervention. But it was not until 1922 that hospitals began grouping newborns into one area, now called the neonatal intensive care unit (NICU).
Prior to the industrial revolution, premature babies and sick were born and treated at home and live or die without medical intervention. In the mid-nineteenth century, baby incubators were first developed, based on an incubator used for chicken eggs. Dr. Stephane Tarnier is generally regarded as the father of the incubator (or isolation as it is now known), after developing it to try to keep the premature baby in the maternity ward in warm Paris. Other methods have been used before, but this is the first closed model; in addition, he helps convince other doctors that this treatment is helping premature babies. France has been a pioneer in helping premature babies, partly because of fears about declining birth rates.
After Tarnier retires, Dr. Pierre Budin, following in his footsteps, notes the infant's limitations in the incubator and the importance of breast milk and mother's attachment to the child. Budin is known as the father of modern perinatology, and his seminal job The Le Nouriscan Le Nourisson is the first major publication dealing with neonatal care.
Another factor contributing to the development of modern neonatology is Dr. Martin Couney and his permanent installment of a premature baby in an incubator at Coney Island. A more controversial figure, he studied under Dr. Budin and bringing attention to premature babies and their suffering through his performances as a spectacle of spectacle at Coney Island and World's Fair in New York and Chicago in 1933 and 1939, respectively. Babies have also previously been featured in incubators at the World Expo 1897, 1898, 1901, and 1904.
Initial years
Doctors take an increasing role in childbirth since the 18th century and beyond. However, newborn care, sick or healthy, remains largely in the hands of the mother and midwife. Some baby incubators, similar to those used for hatching chicks, were made in the late nineteenth century. In the United States, this was shown at a commercial exhibition, complete with infants inside, until 1931. Dr A. Robert Bauer MD at Henry Ford Hospital in Detroit, MI, successfully combines oxygen, heat, moisture, ease of accessibility, and ease of nursing care 1931. Just after World War II the baby care unit (SCBU) was established in many hospitals. In the UK, the initial SCBU opened in Birmingham and Bristol, the latter being formed with just Ã, Â £ 100. At Southmead Hospital, Bristol, early opposition from obstetricians was diminished after the four births born there in 1948 were successfully treated in a new unit.
The incubators are expensive, so the whole room is often kept warm. Cross-infection between infants is feared. The strict maintenance routine involves staff wearing gowns and masks, constant hand washing and minimal baby handling. Parents are sometimes allowed to look through the unit window. Much is learned about feeding - often, snacks taste best - and breathe. Oxygen was given freely until the late 1950s, when it was shown that the high concentrations achieved in the incubator caused some babies to become blind. The monitoring conditions in the incubator, and the baby itself, are the main areas of research.
The 1960s was a period of rapid medical advancement, especially in respiratory support, which ultimately made the survival of premature newborns a reality. Very few babies are born before thirty-two weeks of survival and those with frequent neurological disorders. Herbert Barrie in London pioneered progress in resuscitation of newborns. Barrie published her seminal paper on the issue at The Lancet in 1963. One of the current concerns is the concern that using high oxygen pressure can damage the newborn lungs. Barrie develops an underwater safety valve on the oxygen circuit. The tubes were originally made of rubber, but this could potentially cause irritation to the new sensitive baby trachea: Barrie switched to plastic. This new endotracheal tube, based on Barrie's design, is known as 'St. Thomas's tube'.
Most early units have little equipment, providing only oxygen and warmth, and rely on careful care and observation. In later years, further research allowed technology to play a greater role in decreasing infant mortality. The development of lung surfactants, which facilitate the oxygenation and lung ventilation of undeveloped lungs, has been the most important development in neonatology to date.
Improve technology
In the 1970s, the NICU was part of a hospital established in developed countries. In the UK, some early units run community programs, sending experienced nurses to help care for premature babies at home. But increasing technology monitoring and therapy means special care for babies to be hospitals. In the 1980s, over 90% of births occurred in hospitals. The emergency dashboard from the house to the NICU with infants in transport incubators has become a thing of the past, although transportation incubators are still needed. Specialist equipment and expertise are not available in every hospital, and strong arguments are made for large and central NICUs. On the downside is the long travel time for a weak baby and for the elderly. A 1979 study showed that 20% of infants in NICU up to a week were never visited by parents. Centralized or not, in the 1980s some questioned the role of NICU in saving babies. About 80% of babies born weighing less than 1.5 kg are now safe, compared with about 40% in the 1960s. From 1982, pediatricians in the UK can train and qualify in the subspecialty of neonatal medicine.
Not only care with caution but also new techniques and instruments now play a major role. As in adult intensive care units, the use of monitoring and life support systems becomes routine. This required a special modification for a small baby, whose body is small and often immature. Adult ventilators, for example, can damage the baby's lungs and soft techniques with smaller designed pressure changes. The number of tubes and sensors used to monitor the condition of the baby, blood sampling and artificial feeding make some babies almost invisible under the technology. Furthermore, in 1975, more than 18% of newborns in the UK were admitted to the NICU. Some hospitals recognize all babies are delivered by Caesarean section or under 2500 g of body weight. The fact that these babies lose close initial contact with their mothers is an increasing concern. The 1980s saw questions raised about the human and economic costs of too much technology, and the policy of acceptance gradually became more conservative.
Changing priorities
NICUs now concentrate on treating very small, premature, or congenital babies. Some of these babies come from high-birth twins, but most are still single babies born too early. Preterm labor, and how to prevent it, remains a confusing problem for doctors. Although medical advances allow doctors to rescue low-birth-weight babies, it is almost always better to delay the birth.
Over the past 10 years, SCBU has become much more 'child-friendly', encouraging maximum engagement with infants. Dresses and masks are routinely gone and parents are encouraged to help with as much care as possible. Hugging and skin-to-skin contact, also known as Kangaroo treatments, are considered beneficial to all but the weakest (very small infants are exhausted by the handled stimulus, or the more critically ill babies). Less pressing ways to deliver high-tech drugs to small patients have been designed: sensors to measure blood oxygen levels through the skin, for example; and how to reduce the amount of blood taken for the test.
Some major NICU problems are almost gone. The exchange of transfusions, in which all the blood is removed and replaced, is rare now. Rhesus incompatibility (difference in blood type) between mother and baby is highly preventable, and is the most common cause for past exchange transfusions. However, difficulty in breathing, intraventricular hemorrhage, necrotizing enterocolitis and infection still claim much of the baby's life and is the focus of many new and current research projects.
The long-term view for premature babies rescued by the NICU is always a concern. From the early years, it was reported that higher-than-normal proportions grew with disabilities, including cerebral palsy and learning difficulties. Now the treatments available for many of the problems faced by small or immature infants in the first week of life, long-term follow-up, and minimizing long-term disability, are key areas of research.
In addition to prematurity and low birth weight, the common diseases treated in the NICU include perinatal asphyxia, major birth defects, sepsis, neonatal jaundice, and infant respiratory distress syndrome due to lung immaturity. In general, the main cause of death in NICU is necrotizing enterocolitis. Complications of extreme prematurity may include intracranial hemorrhage, chronic bronchopulmonary dysplasia (see Infant respiratory distress syndrome), or retinopathy of prematurity. A baby can spend one day of observation on the NICU or maybe spend many months there.
Neonatologists and NICUs have greatly improved the survival of very low birth and very premature babies. In the pre-NICU era, underweight babies less than 1400 grams (3 pounds, usually about 30 weeks gestation) rarely survive. Today, babies weighing 500 grams at 26 weeks have a fair chance of survival.
The NICU environment presents challenges and benefits. Stressors for infants can include continuous light, high noise levels, separation from their mothers, reduced physical contact, painful procedures, and impaired opportunities for breastfeeding. NICU can create stress for staff as well. A special aspect of NICU stress for both parents and staff is that babies can survive, but with damage to the brain, lungs or eyes.
NICU rotation is an important aspect of pediatric and obstetric residency programs, but the NICU experience is driven by other special residencies, such as family practice, surgery, pharmacy, and emergency medicine.
Tools
Incubator
An incubator (or isolette ) is a tool used to maintain suitable environmental conditions for neonates (newborns). It is used in preterm delivery or for some short-term infants who are sick.
There are additional equipment used to evaluate and treat a sick neonate. These include:
Blood pressure monitor: Blood pressure monitor is a machine connected to a small cuff that wraps around the patient's arm or leg. This cuff automatically takes blood pressure and displays data for review by the provider.
Oxygen Cotton: This is a clear box that fits the baby's head and supplies oxygen. This is used for babies who can still breathe but require respiratory support.
Ventilator: This is the breathing machine that drains air into the lungs. A seriously ill baby will receive this intervention. Typically, the ventilator takes on the role of the lungs while treatment is given to improve lung function and circulation.
Possible functions of a neonatal incubator are:
- Oxygenation, through oxygen supplementation by the hood or nasal cannula, or even sustained positive air pressure (CPAP) or mechanical ventilation. Infant respiratory distress syndrome is the leading cause of death in premature infants, and primary care is CPAP, in addition to the provision of lung surfactants and stabilizing blood sugar, blood salts, and blood pressure.
- Observation: Modern neonatal intensive care involves advanced temperature measurements, respiration, cardiac function, oxygenation, and brain activity.
- Protection from cold temperatures, infections, noise, drafts and over handling: Incubators can be described as bassin covered in plastic, with climate control equipment designed to keep them warm and limit exposure to germs.
- Nutrition, through intravenous catheter or NG tube.
- Drug administration.
- Maintain fluid balance by providing fluids and maintaining high air humidity to prevent over-loss of skin and breathing evaporation.
An incubator transport is an incubator in a transportable form, and is used when a sick or premature baby is transferred, for example, from one hospital to another, such as from a community hospital to a larger medical facility with the appropriate neonatal intensive care unit. Usually has a miniature ventilator, cardio-breathing monitor, IV pump, pulse oximeter, and oxygen supply built into the frame.
Patient population
Diagnosis dan yum umum pathologists of NICU meliputi:
- Anemia
- Apnea Bradycardia
- Bronchopulmonary dysplasia (BPD)
- Hidrosefalus
- Perdarahan intraventricular (IVH)
- Penyakit king
- Necrotizing Enterocolitis (NEC)
- Patent ductus arteriosus (PDA)
- Periventricular Leukomalacia (PVL)
- Bayi distress perpendicular syndrome (RDS)
- Retinopathy Prematuritas (ROP)
- Sepsis neonatal
- The Tachypnea transients fall into the bayi baru lahir (TTN)
- Level I , Newborn nursery well
- Level II , Special care nursery
- Level III , neonatal intensive care unit (NICU)
- Level IV , regional neonatal intensive care unit (NICU Regional)
- Provide care for infants born> = 32 weeks of gestation and weight> = 1500 g experiencing physiological immaturity or who are sick with problems expected to heal quickly and not anticipated to require subspecialty services on an urgent basis
- Provide care for infants who are eating and grow stronger or recover after intensive care
- Provide mechanical ventilation for short duration (& lt; 24 hours) or continuous positive air pressure
- Stabilize infants born before 32 weeks' gestation and weight less than 1500 g until transferred to a neonatal intensive care facility
- The Level II nursery is required to have a child hospital, neonatologist, and neonatal nurse practitioner in addition to a Level I health care provider.
- Provide ongoing life support
- Provide comprehensive care for the baby born & lt; 32 weeks gestational age and weight & lt; 1500 g
- Provide comprehensive care for infants born at all gestational ages and birth weight with critical illness
- Provides quick and easy access to various child medical subspecialties, pediatric surgery specialist, pediatric anesthesiologist, and pediatrician
- Provide a complete range of respiratory support that may include conventional and/or high-frequency ventilation and inhalation nitric oxide
- Perform advanced imaging, with a sudden interpretation, including computed tomography, MRI, and echocardiography
- Located within an institution with the ability to provide a congenital or acquired surgical repair of complex conditions
- Maintain various child medical subspecialties, child surgeon subspecialists, and pediatric anesthesiologists at the site
- Facilitate transportation and provide outreach education.
- Neonatology
- Child-intensive care unit
- Embrace (organization)
- Neonatal nurse practitioner
- Neonatal care
- Bubble CPAP
- Life on NICU: what parents can expect
- NeonatalICU.com - Expect Premature Babies on NICU
- Tools used in NICU - interactive parental friendly information
- Association of Nurse Health Women, Midwifery and Neonatal
- Neonatal Nursing Academy
- Pre Conception & amp; Neonatal
Tingkat perawatan
The concept of designation for hospital facilities that care for newborns according to the level of complexity of care provided was first proposed in the United States in 1976. Levels in the United States are defined by guidelines published by the American Academy of Pediatrics in the United Kingdom. , these guidelines are issued by the British Association of Perinatal Medicine (BAPM), and in Canada they are maintained by The Canadian Pediatric Society.
Neonatal care is divided into several categories or "treatment levels". this level applies to the type of care required and determined by the regional governing body.
India
India has a 3-tier system based on weight and gestational age of the neonate.
Level I care
Neonates weighing more than 1800 grams or having a gestation maturity of 34 weeks or more are categorized under the I care level. Treatment consists of basic care at birth, supplying warmth, maintaining asepsis and promoting breastfeeding. This type of treatment can be given at home, subcontinent and primary health center.
Nursing Level II
Neonates weighing 1200-1800 grams or having a 30-34 week pregnancy maturity are categorized under second-level care and treated by trained nurses and pediatricians. Equipment and facilities used for this level of treatment include equipment for resuscitation, thermoneutral environmental maintenance, intravenous infusion, gavage feeding, phototherapy and blood transfusion. This type of treatment can be given to the first referral unit, district hospital, teaching institute and nursing home.
Nursing Level III
Neonates weighing less than 1200 grams or having a pregnancy maturity of less than 30 weeks are categorized under level III care. This treatment is provided at apex institutions and regional perinatal centers equipped with centralized oxygen and suction facilities, servo controlled incubators, vital monitor monitors, transcutaneous monitors, ventilators, infusion pumps, etc. This type of treatment is provided by skilled and neonatological nurses.
United Kingdom
The terminology used in the UK can be confusing, as different criteria are used to designate 'local' and 'intensive' neonatal treatment locally and nationally.
Level 1 Neonatal Unit
Also known as 'Special Care Baby Units' (SCBU). This is seen after infants who need more treatment than healthy newborns but are relatively stable and mature. SCBU may feed through tubes, oxygen therapy, antibiotics to treat infections and phototherapy for jaundice. In SCBU, nurses can be given up to four babies to be treated.
Level 2 Neonatal Unit
Also known as the 'Local Neonatal Unit', it can keep babies in need of further support such as parenteral nutrition and continuous positive airway pressure (CPAP). Confusingly, they can also treat infants who require short-term intensive care such as mechanical ventilation. Infants requiring long-term or more complex intensive care, such as very premature infants, are usually transferred to Level 3 units. Infants in Level 2 units can be classified for nursing purposes as 'Special Treatment', 'High Dependency' (HDU) nurses will be assigned up to two babies) or 'intensive care' (where breastfeeding is one-to-one, or sometimes even two-to-one).
Level 3 Neonatal Unit
Also known as 'Neonatal Intensive Care Units' (NICU) - although Level 2 units may also have their own NICU. This is seen after the smallest babies, the most premature and the most unhealthy and often serve a large geographical area. Therapies such as prolonged mechanical ventilation, therapeutic hypothermia, neonatal surgery and inhaled nitric oxide are usually given in Level 3 Units, although not every unit has access to all therapies. Some babies treated in Tier 3 units will require less intensive care and will be maintained in HDU or SCBU seedlings on the same site.
United States
The definition of a neonatal intensive care unit (NICU) according to the National Center for Statistics is "a hospital facility or staff unit and equipped to provide continuous mechanical ventilation support for newborns". In 2012, the American Academy of Pediatric updated their policy statements describing different levels of neonatal care. One major difference in the policy statement updated in 2012 of the AAP compared to the 2004 policy statement was the abolition of sub-specialty breeding for levels II and III with the addition of NICU IV levels. The four levels of neonatal care defined in the latest policy statement from the AAP are:
Level I (nursery newborn)
Unit Level I is usually referred to as a baby nursery well. Newborn nurseries have the ability to provide neonatal resuscitation at each birth; evaluate and provide postnatal care for healthy newborns; stabilize and provide care for infants born at 35 to 37 weeks gestational age who remain physiologically stable; and stabilize sick newborns and those born less than 35 weeks' gestation until transfer to a facility that can provide appropriate neonatal care levels. The types of providers required for newborn nurseries include pediatricians, family doctors, nursing practitioners, and other registered trained nurses.
Level II (special care)
Previously, the Level II units were divided into 2 categories (IIA level & IIB level) based on their ability to provide assistance ventilation including continuous positive airway pressure. Unit Level II is also known as special care nursery and has all nursery level I capabilities. In addition to providing first-rate baby care, Level II units can:
The AAP Guidelines 2004 divide the Level III units into 3 categories (level IIIA, IIIB & IIIC). Unit Level III is required to have a pediatric surgeon in addition to the required care provider for level II (paediatric, neonatologist, and neonatal nurse practitioner) and level I (pediatrician, family physician, nurse practitioner, and other registered nurse ). Also, the type of providers required to be on site or in an institution closely linked to pre-arranged consultation agreements including child medical subspecialists, pediatric anesthesiologists, and ophthalmologists. In addition to providing care and having a level I and level II nursery capability, a Level III neonatal intensive care unit can:
Level IV (regional NICU)
The highest level of neonatal care provided occurs in the NICU's regional neonatal intensive care unit , or Level IV. Level IV units are required to have a child surgical subspecialist in addition to the necessary care providers for Level III units. Regional NICUs have all the capabilities of Level I, II, and III units. In addition to providing the highest level of care, the IV level of NICU:
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References
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