Neonatal Intensive Care Unit
The development of separate Neonatal ICUs recognizes unique problems and requirements of critically ill newborn babies. The Neonatal ICU (NICU) should not be seen in isolation, but as a vital part of a tertiary pediatric center, with well-defined pre-hospital care, emergency medical services, and retrieval teams.
In general, a NICU should provide:
- a) a specialist trained in pediatric intensive care available at short notice
- b) a range of pediatric subspecialty support immediately available junior medical staff with advanced life support skills
- c) nursing staff with experience in pediatric intensive care.
d)Allied health professionals and ancillary support staff specialized in advanced life support equipment for children ranging in age from neonates to adolescents
There may be many reasons for hospitalization of a neonate in an ICU. Most prevalent reasons for admission to a NICU include:
- Preterm delivery
- Low birth weight
- Perinatal problems
- Congenital abnormalities.
Preterm delivery is defined as less than 37 completed weeks of gestation (full term is 38-42 weeks). In reality, those preterm infants who may require admission to a NICU are likely to be less than
32 weeks of gestation and weigh less than 2500 g.
Low birth weight
Infants who are born preterm will have a low birth weight, but more mature infants may be of low birth weight due to intrauterine growth retardation. Other causes include placental dysfunction, smoking, and intrauterine infection, e.g. rubella.
The problems occurring at or around the time of birth, e.g. birth asphyxia or meconium aspiration,
may lead to an infant being admitted to the NICU.
Problems of preterm and low birth weight infants
- Respiratory distress
The main cause of respiratory distress in preterm infants are respiratory distress syndrome.
The primary cause of this syndrome is a lack of surfactant in the immature lung. The more
preterm the infant, the higher the incidence of Respiratory Distress Syndrome. Steroids should
be administered to women in preterm labor in order to enhance lung maturation.
Anatomical Differences in Neonates
There are more chances of upper airway obstruction in neonates due to the presence of following anatomical differences.
- Neonates have larynx situated higher in cervical region
- Epiglottis is narrower
- Limited cartilaginous support of upper airway
- The larynx is positioned higher.
- Low resistance of nasal air passage
There are more chances of alveolar collapse. It may happen due to:
- The number of conducting airways is completed by 16 wks of gestation but the support of mature cartilage & elastic tissue is reduced in infants.
- Poor lung expansion
- Collateral channels ( pores of Kohn & Lambert canals) present in small numbers
- Rib cage configuration
- Circular in horizontal plane in infant
- Slopes gradually in caudal direction
- Attains shape similar to adults by 10 yrs of age
Physiological differences in neonates
- Reduced Lung compliance
- Greater inflation pressure required to maintain lung volumes
- Increased work of breathing.
- Problem exacerbated when the surfactant is deficient & alveoli are maintained at low lung volumes (decreased FRC).
- Apnea: common, if occur for long periods, can lead to bradycardia, oxygen desaturation
- Periodic breathing common during sleep in normal infants
- TUBE TYPES
Polyvinyl chloride or elastic tubes are suitable for long-term intubation
- TUBE SIZE
A selection of sizes, one larger and one smaller than the anticipated size, should be available at intubation.
Oral or nasal tubes may be used. Orally placed tubes are preferred in acute resuscitation and when only a short duration of intubation is required.
- Tube length (depth)
The endotracheal tube tip should be located in the mid-trachea so that the risks of accidental extubation and endobronchial intubation are minimized.
The adult curved Macintosh blade is suitable for all pediatric patients except neonates and infants, in whom a straight blade is needed to displace the relatively large epiglottis anteriorly from the laryngeal inlet.
- Suction catheters
Sizes 5, 6, 8, 10 and 12 FG should be available. The suction catheter should be large enough to remove secretions but not too large to occlude the endotracheal/tracheostomy tube lumen.