Levels of Newborn Care

LEVELS OF NEW BORN CARE

TARGET POPULATION

High-risk infants including those born preterm or with serious medical or surgical conditions

Management

• Establishment of regional systems of perinatal care
• Establishment of uniform classification of the functional capabilities of facilities
• Establishment of uniform national standards such as requirements for equipment, personnel, facilities, ancillary services, and training, and the organization of services (including transport)
• Collection of population-based data on patient outcomes, including mortality, specific morbidities, and long-term outcomes

Level I (Basic):

·   

    A hospital nursery organized with the personnel and equipment to perform neonatal resuscitation, evaluate and provide postnatal care of healthy newborn infants, stabilize and provide care for infants born at 35 to 37 weeks' gestation who remain physiologically stable, and stabilize newborn infants born at less than 35 weeks' gestational age or ill until transfer to a facility that can provide the appropriate level of neonatal care.

Level II (Specialty):

 

•         A hospital special care nursery organized with the personnel and equipment to provide care to infants born at more than 32 weeks' gestation and weighing more than 1500 g who have physiologic immaturity such as apnea of prematurity, inability to maintain body temperature, or inability to take oral feedings; who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis; or who are convalescing from intensive care.

•         Level II care is subdivided into 2 categories that are differentiated by those that do not (level IIA) or do (level IIB) have the capability to provide mechanical ventilation for brief durations (less than 24 hours) or continuous positive airway pressure.

Level III (Subspecialty):

•  A hospital NICU organized with personnel and equipment to provide continuous life support and comprehensive care for extremely high-risk newborn infants and those with complex and critical illness.
• Level III is subdivided into 4 levels differentiated by the capability to provide advanced medical and surgical care.

·         Level III A:

o   Restriction on type and /or duration of mechanical ventilation

·         Level III B:

o   No restrictions on type and /or duration of mechanical ventilation

o   No major surgery

·         Level III C:

o   Major surgery performed on site

o   No surgical repair of serious congenital heart anomalies that require cardiopulmonary by pass.

·         Level III D:

o   Major surgery + surgical repair of  serious congenital heart anomalies that require cardiopulmonary by pass.

REQUIREMENTS

Level II:

·         Space 50 sq ft – per baby

·         Availability of mother room desirable

·         Nurse-patient ratio is 2-3: 1  

·         Written protocol should be available

·         Training and CNE for staffs

·         Equipment: 1 for 5 patients

o   open care system incubator

o   vital sign monitor

o   apnea monitor

o   BP monitor

o   resuscitation kit

o   infusion pump

o   infant ventilator

Level III:

·         Space 80 – 100  sq ft – per baby

·         Availability of mother room essential

·         Equipments:

o   -open care system incubator

o   -vital sign monitor

o   -apnea monitor

o   -BP monitor 1 per bed

o   -resuscitation kit

o   -infusion pump

o   -infant ventilator

o   -cold light source

o   -PO2 and CO2 monitor

o   -ECG monitor with defibrillator

o   -Invasive BP monitor

o   -Intracranial pressure monitor

o   -ABG machine

o   -Portable X ray machine

o   -Portable Ultrasonography machine

·          

       Laboratory facilities:

o   Biochemistry, Microbiology and Hematology

·         

            Patient care team:

o   Neonatologist

o   Nurse patient ratio = 1:1

o   Pediatric surgeon

o   Respiratory therapist, Nutritionist,Opthalmologist

o   Physiotherapist, Biomedical engineer,Audiologist

o   Developmental pediatrician.

·         Transport facilities:

o   With facilities for

o   -warming

o   -resuscitation and assisted ventilation

o   -monitoring

o   -oxygen supply

·         Written protocol should be available

·         Training and CNE for staffs

PRIMARY, SECONDARY AND TERTIARY CARE

Primary care (level 1)

o   Essential health care to the low risk neonate (75%).

o   Primary health centres, subcentres and municipality hospitals provide such care.

Secondary care( level 2)

o   The next higher level where high risk neonate (20%) are managed.

o   District and subdivisional hospitals and Rural hospitals with obstetric, anaesthetic and paediatric specialities provide such care.

Tertiary care ( level 3)

•         Provide highly specialized care for high risk neonate(5%).

•         Medical college Hospitals, Regional centres and All India Institutes provide such care. These centres are equipped with highly specialized units covering all the diciplines.

Reports and records

•         Newborn file:

o   nurses record

o   prescription

o   vital signs record

o   operation note

o   investigation reports

•         Growth record

•         Birth record

•         Birth certificate record

•         Admission and discharge record

•         Morbidity record

•         Mortality record

•         Incident report

•         Newborn screening record

•         Safety compliance and Inspection records

•         Equipment maintenance and calibration record

•         Inventory record

•         Procedure manual

•         Emergency response plans and procedure

•         Hazard exposure records

•         Bacteriological and parasitology examination requests and results records

•         Research records