Adiva Nursery
Neonatal ICU
With improved technological and medical expertise, NICU unit of Adiva is established as one of the best, not only in Delhi but also in India. Strength of the unit comes from the ‘state of the art’ obstetrical and perinatal services rendered in the hospital, which attracts large number of high-risk deliveries. We have one of the newest nursery with 5 beds and 40-50 admissions per annum.
SERVICES PROVIDED
- Care of preterm and very low birth weight babies: The preterm babies have many problems including respiratory difficulty, feeding intolerance, infection and increased chances of bleeding. The unit has 2 Warmer with in-built temperature control and oxygen delivery system. The survivals are improving over months.
- Mechanical ventilation: The unit has mechanical ventilator to support babies with breathing difficulty. We have C-PAP ventilators, which is a gentler, and better mode of ventilation is specific conditions.The NICU takes pride in declaring that it was the upcoming unit in private setup to start ventilation. The survival of babies on mechanical ventilation has improved markebly now.
- Parenteral nutrition: Because of poor swallowing capability and immature gastrointestinal functions, the small preterm and sick babies are not able to tolerate oral feeds well and require intravenous nutrition in form of fats and proteins. We have been using intravenous nutrition in our unit which is well supported by pioneer work in Parenteral Nutrition initiated in the department.
We encourage breast feeds at the earliest and mothers express their milk in the nursery and very premature babies are started on expressed breast milk at the earliest. Mothers are also involved in the care of the baby. They are encouraged to hold the baby next to their skin (Kangaroo Mother Care) which helps in establishing lactation and also improves the bonding with the baby. - Surfactant delivery: Premature lungs are deficient in surfactant chemical which results in breathing difficulty and they may require ventilatory support. Giving surfactant to these babies improve their lung function, helps them come out of ventilator faster and ultimately helps in improving survival and reduce hospital stay. We have been using surfactant in these babies with good results.
- Neurosonography: Premature babies are prone to have intraventricular hemorrhage (brain hemorrhage) especially in first week of life. Sick ventilated babies also have a higher chances of having such problem. Bed side ultrasound is very important in picking up these hemorrhages for diagnostic value, to decide treatment modalities and to prognosticate. We have the facility of portable USG round the clock done by very senior consultants in the field.
Ultrasound is also used to diagnose many malformations related to other organ systems. - Bed side X-ray facility: X-ray machine is stationed in the nursery to get the X-rays of the babies without any untoward delay.
- Developmental support team: A team comprising of a Developmental Pediatrician visits the nursery regularly and remains involved in the developmental support of the sick preterm babies. We try to give physical, visual and auditory stimuli once sick babies are stable for their faster recovery and rehabilitation.
- Staff nurses: We have trained neonatal staff nurses to take care of the neonates. We have a nurse : baby ratio of 1 : 2 for intensive care area and 1 : 3 nurse : baby ratio for babies not requiring intensive care.
- Routine Hearing Screening: All babies in nursery are subjected to OAE (Otoacoustic Emission Test) done to pick up babies with hearing loss. It is a simple test done in nursery itself and has been a great help in picking up babies with hearing loss.
There is a neonatal consultant available round the clock in the NICU along with the resident staff. - Procedures: All procedures related to the neonate like exchange transfusion (both central and peripheral), peritoneal dialysis, surfactant delivery, central line insertion, arterial line insertion and intercostal tube drainage are carried out with precision.
Common neonatal problems and solutions
Prematurity: Babies born before 37 weeks of gestation are premature and especially those born before 34 weeks are more prone to have problems. These babies may need to be in the nursery for a period of 1-8 weeks depending on the level of prematurity. These babies require special care in NICU including temperature control, respiratory support, and nutritional support.
Respiratory Distress: It means difficulty in breathing in newborn, which may manifest as fast or laboured breathing. It may be because of prematurity per se due to immaturity of lungs, congenital or aspiration pneumonia or rarely structural congenital malformations of the lungs. Baby may need oxygen therapy with hood or may need to be supported with a ventilator (artificial life support system). Such babies need closed monitoring for first 5-7 days and are also given intravenous fluids, antibiotics and other supportive medications. Preterm babies may require a medicine called "Surfactant", which is instilled in their lungs for better lung maturity.
Thermoregulation: All newborns have a higher chance of having low temperature called hypothermia. They are properly covered with clothes specially covering the head, hands and feet. They are placed in incubators or radiant heat warmers specially designed to take care of their temperature and humidity needs. Those babies whose hands and feet are cold, but rest of body is warm are in cold stress which may be a sign of sickness and it also results in poor weight gain.
KMC (Kangaroo Mother Care): It is a technique where the mother keeps the baby close to her with skin to skin contact within her clothing. This helps the baby to maintain temperature and also helps to establish bonding between mother and baby and breast-feeding.
Nutritional support: Though breast feeding is the best feed for all sick and premature babies alike, many of these babies are not in a condition to accept direct breast feeds. They are given intravenous nutrition initially and then expressed breast milk through orogastric tube, which goes from mouth to stomach. Later breast feeds are supplemented to fulfil the increased protein and calorie requirements of sick and preterm babies.
Retinopathy of prematurity: It is a disease almost exclusively limited to premature babies and is an important cause of blindness in these babies. It is due to developmental immaturity of the newborn eyes and is usually seen in babies 1500 gms of birth weight. A small percentage of babies (6-10%) with ROP may require laser surgery. Frequent eye check ups are required from 4 weeks of age after birth to monitor the growth of retina to be continued till 42 weeks of gestation
Do's and Don'ts of newborn care
- Baby should be given only breast milk for first six months of life.
- Exclusive breast feeding means nothing except breast-feeds not even water, ghuttis, gripe water, tonics or any form of milk.
- Babies need proper clothes, which cover them properly especially head, hands and feet. They should not be over clothed as well.
- Babies pass watery stools after first 3-4 days of life especially after feeding which is normal for them.
- A baby, who is feeding well, will be passing urine at least 8-10 times a day.
- Babies don't need any Kajal, Surma, Talcum powder or daily bath. Bathing should be postponed for first few days after birth. A good rule to follow is delay bath till umbilical cord falls.
