Levels of Neonatal Care

1. Introduction

Effective organization of newborn care is essential to reduce neonatal mortality (30% of global neonatal deaths occur in India).
Services are organized into a three-tier system based on the complexity of care required and the level of the health facility.

Care is provided at three distinct levels corresponding to the health infrastructure:

Location: Sub-centers and Primary Health Centers (PHC).
Facility: Newborn Care Corner (NCC).
- Mandatory space within the labor room/OT.
Target Group: All newborns at birth (approx. 85-90% of deliveries).
Services:
- Essential care at birth (warmth, drying).
- Basic resuscitation (bag and mask).
- Early initiation of breastfeeding.
- Weighing.

Location: Community Health Centers (CHC) and First Referral Units (FRU).
Facility: Newborn Stabilization Unit (NBSU) (in addition to NCC).
Target Group: Sick newborns and Low Birth Weight (LBW) babies not requiring intensive care.
Services:
- Resuscitation and provision of warmth.
- Management of sepsis, neonatal jaundice, and feeding support.
- Stabilization of sick neonates before referral to Level III.

Location: District Hospitals (DH).
Facility: Special Newborn Care Unit (SNCU).
Requirement: Mandatory for facilities with >3000 deliveries/year.
Target Group: Sick newborns requiring special care (excluding assisted ventilation and major surgery, per basic guidelines).
Services:
- Care of VLBW infants.
- Management of severe sepsis, hyperbilirubinemia.
- Exchange transfusion.

Space: 20–30 sq. ft. clear floor area within the labor room.
Environment: Draft-free, appropriate power source.
Essential Equipment:
- Radiant warmer (fixed height).
- Resuscitation kit (Bag and mask - 500ml).
- Suction pump (foot-operated or Dee Lee trap).
- Weighing scale.
Staffing: 1 Staff nurse/ANM (in addition to the delivery attendant).

Space: ~200 sq. ft. for a 4-bedded unit (40–50 sq. ft. per bed).
Location: Close proximity to the labor room.
Equipment: 4 Radiant warmers, phototherapy unit, laryngoscope, oxygen supply.
Staffing:
- Nurses: 1 dedicated staff nurse round-the-clock.
- Doctors: Medical officer skilled in newborn care.

Bed Strength: Minimum 8, Maximum 16 (based on 3 beds/1000 annual deliveries + 30% extramural buffer).
Space Requirement: 100 sq. ft. per bed minimum.
- Baby Care Area: 50 sq. ft./bed.
- Ancillary Area: 50 sq. ft./bed (Stations, Lab, Mothers' area).
Zoning:
- Clinical: Baby care area (divided into interconnected rooms), Examination area.
- Support: Gowning room, Clean utility, Soiled utility (negative pressure), Side lab.
- Mothers' Area: For expression of breast milk (EBM) and KMC.
Environment:
- Temperature: Maintained at 26–28°C (78.8–82.4°F).
- Lighting: Cool white fluorescent/CFL/LED; shadow-free; no direct glare on neonate.
- Water/Power: 24-hour uninterrupted supply + Generator backup (25-50 KVA).
Staffing (Standard 12-bed Unit):
- Doctors: 3 Physicians (round-the-clock cover).
- Nurses: 10 Staff Nurses (approx 1:3-4 ratio to cover shifts and leave).
- Support Staff: 4.

Hand Hygiene:
- Single most effective measure.
- Elbow-operated taps; sinks located within 20 ft of every bed.
- Hand washing: 2 minutes before entry; 20-30 seconds (hand hygiene) between babies.
Space: Minimum 3 ft distance between beds.
Asepsis:
- Strict gowning and shoe change policy.
- Restrict visitors (Policy: Parents allowed for care/feeding; others restricted).
- One set of instruments (stethoscope, thermometer) per baby if possible.
Biomedical Waste: Proper segregation (Yellow, Red, White, Blue bins) and disposal.