A superspeciality health care hospital
   

            Department of Neonatology
            BABY FRIENDLY NEONATAL INTENSIVE CARE UNIT

Faculty

Dr. Usha Saxena
 (Emeritus)
Dr. Neelam Kler
(Chairperson)
Dr. Satish Saluja
 (Vice Chairperson)
Dr. Pankaj Garg
Dr. Arun Soni

Sister Thressiama
(Nursing Incharge)

24 hour helpline: 9810484848

HIGH RISK FOLLOW UP CLINIC

Clinic: GRH OPD 12.00 Noon - 2.00 PM every day, Room no 14

Neonatal ICU

Care of newborn babies has vastly improved in India over last two decades. The department of Neonatology takes pride in undergoing this transformation. This unit came into existence in 70's. With improving technological and medical expertise this unit has 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 largest nurseries with 26 beds and 1000-1200 admissions per annum.


Preterm baby on ventilator in an incubator
Baby on ventilator

SERVICES PROVIDED

  1. 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 10 incubators with in-built temperature control and oxygen delivery system. The survivals are improving over years.

  2. Mechanical ventilation including high frequency ventilation: The unit has mechanical ventilator to support babies with breathing difficulty. We have 8 state of the art ventilators including 6 high frequency ventilators, which is a gentler, and better mode of ventilation is specific conditions.

    The NICU takes pride in declaring that it was the first unit in private setup to start ventilation. The survival of babies on mechanical ventilation has improved markedly now. We are in the process of acquiring Nitric Oxide which is a modality used in very sick patients on ventilator to help them come out of ventilator faster.

  3. Parentral 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 requires intravenous nutrition in form of fats and proteins. We have been using intravenous nutrition for very long time in our unit which is well supported by pioneer work in Parentral 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.

  4. Surfactant delivery: Premature lungs are deficient in this chemical which results in breathing difficulty and they may require ventilatory support. Giving surfactant to these babies improve their lung function, helps them coming out of ventilator faster and ultimately helping in improving survival and reduce hospital stay in them. We have been using surfactant in these babies for a long time for very good results. We are amongst the earliest centers in the country to start using surfactant.

  5. Echocardiography: Bed side echocardiography is very important tool in the diagnosis and management of heart problems in premature as well as term babies. We are very fortunate to have the services of Dr. Vikas Kohli, who is the qualified Pediatric Cardiologist round the clock who has been managing all heart problems related to neonates.

  6. 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 modalites and to prognosticate. We have the facility of portable USG round the clock done by very senior consultants in the field.

    Ultrasound in also used to diagnose many malformations related to other organ systems.

  7. Bed side Xray facility: Xray machine is stationed in the nursery to get the Xrays of the babies without any untoward delay.

  8. Pediatric surgery facilities: We have excellent facilities for neonatal surgeries with 4 senior Pediatric Surgeons attached to the unit.

  9. Developmental support team comprising of a Developmental Pediatrician and an occupational therapist 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.

  10. 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.


    Neonatal Nurse taking care of premature baby

  11. Comprehensive eye checkup: We have ROP screening program for our premature babies. ROP is a disease of very preterm babies, which can lead to blindness if not treated in time. ROP screening program has been going on for last 8 years and despite the improved survivals of these babies, the blindness has been prevented in majority of babies. We have committed neonatal ophthalmologist Dr. Amit Khosla who takes care of the ROP program. Babies with advanced stage ROP are treated with laser therapy at the earliest. We have one of the best results in this modality and we get lot of referral for laser therapy from various NICUS' of the country.

  12. Routine Hearing screening: All babies in nursery are subjected to OAE (otoacoustic emission test) done to pick up babies with hearing loss. It isa simple test done in nursery itself and has been a great help in picking up babies with hearing loss.

  13. There is a neonatal consultant available round the clock in the NICU along with the resident staff.

  14. 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.

SURVIVALS

Outcome of babies less than 1000 gms in last 5 yrs

The survival of babies weighing more than 1000 gms has reached 90% and has been improving over last 5 years now.

NEONATAL TRANSPORT SERVICES

Excellent neonatal transport facilities are available round the clock. The resident doctor on duty carries cellular helpline (9810484848) and on receiving the requisition for transport, the transport team comprising of a doctor and a technician goes with the transport incubator fitted with ventilator and monitoring equipment. Over last two years, our transport team has been transporting sick newborn babies not only from various parts of Delhi but also from surrounding states. The air lifting of a baby from Amritsar was well acknowledged in the leading newspapers.


Transport Ventilator and Incubator

ACADEMIC PROGRAM

We have a regular teaching schedule for the residents three times a week at 9.15AM. We run an excellent academic curriculum for the nurses, postgraduates and residents. The department has been organizing CMEs, workshops and conferences on regular basis.

The departmental academic credits are well represented in National, International forums, Conferences and journals. Consultants in the department have been closely associated with National Neonatology Forum, India and actively participate in various community health programs coordinated by NNF.

Advanced CME on Neonatal Issues: Case Scenario Based Protocols
Organised at India Habitat Centre on 12th and 13th April 2003

We conduct training program for pediatricians in neonatal intensive care. Pediatricians from all parts of India join us as clinical observer and work in house to learn all aspects of neonatal intensive care.

Forth-coming course in Neonatal Intensive Care Workshop: A 5 day programme to be held in the month of August 2004

NICU SUPPORT GROUP

The department has been instrumental in forming a "NICU parent support group" which provides emotional, educational and psychological support to the stressed parents of the babies admitted in the neonatal unit.

CASE STUDIES

BABY WEIGHING 800gms GOES HOME AFTER 2 MONTHS OF HOSPITAL STAY

B/R was born outside the hospital by Normal Vaginal Delivery and shifted to our center at 3 hours of life. The mother had one missed abortion at 5 months of pregnancy earlier. This baby was born at 6months of gestation (26-27 weeks) and weighed 800gms. Baby received two doses of surfactant (a medicine instilled in lungs of premature babies to enhance their functioning), required specialized care in the NICU for two months. Baby also underwent hernia repair surgery just before discharge (at weight of 1700 gms). Baby is active, playful and is neurologically fine at the moment. Baby has been discharged on 15/5/03 after a stay of 2 months and 7 days with the advice of frequent follow-ups.

BABY AIR LIFTED FROM AMRITSAR GOES HOME

B/M was born in Amritsar by normal vaginal delivery. Baby was born full term and weighed 3.250 Kg. Baby started having tachypnea soon after birth which required nursery admission. On second day of life, baby was excessively irritable and had seizures. Baby was becoming drowsy and at that stage the attendants contacted us for transport of the baby. The baby was airlifted in a charted air craft in the transport incubator - ventilator after initial stabilisation. Baby had respiratory distress requiring oxygen for first two days. Baby was thoroughly investigated and after getting satisfactory reports, started on feeds which baby accepted well. Baby improved and became active and discharged after total stay of 8 days.

Survival of inborn versus outborn babies in Sir Ganga Ram Hospital, Nursery

Information for Parent 

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 means difficulty in breathing in newborn, which may manifest as fast or laboared 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 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 though 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 fulfill 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 covers 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.

  • Vaccination is the most cost-effective way of health for children.

Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, INDIA
Tel: 25735205, 25861463 Fax: 25861002 Email: gangaram@sgrh.com
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