Sncu Process In Madhya Pradesh Nipi Districts

Sick New Born Care Unit Neonatal mortality accounts for over 60% of Infant mortality and around 40% or fewer than five mortality. Further reduction in Infant and Child mortality is critically dependant upon significant decline in Newborn deaths. Now with Advent of JSY an average 70% of deliveries are conducted in the institutions, i.e., at P.H.C, C.H.C. & C.H and District hospitals, there are no separate facilities to manage sick Neonates in the hospital and health centers, Even at district hospital, the sick Neonates (Home delivered and Institutional delivered) are generally treated along with the older sick children.

Global Estimate of Cause of Neontal Mortality (WHO) Other, 5% Congenital Anomalies, 10%

Infections , 32%

Prematurity, 24%

Asphyxia, 29%

OBJECTIVE:

The sole objective of these UNIT’s in NIPI Districts is to reduce the Neonatal mortality Rate or death of Newborn during the first month of life.

COMPONENTS: (a) Coordination of Health Department, NIPI and IPGME & R(Kolkatta) to provide strategic partnership to bring down the NMR. (b) Strengthening of Health facilities already existing, by developing levelII Care at the District Hospital and Stabilizing Units at the P.H.C, CHC (c) Capacity development including training of Sisters and Doctors in Critical Newborn Care. ( Training is planned to be done by NNF M.P. Chapter and IPGME&R Kolkatta.

FACILITIES: The fully air conditioned 12, bedded (Step Down 8 bed Extra) unit has a set up with servo 'controlled radiant warmer" photo therapy units, digital weighing scale, pulse oxi-meter, syringe pump, ABG machine, electrolyte analyzer, portable X-ray, Central Oxygen supply, autoclave and washing machine (supported by AHSD, Purulia Branch) which can be compared with any modern super specialized institution. The unit is manned with four trained Pediatricians, Twelve trained nursing staff and other supportive staffs which are arranged from the existing manpower of District Hospitals.

FUTURE EXPANSION:All the CHC’s / DH would have stabilization units linked up to the central unit. Community Mobilization, such as Women's group, TBA School Children, Adolescent girls for community participation in Neonatal Care would be developed to reach the deprived. Yashoda Working in Maternity Wards will be helping the care of newborn and educating mothers of children needing special care. All such programmes will be linked and integrated with the Apex Unit.

PROTOCOLS FOR NEWBORN UNIT

1. Neo-natal Unit is a separate unit within the District Hospital 2. Civil Surgeon, District Hospital is the overall charge of the unit like other units of the District Hospital 3. All babies born in this hospital will be looked after by this unit 4. New born babies, will be admitted directly in the pediatric ward under the bed-in charge of pediatrics and if they require intensive care, they may be transferred to the Neonatal Unit subject to availability of beds. Once stabilized the newborn will be transferred back to the pediatric ward under the same pediatrician. During the newborn's stay at the Neonatal Unit his/her mother will occupy his/her bed. 5. There is provision of running 21 beds, but to start with it will run with 12 beds. 6. The District Health Society will provide for any critical gap in terms of economics. 7. DHS may change the terms and conditions after reviewing the progress of this unit.

GENERIC PLAN FOR DISTRICT LEVEL SICK NEWBORN CARE UNITS (LEVEL II) Sick Newborn Care Units (SNCU) are a special newborn unit meant primarily to reduce the case fatality among sick children born within the hospital or outside, including home deliveries within first 28 days of life. These units will have: 1) Main Sick Newborn Care Unit: This should have at least 12 beds, which would cater to the sickest child in the Hospital. It will have space for nursing work station, Hand Washing and Gowning at the point of entry. 2) Step down unit for children: This is an additional 6 bed Step down Unit where recovering neonates can stay i.e. neonates who don’t need intensive monitoring. 3) Special newborn care ward: This is an additional 10 beds , where both the mother and the newborn can stay together for neonates who require minimal support such as for phototherapy , uncomplicated low birth weight for observation esp. weighing more than 1800gm and superficial infections etc. 4) Follow up area: This should be an additional area outside but not far away from the SNCU. This should be designated for follow up of the neonates discharged from the SNCU. 5) Newborn corner with facilities for neonatal warmer and resuscitation at the labor room and Obstetrics Operation Theatre 6) Side laboratory room with facilities for at least doing neonatal septic screen and measuring bilirubin level 7) Teaching and training room. 8) Day and Night shelter for mothers of out born neonates with I.E.C. facilities e.g. T.V. with Audio- Video facilities 9) Place for In-house facility for washing, drying and autoclaving 10)Duty room for doctors and Nurses 11) Place for Promotion of Breast feeding and learning mother craft 12) Place for Soiled Utility/Holding Room and Clean Utility/Holding Area(s)

Pictures of a Model SNCU:- (Pictures Courtesy IPGME & R Kolkatta:- Dr Arun Singh)

WARD

HAND WASHING CORNER

NEWBORN CARE

Pictures Courtesy IPGME&R and District Health Society Purulia and GOVT of West Bengal

SIDE LAB

STERILISATION UNIT

STERILISATION UNIT

Sister Giving care to Baby PHOTOTHERAPY

Pictures Courtesy IPGME&R and District Health Society Purulia and GOVT of West Bengal

BREAST FEEDING & SISTERS STATION

Infant Mortality Rates Decline in India Dr Amitav Sen Presentation

NIPI- A Child Health Initiative to Achieve MDG-4