At Rajagiri Hospital, our Neonatal Intensive Care Unit (NICU) provides care for babies after birth who need special attention. Some of the reasons include preterm birth, low birth weight, breathing difficulty, low blood sugar and infection.

Our level 2 beds in the nursery provide care for some babies who are convalescing but who continue to require the services of a specialized hospital.

Physicians, nurses and support staff who work in the NICU are available 24 hours a day, 7 days a week. The NICU team participates in all births when it is expected that the baby may experience difficulties.

Members of the NICU team also meet with mothers before the birth of their baby to discuss the care that their baby will need and what the family can expect after the baby is born.

Family integrated care is the philosophy that is guiding how we provide care for the infants in our NICU .Parents are encouraged to be active members of the team that takes care of their infant while in our unit. Our nurses understand the unique medical needs of infants and can teach parents to understand how best to care for their babies.

Learn more about Family Integrated Care

Neonatal Intensive Care Unit (NICU)

Rajagiri hospital

Chunangamvely

Aluva – 683112

Kerala, India

Phone: +91 – 484 – 6655000, ext. 5238,5240

Email: mail@rajagirihospital.com

What is the neonatal intensive care unit?

Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained healthcare professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU and babies must be transferred to another hospital.

Although about 9 percent of all newborn babies require care in a NICU, giving birth to a sick or premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds and equipment in the NICU can be overwhelming. This information is provided to help you understand some of the problems of sick and premature babies. You will also find out about some of the procedures that may be needed for the care of your baby.

Which babies need special care?

Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birth weight (less than 2500 grams), or have a medical condition that requires special care. In Kerala, nowadays more number of babies are born preterm, and many of these babies also have low birth weights. Twins, triplets and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections or birth defects are also cared for in the NICU.

The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following:

Maternal factors:

• Age younger than 16 or older than 40 years
• Drug or alcohol exposure
• Diabetes
• Hypertension (high blood pressure)
• Bleeding
• Sexually transmitted diseases
• Multiple pregnancy (twins, triplets, or more)
• Too little or too much amniotic fluid
• Premature rupture of membranes (also called the amniotic sac or bag of waters)

Delivery factors:

• Fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen)
• Breech delivery presentation (buttocks delivered first) or other abnormal presentation
• Meconium (the baby's first stool passed during pregnancy into the amniotic fluid)
• Nuchal cord (cord around the baby's neck)
• Forceps or cesarean delivery

Baby factors:

• Birth at gestational age less than 37 weeks or more than 42 weeks
• Birth weight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces)
• Small for gestational age
• Medication or resuscitation in the delivery room
• Birth defects
• Respiratory distress including rapid breathing, grunting or apnea (stopping breathing)
• Infection such as herpes, group B streptococcus, chlamydia
• Seizures
• Hypoglycemia (low blood sugar)
• Need for extra oxygen or monitoring, intravenous (IV) therapy or medications
• Need for special treatment or procedures such as a blood transfusion

Who will care for your baby in the NICU?

The following are some of the specially trained healthcare professionals who will be involved in the care of your baby:

• Neonatologist - a pediatrician with additional training in the care of sick and premature babies. The neonatologist supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU.
• Occupational therapists
• Dietitians
• Lactation consultants
• Pharmacists
• Hospital chaplains.

The members of the NICU team work together with parents to develop a plan of care for high-risk newborns.

Neonatal Intensive Care (NICU)

If you have a preemie, a high-risk pregnancy or a newborn with critical medical needs, you want to be assured that there is a team in place ready to care for the region’s smallest patients.

The Neonatal Intensive Care Unit at Rajagiri Hospital lays stress on its family-centred care philosophy where families are an important part of their child’s team.

You are encouraged to actively participate in the care of your infant, and join the medical and nursing staff in our daily rounds when we discuss your baby’s treatment plans .Every infant is unique, and families are the most important and constant factor in an infant’s life .Staff members respect and support the role of family as the primary caregivers for the infant’s life.

An Environment That Improves Survival

Muted lights, minimized noise and an environment that encourages bonding makes our NICU a model for other NICU’s throughout the country. This type of environment, among other things, has been shown to improve the survival of critically ill infants and helps babies get better faster .We do this by:

• Creating a soothing environment similar to the womb
• Promoting parent and child bonding, critical to infant survival
• Providing facilities and physicians the privacy that is sometimes necessary to manage the most difficult conditions
• Reducing the external stimuli that can be stressors for newborns
• Minimizing the movement of the child from  one environment to another

Services and Related Information

• Information for Families
• NICU Programs and Services
• Information for Physicians
• Glossary of NICU Terms

Information for Families

• Family Integrated Care
• What to Expect
• Multi-disciplinary Team
• NICU Visiting Hours
• Obtaining Information about Patients
• Parking
• Infection Control
• Security

Family Integrated Care

What is Family Integrated Care?

Family Integrated Care is the philosophy that is guiding how we provide care for the infants in our NICU. Parents are encouraged to be active members of the team that takes care of their infant while in our unit. Our nurses understand the unique medical needs of infants and can teach parents to understand how best to care for their babies .Our nurses also understand the unique role that parents can play in supporting and caring for their infants while in the NICU.

What is the purpose of Family Integrated Care?

The goal of Family Integrated Care is to partner you with your nurse and the medical team which will help you feel more confident and comfortable caring for your infant. We hope that by the time your baby is discharged home, you will feel more secure taking care of and understanding the needs of your baby.

What does Family Integrated Care mean for me?

Morning Medical Rounds

We feel that if you are present and participate in medical rounds, you will have a better understanding of the care that is provided to your baby. These rounds occur every day in the morning.

Parenting Your Baby

With the support provided by your baby’s nurse, you will learn to feel more comfortable caring for your baby and holding your baby skin-to-skin as much as possible. The medical team, especially the nurses, will continue to act as coaches to assist you in taking over most of the care of your baby as your baby gets better and closer to discharge.

What to Expect

Equipment

Because babies being cared for in the NICU need special medical attention, you will be seeing many pieces of equipment around each baby’s incubator and throughout the nursery. This may be overwhelming at first, but be assured that the equipment helps us deliver the best possible care for your baby. You baby’s nurse will help you familiarize yourself with all of the equipment.

Staff

Nurses, working 8-hour shifts, will help you learn how to care for your baby. Your involvement and presence is very important and as your baby improves, you will find yourself more involved in your baby’s care. During your baby’s stay, care is supervised by full-time neonatologists and nurse managers in conjunction with fellows and residents. A Fellow is a qualified pediatrician receiving additional training in neonatology. A Resident is a qualified medical doctor training to be a pediatrician.

Multi-disciplinary Team

• Neonatologist -  a pediatrician specializing in the care of newborns , the head of the medical team
• Neonatal Fellow – a qualified pediatrician receiving additional training in neonatology
• Neonatal Resident – a qualified medical doctor training to be a pediatrician
• Medical Consultants
  • Cardiologist                -   for heart problems
  • Neurologist                - for brain and nervous system problems
  •  Nephrologist              - for kidney (urine) problems
  •  Gastroenterologist    – for intestinal problems and nutrition
  •  Endocrinologist          - for glands and hormone problems
  •  Hematologist             – for blood problems
  •  Ophthalmologist       – for eye problems
  •  Surgeon                       - for surgical problems
  •  Orthopedician            – for bone and joint problems
• Nursing
  • Registered Nurse (R.N.) – performs and coordinates your baby’s daily care
  • Team leader                    – experienced R.N. who leads the nursing staff
• Primary Nurse  - R.N. assigned to the care of your baby for their stay in the hospital
• Nursing Unit Administrator (NUA) – supervises all registered nurses, team leaders ,unit clerks and service assistants
• Unit Clerk  - coordinates admissions , transport calls ,interdepartmental consultations, discharge planning and transfer of patients
• Lactation Consultant – available to assist with breastfeeding and pumping
• Pharmacist – provides consultative services to the medical team in selecting and ordering medications
• Dietician – provides nutritional consultation to the medical team
• Occupational Therapist – available to work with your baby on any developmental issues
• Physical Therapist – available to provide structures activities aimed at recovery or rehabilitation
• Speech/feeding Pathologist – are specially trained to evaluate feeding patterns and problems in newborns. They help the baby learn how to suck, swallow and breathe in a coordinated way.
• Audiologist – are trained to test and evaluate hearing in newborns. All babies in the NICU have a hearing test prior to going home.
• Chaplain – available for spiritual and religious care and emotional support

Technicians

• Lab technician: During a baby's stay in the NICU, frequent blood tests are required to ensure that he or she is doing well. Lab technicians specially trained in drawing blood from a baby will be involved in each baby's care. While a baby has an arterial line (a thin tube that stays inserted into an artery for an extended period of time), most lab tests can be done on blood drawn from this line. If the baby no longer has an arterial line or is having a test where an arterial line cannot be used, blood will need to be drawn from another area of the baby’s body. Blood can be drawn in a variety of ways. Sometimes a needle and syringe will be used to draw blood, and sometimes a "heelstick" will be done to draw smaller amounts of blood. A "heelstick" is a small puncture to the baby's heel. Often, we will warm the foot and then use a small lancet (like that used by diabetics to do a finger stick to check their blood sugar) to puncture the heel to get a steady drip of blood as we gently squeeze the foot. This blood is either collected in a small glass cylinder, or dripped directly onto a test strip.
• Ultrasound technician: Many babies will need a variety of diagnostic tests performed to assess them for various issues. Ultrasound is a noninvasive test, like the one performed on pregnant women. A two-dimensional picture is obtained by using sound waves that bounce off the internal anatomy. Ultrasound can be used with Doppler, which gives an ultrasound color picture of blood flow. Ultrasound is a quick bedside procedure, without side effects, so it is used whenever possible to assist with diagnosis. The ultrasound technicians who perform these tests on the baby are specially trained to do ultrasounds on infants and children.
• X-ray technician: Most babies admitted to an NICU will receive some type of X-ray during their stay. This is an important diagnostic test, but it exposes the baby to radiation. The amount of radiation is carefully controlled in relation to each baby's size and weight. Most X-rays can be done at the baby's bedside using portable equipment. The X-ray technicians have been specially trained in X-ray techniques, portable X-ray and performing X-rays on critically ill infants and children.

NICU Visiting Hours

You are welcome to be with your family any time you’d like. The following guidelines provide a private and safe place for the families and babies.

• All visitors must be with one of the infants’ parents
• All visitors and parents must sign the logbook at the front desk when arriving and sign out when leaving
• Two visitors at a time may be with the parents at the bedside
• Brothers and sisters of the baby need to check in at the desk before each visit .They will be asked a few questions to make sure that they are in good health
• Children under 16 who are not brothers or sisters of the baby may not go into the nursery but are welcomed in the lounge

Access for parents and visitors may be limited in the following circumstances:

• During shift change – usually between 7:15 and 7:45 a.m., or in the evening. (Your nurse can let you know exactly when )
• During some medical procedure involving your baby or a nearby baby. Please discuss this with your nurse.
• Visitation hours for parents’ visitors may change to ensure the safety of staff and patients in the NICU

We have a limited amount of locker space available for valuables, please leave them at home.

Obtaining Information about Patients

Information is given only to the infant’s parents. They may call at any time. For security reasons, the ID band number is required before any information is given out. Call or toll free

Parking

Parents of babies in the NICU are eligible for parking passes .Social workers provide parents information on how to pick up passes.

Infection Control

With every visit, parents and visitors are asked to please remove all jewelry, roll up sleeves and wash hands and forearms thoroughly with soap and water. (Your baby’s nurse can help you with any questions you may have about hand washing)

You will be asked about your health and the health of each visitor you bring. Before visiting, please inform the nursing staff if you have a cold, fever, vomiting, diarrhea or any rash.

Please view the Infection Control reference sheet for more information.

Infection Control and Prevention (Reference Sheet)

Infection Control is a hospital-wide program at Rajagiri Hospital that minimizes the risk of infection to patients, staff and visitors.

Prevention of infections in the low birth weight infant requires all staff to pay special attention to patient care practices and to employ health standards .Below is some important information for you and your family because you also play a vital role in helping prevent infections.

Hand washing

Hand washing is the most important thing all of us can do to prevent infection from spreading. Before you enter the nursery, please wash your hands thoroughly with soap in the dispenser at the sink and with water .Wash every part of your hands- the front, back, between the fingers and your thumbs .Make sure your nails and nail beds are clean .Wash a little above your wrists and point your hands downward toward the sink so the germs can run off into the sink .Once you start washing your hands, continue for atleast 15 seconds .Rinse off all the soap and dry your hands well.

ALWAYS wash your hands:

• Before and after you touch your baby (and between babies, if you have more than one). Please avoid touching any other baby in the nursery.
• Wash your hands after you touch any area of your body that has a lot of germs –your nose, or mouth, head and hair, and after going to the bathroom.
• When you leave the nursery for a break, wash your hands each time you come back .Avoid handling your baby if you have a rash or open sores on your hands.

In order to protect your baby, we need ongoing information about your exposure to common health problems .You will be asked some questions by the nursing staff about fever, rashes or flu , etc. If you or anyone who has visited your baby experience any of the following

• Fever
• Diarrhea
• Vomiting
• Rash
• Cough
• Sore throat
• Runny Nose
• Itchy eyes

Please avoid coming to see your baby, but remember phone the NICU immediately.

If you have been in contact with someone who has or who develops within a week CHICKEN POX or MEASLES, or if you or anyone has developed them within one week of a visit to the NICU – PLEASE TELL US. The Nursery will discuss your situation with the Infection Control Department and a decision will be made regarding your coming to the NICU to see your baby.

NICU Programs and Services

The NICU at Rajagiri Hospital provides programs and services focusing on the wellness of your family and baby.

Screening Programs

• Hearing evaluations
• Eye evaluations for retinopathy of prematurity ,  a possible side effect of premature birth
• Metabolic disorders
• Car seat testing

Child Development Program

We assess your infants’ behavioral and developmental needs. This helps you to become well informed and comfortable in caring for your baby, and links you to community services that may be helpful when discharged. High risk infants are followed in the NICU Follow-up Clinic under the Infant Follow-Up Program (IFUP).

Infant Cardiopulmonary Resuscitation (CPR)

Classes are offered for parents who are urged to take a class before bringing their baby home.

Breast-feeding Rooms

Use these private spaces during feeding or pumping milk before your infant can breast-feed. Nurses and lactation consultants will encourage you to collect and store breast milk until the baby can be fed by breast.

NICU Family Resources and Teaching

The Neonatal Intensive Care Unit (NICU) provides parents and families with babies in the NICU access to current, high quality resources in support of their health information needs.

• Books and materials that focus on prematurity , parenting , breast feeding, newborn growth and development
• Brochures and pamphlets relevant to car seat safety ,respiratory syncytial virus , infant feeding and developmental progress
• DVDs and videos on the NICU experience , newborn care , parenting and home safety
• Information on community resources and support groups
• Internet information that pertains to prematurity , parenting and breast feeding

Assessment of newborn babies

Each newborn baby is carefully checked at birth for signs of problems or complications. A complete physical assessment will be performed that includes every body system. Throughout the hospital stay, physicians, nurses and other healthcare providers continually assess a baby for changes in health and for signs of problems or illness. Assessment may include:

Apgar scoring:

The Apgar score is one of the first checks of your new baby's health. The Apgar score is assigned in the first few minutes after birth to help identify babies that have difficulty breathing or have a problem that needs further care. The baby is checked at one minute and five minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color.

Each area can have a score of zero, one or two, with ten points as the maximum. A total score of ten means a baby is in the best possible condition. Nearly all babies score between eight and ten, with one or two points taken off for blue hands and feet because of immature circulation. If a baby has a difficult time during delivery, this can lower the oxygen levels in the blood, which can lower the Apgar score. Apgar scores of three or less often mean a baby needs immediate attention and care. However, only 1.4 percent of babies have Apgar scores less than seven at five minutes after birth.

Birth weight and measurements:

A baby's birth weight is an important indicator of health. The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs. (3.2 kg). In general, small babies and very large babies are at greater risk for problems. Babies are weighed daily in the nursery to assess growth, fluid and nutrition needs. Newborn babies may lose as much as 10 percent of their birth weight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 10 ounces in the first few days. Premature and sick babies may not begin to gain weight right away.

Most hospitals use the metric system for weighing babies.

Converting grams to pounds and ounces: 
1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1,000 grams = 1 Kg.

Measurements:

Other measurements are also taken of each baby. These include the following:

• Head circumference (the distance around the baby's head), is normally about one-half the baby's body length plus 10 cm
• Abdominal circumference - the distance around the abdomen
• Length - the measurement from crown of head to the heel.

A complete physical examination is an important part of newborn care. Each body system is carefully examined for signs of health and normal function. The physician also looks for any signs of illness or birth defects. Physical examination of a newborn often includes assessment of:

• Vital signs:
  • Temperature - able to maintain stable body temperature 98.6° F (37° C) in normal room environment
  • Pulse - normally 120 to 160 beats per minute
  • Breathing rate - normally 30 to 60 breaths per minute
• General appearance - physical activity, tone, posture and level of consciousness
• Skin - color, texture, nails, presence of rashes
• Head and neck
  • Appearance, shape, presence of molding (shaping of the head from passage through the birth canal)
  • Fontanels (the open "soft spots" between the bones of the baby's skull)
  • Clavicles (bones across the upper chest)
• Face - eyes, ears, nose, cheeks
• Mouth - palate, tongue, throat
• Lungs - breath sounds, breathing pattern
• Heart sounds and femoral (in the groin) pulses
• Abdomen - presence of masses or hernias
• Genitals and anus - for open passage of urine and stool
• Arms and legs - movement and development

Gestational assessment:

Assessing a baby's physical maturity is an important part of care. Maturity assessment is helpful in meeting a baby's needs if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than it appears by size, and may need different care than a premature baby.

An examination called The Dubowitz/Ballard Exam for Gestational Age is often used. A baby's gestational age often can be closely estimated using this exam. The Dubowitz/Ballard Exam evaluates a baby's appearance, skin texture, motor function and reflexes. The physical maturity part of the exam is done in the first two hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery. Information often used to help estimate babies physical and neuromuscular maturity are shown below.

Physical maturity:

The physical assessment part of the Dubowitz/Ballard Exam looks at physical characteristics that look different at different stages of a baby's gestational maturity. Babies who are physically mature usually have higher scores than premature babies. Points are given for each area of assessment, with a low of -1 or -2 for extreme immaturity to as much as 4 or 5 for post-maturity.

• Skin - ranges from sticky and red to smooth to cracking or peeling.
• Lanugo (the soft downy hair on a baby's body) is absent in immature babies then appears with maturity and then disappears again with post-maturity.
• Plantar creases - these creases on the sole of the feet range from absent to covering the entire foot depending on the maturity.
• Breast - the thickness and size of breast tissue and areola (the darkened nipple area) are assessed.
• Eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue are assessed.
• Genitals, male - presence of testes and appearance of scrotum, from smooth to wrinkled.
• Genitals, female - appearance and size of the clitoris and the labia.

Neuromuscular maturity:

Six evaluations of the baby's neuromuscular system are performed. These include:

• Posture - how does the baby hold his or her arms and legs.
• Square window - how much the baby's hand can be flexed toward the wrist.
• Arm recoil - how much the baby's arms "spring back" to a flexed position.
• Popliteal angle - how much the baby's knee extends.
• Scarf sign - how far the elbow can be moved across the baby's chest.
• Heel to ear - how close the baby's foot can be moved to the ear.

A score is assigned to each assessment area. Typically, the more neurologically mature the baby, the higher the score. When the physical assessment score and the neuromuscular score are added together, the gestational age can be estimated. Scores range from very low for immature babies (less than 26 to 28 weeks) to very high scores for mature and post-mature babies. All of these examinations are important ways to learn about your baby's well-being at birth. By identifying any problems, your baby's physician can plan the best possible care.

Intravenous lines and tubes

Because most babies in the NICU are too small or sick to take milk feedings, medications and fluids are often given through their veins or arteries. Babies may also need frequent lab tests and measurements of blood oxygen levels. There are several ways a baby may receive fluids and medications and have blood drawn without additional needle sticks, including the following:

• Intravenous line (IV) - Babies may have an IV placed in a hand, foot, or scalp, where veins are easily accessed. Tubing connects the IV to a bag containing fluids that are carefully delivered with a pump.
• Umbilical catheter - After the umbilical cord is cut at birth, newborn babies have the short stumps of the cord remaining. Because the umbilical cord stump is still connected to their blood and circulatory system, a catheter (small flexible tube) can be inserted into one of the two arteries or the vein of the umbilical cord. Medications, fluids, and blood can be given through this catheter. After placement of the umbilical catheter, x-rays are taken to check the location in the baby's body.
• Percutaneously Inserted Central Catheter (PICC line) - A catheter is placed in a deep vein or artery in the baby's arm and is used for meeting a baby's longer-term needs than an IV in the hand or scalp.

A baby may need IV lines or catheters for just a short time or for many days. Once a baby is well enough to take milk feedings and is gaining weight, IV lines can often be removed. Sometimes, an IV may be needed for giving a baby antibiotics or other medication even when the baby can be fed normally.

Procedures and equipment

What monitoring equipment is used in the NICU?

NICUs are equipped with complex machines and monitoring devices designed for the unique needs of tiny babies. There are mechanical ventilators (breathing machines), oxygen, medications and supplies for medical care. Furthermore, there is technology to monitor nearly every system of a baby's body including body temperature, heart rate, breathing, oxygen and carbon dioxide levels and blood pressure. The following list includes some of the monitoring equipment often used in the NICU:

• Heart or cardiorespiratory monitor - This monitor displays a baby's heart and breathing rates and patterns on a screen. Wires from the monitor are attached to adhesive patches on the skin of the baby's chest, abdomen and leg.
• Blood pressure monitor - Blood pressure is measured using a small cuff placed around the baby's upper arm or leg. Periodically, a blood pressure monitor pumps up the cuff and measures the level of blood pressure. Some babies need continuous blood pressure monitoring. This can be done using a catheter (small tube) in one of the baby's arteries.
• Temperature - A temperature probe is placed on the baby's skin with an adhesive patch. A wire connects the temperature probe to the overhead warmer (or isolette) to help regulate the heat needed to keep the baby warm.
• Pulse oximeter - This machine measures the amount of oxygen in the baby's blood through the skin. A tiny light is taped to the baby's finger or toe, or in very tiny babies, a foot or hand. A wire connects the light to the monitor where it displays the amount of oxygen in the baby's red blood cells.
• Transcutaneous oxygen/carbon dioxide monitor - This machine measures the amount of oxygen and carbon dioxide in the baby's skin. A small circular pad is taped on the baby's skin. The pad warms a small area of skin underneath and measures oxygen, carbon dioxide, or both. A wire connects the pad to the monitor and displays the levels. Because the transcutaneous monitor heats the skin, it must be moved to different places on the baby's skin periodically. The heating may leave a temporary reddened spot on the baby's skin, but this will fade. Transcutaneous oxygen levels are usually lower than levels of the pulse oximeter.
• Ultrasound - Ultrasound uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. In the NICU, ultrasound may be used to examine the heart, abdomen and internal structures of the baby's brain. Ultrasound is painless and provides much information about a baby's health.
• X-ray - Portable x-ray machines may be brought to the baby's bedside in the NICU. X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film. X-rays are taken for many reasons including checking the placement of catheters and other tubes, looking for signs of lung problems such as hyaline membrane disease, and checking for signs of bowel problems.
• Computed tomography (Also called CT or CAT scan.) - A CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called "slices"), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. CT scans also minimize exposure to radiation. CT scans are sometimes done to assess bleeding inside a baby's head. A CT scan is done in a special room and the baby will need a sedative medication so that he or she will be motionless for the exam.
• Magnetic resonance imaging (MRI) - MRI is a diagnostic procedure that uses a combination of a large magnet, radio frequencies and a computer to produce detailed images of organs and structures within the body. Like a CT scan, MRI is performed in a special area of the hospital. It is often done to examine a baby's brain stem, spinal cord, and soft tissues. The baby will need a sedative medication so that he or she will be motionless for the exam.
• Endotracheal tube (ET) - This tube is placed through the baby's mouth or nose into the trachea (windpipe). The ET tube is held in place with special tape and connects to a mechanical ventilator (breathing machine) with flexible tubing. An x-ray is used to check the tube's placement. When a baby has an ET tube, he or she is unable to make sounds or cry.
• Respirator or mechanical ventilator - This machine helps babies who cannot breathe on their own or who need help taking bigger breaths. High frequency ventilators give hundreds of tiny puffs of air to help keep a baby's airways open. Ventilators can also deliver extra oxygen to the baby.
• Continuous positive airway pressure (CPAP) - Through small tubes that fit into the baby's nostrils, called nasal CPAP, this machine pushes a continuous flow of air or oxygen to the airways to help keep tiny air passages in the lungs open. CPAP may also be given through an ET tube.
• Extracorporeal membrane oxygenation (ECMO) - This is a special technique for babies with respiratory disease that does not respond to maximum medical care. With ECMO, blood from the baby's vein is pumped through an artificial lung where oxygen is added and carbon dioxide is removed. The blood is then returned back to the baby. ECMO is only used in specialized NICUs.

Testing and lab procedures

Babies in the newborn intensive care unit (NICU) need frequent examinations and monitoring as part of their care. Although many tests require drawing blood from your baby, they are necessary to help monitor your baby's condition and to identify potential problems. Common tests or lab work in the NICU may include the following:

• Blood typing - to check the blood group (A, B, O) and the Rh factor (positive or negative).
• Testing for anemia (too few red blood cells) or polycythemia (too many red blood cells).
• Testing for infection in the blood, urine, or spinal fluid.
• Blood gases to measure oxygen levels and carbon dioxide.
• Blood sugar.
• Electrolyte levels.
• X-rays (to check placement of tubes or view the condition of the lungs, heart, or abdomen).

Each baby's needs and care is different. Always consult your baby's physician for more information about which tests are needed for your baby.

Common NICU Tests

Blood tests:

The most common blood tests performed in the NICU are the following:

• Arterial blood gas (ABG): This test measures the acidity (pH) and the oxygen and carbon dioxide levels in the blood. ABG is used to assess the lungs’ ability to move oxygen into the blood and remove carbon dioxide from the blood. 
  These also measure the pH and the oxygen and carbon dioxide levels in the blood. However, the ABG test measures oxygen in a manner that better correlates with lung function. This is because the oxygen level of the blood in the capillaries is already depleted and on its way back to the heart and lungs. , CBG (capillary) and VBG (venous) tests can still be used as screening tools for respiratory issues because the blood carbon dioxide levels are similar to those in an ABG.
• Complete blood count (CBC): This test analyzes the components of blood, including hemoglobin, hematocrit, platelets, red blood cells and white blood cells.
  • Hemoglobin: Is a major portion of the red blood cells. It enables the body to carry oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs to be removed.
  • Hematocrit: Is another portion of the red blood cells. It enables us to determine the percentage of red blood cells present in the body. The normal percentage will vary according to age, sex and the laboratory performing the test. Too high of a percentage can indicate dehydration, blood loss or other issues. Too low of a hematocrit can indicate anemia.
  • Platelets: Platelets are vital to blood clotting to stop bleeding. The platelet count is an important screening test of platelet function. If the platelet count is too low the patient may be prone to spontaneous bleeding that is difficult to control. Bleeding can occur in various parts of the body. If the platelet count is too high, it may indicate massive blood loss, infection or other disorders that require more testing.
  • Red Blood Cell Count: Results can be used in other tests to help diagnose a condition.
  • White Blood Cell Count: This can be an indicator of infection or inflammation in the body. The white blood cell count should be used with a white blood cell differential. The differential evaluates each of the five types of white blood cells – neutrophils, eosinophils, basophils, lymphocytes and monocytes – to give a better idea of the immune system response.
• Electrolyte measurement: Electrolytes are the basic chemicals of the body. They include sodium, potassium, chloride, calcium and magnesium. These chemicals are essential to the function of all body cells.
• Septic workup: These tests include blood cultures, a urine culture and a spinal tap. All of the samples are sent to the lab. Each specimen is allowed to grow and then examined under a microscope for the presence of microorganisms that cause infection. These microorganisms may be bacterial, viral or fungal. If any are found, the baby has an infection that needs to be treated aggressively with IV antibiotic, antifungal or antiviral medications. It takes 24 to 48 hours to get culture results, so to be safe, antibiotics are started as soon as the specimens are gathered and before the culture results are known.
• Glucose (blood sugar) test: This test can be done at the bedside with one drop of blood taken from a heel stick. The blood is placed on a chemically treated strip. If the result is very high or low, a larger amount of blood may be drawn to get a more accurate measurement of the blood sugar. The amount of sugar in the IV solutions can be adjusted to keep glucose levels within the normal range.
• BUN and creatinine tests: These tests assess kidney function. A high BUN measurement can signal kidney disease, reduced blood flow to the kidneys or other problems. A low BUN measurement can signal overhydration and other issues. The creatinine test is a slightly more sensitive test of kidney function. A high creatinine level signals decreased kidney function.
• Bilirubin test: Bilirubin is a byproduct of the breakdown of red blood cells. The liver rids the body of this byproduct. Bilirubin can build up in the blood when the body is unable to eliminate it — either because too much is being produced or the liver is not mature enough to keep up with the amount being made.

Urine tests:

A newborn’s kidneys are very sensitive to changes. Some changes that can alter urine production include: 

• Increased or decreased blood pressure
• A change in blood volume
• An infection
• A change in the pH of the blood
• A change in the electrolyte or glucose levels in the blood

A urine test can screen for some of these issues.

Weight monitoring:

Babies are weighed nearly every day. If a baby is gaining too much or too little weight, staff will conduct other tests to rule out an infection or other health issues. They will also review the baby’s calorie intake. Optimal calorie intake depends on the baby’s weight, and adjustments need to be made as the baby grows. As the baby begins to eat by mouth, staff will adjust calories received from the IV solution to balance the calories received from food. They also consider the amount of fluids that the baby consumes. Calories can be added to breast milk and/or formula, so the baby gets the same amount of calories in a smaller amount of fluid.

X-rays:

An X-ray uses invisible energy beams to produce images of internal tissues, organs and bones on a special plate, which is similar to camera film. This plate then sends the images to a computer.

X-rays are performed for a variety of reasons, such as:

• Determining the optimal placement of various tubes
• Measuring the size and shape of the heart
• Detecting lung problems
• Assessing general bone structure
• Detecting stomach and intestinal problems

Although X-ray involves exposure to radiation, the amounts of exposure are controlled and monitored closely. Unnecessary X-rays are avoided. If the genitals are within the area of exposure, they are covered with a lead shield.

Ultrasounds:

An ultrasound uses high-frequency sound waves and a computer to create images of soft body structures, such as tissues, organs and blood vessels. A transducer, which looks like a microphone, is attached to the ultrasound machine. The technologist performing the ultrasound gently moves the transducer over the child’s skin. The machine takes pictures and saves them to a computer so the doctor can review them later.

Echocardiograms:

An echocardiogram is a procedure that assessed the heart’s structures and function. A small probe called a transducer is placed on the child’s chest and sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the child’s chest in certain locations and at certain angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce (or "echo") off the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer translates the “echoes” into an image of the heart walls and valves.

CT (computed tomography) scans:

While a regular X-ray shows a lot of useful information, it cannot provide specific details about internal organs and other structures. A CT (computerized tomography)scan provides much greater detail than a regular X-ray.

With a CT scan, an X-ray beam moves in a circle around the body. This allows for many different views of the same organ or structure. The X-ray information is sent to a computer, which interprets the data and displays it in two-dimensional form on a monitor.

MRI (magnetic resonance imaging):

MRI (magnetic resonance imaging) uses a large magnet, radio waves and a computer to produce detailed images of organs and body structures. Unlike X-rays and CT scans, MRI does not use radiation. There are no known harmful effects from having an MRI scan.

Division of Newborn Medicine Contact Us

International Patients

For families residing outside India, please contact Rajagiri Hospital International Health Services which facilitates the medical review of patient records and appointment scheduling.

Division of Newborn Medicine Find Us

The level III Neonatal Intensive Care Unit (NICU) is located at Rajagiri Hospital, Chunangamvely, Aluva-683112 in the main hospital building on Tower 2 in the 2nd floor.

• Enter the hospital through the Main Entrance and take the elevators to the second floor
• On the second floor , at the top of the stairs, facing the lobby , make a left turn to enter Tower 2
• There is a desk clerk on your left, adjacent to the Family Lounge, who will make arrangements for you to visit the NICU

Services for High Risk Pregnancies

If you’re experiencing a high-risk pregnancy or have certain medical conditions that could make a pregnancy risky, you can trust us to safely guide you through pregnancy. The Perinatal Medicine wing of the Department of Neonatology offers a high level of care you won’t find anywhere in the region.

What is a High-risk Pregnancy?

A high-risk pregnancy is one in which certain conditions put you, your developing fetus or both at higher-than-normal risk for complications during pregnancy and/or after your baby’s birth. These conditions can include:

• You’re over 35 years old
• You have a chronic or complex medical condition such as high blood pressure, heart or kidney disease, or an autoimmune disorder
• You have diabetes or develop it during pregnancy (pregnancy induced diabetes)
• You have a family history of genetic or hereditary concerns
• You’re carrying more than one baby (twins or triplets , for example), also called multiple gestation
• Your pregnancy is not progressing as expected
• You’ve had a previous preterm delivery ( premature birth )
• You’ve had complications during a previous pregnancy

Our services include:

• Prior antenatal consults- to discuss with parents , the expectant care and management throughout pregnancy , at delivery and following the birth of your baby
• Preparing in advance, a detailed plan for delivery including the nature of the team to be in attendance at delivery
• 24/7 access to our specialists during your pregnancy
• Care coordination with any other specialists you may need to see

In addition to doctors, your care team at the Neonatal Unit includes nurses, lactation consultants, dieticians and ultrasonographers.This team works closely with you and your obstetrician to find answers and safely guide you through a complicated pregnancy.

For added confidence, we also offer the region’s only level III Neonatal Intensive Care Unit (NICU) - a unit designed to care for newborns with any problems 24/7.

Neonatal Transport Program

The Neonatal Transport Program maintains a specially trained team capable of transporting the smallest and sickest infants from area hospitals to the Rajagiri Hospital NICU when they require the highest level of care and sub-specialists that can only be provided at a level III Regional NICU. The Transport Team functions as a complete mobile ICU, utilizing a specialized portable incubator with an integrated ventilator and monitor, so that the patient remains fully supported throughout the transport process .The team transports babies by road using an ambulance. When appropriate , the team also provides return transport to the referring facility .The program is committed to providing team mobilization within 30 minutes or less, with a policy for triaging patients in the event of multiple, simultaneous referrals.

In addition, the Neonatal Transport Program offers these services:

• A transport team comprised of a neonatologist, a NICU transport nurse, a fellow/resident and support staff who accompany the newborn on critical transports.
• Ambulance transportation, the arrival of which depends on the patient’s need, distance and the referring facility’s ability to manage the newborn until the transport team arrives.
• A transport director and a transport coordinator who ensure clinical practice compliance and oversee the daily operations of the program.
• Transport incubators with self-contained power supplies to maintain neutral thermal environment, continuous cardiopulmonary monitoring, mechanical ventilation, blended oxygen, suction devices and infusion pumps .Other supplies and medications are readily available to the team.

Contact Us

For more information about the Neonatal Transport Program, please contact:

Neonatal Transport Process

When considering a transfer, simply call our transport hotline. The hotline provides quick access to a doctor who reviews your patient’s symptoms, medical history and current condition. Sometimes, just a second opinion can help, and it is not necessary to transfer the patient .However, if the patient does require a specialized transport team, a neonatologist is available for phone consultation while the team is en route to the hospital.

If you are a physician faced with an infant who would benefit from neonatal intensive care, here is how to start the transport process:

• Call the NICU Transport Hotline at 0484 6655000( extn 5241)
• A unit secretary will answer your call and will obtain a call back number from you.
• If not immediately available, a neonatologist will return your call within five minutes.
• We do the rest! This includes making arrangements with the transfer center.
• The neonatologist is available for medical consultation management questions prior to and during transport.

What to Expect

Upon arrival, the transport team will assess the patient’s current condition and begins stabilization procedures immediately. This may include drawing blood, starting an IV, and intubating the infant. The infant will be stabilized as quickly as possible in preparation for transfer.

Before leaving the hospital, the transport team will briefly visit with the infant’s parents. The transport team will explain what they are doing, how the infant is being transferred and allow parents to see and touch the baby. Understandably, this is a very stressful and emotional time for families and we make every effort to involve the family and ease their concerns. Because the team must focus solely on the care of the infant during transport, parents and family members are asked to meet their baby at the hospital .Upon arrival at Rajagiri Hospital, the infant is admitted to the Neonatal Intensive Care Unit (NICU).

Communication with Referring Physicians

A member of our NICU team will contact the referring physician with the infant’s status once the infant has arrived and been stabilized in the NICU. NICU physicians will continue to update the referring physician throughout the infant’s stay in preparation for discharge or return transfer to the referring hospital and physician.

Additional Services

Attendance at Deliveries

In an effort to aid you in improving perinatal outcomes, our transport team can attend and assist with deliveries. Should your obstetrical patient present or advance too far progressed for transport, our neonatal team will assist with delivery, stabilize as needed and transport the infant. Attendance at deliveries will be determined on a case by case basis after consultation with the neonatologist on call.

Return Transport

We recognize the need of your patients to be close to home and family. Our transport team offers return transport for patients by ambulance, depending on the baby’s condition.

Education and Outreach

Currently being updated

Currently being updated Infant Follow-Up Program

• Infant Follow-Up Program
• Meet our Team
• Frequently Asked Questions (FAQ)
• Patient Resources
• Contact Us
• Find Us

Infant Follow-Up Program Overview

Children who are born prematurely benefit from special monitoring and intervention during their first year of life .The Infant Follow-Up Program (IFUP) provides ongoing medical and developmental evaluation and support for very premature infants.

Babies are referred to the program from the NICU by the doctors .Referrals can also come from pediatricians, Early Intervention providers and parents.

We provide consultation to families and pediatricians regarding developmental and medical issues that are specific to premature infants.

How Rajagiri Hospital approaches prematurity

Our multi-disciplinary team includes pediatricians, neonatologists, pediatric psychologists, physical therapists and if needed, pediatric neurologists. At each visit, we evaluate your infant’s development and recommend ways to manage any health or developmental problems that may arise .We also coordinate referrals to other medical specialties such as Audiology, Feeding and Nutrition, Gastroenterology, Orthopedics, Ophthalmology, Occupational Therapy, Pulmonary and Speech and Language for evaluations as needed.

Long-term follow-up

The Infant Follow-up Program at Rajagiri Hospital is designed for babies who are born at less than or equal to 32 weeks gestational age .Patients in this program are assessed about every six months until they reach the age of 3 years .Services include evaluation by a neonatologist, physical therapist ,occupational therapist, neurologist and child psychologist .Our staff coordinates with your pediatrician about any concerns you may have.

Infant Follow-Up Program Frequently Asked Questions (FAQ)

Who goes to the Infant Follow-Up Program?

The Infant Follow-Up Program (IFUP) is open to all infants who have been patients in the Neonatal Intensive Care Unit at Rajagiri Hospital and referring community hospitals, whose gestational age at birth was less than 32 weeks.

When is the first visit?

Typically the first visit to the IFUP happens when your child is between 6 and 12 months old .Earlier visits may be requested for specific medical, developmental or social concerns .In fact, we have recently begun to see patients around three months from NICU discharge. We continue to follow children until they transition to preschool (usually around three years of age).

What happens during the visit?

Each visit includes a medical and developmental evaluation and may include a consultation with a pediatrician, neonatologist, physical therapist, psychologist or pediatric neurologist. Based on the results of the comprehensive evaluation, the team will provide feedback on your child’s developmental progress .This feedback will include areas of strength and weakness for your child, as well as recommendations to enhance his or her development .Referrals are frequently made to medical specialty services and community resources.

Do I take my child to this program instead of the pediatrician?

No. The Infant Follow-Up Program does not replace regular visits to your pediatrician .The program has been designed to complement the care provided by your pediatrician.

How frequent are the visits and what is the length of each visit?

We usually see children, for the first time, when they are around 3 to 6 months corrected age (from their due date). The frequency of the visits ranges from once every 3 to 12 months and is adjusted to your child’s changing needs. Our clinic meets once a week on Tuesday. Since your child will be evaluated by several specialists, you can expect the visit to last approximately three hours.

Will I have a chance to discuss the results of the visit?

Yes. After your child’s exam, the physician will provide you with feedback from the team’s evaluation and also answer questions you might have .In addition, a written report of the visit will be mailed to you and your pediatrician, as well as other providers that you identify .We provide support in coordinating visits with other specialists, as well as with other community services your child might need.

How long after discharge do I need to call to make the first appointment?

We recommend you call us as soon as you get settled in at home because we make appointments several months in advance.

Whom should I call to schedule an appointment, or address further questions?

Contact our program coordinator, at . You may also email us at or simply check the “Request an Appointment” button on the right-hand side of the screen.

Infant Follow-Up Program Contact Us

International Patients

For families residing outside India, please contact Rajagiri Hospital International Health services which facilitates the medical review of patient records and appointment scheduling.

Infant Follow-Up Program Find Us

Rajagiri Hospital
Tower 2
First Floor

The Infant Follow-Up Program is located on the first floor of Tower 2 of Rajagiri Hospital.

• Enter the hospital through the Main Entrance and take either the elevators to the first floor or walk up the stairs on the front lobby
• Once you reach the first floor ,facing the main lobby ,  take a left turn ,beyond the stair case and then turn right
• At the end of the corridor, walk through two sets of double doors and enter the out-patient wing of the Department of Pediatrics

Security

Neonatal Intensive Care Unit

Safety in our nurseries is important to us. To ensure the security of families and babies, the following measures are in place:

• Parents are always welcome to be with their babies. All visitors are to be accompanied by at least one parent at the bedside. See more in What to Expect.
• Parents are to meet the desk clerk at the entrance to the NICU to announce their arrival .Visitors are welcome accompanied by a parent.
• There is a ward clerk in the NICU during the day and evening hours.
• Parents and visitors are reminded to keep valuables at home. There are a few lockers available in each nursery for your use.
• Parents and visitors are asked to follow directions regarding infection control and prevention.
• This could include answering questions about your health and the health of each visitor, careful hand washing when entering and leaving the nurseries, and any other precautions that are in place.
• Security personnel frequently patrol the 2nd floor and surveillance equipment is installed throughout the hospital.

Glossary of NICU Terms

Apnea: A pause of over 20 seconds in an infant's breathing pattern.

Bilirubin: A byproduct of the breakdown of red blood cells.

Blood gas: A blood test for determining the pH and levels of oxygen, carbon dioxide and bicarbonate in the blood. The test tells if a baby needs more or less oxygen or other changes in the respirator.

Bradycardia: Slowing of the heart.

Bronchopulmonary dysplasia (BPD): Changes in a baby's lungs following severe respiratory distress in premature infants who have been treated with oxygen and mechanical ventilation.

Continuing care nursery (CCN): A nursery that eases an infant's transition to home.

Continuous positive airway pressure (CPAP): A method in which low pressure is kept in the airways to keep the air sacs in the lungs open and make it easier for a baby to breathe .The baby does all the breathing on his or her own.

Cyanosis: Bluish coloration of the skin, lips or nails that happens when there is not enough oxygen in the blood.

Echocardiogram:  A method of recording a picture of the heart using the echo of sound waves that can be used to evaluate the structure and function of the heart.

Endotracheal tube (ETT): A plastic tube placed through the nose or mouth into the trachea (windpipe). The tube allows oxygen to be delivered to the lungs by a respirator.

Gavage feeding: Feeding through a small plastic tube passed through the nose or mouth into the stomach.

Gestational age: Age of a baby in weeks, starting from the beginning of pregnancy.

Glucose: Sugar in the blood used for energy.

Hematocrit ("crit"): The percentage of red blood cells in the blood.

Hyperalimentation (HAL): Administration of nutrients into a vein .Used with infants who cannot be fed breast milk or formula.

Incubator: A type of enclosed bed for an infant who is not mature enough to maintain his or her temperature in an open bed.

Induced hypothermia: A treatment that reduces a baby's core temperature .The treatment is thought to provide some protection to the injured brain of an infant who has suffered from a traumatic event before or during the birth process.

Intralipid: A white, high-calorie solution given through a vein to provide fat for babies who cannot be fed breast milk or formula.

Intravenous (IV): A thick, plastic tube placed in a baby's umbilical artery and/or vein (UA or UV line) or in a vein in the head, hand  or foot. It is used to take a blood sample and/or to give fluids and nourishment.

Isolette: See "incubator."

Intraventricular hemorrhage (IVH): Abnormal bleeding in the brain's central chambers (ventricles).

Jaundice: A yellow color of the skin caused by too much bilirubin in the blood .Usually, this is a temporary condition.

Meconium: A baby's first stool, which is  dark green or black.

Nasogastric (NG) or orogastric tube: A small plastic tube placed in the stomach through the nose or mouth. It can be used to feed a baby, give medicines or remove air from the stomach.

Necrotizing enterocolitis (NEC): A serious illness that affects the bowel wall.

NPO: Latin abbreviation for "nothing by mouth ".If a baby is kept NPO, nutritional needs will be met by intravenous fluids.

Oscillator ventilator: A highly specialized breathing machine.

Oxygen: A colorless, odorless gas that makes up 21 percent of the air we breathe. Sick or premature babies often need extra oxygen.
Oxygen hood (OXY-Hood): A clear plastic box with a tube attached that is placed over the head to deliver oxygen to a baby.

Patent ductus arteriosus (PDA): A condition in which the blood vessel that connects the aorta (the main artery of the body) and the pulmonary artery (the artery that brings blood to the lungs) does not close as it should after birth.

Persistent pulmonary hypertension (PPHN): A condition in which the blood continues to flow through an  infant's heart the way it did in the womb. This condition causes cyanosis and extreme instability of the body.

Phototherapy: Treatment for jaundice using fluorescent  lights.

Pneumonia: An inflammation of  the lungs.

Pneumothorax: The presence of air between the outer lining of the lung and the  chest wall, which causes the lung to collapse.

Premature infant: An infant born before 37 weeks of pregnancy.

Pulse oximeter (pulse ox): A machine that measures the amount of oxygen bound to the hemoglobin molecules in the blood through a small probe wrapped around an infant's hand or foot.

Radiant warmer: An open bed with an overhead warmer that helps keep a baby warm.

Respirator (ventilator): A machine to help with breathing.

Respiratory distress syndrome (RDS): A condition in a newborn that causes breathing difficulties. It is a result of an insufficient supply of a chemical called surfactant that helps expand the small air sacs in the lungs.

Retinopathy of prematurity (ROP): An eye disease found primarily in premature infants.

Sepsis: An infection.

Tachypnea: Fast breathing.

Transcutaneous monitor (TCM): A monitoring device placed on the skin to record blood oxygen levels.

Ultrasound: A method of taking pictures of body organs such as the brain, kidney or liver.

Vital sign: An indication  that a person is  alive .Vital signs include temperature, heart rate, breathing rate and blood pressure.