Practical Newborn Critical Care Nursing Dipak K Guha, Rashmi Guha, RD Srivastava
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1Practical Newborn Critical Care Nursing2
3Practical Newborn Critical Care Nursing
Editor-in-Chief Dipak K Guha MD FIAP FRSTM & H, FNNF Chairman and Neonatologist-in-Chief Department of Pediatrics and Neonatal-Perinatal Medicine Sri Balaji Action Medical Institute, New Delhi Formerly, Medical Superintendent and HOD Pediatrics and Neonatology, Kasturba Hospital, Delhi Past President: National Neonatology Forum Editors Rashmi Guha MD Senior Consultant, Pediatrician Neonatologist Tirath Ram Shah Hospital, Delhi RD Srivastava MD DCH Chief Neonatologist Department of Pediatrics and Neonatal-Perinatal Medicine Sri Balaji Action Medical Institute, New Delhi Foreword by Dr ON Bhakoo
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Practical Newborn Critical Care Nursing
© 2006, Dipak K Guha, Rashmi Guha, RD Srivastava
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2006
Typeset at JPBMP typesetting unit
Printed at
5Dedicated to
All Newborn
Nurses of India
Doctoring and Nursing are two equally important arms for the care of critically sick neonates and require special education as well as skills. This involves learning fetal and neonatal physiology in health and disease as well as mastering the use of increasingly complicated patient care equipments.
Pediatricians trained in neonatal care are becoming increasingly available for level II and III care neonatal units. However, there is a tremendous lack of adequately trained nurses to look after critically sick neonates. This puts lot of strain on nurses trained only in basic nursing to cope up with the specialized nursing of these sick neonates. Such a challenge has been met by a large number of our nurses by in-service self-learning with the help of their medical colleagues. Many advanced neonatal units in our country have evolved their own in-service training system for the new nurses.
There has always been a need for a book on neonatal nursing which selectively addresses such issues and discusses step by step nursing care under different clinical situations. The present book by Dr. Deepak Guha and his colleagues precisely fulfills such a requirement. The editors have compiled guidelines for nurses for managing sick neonates weighing from less than 600 grams upwards and those suffering from various illnesses and requiring different support systems. The book describes nearly 100 protocols. Each protocol is further elaborated under subtitles like, Purpose, Pertinent or background information, Policy, Expected Outcome, Protocol steps and Caution, i.e. precautions to be taken. It is further supported by algorhythms, line diagrams, graphs or tables as required for further clarification. Basic problems tackled include thermoregulation, nutrition management for different birth weight groups, fluid therapy, acid-base balance and support for respiratory failure. Sections are also devoted to parent counseling, care by the parent, lactation management and neonatal transport. Issues related to surgical, cardiac and 8ophthalmic consultations have been discussed in practical details. There is a special section devoted to the training need for a Neonatal Nurse Specialist as well as the job description of an In-charge Nurse with detailed instructions for housekeeping, administration, documentation and infection control. In fact, this book deals with patient care protocols in such a great detail that leaves no scope for error. It is possible that some of the neonatal units may like to modify a few of the protocols of this book depending upon the available facilities for patient care in their hospital.
This book is a good companion for a nurse who wants to practice effective nursing of critically sick neonates. This can also prove to be an ideal guide for someone who wants to take up leadership role as a supervisor, manager and an inspiring teacher in neonatal nursing. This manual should be equally useful to the sensitive pediatricians, both trained as well as in-training, to check if they know all the details they need to know about management of neonatal critical care.
Dr ON Bhakoo
md dch fiap fams fnnf
Formerly Professor and Head
Department of Pediatrics and Neonatology
Post Graduate Institute of Medical Education and Research
Nursing personnels primarily provide the care of newborn world over. The role of Neonatologist is only secondary and supervisory to provide the direction for overall organization and services for the newborn care unit. Any amount of excellence in the capability of neonatologists and availability of high tech equipments cannot improve the quality of newborn care until we have quality input from neonatal nursing personnels. Yes, of course, all of us who practice neonatology in India are aware of this hard fact, yet we are in a stage of denial and nothing concrete has been done in promoting the quality of nursing in newborn care, either by the Nursing Organizations or Pediatric/Neonatology Forum.
As President of NNF, the editor-in-chief of this manual pushed through and was instrumental in publishing NNF Recommendations on Education and Training in Neonatal Nursing and a Manual of Neonatal Nursing, in 1992. It was very widely accepted and appreciated. Unfortunately thereafter in last one and half decades no significant efforts to provide structured guidelines or protocols for neonatal nursing have been made and neonatal nursing is only in lip services with no special training facilities available. It is therefore the responsibility of individual unit of the country to take a small step forward in the direction of training nursing personnel in neonatal nursing.
The Practical Newborn Critical Care Nursing is small effort by the editors to provide structured guidelines and protocols of neonatal nursing which every neonatal unit providing critical care to newborn will find handy in training nurses in neonatal nursing. These protocols have been developed on the basis of forty years of experience and observations of the editor-in-chief in India and abroad. Most of the protocols included can be used in our country in any basic newborn care unit as well as level-II and level-III units. However, some sections and protocols e.g. Role of Neonatal Nursing—a Challenge, Role of Neonatal Nurse Practitioner (NNP), Identification Process of Newborn, Documentation, role of 10ancillary staff, care of cardiac patients, use of ecmo, high frequency ventilation and oscillatory ventilation, etc. may not be feasible in the present scenario in most places. Yet these and some more protocols inappropriate at present have been included because of the editor-in-chief's firm belief and philosophy that “utilize the present facilities to the hilt and think high for future” is the only way to improve one's quality.
If you use these protocols with need based modifications and take your nurses in confidence you will be able to do a great service to neonatology in particular and newborns of India in general. The present manual will meet the long awaited need and fill the void in neonatal nursing education and training for the care of newborn babies.
I would like to congratulate my editors Dr Rashmi Guha and Dr RD Srivastava for accepting the challenge in producing this document. I would also like to thank Shri JP Vij (Chairman and Managing Director), Mr Tarun Duneja (General Manager, Publishing), Mr PS Ghuman (Senior Production Manager), Mr Shakiluzzaman, Mrs Kamlesh Bisht and other editorial staff of Jaypee Brothers Medical Publishers for the excellent job they have performed in bringing out this manual.
It is earnestly hoped and desired that our efforts in producing this Manual will have wide acceptance and help improving neonatal nursing in the country and therefore neonatal intensive care.
Dipak K Guha
Rashmi Guha
RD Srivastava