4th September : The Sixth Single Theme Workshop in Neonatology got underway in the Advanced Pediatric Centre Auditorium in PGI on Saturday, 4th September. The theme of this year’s workshop is “How to Set Up a Good Neonatal Unit”. This is a national-level workshop being attended by pediatricians from all over India. A unique feature of the Single Theme Workshops conducted annually by the Newborn Unit is that delegates of each workshop vote for the preferred theme of the next year’s workshop.
Prof Anil Narang, ex-head of the Newborn Unit at PGI and currently head of the newborn unit at Chaitanya Hospital, set the stage by talking about the concept of regionalization of neonatal care. He emphasized the need for an efficient referral system with 3 levels of neonatal units, namely level 1 (normal newborn nursery), level 2 (special care newborn nursery) and level 3 (intensive care nursery). He spoke about the standards that each level of newborn nursery is expected to have.
Mr Surinder Sawhney, Principal Architect at Surinder Sawhney Associates, talked about the architecture and physical infrastructure of a newborn nursery. He said that the success of the design of a neonatal ICU depends on efficient process flows, detailed space program and anticipation of future needs, appropriate interior finishes to optimize function and space, appropriate technology inputs, measures to control infections and juxtaposition of the NICU with the delivery area. He spoke about the importance of wall cladding systems, false ceilings, appropriate flooring, hand washing facilities, illumination, electrical fittings, air changes and air filtration.
Dr Umesh Vaidya, Chief Neonatologist at KEM Hospital, Pune, spoke about the importance of manpower (and womanpower!) in the successful functioning of a newborn unit. Quoting the recommendations of the National Neonatology Forum of India, he provided a detailed description of the medical and nursing staffing pattern and the training requirements of the staff. He cautioned the delegates that the intensive care of newborn babies is physically, mentally and emotionally demanding and may lead to a condition called “burn out” among nursing and medical staff.
Dr Sourabh Dutta, Additional Professor in the Newborn Unit at PGI, spoke about the importance of having well-structured, written protocols of treatment of all common diseases of newborn infants that are to be followed by all members of the department. He said that protocol-based management ensures uniformity in the treatment of all babies, quick responses to emergent situations and standardization of training. He quoted research studies that had proved that protocol-based management of sick ICU patients yielded better results than routine care that is left to the whim of individual doctors.
Dr Praveen Kumar, head of the newborn unit in PGI, delivered a talk about the management of patient-related data in the newborn ICU. He said that accurate and retrievable patient records are required for ongoing and future treatment of patients, research, audit and medico-legal purposes. He urged the delegates to gradually move from paper-based records to computerized databases, because paper-based records had several limitations- including difficulties in indexing, collating and storing. He spoke about the NICU patient data manager that has been developed by PGI Newborn Unit.
Speaking later in the day about quality assurance and quality improvement, he said that the Quality Council of India’s National Accreditation Board for Hospital and Healthcare Providers offers quality parameters and certification for hospitals. He emphasized on the need for mapping the process, collecting data in real-time and analyzing data to be able to ensure quality of care provided in the NICU.
Prof Ashok Deorari from AIIMS Delhi spoke about neonatal equipments. He said that the optimum care of sick and small newborn infants necessitates the use of biomedical equipments, ranging from simple thermometers to highly sophisticated and complex microprocessor-driven incubators and ventilators. He gave many practical tips to the delegates regarding the process of deciding which equipments to buy, how to select a brand, how to decide on the desired technical specifications, how to maximize the use of available equipments and how to ensure good maintenance.
Dr Ashish Mehta, consultant neonatologist at Arpan Newborn Care Centre and Director of the NICU in Sterling Hospital, Ahmedabad, spoke about the crucial issue of the financial aspects of a newborn unit. He said that although newborn intensive care is capital-intensive, it is doable in India. He described the components of the establishment cost of an ICU. He emphasized that the number of useful years of life gained by saving one newborn life made newborn intensive care far more cost-effective compared to expensive interventions in late adult life, like joint replacements, bypass surgery and organ transplantation.
There were two panel discussions held in the course of the day. These discussions gave the delegates an opportunity to ask questions about various issues in the setting up and maintaining a newborn unit. They brought up problems that they had faced in their personal experience and were able to get clarifications from the experts on the panel.