The Division of Neonatology under the Department of Paediatrics was started in Amrita Hospital, in April 2002. The neonatal intensive care unit (NICU) serves as a tertiary care referral centre for all medical and surgical problems in the newborns up to the first four weeks of life. Preterm infants from 24 weeks gestation onwards are managed in this unit. Because of the presence of this unit and the availability of pediatric subspecialists in every discipline here, this unit serves as one of the largest referral center for a large number of high risk obstetric patients and neonates.
The NICU has 22 beds with16 intensive care and 8 intermediate care beds. The high risk deliveries are attended by a team of physicians (trained in neonatology) and nurses. The unit is very well equipped to manage every newborn critical illness with trained staff except ECMO. All modalities of ventilation including HFOV and INO therapy are routinely carried out in this unit. In critically ill newborns, even major surgeries (CDH repair, laparotomy for NEC) are performed in the NICU itself. Although we prefer to have maternal transfers (in-utero transport), our transport team transports infants to our unit in dedicated transport incubator with ventilator. Occasionally, we have also attended deliveries in referring hospitals to resuscitate and transport infants to our center. We have very collegial and cordial relationship with our obstetric and maternal fetal medicine consultants which prepares us to anticipate and deal with any sort of emergency in the delivery room.
There are more than 500 infants admitted to this NICU annually. Nearly half of the infants admitted to this unit are from maternal (in-utero) transports. A large percentage of infants are also transported to this unit as neonatal transports. We also receive infants from neighboring South Indian states and a few infants from outside India as well.
The outcome of infants is comparable to the large international data base such as the one from Vermont-Oxford network. Naturally, inborn infants have a slight edge over out born infants in outcome with lower morbidity and mortality.
Our philosophy is in family centered care with health care providers (physicians, nurses, physical/occupational therapists, social workers) working as a team with the explicit goal of achieving a near perfect survival without residual handicaps. The pediatric subspecialists provide the needed support for us in this endeavour. As several of our referred patients have extremely complex medical and surgical problems, it will not be surprising to see that an infant is taken care of by several consultants in unison. This team work approach is the reason for the successful outcome of our patients.
The backbone of the ICU is a team of extremely dedicated nursing staff who is always willing to take up additional responsibilities at any time 24/7, three hundred and sixty five days of the year.
In our eagerness and dedication to help sick newborns and their distraught parents, we have taken a pledge to never refuse an admission to our unit. We also believe that if an infant can be managed at their local community hospital we should transfer the infant back to that referring hospital with referring physician’s input. We recognize that periodic communication with the referring physicians is very important and tend to keep them abreast of the infant’s clinical course.
Our energetic and enthusiastic social worker works with every patient’s family and provides the much needed emotional support during their hospital stay which is very highly appreciated by everyone. We also tend to involve parents (if they are ready) at an early stage itself in their infant’s care which facilitates early discharge and shorter length of stay. In addition to this, we encourage parental bonding from early on itself of the infant’s hospitalization and encourage Kangaroo care as much as possible. We are in the process of implementation of NIDCAP also.
We recognize that our responsibility towards the NICU graduates does not end when they are discharged home. We reassess them at regular intervals for developmental evaluation and enroll them in the early intervention program if needed. This busy neurodevelopmental clinic also receives outside referrals from infants discharged from NICUs of other hospitals.