Annexure 1

SNCU Mentoring Visit Checklist

A. GENERAL DETAILS
1.

Name of the unit: SNCU

2.

Address: DISTRICT HOSPITAL

3.

Year in which operations started:

4.

In charge of SNCU :
Telephone no.:

Mobile:

Fax: E-mail:B. UNITS PERFORMANCE

S.N
o.
1
2a
2b
2c
3a
3b
3c
4a
4b
4c
5

Parameter

Value/Details

Available number of beds in the unit

Total inborn babies admitted (monthly)
Total out born babies admitted (monthly)
Total number of babies admitted with LBW (low birth
weight)
Total number of babies referred-out due to surgical
reasons (monthly)
Total number of babies referred-out due to non-surgical
reasons (monthly)
Total number of babies referred-in (monthly)
Mortality figures inborn (monthly)
Mortality in out born babies (monthly)
Mortality in LBW babies (monthly)
The five (5) commonest diagnoses
(in last one year or since inception if unit is <1yr old)

C. FACILITIES OFFERED
S.N
o.
1
2
3
4

5
7

Parameter
24-hr delivery and newborn care support
24-hr on-call support by a qualified Paediatrician
Facilities for respiratory support (CPAP, etc.)
Radio-diagnostics X-ray (essential) and/or USG/CT
(either sourced from the hospital or from an private
radiology centre under an MOU)
Laboratory services (either sourced from the hospital lab
or from an private lab under an MOU)
Blood transfusion services

Value/Details

8
9
10

Neonatal transport service

24-hr electricity backup (generator, UPS, solar power,
etc.)
24-hrs water supply (either direct or through storage
tanks)

D. List of available Key equipments in the SNCU

(Mention the number available and functional number of equipments against each item)

S.
No.

1
2
3

4
5
6
8
9
10
11
12

13

Particulars

Number
Currentl
y
Availabl
e

Number
Currentl
y
Function
al

Numb
er
Lying
Unuse
d

Radiant warmer (with Servo control)

Phototherapy unit
Self inflating bag
Blood Glucometer with Strips
Stethoscope with neonatal chest piece
Non-invasive BP monitors
Pulse oximeter
Room thermometers
Electronic weighing scale
Foot operated suction apparatus/mucus
trap/ Central Suction
Central O2
O2 cylinders

E. CLINICAL SUPPORT SERVICES

S.
Services
No.
1
Management of Bio-Medical Waste (BMW)
Following house keeping protocols as per Guidelines
2
a. Availability of 5% Lysol or 3% Phenol, 2%
Gluteraldehyde, Bleaching powder in enough
quantity(Please check the House keeping records from
in charge sister and verify personally
b. Mopping of floors Number of times
c. Equipment cleaning protocols
d. BMW Management
Supply Chain Management (drugs, consumables and other
3
materials)
4
How & what equipment is used for the Referral transport of
Newborns from labour room/ PNC ward to SNCU and from SNCU to Higher facility.

Response

F. HUMAN RESOURCES
S.
N.

Group

1
2
3

Pediatricians (Both regular & Contractual)

Medical Officers (Both regular & Contractual)
Staff Nurses (Both regular & Contractual)

Numbe
r

Availability per
shift
(M/E/N)*

4
5
6

In-Charge Sister (Both regular & Contractual)

Data Entry Operator
Support Staff
a. Sweepers
b. Aya-bais
c. Security
Please check the Duty roaster of all the
above staff

*Considering 3 shifts (M/E/N), Morning, Evening and Night

Skills to be observed by the Mentors for each Health

Care Provider
Name of the Health Care Provider:
S.NO
Task
1
Infection Control Protocols
a. Cleaning of equipments
b. Cleaning of floors & walls
c. Hand washing
2
Care of pre-term baby
a. Expression of Breast milk
b. Gavage feeding/ Maintenance of feeding

5
6

1/0 Score

Remarks

tube
c. Paladai feeding
d. KMC
Care of Sick Newborn
a. Management of Sepsis
b. Management of Hyperbilrubinemia
c. Management of LBW/Premature babies
Handling of equipments
a. Warmer
b. Infusion pumps
c. Phototherapy
d. Pulse Oxymeter
e. Blood Glucometer
Counselling for KMC and others
Follow-up Mechanism for Discharged Newborns

Pass Score =

Student Score =

Pass

Yes

No

Skills to be Demonstrated by Mentors and ensuring

competency of every Staff for the same
I.

Management of Asphyxia: (Demonstration in the Labour Room)

Establishment of functional Newborn Care Corner in LR and OT
Demonstration of Warmer for temperature settings and trouble
shooting.
Demonstration of Resuscitation equipments including oxygen cylinder.
Prevention of infection by means of infection control measures
Resuscitation measures and protocols (to use the check list for giving
the Scores)
Care of umbilical cord
Early initiation of breast feeding delivery on the mothers abdomen
Weighing the newborn
Protocols for hand washing and eye & cord care

II.

Priority Signs
Awareness about Priority signs is very important for the staff to
identify sick neonates who need immediate assessment and admission
to SCNU.

III.

Care of sick newborn

Managing of low birth weight infants <1800 grams protocols for same
Managing all sick newborns (except those requiring mechanical
ventilation and major surgical interventions) as per the guideline
Phototherapy for newborns with hyperbilirubinemia protocols for same
Follow up of all babies discharged from the unit and high risk newborns
Immunization services as per MOHFW/GOI guidelines
Referral services Protocol followed for referring in of a newborn
Protocol for transfer of a sick newborn to a referred to facility

IV.

Prevention of Hypothermia
Protocol to be followed for keeping the baby warm

V.

Correct technique of breast feeding

Does the staff inform/teach the mother how to breast feed the newborn

VI.

Care for pre-term baby

Daily weighing of baby
Promotion of breast feeding (Expression of Breast milk, OGT feeding,
paladai feeding)
Maintenance of feeding tube
Promotion of skin to skin care (Demonstration of KMC)

VII.

Fluid Management
Protocol for managing intravenous (IV) fluids in newborn
Protocol for rational use of antibiotics

VIII. Infection Control

Protocols for House keeping and cleaning of equipments (as per FBNC
Operational guidelines) and facility Protocols for Bio-Medical Waste
management

Annexure II
Newborn Resuscitation Structured Questionnaire
Name of Participant:_____________________
Date:
_______________
Observation: Observe if the participant is performing the following tasks correctly and in the correct
sequence. Score one for each point conducted in the correct sequence and technique or mark 0 if the
task is not done as recommended and calculate the Score.
S.N
O

2
3
4
5

6
7

Task
Get ready with:

` Bag and mask

` Suction equipment
` Radiant warmer or other heat source
` 2 warm towels
` Clock with seconds hand
` Oxygen source
` Gloves
` Shoulder roll
` Cord tie
` Scissors
` Cap
Suck babys mouth and nose at mothers abdomen
only if meconium is present and baby is not crying
Dry the baby, remove the wet towel and wrap the
baby in warm dry towel
Assess breathing
If baby is not breathing cut cord immediately.(To
utilize golden minute dont wait for cord pulsations
to stop which occur in 1-3 minutes)
Place the baby on a warm, firm flat surface
Position the baby in slight neck extension using a
shoulder roll
Suction mouth and nose

9
10
11

Stimulate the baby by flicking the soles and

rubbing the back
Reposition and reassess breathing
If not breathing, provide bag and mask
ventilation for 30 seconds, makes sure that the
chest rises with each ventilation
Reassess the baby after 30 seconds of ventilation
If still not breathing, continue bag and mask
ventilation, start oxygen and assess the heart rate
If the baby is still not breathing, continue bag and
mask ventilation and refer to higher center

1/0 Score

Remarks

12

At any point if baby starts breathing, provide

observational care

Pass Score =

Student Score =

Recommendations for improving the quality care in SNCU:

1.
2.
3.
4.
5.
6.

Pass

Yes

No