Beruflich Dokumente
Kultur Dokumente
COMPLETE GUIDE LINE AND TOOLKIT FOR BUILDING UP A FULLY FUNCTIONAL SNCU(SICK NEWBORN
CARE UNIT) .
SNCU TOOLKIT
PRESENTED BY NCRC AND DEPARTMENT OF NEONATOLOGY SSKM(KOLKATA)
Editor-in-chief
Dr Arun Kr Singh ,MD , Prof & Head, Dept of Neonatology, IPGMER
A COMPLETE GUIDE LINE AND TOOLKIT FOR BUILDING UP A FULLY FUNCTIONAL SNCU
(SICK NEW BORN CARE UNIT)
Contributors
Sri Mrinal Chakrbarty , Asst Superintendent, SSKM Hospital, Special cell for Monitoring and evaluation
of SNCU
Md Siddique , Assistant Program Manager , Special Cell for Monitoring and evaluation of SNCU
Sri Avijit Samanta , Data Entry Operator cum Data Manager , Special Cell for monitoring and evaluation
of SNCU
Preface:
This book is a compilation of the years of experience gathered by Dr AK Singh and his team
from the Department of Neonatology , IPGMER, Kolkata in the field of development ,
functioning , supervision, capacity building and evaluation of the Sick New born Care Unit
throughout the country with a vision to improve the quality of facility based newborn care . The
book is developed as a cook book for building sick new born care units with unique
operational challenges. The concept was first materialized with the pioneering work of
PURULIA MODEL in 2003 and it is now regarded as an essential intervention for reduction of
the NMR of the whole country.. The publication is an attempt to share the immense experience
behind the evolution of this novel concept. It is also going to focus on the status report from
existing sick new born care units of west Bengal . The most useful technical details for
establishment of sick new born care units is brought out in this publication by the effort of a
group of doctors, engineers, statisticians , public health specialists and nursing educators
concentrating on newborn health at the department of Neonatology, IPGMER, Kolkata.
ACKNOWLEDGEMENT
DR Dilip Mahalanabis, MBBS, FRCP, DCH , DIRECTOR,SOCIETY FOR APPLIED STUDIES, KOLKATA.
Sri Samar Ghosh, CHIEF SECRETARY, GOVT OF WEST BENGAL.
DR M N Roy , ADDITIONAL CHIEF SECRETARY, GOVT OF WEST BENGAL.
Sri Dilip Ghosh , MISSION DIRECTOR, NRHM, GOVT OF WEST BENGAL.
Shri Ashim Kumar Das,
DR J M Chaki ,
DR Papri Nayek ,
STATE FAMILY WELFARE OFFICER & JT .DHS , DEPT OF HEALTH & FAMILY
WELFARE ,GOVT OF WEST BENGAL.
DADHS (MCH), DEPT OF HEALTH & FAMILY WELFARE ,GOVT OF WEST
BENGAL.
CONTENTS
TOPIC
PAGE NO
INTRODUCTION
1-3
4-5
GENERIC PLAN
6-26
MANPOWER
27-28
HR MANUAL
29-34
EQUIPMENT
35-41
HOUSE KEEPING
42-46
RUNNING COST
47-51
SNSU
52-55
ADMISSION CRITERION
56-
REFERENCES
Ref.Newborn Aides: an innovative approach in sick
newborn care at a district-level special care unit.Sen A,
Mahalanabis D, Singh AK, Som TK, Bandyopadhyay S,
Roy S.J Health Popul Nutr 2007 Dec;25(4):495-501.
CHAPTER 1
GENERIC PLAN FOR DISTRICT LEVEL SICK NEWBORN CARE UNITS .
GENERIC PLAN FOR DISTRICT LEVEL SICK NEWBORN CARE UNITS (LEVEL II)
Sick Newborn Care Units (SNCU) are a special newborn unit meant primarily to reduce the case fatality
among sick children born within the hospital or outside, including home deliveries within first 28 days of
life.
0VERVIEW:
a.
b.
c.
d.
e.
a.
Components of a SNCU.
Description of individual components.
Minimum space requirement for each room.
Specifications.
Guidelines regarding electricity.
COMPONENTS OF A SNCU:
Main Sick Newborn Care Unit: This should have at least 12 - 16 beds, which would cater to the sickest
child in the Hospital. It will have space for nursing work station, Hand Washing and Gowning at the point
of entry.
Step down Unit: This is an additional 6- 8 bed Step down Unit where recovering neonates can stay i.e.
neonates who dont need intensive monitoring.
Newborn Ward: This is an additional 10 - 20 beds, where both the mother and the newborn can stay
together. This facility is to be used
phototherapy, for uncomplicated low birth weight babies (esp. weighing more than 1800gm) requiring
only observation and those stable babies who require only intravenous antibiotic therapy.
Neurodevelopmental Follow up clinic: While having this facility is not mandatory to start a sick newborn
care unit still a dedicated follow up clinic catering to the NICU graduates, which can also function as OPD
for newborns can complement the therapeutic activities of the sick newborn care unit .
Newborn corner:
with facilities for neonatal warmer and resuscitation at the labour room and Obstetrics Operation
Theatre.
Ancillary area:
Store room
Power room
b.
Sick Newborn Care Units (SNCU) should be ideally established in a facility in a resource poor
area where not less than 1000 deliveries occur per year.
The SNCU should have at least 12-16 warmer beds providing 24 hours service.
Should be located near the Labour Room, Labour Ward and Obstetrics Operation Theatre.
Ancillary area
b)
c)
Neonatal ward
d)
Isolation room.
e)
Triage room.
FIG:1.2
A slab, 3 ft. from the floor and 1.5 ft. wide all
closure
of
one
section
for
storage area.
Space requirement:
Minimum space requirement for each bed area
is 100sq.ft. This would be divided as follows:
a) 50sq.ft per bed would be for individual
patient care area.
b) 50sq.ft per bed would be for ancillary
area.
3 glass door concept. (FIG:1.3,1.4)
A 3 glass door concept was introduced in order
FIG:1.3
c) Neonatal Ward
d) Isolation room
e) Triage Room
FIG:1.7
FIG:1.6
11
Ancillary area
The ancillary area should include separate
areas for
1. Teaching Room:
The SNCU also serves as a
teaching and hands-on-training centre
for the entire district. Thus with every
unit there should be a room allotted for
teaching and training. This space can
also be utilized for patient party
meetings. The departmental library can
be set up in this place. In order to aid
the teaching activities a computer and a
projector should be present. This area
can also double up as an area for video
conferencing.
FIG:1.8
SNCU unit
6. Store: A 3 zone storage area is
desirable (FIG:1.9,FIG:1.10)
12
a. First
storage
area
(central
act
as
an
FIG:1.9
equipment
storage room.
charts,
information
area
can
be
the
will
contain
FIG:1.10
individual
7.
Microscope and
provision for staining
Automated cell
counter(desirable, not
mandatory)
Electrolyte analyzer
14
8. Breast
feeding
room/area
cum
FIG:1.13
9. Doctors Room(FIG:1.13)
10. Nurses room
11. Sister-in-charges Room
12. Washing, Drying
and
Autoclave
Rooms:- (FIG:1.14)
Infant clothing, sheets and
gown should be laundered on a regular
schedule and as needed. Space for
commercial grade washing machine and
a dryer should be accommodated.
Dryer should be vented through an
outside wall this same facility can also
accommodate the ETO machine and the
autoclave.
FIG:1.14
15
100%
exhausted
outside.(FIG1.15)
to
the
worn
during
cleaning.
Other
will
also
be
used
to
the
FIG:1.15
16
care
of
newborn
c.
unit)
bed unit)
mother craft-100sq.ft
75-100 sq.ft
16. Neurodevelopment
clinic=650sq.ft
17
d. SPECIFICATIONS:
Yellow and blue tiles should not be used
at all.
Tiles should be given up to 7ft
WATER SUPPLY
light
as W1 in the layout]
( to provide
There should be
a.
b.
windows.
c.
WALLS
Sluice Room
Should be made of washable tiles
The colour of the tiles should be white
or off-white
splashing
designed
to
avoid
material.
rim. (FIG1.16)
and
towel
dispensers
and
for
washing
sinks.
Space
for
pictorial
hand
mold
FIG:1.16
19
on
cellulose
material
FLOOR
should be latex-free.
Cleaning: Infection control is crucial in
colour.
to minimize glare.
choice
in
rapidly
newly
Comfort/sound
Environmental
Maintenance
Suggested
control
impact
cost
use
medium
poor
good
medium
Supply areas
Low
medium
poor
fair
medium
Supply areas
Low
medium
fair
fair
medium
none
Medium
low
good
good
high
Public areas
High
high
good
Very good
low
Initial costs
durability
linoleum
Low
Vinyl
Cushioned
vinyl
carpet
rubber
VENTILATION
20
Patient cure
area
The ventilation should preferably be provided by a duct air conditioning system capable of both
temperature control as well as exchange of air. It has to be so devised that a minimum of 6 exchanges
/hour with 2 changes being outside air can be ensured. The filters of this ventilation system should be
located outside infant area for them to be easily & safely changed. Fresh air should be at least 25 ft.
away from the exhaust outlet of the ventilating system and all forms of noxious fumes and vehicular
exhaust.
TEMPERATURE
SNCU
The temperature inside the main SNCU
should be maintained at (22- 26C), round
the clock preferably by thermostatic Control.
While the babies in the main SNCU and step
down units can be kept warm by use of
warmers
at
the
prescribed
temperature,
ACOUSTIC CHARACTERISTICS
21
Control :
ILLUMINATION
All lighting fixtures should
be easily
cleaned.
Inside SNCU:
Adequate
day
light
for
natural
or CFL
Procedure light:
field.
22
e. GUIDELINES REGARDING
ELECTRICITY
two
air-conditioners
should
be
for SNCU)
and logged.
5V.
be
V.
PWD
personnel
should
members.
the
equipment
for
so
procedure
care
the
is
23
SNCU.
11) Necessary
information about
the
should
be
available,
e.g.,
X-ray
kept
around
feet.
Table 1.2
Equipment
Approximate Power
Consumption (Watt)
Type of
Power
Raw
Radiant Warmer
Infusion Pump
9W
Clean
Syringe Pump
12 W
Clean
Raw
Compressor
550 W
Raw
Main Unit
140 W
Clean
Humidifier
150 W
Raw
5
Ventilator
Spotlight
100 W
Raw
Weighing Scale
150 W
Clean
X- Ray Machine
2150 W
Raw
24
USG Machine
850 W
Clean
10
Ethylene-oxide
gas sterilizer
3500 W
Raw
switch-gear.
feeding point .
25
26
CHAPTER 2
MAN POWER NEEDED FOR SNCU
Particulars
Doctor with one in charge
Nurse
In charge
Staff Nurse
GDA
Sweeper
Rogi Shahayak
Data Entry Operator
Lab. Technician
Critical Care Technician
Neonatal nursing aides
Table 2.1
No. of Personnel
6
2
21
6
9
2
1
1
1
8
All Nursing staffs are to be sent to Dept. of Neonatology, IPGME&R, Kolkata to attend 1 month
neonatal nursing training programme. Especially the Sister-in-charges require 1 month hands on
neonatal nursing orientation training programme before starting their SNCU duties.
27
Neonatal Aides/Yashodas/Mamta
Eight (2 per shift, 2 for covering day
off, leave, sickness etc.) would be of immense
help.
Nursing personnel:
STAFF NURSE
Other staff:
28
CHAPTER 3
HUMAN RESOURCE MANUAL
29
DUTY
MANUAL
TECHNICIAN
30
FOR
PATHOLOGY
31
CHECKLIST
OF
SOME
IMPORTANT
PRECAUTIONS TO BE TAKEN IN PATIENT
CARE:
32
33
34
CHAPTER 4
Equipment list for SNCU complex
25
26
27
28
29
30
31
32
33
34
35
36
Vacuum Cleaner
ETO Sterilizer
Sterilizer
Hot Air Oven
Refrigerator
Washable slippers
Bucket for waste disposal large size
Bucket (foot operated) with lid small size
Bowl (Small & Medium) for procedure
Trolley for keeping drums/fluids/articles/gowns
Torch (small)
Non stretchable measuring tape (mm scale)
35
20
10
20
20
10
22
22
6
14
20
5
12
20
2
1
3
3
1
1
1
2
15
Adequate
Adequate
different sizes
Adequate
Numbers
1
1
2
1
1
25
3 each
1 each bed
3
3
2
22
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
3
3
2
2
1
1
2
1
1
2
7
5
20
1
needed
1
10
12
10
2
2
2
2
4
1
10
2
1
3
3 sets
4 to start with
1
1
2
5
2
Adequate
Adequate
11
2
1
36
ISOLATION WARD:
1
2
3
4
5
6
7
8
3
1
1
3
3
3
1
1
37
Doctors Room:
2
3
Sister Room.
Teaching Room.
2O
Bed - 1
Chairs - 2
Table
Locker (multichambered)
Table - 1
ILR - 1
Table - 1
TV with DVD with audio system(for IEC)- 1
22
22
6
8
20
5
1 (essential)
1 (essential)
3.Bilirubinometer .
1 (essential)
4 (essential)
6. Dry Biochemistry.
1 (desirable)
38
DATA COLLECTION:
Item
1.Desk top computer( with color monitor, CPU, UPS, laser printer &
1 (essential)
computer table).
2. Over head projector with OHP sheets.
1 (essential)
1 set (essential)
4. LCD projector.
1 ( desirable)
UNIT LIBRARY:
Item
Essential
Essential
39
Warmer.
Suction machine.
Resuscitation set.
Emergency management set.
Oxygen.
Hand washing arrangement with soap and chemical disinfectant.
Radiant Warmer.
Servo Controlled- Indian.
Servo Controlled-Imported.
Neonatal Resuscitation
kit- Self inflating bag
Indian.
Oxygen concentrator.
6
7
8
9
Reputed Manufacturers*
Approx.
Price(INR)*
Meditrin, Zeal,Phoenix
Fischer Paykel,DatexOhmeda-GE
25,000 - 70,000
1.5- 3 Lakhs
Medela, Phoenix
Atom,Medela,Phoenix
14,000-60,000
20,000-2,00,000
Meditrin
Imported- Laerdal
1000 - 1400
4000 - 5000
Devilbliss
Airsep
Local
Atom D58
Zeal ,Meditrin
Datex,Pacetech Model 520
Series 300,Nellcor N180
40
60,000-75,000
1- 1.5 lakh
600-800
40000
14 Thousand
50-90 Thousand
10
Becton Dickinson
350
Ginevry
Remi
41
1.6 lakh
15 Thousand
CHAPTER 5
House Keeping and Disinfection Routines
Name
Disinfection method
Frequency
Floors
5% phenol
Walls
2% Bacillocid
Fans
Once a week
Window AC
Refrigerator
Buckets
Sinks
Vim, surf
to
be Once a week
Name
Disinfection
method
Frequency
Bucket
Daily
in Dry in sunlight and store
morning shift inverted when not in use
Sinks
Daily
in morning shift
and
when
required
Mop head
42
Other consideration
Dry in sunlight
Swab
containers/injection/medicine
tray
Set for procedures
Wash with
and water.
Autoclave
Autoclave
Cheattle forceps
Autoclave
Steel drums
autoclaved
Every
hours
Prevention of Infection
Basic Requirements for asepsis in a baby care area include the following:
Presence of conveniently located sinks and hand basins with foot /or elbow/or
sensor taps in adequate number
All rings, bangles, sacred threads, watch to be removed. All cuts and abrasions to be covered
with water proof dressing. Finger nails to be kept short (not more than one fourth of an inch.
If full sleeve is worn, rollup above elbow. wash hands with soap and water for 2 minutes,
Follow 6 steps of hand washing.
43
Hand should be rinsed thoroughly prior to drying. Drying can be done with
autoclaved paper towels. Even old newspapers cut into squares and
autoclaved can be used for this purpose.
In order to maintain skin integrity despite regular hand washing, staff should
be encouraged to use hand cream/lotion when they go on breaks,
Protective Apparel/Gowning:
A few small Western studies which have been conducted do not support use of gowns or
changing of shoes. It is prudent in our country, where there is lot of exposure to dust, dirt
and fomites ,to change clothes or wear a gown and change shoes before entering the unit,
Disposable mask may be worn if any staff member is suffering from cold/URTI and cannot be
kept away from active duty.
44
Name
Indication of use
Frequency
Instructions
for
use/special issues
-
45
Name
Walls of unit
Incubators & radiant warmers
Weighing machine surface
-Prepare
solution
as
per
manufacturers instructions.
-Switch of air conditioner before
spraying
Cidex
(2% glutaraledehyde)
Oxygen/suction tubing
Clean thoroughly with soap and water
Face mask and resuscitation before immersion in Cidex
bag
Contact time: for sterilization: 4-6
hours
For disinfection -15 minutes
Once prepared, the solution is active
for 14 days, but this depends on usage.
Ideally the activity should be checked
with indicator strips available from
manufacturer
Formalin
Fumigation of SNCU
Sodium hypochlorite
Spirit(70% alcohol)
Skin preparation
Do not use for cleaning of incubators &
Cleaning of laryngoscope warmers.
blades,thermometers,tape
measures ,stethoscope
Oxygen
hood
,feeding After washing in soap and water,
utensils, swab containers, feeding utensils to be boiled for 10
injection tray, face mask minutes
,buckets
Cleaning floors
Phenyl
Povidoneiodine(betadine)
Skin preparations
46
CHAPTER 6
Running Cost of a Sick New Born Care Unit At The District
Amount
100.00 20
2000.00
Tegaderm
42.00
15
630.00
Micropore (1)
36.00
02
72.00
205.00 30
6150.00
B.T. set
48.00
08
385.00
Syringe 1cc
5.00
150
750.00
Syringe 2cc
5.00
60
300.00
Syringe 5cc
5.00
60
300.00
Syringe 10cc
7.00
60
420.00
Syringe 20cc
13.00
15
195.00
Syringe 50cc
27.00
60
1620.00
NG tube (5/6)
14.00
15
210.00
Suction catheter
14.00
30
420.00
55.00
30
1650.00
15
1425.00
04
48.00
(Rs.)
2025.00
Connector
with 100.00 10
extension tubing
P.M. Line (100 cm)
145.00 30
1200.00
Dynaplast
112.50
450.00 112.50
Total
4350.00
24,262.50
Hence, the Cost / bed / day = Rs. 809.00 (Rupees eight hundred nine only)
47
MEDICATIONS
NS (25 cc)
NS (100 cc)
25D (25 cc)
3% NaCl (100 ml)
25D (100 ml)
Isolyte P (500 ml)
Calcium Gluconate (10 ml)
MVI
KCl
Total
20.00
13.00
16.00
44.00
41.00
100.00
16.00
11.35
15.00
276.35
The above calculation is the Average fluid requirement for 48 hrs / bed.
Hence, the Total monthly cost = Rs. 277 x 15 = Rs. 4145.00 (Rupees four thousand one hundred forty
five only).
So, Cost / Bed / Day = Rs. 138.00 (Rupees one hundred thirty eight only).
Other Essentials
Item
NaHCO3
AminoPhylline
Gardenal
Phenytoin
Fosolin
Lorazepam
Midazolam (5 ml)
T-bact
MgSO4
Vit A
Adrenaline
Lasix
Heparin
Morphine
Total
48
No. of
unit
4
4
5
5
5
5
4
4
8
10
4
4
4
2
Price (Rs.)
64.00
48.00
110.00
51.00
125.00
87.00
332.00
320.00
48.00
45.00
24.00
12.00
448.00
44.00
1,758.00
Hence, the cost / bed / month is Rs. 1758.00 (Rupees one thousand seven hundred fifty eight only)
So, the cost / bed / day = Rs. 59.00 (Rupees fifty nine only)
Antibiotics
Antibiotic
Unit Price
(Rs.)
Piperacillin- 100.00
Inj.
Tazobactum
(Pipzo 1.125 gm)
Inj. Amikacin (100mg)
3000.00
18.00
30
540.00
110.00
70.00
8
15
880.00
1050.00
330.00
10
3300.00
370.00
740.00
150.00
600.00
16.00
15
240.00
Total
10,350.00
Hence, the cost of antibiotic / bed / month = Rs. 10,350.00 (Rupees ten thousand three hundred fifty
only)
So, the cost / bed / day = Rs. 345.00 (Rupees three hundred forty five only)
Misc. Medication
Item
Amount (Rs.)
Syrup. Ostocalcium
63.00
02
126.00
Tonoferon drops
40.00
02
80.00
Multivitamin drops
30.00
02
60.00
Lactodex-HMF
12.00
50
600.00
02
40.00
Domstal suspension
04
140.00
35.00
49
Paracetamol drops
23.00
02
46.00
Cephalexin drops
52.00
01
52.00
04
Ciprofloxacin
eye 13.00
drops
Clotrimazole mouth 54.00
paint
Dopamine
36.00
02
26.00
02
108.00
04
144.00
Dobutamine
02
900.00
72.00
450.00
TOTAL
2,394.00
Hence, the Cost / bed / day = Rs. 80.00 (Rupees eighty only)
5
6
7
8
9
10
Item
Cord clamp
Delees mucus trap
E.T. tube (portex)
Chemical disinfectants
(Cidex,
Bacillocid,
Liquid
Soap,
Detergent,
Sterillium,
Savlon, Phenol,
Lysol,
Betadine,
Rectified
Spirit)
Unit
10 each
10 each
145 each
(For 12 Bedded
Unit)
Cost
6000.00
6000.00
1450.00
35000.00
Glucostix
Capillary tube
Multistix
Stationeries
Sterile gloves
Cap, Mask
Cap
Mask
6 units
400 units
1 unit
1 unit
50
550.00
10.00
1000.00
1000.00
5.00
3300.00
4000.00
1000.00
1000.00
250.00
50
50
5.00
5.00
250.00
250.00
62,750.00
Total
50
This cost is inclusive of all maintenance activities for the newborn (Labour room + O.T + SNCU +
Postnatal ward + Neonatal ward) for one month.
Hence per day cost could come down to Rs. 2092/Cost/ Patient/ Day/ Bed:
Item
Cost (Rs.)
For Disposables
809.00
138.00
For
non-antibiotic
IV 59.00
Medications
For IV antibiotics
345.00
80.00
Total
1431.00
Maintenance cost for all activities including Labour Room, OT, SNCU, Postnatal ward, Neonatal Ward
for one month = Rs. 62,750.00 (Rupees sixty two thousand seven hundred fifty only).
So, cost / day = Rs. 2,092.00 (Rupees two thousand and ninety two only)
Hence, cost for a 12 bedded SNCU unit annually
Maintenance /year
= Rs.
7, 53, 000.00
___________________
Rs.70, 20, 780.00
___________________
Amount in words: Rupees Seventy Lakh Twenty Thousand Seven Hundred Eighty only.
51
CHAPTER 7
Sick Newborn Stabilizing Unit
LEVEL I:
Level I units provides a basic level of newborn care to newborns at low risk along with the healthy
newborns.
a) Basic and essential neonatal care
Temperature maintenance
Eye care
Cord care
52
Detection and referral and appropriate care-seeking for babies with danger signs.
Arrangement of Phototherapy.
Initiate and maintain intravenous access for fluid and medications as and
when required.
Gavage feeding
Nasal oxygen with oxygen saturation monitoring.
Arrangement for estimation of Blood Glucose and Bilirubin.
These are the special services provided along with the basic services for newborn.
Location of SNSU
Ideally should be located next to the Labour Room or within/ close proximity of the Maternity Ward.
Configuration of SNSU
Physical dimension: 10ft x 25 ft = 250sq.ft approximately (where only radiant warmers will be kept).
Provisions for elbow operated/ foot operated hand washing should be there.
53
Ideally the walls and the floor should be white/ off-white in colour. Yellow and Blue colour should
be avoided.
In general the walls, floors, windows and doors should be easily washable.
There should be 6 electricity outlet wall tap two input, 10/15 amp. for the beds.
There should be 12-14 outlets (combined 5-15 amp. female plugs) divided in two boards.
54
Special Skills:
1. Provide intravenous fluid and injection.
2. Provide resuscitation with bag & mask.
3. Use head box.
4. Use phototherapy.
5. Monitor care during transport.
55
CHAPTER 8
Admission criteria to SNCU
NEONATAL WARD
>2.2 Kg or
>1.8 Kg but stable
< 34 weeks
34-37 wks
>37 wks
AFD
APGAR Score
Between 4-6 at 1 min /gasping
breathing (moderate hypoxia)
Less than 3 at 1 min/ no resp at 1
min (severe hypoxia)
Normal APGAR
Complicated LFD
Uncomplicated LFD
Uncomplicated LFD
Symptomatic Hypoglycaemia
Asymptomatic Hypoglycaemia
Normoglycemia
Exchange transfusion
Phototherapy
Newborn with risk factors
Sepsis for investigation
Physiological jaundice
Routine care
Stable high risk neonates
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