What essential drugs (with dosing) and equipment should be stocked in a Special Newborn Care Unit (SNCU)?

Essential Drugs and Equipment for Special Newborn Care Units (SNCU)

Critical Airway and Respiratory Equipment

A well-equipped SNCU must have comprehensive airway management capabilities immediately available, as respiratory compromise is the leading cause of neonatal morbidity and mortality.

Airway Management Devices

• Laryngoscopy equipment appropriate for neonates including both direct and video laryngoscopes with blades in multiple sizes 1
• Endotracheal tubes in uncuffed sizes: 2.5,3.0,3.5,4.0,4.5.0,5.5, and 6.0 mm 2
• Oropharyngeal airways in sizes 0-5 and nasopharyngeal airways 12F through 30F 1
• Supraglottic airway devices (laryngeal mask airways) as backup 2
• Bulb suction for initial airway clearance 1
• Suction equipment: portable and fixed suction apparatus with rigid pharyngeal curved tips and flexible suction catheters 6F-16F 1
• Magill forceps for foreign body removal 1

Ventilation Equipment

• Mechanical ventilators suitable for all neonatal sizes with capability for volume and pressure control 1
• Bag-valve-mask resuscitators: self-inflating manual ventilation devices with masks to fit neonates, in both 450-750 mL sizes 1, 2
• Oxygen delivery systems: portable and on-board oxygen supply with regulators 1
• Oxygen administration devices: transparent masks (nonrebreathing and valveless), nasal cannulas in neonatal sizes 1
• Noninvasive positive pressure ventilation devices 1

Respiratory Monitoring

• Pulse oximeter with neonatal-appropriate sensors 1
• Continuous waveform capnography to confirm endotracheal tube placement 1, 2
• Oxygen analyzers for every patient 1

Essential Cardiovascular Equipment

Resuscitation and Monitoring

• Defibrillator capable of manual/automatic defibrillation with pediatric pads, cardiac rhythm monitoring (minimum 3 leads), and transcutaneous pacing 1
• Cardiorespiratory monitor with continuous heart rate, rhythm, respiratory rate, and temperature monitoring 1
• Blood pressure monitoring: automated devices with neonatal-sized cuffs 1
• Doppler ultrasonography device for blood pressure assessment 1

Hemodynamic Support

• Infusion pumps with microcapability (0.1 mL/hr) in adequate numbers 1
• Pressure infusion devices for IV fluids 1
• Blood warming apparatus 1

Critical Medications

Resuscitation Medications

The following medications must be immediately accessible in the SNCU, as delays in administration directly impact survival:

• Epinephrine (1:1000 and 1:10,000 solutions) 1
• Atropine 1
• Adenosine 1
• Amiodarone 1
• Naloxone hydrochloride 1
• Sodium bicarbonate (4.2% and 8.4%) 1
• Dextrose (D10W and D50W) 1
• Calcium chloride 1
• Magnesium sulfate 1

Antimicrobial Agents

Ampicillin and gentamicin remain the most commonly used first-line antibiotics for early-onset neonatal sepsis:

• Ampicillin - most frequently prescribed antibiotic in NICUs 3, 4
• Gentamicin - second most common antibiotic 3, 4
• Cefotaxime - third-line agent 5, 4
• Vancomycin - for resistant organisms 3, 4
• Amikacin - commonly prescribed aminoglycoside 5
• Levofloxacin - increasingly used for preterm neonates 5
• Piperacillin-tazobactam - for complicated infections 5
• Meropenem - for resistant infections 5
• Amphotericin B - first-line for systemic Candida infections 6
• Azithromycin - showing increased use 3

Respiratory Medications

• Surfactant (beractant, calfactant) 3, 4
• Caffeine citrate - third most common medication overall 3, 4
• Bronchodilators 1, 7

Cardiovascular Medications

• Dopamine 3
• Dobutamine - for populations with high mortality 4
• Milrinone - increasing use, particularly for term infants 3, 4
• Epinephrine (also for resuscitation) 4
• Vasopressor agents 1

Sedation and Analgesia

• Fentanyl 3
• Midazolam 3
• Analgesics (topical, oral, and parenteral) 1
• Neuromuscular blocking agents 1, 2

Other Essential Medications

• Furosemide 3, 4
• Anticonvulsants 1
• Corticosteroids 1
• Antiemetic agents 1
• Antipyretic drugs 1
• Inotropic agents 1
• Antidotes (common antidotes must be accessible) 1
• Ferrous sulfate 4
• Multivitamins 4

Vascular Access Equipment

• IV catheters in neonatal sizes 7
• Intraosseous needles 7
• Umbilical vessel cannulation supplies 1
• Central line supplies: triple, double, and single lumen catheters 1
• Arterial line catheters 1
• Antiseptic supplies for skin preparation 1
• Isotonic crystalloid fluids with adjustable delivery rate tubing 1

Diagnostic Equipment

• Glucometer for blood glucose monitoring 1, 7
• Thermometer with range for hypothermia and hyperthermia (25°C to 44°C) 1
• Stethoscope 1
• Electrocardiograph 1
• Equipment for chest decompression: 23-gauge diameter needles, maximum length 0.75 inches for newborns 1

Temperature Management

• Infant warmers (overhead radiant warmers) 1
• Heating devices and heat packs 1
• Thermal absorbent blankets and head covers 1
• Blankets and towels 1
• Aluminum-foil roll or heat-reflective material 1

Neonatal Delivery and Stabilization Supplies

Every SNCU must maintain dedicated newborn delivery supplies as unexpected deliveries may occur:

• Umbilical cord clamps (minimum 2) 1
• Tool for cutting umbilical cord 1
• Gauze dressings 1
• Materials to maintain body temperature 1

Infection Control Supplies

Standard Precautions

• Waterless hand cleanser 1
• Sharps containers (fixed and portable) 1
• Biohazardous materials collection bags 1
• Disinfectant solutions for equipment cleaning 1
• General trash collection bags 1

Transmission-Based Precautions

• Contact precautions: examination gloves (sterile and non-sterile), eye protection, gowns 1
• Droplet precautions: surgical masks and eye protection 1
• Airborne precautions: N95 respirator masks in appropriate sizes, powered air-purifying respirators (PAPR) 1

Additional Essential Equipment

Feeding and Nutrition

• Nasogastric/orogastric tubes 1
• Infant formula and oral rehydrating solutions 1
• Enteral and parenteral nutrition supplies 1

Wound Care and Hemorrhage Control

• Gauze sponges 1
• Adhesive bandages and tape (various sizes, hypoallergenic and adhesive) 1
• Occlusive dressings 1
• Sterile multitrauma dressings 1

Miscellaneous Critical Items

• Infant scales for accurate weight measurement 1
• Length-based resuscitation tape for equipment sizing and drug dosing 1
• Syringes and needles in various sizes 1, 7
• Urinary catheters (pediatric sizes) 1
• Bandage and trauma shears 1
• Two-way communication devices for medical control 1

Organizational Requirements

Equipment competency and accessibility are as critical as equipment availability itself 1. The SNCU must ensure:

• Daily verification of proper location and function of all equipment 1
• Staff competency assessment in equipment use 1
• Immediate accessibility of resuscitation equipment 1
• Standardized organization of equipment for quick access 2
• Regular inventory checks with expiration date documentation 7
• Replacement protocols for used or expired items 7

Common Pitfalls to Avoid

• Inadequate stock of neonatal-sized equipment: Adult-sized equipment cannot be safely adapted for neonates 1
• Failure to maintain medication expiration dates: Only 35% of commonly prescribed NICU medications are FDA-approved for infants, making proper storage critical 3
• Inaccessible emergency equipment: Equipment stored in distant locations delays critical interventions 7
• Lack of weight-based dosing tools: Calculation errors are common without precalculated dosing references 1
• Insufficient infection control supplies: Neonates have the highest infection incidence of any age group 6
• Missing backup airway equipment: "Cannot intubate/cannot oxygenate" scenarios require immediately available alternatives 2