The Neonatal Intensive Care Unit at the Royal Hospital is the largest neonatal tertiary referral center in the Sultanate of Oman. It aims to provide the best and safest critical care to newborns admitted to the unit with a wide variety of complex medical, cardiac and surgical problems. The emphasis is on improving quality of care by using evidence-based treatment and by regular audit of health outcomes.
STAFF
Medical:
Dr. Mujtaba Al Ajmi, MD,MRCPCH, Sr. Consultant & Head
Dr. M. Govind Pai, MBBS, MD, Sr. Specialist
Dr. Basheer Ahmed Itoo, MBBS, MD, MRCP (UK), MRCPCH, FRCP (Edin), Sr. Specialist
Dr. Prakash Manikoth, MBBS, DCH, MRCP (UK), FRCPCH, Sr. Specialist
Registrar / Specialist: 2 permanent and 3 additional for on call duties
Medical Officers/OMSB residents: 6 on rotation
Nursing:
Ward Nurse Mrs. Naima Al Belushi, Ward In charge
Asst. Ward Nurse Mrs. Salma Al Kharusi
Asst. Ward Nurse Mrs. Muhaira Al Harthi
Ward Coordinator Mrs. Annamma Abraham
Staff Nurses: 84
BED STRENGTH
The unit has bed strength of 30 as detailed below:
- Level IIIB Neonatal Intensive Care Unit- high dependency care- 8
- Level IIB Special Care Baby Unit- intermediate dependency care- 7
- Level IIA Special Care Baby Unit- intermediate dependency care- 7
- Level IIA Special Care Baby Unit- low dependency care- 8
SERVICES
- Neonatal intensive care, inclusive of:
- Conventional mechanical ventilation
- High-frequency ventilation
- Surfactant replacement therapy
- Neonatal total parenteral nutrition
- Cranial ultrasonography
- Neonatal echocardiography
- Neonatal cardiac surgery (pre and post operative care)
- Pediatric surgery
- Attendance at high-risk or potentially complicated deliveries
- Prenatal consultation and counseling for parents
- All pediatric subspecialists
- Fetal medicine services
- Post natal rounds of two wards (each with 28 beds and observation room)
- Circumcision
- Genetic counseling
- Breastfeeding support
- Clinical pharmacist
- 24-hour consultation and advice on neonatal problems to pediatricians in the country
- Newborn Screening
- Clinical screening of well babies
- Screening for Retinopathy of Prematurity
- Universal Newborn Hearing Screen
- Thyroid screening programme
- Newborn clinics
- High risk developmental clinic
- Neonatal follow-up clinic
- Neonatal cardiac clinic
- Medical and escort to neonates being transferred to other regions and for those being sent abroad for treatment
- Baby Friendly Hospital Initiative (BFHI) training course
- Neonatal Resuscitation Programme (NRP) provider and instructor courses
- Medical and Surgical Neonatal Course
WORKLOAD AND STATISTICS
Of the 6,500 babies delivered at the Royal Hospital each year, about 650 are admitted to the Neonatal Intensive Care Unit. Another 150 neonates are admitted from regional referral hospitals and private health care establishments in the capital area. The average bed occupancy is 90 % and that of the NICU (level IIIB) is 110 %. The perinatal mortality rate is 12 (inclusive of a significant number of non salvageable babies). The early neonatal mortality rate is 3.8 (of which 36% are fatal congenital malformations). With the establishment of neonatal units in the various Regional Hospitals, the pattern of referrals has changed to more complex medical, cardiac and surgical infants who cannot be managed there. Once the acute problems are resolved, these infants are transferred back to the referring hospital for continuation of care.
Very Low Birth Weight (< 1500 g) / Very Preterm (<32 weeks) Infants
Among newborn babies, those born too small and too early are especially vulnerable to complications related to prematurity. The unit has achieved good health outcomes for Very Low Birth Weight (< 1500 g) / Very Preterm (< 32 weeks) infants, with mortality and morbidity rates comparable to international standards as evident in the table mentioned below:
|
Quality Measures for Very Low Birth Weight Babies ( < 1500 g) |
Neonatal ICU, Royal Hospital, 2006-2008, mean (<1500 g) |
Vermont-Oxford Network, mean (501 to 1500 g) |
| Mortality | 16.3 % |
17.0 % (2005) |
| Necrotising enterocolitis | 2.8 % | 7.0 % (2005) |
| Chronic lung disease | 8.2 % | 25.4 % (2008) |
| Intraventricular hemorrhage, stages 3 & 4 | 7.2 % | 10.1 % (2008) |
| Periventricular Leukomalacia | 2.8 % | 3.2 % (2008) |
| Retinopathy of Prematurity, stages III & IV | 3.3 % | 7.9 % (2008) |
(The Vermont-Oxford Network is an organization of more than 700 Neonatal Intensive Care Units, predominantly in the United States).
ACHIEVEMENTS
- Comprehensive management of preterm babies (≥ 24 weeks or ≥ 650 gm birth weight).
- WHO sponsored Multicentre Growth Reference Study (MGRS) which constructed growth reference curves for Oman for children of age 0 to 5 years.
- Successful management and separation of ischiopagus tetrapus conjoined preterm twins born at 28 weeks gestation.
- Comprehensive referral and management system for neonates with a wide variety of problems in Oman.
- Protocols for admission and management of neonates.
- Screening and management of Retinopathy of Prematurity.
- Establishment of in-house data base of neonates.
- National training center for Neonatal Resuscitation Program (provider and instructor courses).
- Three of the senior medical staff has been certified as NRP instructors by the Life Support Training Center, KFSH, Riyadh.
ACADEMIC ACTIVITIES
- Teaching and Training:
- Medical students of Sultan Qaboos University, College of Medicine and Health Sciences, Oman.
- Clinical teaching, supervision, and mentoring of post graduate residents enrolled in the four year structured Pediatric Residency Programme of the Oman Medical Specialty Board, MRCPCH trainees and Nurses.
- Monthly activities: Mortality meeting, Perinatal meeting, Fetal medicine.
- Regular CME Programs: Lectures, Grand Rounds, Radiology rounds, Journal Club, Symposia and Workshops.
- Practical training in ventilation and cranial ultrasonography.
- Clinical research and analyses.
- Neonatal audit of morbidity and mortality.
RESEARCH
- Outcome of Very Preterm Babies.
- Nasal intermittent positive pressure ventilation in neonates.
- Steroids in Meconium Aspiration Syndrome.
- Indomethacin Prophylaxis for Intraventricular Hemorrhage in Very Low Birth Weight Babies
FUTURE PLANS
- Expansion of the unit to 42 beds.
- Establish additional facilities like Nitric oxide ventilation, ECMO, cerebral function monitoring and whole body hypothermia for perinatal asphyxial encephalopathy.
- Comprehensive Review of Neonatal Outcomes: add more events.
- Establish a well structured and accredited neonatology fellowship programme.
PUBLICATIONS
For the list of 33 publications in journals and books by the Neonatologists please go to the Child Health Publications http://www.royalhospitaloman.com/child_health_3.htm
