Neonatal intensive care: present and future trends in Thailand.

Abstract

A neonatal intensive care unit (NICU) provides the personnel, equipment, and related infrastructure necessary to support the life of a premature or sick neonate. Neonatologists, other medical specialists, nurses, and auxiliaries are on hand to treat and manage their young patients with respirators, monitors, infusion pumps, portable X-ray machines, incubators, and intensive care warmer units as required in a facility large enough to provide unrestricted working space together with pipelines and hand washing facilities. Appropriate laboratory support is needed, while complementary ultrasound, computer tomography, and magnetic resonance scanning are always welcome. Most health institutions in Thailand, however, do not have the personnel, equipment, infrastructure, and financial resources to establish and operate dedicated NICUs. Lack of financial support is the largest constraint. These institutions make do as best they can with available facilities and may be considered to have special care facilities in their nurseries which provide essential life support, but not on the scale of NICUs in the US and Europe. Thailand is two decades behind the US and Europe in terms of providing NICU services to patients in need. Experience with the small NICU established in October 1990 at Ramathibodi Hospital is described. Few would dispute the importance of and need for NICUs to decrease neonatal morbidity and mortality. Such expensive and sophisticated care should, however, be postponed in Thailand in the interest of ensuring that basic needs such as good maternal antenatal care, deliveries, and neonatal care are met. Specialized neonatal care may be encouraged in centers insofar as available resources permit. No official training program exists for neonatologists leading to a board certification by the Thai Medical Council. Moreover, Ramathibodi Hospital has the only neonatal nurse practitioner program. Perinatal training programs for doctors and nurses must be organized in stepwise fashion to prepare for a future in Thailand when NICUs will be widely established in medical schools, regional hospitals, and large private hospitals.