My sister is studying at AIIMS. She is searching to download NICU Protocols. So she said me also to search. So someone is here who will provide link to download NICU Protocols for students of AIIMS?

Here I am providing information related to NICU Protocols for your reference:

NICU Protocols
Calcium homeostasis in newborn
Body Ca exists in two major compartments: skeleton (99%) and extracellular fluid (1%). Ca in the extra cellular fluid is present in three forms5
Bound to albumin (40%)
Bound to anions like phosphorus, citrate, sulfate and lactate (10%) and
Free ionized form (50%)

Hypocalcemia is defined by different tSCa and iSCa cutoffs for preterm and term infants (Table 1).

Panel 1: Definition of hypocalcemia
Gestation of infants Total serum calcium level Ionic serum calcium level
Preterm <7 mg/dL (1.75 mmol/L) <4 mg/dL (1 mmol/L)
Term <8 mg/dL (2 mmol/L; total) <4.8 mg/dL (1.2 mmol/L)

Early onset neonatal hypocalcemia (ENH)
Table 1 Causes of early onset hypocalcaemia
Prematurity
Preeclampsia
Infant of diabetic mother
Perinatal stress/ asphyxia
Maternal intake of anticonvulsants (phenobarbitone, phenytoin sodium)
Maternal hyperparathyroidism
Iatrogenic (alkalosis, use of blood products, diuretics, phototherapy, lipid infusions etc)

Prematurity: This may be related to premature termination of trans-placental supply, exaggeration of the postnatal drop to hypocalcemic levels, increased calcitonin and diminished target organ responsiveness to parathyroid hormone.

Infant of diabetic mother (gestational and insulin dependent): This may be related to increased calcium demands of a macrosomic baby. Magnesium depletion in mothers with diabetes mellitus causes hypomagnesemic state in the fetus. This hypomagnesemia induces functional hypoparathyroidism and hypocalcemia in the infant. A high incidence of birth asphyxia and prematurity in infants of diabetic mothers are also contributing factors.

Perinatal asphyxia: Delayed introduction of feeds, increased calcitonin production, increased
endogenous phosphate load, renal insufficiency, and diminished parathyroid hormone secretion- all may contribute to hypocalcemia.

Maternal hyperparathyroidism: This causes intrauterine hypercalcemia suppressing the parathyroid activity in the fetus resulting in impaired parathyroid responsiveness to hypocalcaemia after birth. Hypocalcaemia may be severe and prolonged.

Intrauterine growth restriction (IUGR): Infants with IUGR may have hypocalcemia if they are born preterm and/or have had perinatal asphyxia. IUGR or Small for gestational age (SGA) is not an independent risk factor for ENH.

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