Facility Based Newborn Care (FBNC)

Introduction

Flagship initiative under RMNCH+A strategy of National Health Mission (NHM), Ministry of Health & Family Welfare
Provides tiered, facility-based care to sick and small newborns (birth to 28 days) at all levels of public health facilities
Revised Operational Guidelines released November 2025 (after 14 years) – emphasize quality improvement, Mother-Newborn Care Units (MNCU), CPAP provision, newborn screening and zero-separation policy
Goal: Reduce neonatal mortality rate (NMR) to <12/1000 live births by strengthening secondary-level care without need for mechanical ventilation/surgery

Location: All delivery points (Labour Room & Obstetric OT) – PHC, CHC, SDH, DH, Medical Colleges
Bed capacity: 1–2 radiant warmers + resuscitation corner
Services provided:
- Essential newborn care (warmth, resuscitation, infection prevention)
- Early initiation of breastfeeding, weighing, Vitamin K, eye prophylaxis
- Screening for birth defects (RBSK linkage)
Infrastructure: Draught-free area, radiant warmer, suction machine, AMBU bag (size 0 & 1), oxygen, weighing scale, clock
Human resources: Trained staff nurse/ANM present 24×7; FBNC-trained
Referral: Sick newborns to NBSU/SNCU

Location: First Referral Units (FRU), Community Health Centres (CHC) and sub-district level
Bed capacity: 4–6 beds
Services provided:
- Management of mild to moderate sick/small newborns (respiratory distress, jaundice, sepsis, hypoglycemia, hypothermia)
- CPAP (in revised 2025 guidelines), phototherapy, IV fluids, oxygen therapy
- KMC (Kangaroo Mother Care) initiation
- Lactation Support Unit (LSU) integration
Infrastructure: Dedicated space with radiant warmers, CPAP machines, phototherapy units, glucometer, pulse oximeter, infusion pumps
Human resources: 1 FBNC-trained Medical Officer + 3–4 staff nurses (3:1 nurse:bed ratio), support staff
Referral: Severe cases to SNCU; reverse referral after stabilization

Location: District Hospitals, high-caseload SDHs and Medical Colleges
Bed capacity: Minimum 12 beds (inborn + outborn); scalable as per delivery load
Services provided:
- Comprehensive secondary-level care for sick/small neonates (not requiring ventilation/surgery)
- Advanced CPAP, exchange transfusion, total parenteral nutrition, advanced phototherapy
- Zero-separation policy in MNCU (mother beds inside unit)
- Lactation Management Centre (LMC) for expressed breast milk
- Newborn screening (hearing, metabolic, congenital hypothyroidism)
- Follow-up of high-risk newborns
Infrastructure: Centralized oxygen, CPAP/ventilators (non-invasive), radiant warmers/incubators, phototherapy, infusion pumps, monitors, lab support
Human resources: 1 Paediatrician/FBNC-trained MO per shift + 3:1 nurse:bed ratio (24×7), support staff, developmental care specialists
Referral: Tertiary care (NICU with ventilation) for mechanical ventilation/surgical cases

Lactation Management Units (LMU/LMC/LSU): Three-tier system for breastfeeding support and donor human milk
Kangaroo Mother Care (KMC) Corners: Mandatory in all units for LBW babies
Human Resources & Training: FBNC training package (revised 2023–2025) for doctors & nurses; Neonatal Resuscitation Module
Equipment & Infrastructure Standards: As per revised 2025 guidelines; MusQan certification linkage
Referral & Transport: Functional ambulance with pre-transport stabilization; reverse transport policy
Monitoring & Quality: Real-time HMIS/ABDM tracking, NQAS/MusQan audits, outcome indicators (NMR, survival rates)
Integration: With RBSK (birth defects screening), SAANS (pneumonia), Anemia Mukt Bharat, U-WIN (immunization)