Level of neonatal care Made By Sonal Patel

1. Levels
of
Neonatal Care

2. • The American Academy of Pediatrics
categorizes hospitals into four levels based on
the care a facility can provide to newborns.
• These levels of care correspond to the
therapies and services provided.
• Facilities offering neonatal intensive care must
meet health care standards through
federal/state licensing or certification.

3. • The four categories are:
• Level I: Well newborn nursery
• Level II: Special care nursery
• Level III: Neonatal intensive care unit
(NICU)
• Level IV: Regional neonatal intensive-
care unit (regional NICU)

4. Level I (Well Newborn Nursery)
• Level I units are typically referred to as the well baby
nursery.
• These facilities have the capability to provide
neonatal resuscitation at every delivery; evaluate and
provide postnatal care to healthy newborn infants;
stabilize and provide care for infants born at 35 to 37
weeks' gestation who remain physiologically stable;
and stabilize newborn infants who are ill and those
born less than 35 weeks' gestation until transfer to a
facility that can provide the appropriate level of
neonatal care.

5. • Required provider types for well newborn nurseries
include pediatricians, family physicians, nurse
practitioners and other advanced practice registered
nurses.

6. Level II (Special Care Nursery)
• Level II units are also known as special
care nurseries and have all of the
capabilities of a Level I nursery.
• These facilities are required to have
pediatric hospitalists, neonatologists and
neonatal nurse practitioners ,in addition
to Level I health care providers.

7. • Level II units are able to:
• Provide care for infants born at
32 weeks gestation or older and weighing
more than or equal to 1500g who have
physiologic immaturity or who are
moderately ill with problems that are
expected to resolve rapidly and are not
anticipated to need subspecialty services
on an urgent basis.

8. • Provide care for infants who are feeding and
growing stronger or recovering after intensive
care.
• Provide mechanical ventilation for a brief
duration or continuous positive airway
pressure.
• Stabilize infants born before 32-weeks
gestation and weighing less than 1500g until
transfer to a neonatal intensive care facility.

9. Level III (Neonatal Intensive Care Unit)
• Level III units are required to have the same care
providers required for Level II facilities (pediatric
hospitalists, neonatologists and neonatal nurse
practitioners) and Level I facilities (pediatricians, family
physicians, nurse practitioners and other advanced
practice registered nurses).
• In addition, Level III units must provide, either on site or
at a closely related institution by prearranged
consultative agreement, the following providers:
pediatric surgeons, pediatric medical subspecialists,
pediatric anesthesiologists and pediatric
ophthalmologists.

10. • Level III neonatal intensive-care units are able to:
• Provide sustained life support
• Provide comprehensive care for infants born at all
gestational ages and birth weights with critical illness
• Offer prompt access to a full range of pediatric
medical subspecialists, pediatric surgical specialists,
pediatric anesthesiologists and pediatric
ophthalmologists

11. • Provide a full range of respiratory
support that may include conventional
and/or high-frequency ventilation and
inhaled nitric oxide
• Perform advanced imaging, with
interpretation on an urgent basis,
including computed tomography,
MRI and echocardiography

12. Level IV (Regional NICU)
• The highest level of neonatal care provided occurs at
regional NICUs, or Level IV neonatal intensive care
units. These units are required to have pediatric
surgical subspecialists on staff in addition to the care
providers required for Level III units.
• Regional NICUs have all of the capabilities of Level I,
II and III units. In addition to providing the highest
level of care, Level IV NICUs:

13. • Are located within an institution that has the
capability to provide surgical repair of
complex congenital or acquired conditions
• Maintain a full range of pediatric medical
subspecialists, pediatric surgical
subspecialists and pediatric anesthesiologists
at the site
• Facilitate transport and provide outreach
education
• Provide ECMO (Extracorporeal Membrane
Oxygenation)