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NICU Levels: What Do They Mean?

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If you've ever had a baby, you might be familiar with the acronym NICU. Neonatal Intensive Care Units, or NICUs, are special departments within hospitals that deal with newborn babies and any special care that they may require. Here's a quick guide to learn more about the different levels of NICUs and what do they do.

The History of the NICU

In 1922, hospitals began creating spaces specifically for newborns and the first NICUs were born. However, it wasn't until the 1970's that they were an established part of every hospital in the developed world. In 2004, the American Academy of Pediatrics introduced what we now know as the levels of NICU and in 2012 amended it to four levels of NICU, which set forth expectations and regulations for determining the level of care and resources required to be certified in each level.

Level I NICU

Level I NICUs are where most babies go after birth. Full-term, healthy babies with a low risk of complications go to this nursery after they're born. It isn't really a NICU in the way that most people think, since there's no need for the intensive care aspect.

Babies that have reached at least 35 weeks of gestational maturity, meaning the mother was pregnant for 35 weeks, go to Level I. They also stabilize newborn infants who are ill and those that were born less than 35 weeks gestation until they can be transferred to a facility that can provide the appropriate level of neonatal care. Level I NICUs must be staffed by pediatricians, family physicians, nurse practitioners, and other advanced practice registered nurses.

Level II NICU

Level II NICUs have to be able to do everything that a Level I can do and are often called, special care nurseries. These nurseries are for babies that were born prematurely at 32 weeks or later, or for babies that weigh more than 1500 grams. In addition to the Level I abilities, Level IIs must have immunologists, nutritionists, and specialized nurses.

This level of NICU is able to:

  • Provide care for babies born at least at 32 weeks and who are moderately ill with problems that are expected to get better quickly and aren't anticipated to need special care urgently
  • Provide care for babies feeding and growing stronger or getting better after intensive care
  • Provide mechanical ventilation for a brief duration for at least 24 hours or can maintain continuous positive airway pressure
  • Stabilize and transfer babies that need to be moved to a Level III NICU
  • Required to have neonatologists, pediatric hospitalists, and neonatal nurse practitioners in addition to the Level I health care providers

Level III NICU

Level III NICUs are for all degrees of prematurity and used to be the highest level until 2012. Babies with congenital malformations are sent to Level III.

Level III units are required to have pediatric surgeons in addition to the care providers required for Level II and Level I. They are also required to have pediatric medical subspecialists, pediatric anesthesiologists, and pediatric ophthalmologists on site or nearby.

This level of NICU is able to:

  • Provide sustained life support
  • Provide comprehensive care for babies born before 32 weeks that weigh less than 1500 grams
  • Provide comprehensive care for babies born at any number of weeks and birth weights that have a serious illness
  • Provide a full range of respiratory support
  • Provide advanced imaging and interpretation
  • Provide access to a full range of pediatric surgical specialists, pediatric medical subspecialists, pediatric ophthalmologists, and pediatric anesthesiologists

Level IV

In some states, like Florida, there are not any NICUs with official Level IV designation. But here at AdventHealth, we've taken the initiative and made all of our Level III NICUs meet or exceed the requirements for Level IV while we continue to lobby the state legislature to change the law.

The additional requirements for Level IV are like the previous levels in that they must be capable of doing what the lower levels do but with the following differences:

  • Must be in an institution with 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
  • Provide transportation and outreach education

If you're pregnant and looking for the highest level of care available for you and your baby, please visit our Pediatric Care page to learn more.

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