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NICU Levels: What Do They Mean?

A New Born Baby Sleeps in an Incubator

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If you've had a baby or are expecting, you might be familiar with the acronym NICU. Neonatal Intensive Care Units, or NICUs, are specialized departments within hospitals that focus on newborn babies and any extra care that they may require.

AdventHealth for Children in Orlando is now recognized as a Level IV NICU, offering the highest level of newborn care for your little one.

Here's a brief guide to learn more about the different levels of NICUs and what 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 1970s that they became an established part of every hospital in developed countries.

In 2004, the American Academy of Pediatrics introduced what we now know as the levels of NICU. In 2012, it was amended 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

Most babies will receive Level I NICU care after birth. Full-term, healthy babies with a low risk of complications will be provided with this specialized care from the comfort of mom’s room. This isn’t your typical NICU since there is 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 are classified as Level I. Level I care also stabilizes newborn infants who are ill or were born sooner than 35 weeks until they can be transferred to a facility that can provide the appropriate level of neonatal care.

In Level I NICU care, a pediatrician or advanced nurse practitioner will visit mom’s room each day to complete an assessment and talk with the families.


Level II NICUs must be able to do everything a Level I can do; they are often called special care nurseries. These nurseries are for babies that were born prematurely between 32 and 34 weeks, or for babies that weigh more than 1,500 grams (about 3.3 pounds).

Level II NICU can:

  • Provide care for babies born at least at 32 weeks who are moderately ill with problems that are expected to get better quickly, and who aren't anticipated to need urgent specialty care
  • 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

Level II NICUs must be staffed by neonatologists, pediatric hospitalists and neonatal nurse practitioners in addition to the Level I health care providers. They must also have immunologists, nutritionists and specialized nurses.


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 NICUs.

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

Level III NICU can:

  • Provide sustained life support
  • Provide comprehensive care for babies born before 32 weeks that weigh less than 1,500 grams (3.3 pounds)
  • 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 NICU is the highest level of care available for premature and critically ill newborns.

A Level IV NICU designation must meet all Level III capabilities, plus have the ability to care for infants born earlier than 32 weeks gestation and weighing less than 1,500 grams, provide life support, perform advanced imaging including MRI and echocardiography, as well as provide a full range of respiratory support and more criteria.

While some hospitals and states don’t differentiate between Levels III and IV, being officially recognized as a Level IV NICU means that the hospital has capabilities and access to services that go beyond other facilities. Our AdventHealth for Children NICU in Orlando can handle the most acute care, the most complex medical cases and can perform surgeries for acquired or congenital conditions.

Level IV NICUs are leading-edge, state-of-the-art, top-quality facilities. Your baby won’t be transported from a Level IV NICU to go somewhere more specialized, because Level IV is the best place for a baby to be at their most fragile time.

AdventHealth for Children in Orlando is Now a Level IV NICU

Here at AdventHealth for Children, after taking the initiative to lobby the state legislature of Florida to change the law to include Level IV NICUs in our state, we are now officially recognized as a Level IV NICU.

Our expert, caring team constantly strives to innovate and improve patient care so babies have optimal outcomes. For patients’ families, our Level IV NICU designation means you can be confident we have the expertise to care for even the most critically ill baby. Thank you for putting your trust in us.

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

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