The Beginner’s Guide to NICU Levels of Care

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It’s hard to know what to expect from the NICU. Newborn babies can be admitted to the NICU for all kinds of reasons, but for babies who are born premature (earlier than 37 weeks) or ill, it’s likely he or she will spend some time in the NICU. There are four NICU levels of care, and depending on how critical the baby’s condition is will determine which level of care is needed. So how do you know which level NICU can provide for the needs of your baby?

Level I – Basic care

Well newborn nurseries lend basic care for full term newborns who are at low risk for complication. Once a baby is born and is seemingly healthy, the level I nursery will provide a routine evaluation. Each level I nursery has the ability to handle newborn resuscitation if needed and can stabilize premature or sick babies who need specialized care for transportation.

Level II – Specialized care

Reserved for newborns who are moderately ill, a level II nursery hosts babies who do not have an urgent condition or are expected to improve quickly. These babies are typically born at or later than 32 weeks’ gestation and weigh greater than 1500 g (3.3 lbs.) at birth. Health problems that are treated in a level II nursery include apnea, failure to maintain body temperature or accept oral feedings, or immaturity due to relatively uncomplicated premature delivery. Level II nurseries have the staff and equipment (such as assisted ventilation, x-ray machines, and blood gas analyzers) necessary to provide continuous care on a temporary basis and handle emergency situations. If newborns in a level II facility require increased medical intervention, they are referred to a level III nursery.

Level III – Subspecialty Intervention

If your baby is born sooner than 32 weeks’ gestation or weighs less than 1500 g (3.3 lbs.) at birth, he/she will require care in a level III nursery. These nurseries have subspecialty services for advanced high-risk neonatal care – such as neonatology and maternal-fetal medicine – with the capability to provide life support as long as necessary using advanced respiratory support. These units have pediatric nutrition and pharmacy support, monitoring equipment, advanced imaging services (as well as immediate interpretation), and social services. If a newborn baby has a condition that requires surgical correction, a level III facility ideally has a pediatric surgeon and anesthesiologist on call or at a facility nearby to perform the procedure(s).

Level IV – Regional acute NICU

A level IV nursery is for babies who are in critical condition and require corresponding care. Pediatric specialists, surgeons, and physicians are available in the unit 24/7 who can take quick action if needed. The professional staff in a level IV facility handles complex surgical repair of congenital or acquired conditions. This type of nursery also facilitates transportation to and from other levels of care and coordinates continuing education for maximum competency of the personnel.

If yours is a high-risk pregnancy, it could be worthwhile to research the hospitals in your area to find out which one can meet your baby’s needs should any potential problems occur. Babies can move forward and back in the NICU levels of care. If a baby is improving and the case becomes not so crucial, he or she could move to a lower level facility. Regardless of the level of care, each NICU has the same underlying goal: to care for sick newborns as efficiently as possible.

Sources: http://rockymountainhospitalforchildren.com/service/neonatal-intensive-care-unit-levels

http://pediatrics.aappublications.org/content/130/3/587

Image credit: Michael Bentley, https://www.flickr.com/photos/donhomer/

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