Did you know?
There are various levels of NICU care! The American Academy of Pediatrics categorizes hospitals into four levels based on the care a facility can provide to newborns. The definition of each may vary from state to state or by hospital, but here is a general breakdown of the different levels!
Level I
This type of care is designated for healthy newborns AKA the well newborn 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 35-37 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. Most neonatal nurses do not have a long career in Level I, as newborn infants often stay in the same room with their mother. Some NICU nurses start out here to learn the fundamentals of a healthy newborn and then transition to a higher level of care.
Level II
This is a special care nursery. This unit can care for babies born at 32 weeks gestation or older (often referred to as moderately preterm) and weigh more than or equal to 1,500 grams. They can stabilize infants born earlier than 32 weeks and those weighing less than 1,500 grams until they can be transferred to a higher level facility.
These babies have physiologic immaturity or can be moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis. Sometimes babies admitted to this unit are full-term but require close monitoring or intravenous antibiotics after birth.
This level is reserved for newborns delivered prematurely or those with illness, requiring immediate care. These newborns commonly need specialized care due to their prematurity such as intravenous fluid administration, specialized feeding, phototherapy, help with thermoregulation, oxygen therapy, and medications. They usually need time to mature and grow prior to discharge.
Special care (level 2) nurseries may be broken down into:
Level 2A nurseries which do not provide respiratory assistance
Level 2B nurseries which provide some respiratory assistance such as continuous positive airway pressure
Level III NICU
A Level 3 NICU can provide intensive care for babies born at almost any gestational age, from "very premature"—babies born at 27 to 30 weeks, and above. All Level 3 NICUs can care for babies born at more than 28 weeks, are able to provide respiratory support for babies who are having trouble breathing and can deliver intravenous fluids to babies who cannot take breast milk feedings. This includes conventional and/or high-frequency ventilation and inhaled nitric oxide.
Neonatal nurses in this level render care to very sick newborns, often with complex congenital problems. Newborns may need much intense care, such as incubators, ventilators, surgery, and other support equipment. This level of care can provide sustained life support as well as equipment and machinery necessary to care for infants born at all gestational ages and birth weights. In addition, level III NICUs can perform advanced imaging, with interpretation on an urgent basis, including computed tomography, MRI and echocardiography.
Level IV NICU
This is the highest NICU level, and this unit is well-equipped to care for the most complex and tiniest babies as young as 22 to 24 weeks gestational age. The term "micro preemies" is used to describe babies born between 22-26 weeks of gestation or smaller than 1 pound 13 ounces. Level 4 NICUs can provide very sophisticated types of respiratory support for very sick babies, including extracorporeal mechanical oxygenation (ECMO), surgical interventions, consultations, referrals, and specialties.
Typically, these NICUs are referral centers. They offer all of the above PLUS surgical interventions, ECMO (heart and lung bypass), and require subspecialty care. This includes consults from various departments such as Cardiology, Cardiothoracic surgery, ENT, Plastics, Genetics, Neurosurgery, Infectious Disease, General Peds Surgery, Pulmonology, Speech/Language/Feeding specialists, etc. In addition, they have the capability of facilitating transport and providing outreach education.
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