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Inside the NICU: What Are the Different Levels of Neonatal Care?

December 3, 2020

A superior neonatal intensive care unit (NICU) can give your baby a second chance at life. But what should you consider when evaluating options?

Think of a NICU as a sanctum for your newborn, a harbor of specialized care, underpinned by superlative medical experts and advanced technologies. A NICU is usually required for babies born premature, or with specific conditions at birth.

There are four different levels of NICUs – Level I, Level II, Level III and Level IV – each classified on their level of expertise and specialist care. The higher the level, the more specialized the care. If you’re at risk of a preterm delivery or have had complications in your pregnancy, it’s worth considering a hospital with a higher-level NICU. Here’s what you should know.

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  • Level I NICU

As the most basic level of neonatal intensive care, a Level I unit is capable of rendering neonatal resuscitation, providing treatment to newborns, stabilizing and providing care to infants born between 35 and 37 gestational weeks, and treating infants born with illnesses at less than 35 gestational weeks. In the last case, this is usually an interim arrangement until the baby has been transferred to another facility with the requisite level of care. The ecosystem within a Level I NICU is usually composed of pediatricians, general physicians, nurses and other medical specialists.

  • Level II NICU

As the next level of neonatal intensive care, Level II NICUs provide all the services of a Level I NICU, plus additional specialized services. They are made up of pediatricians, neonatologists, neonatal nurses, as well as all those medical specialists required of a Level I NICU. Level II NICUs extend care to infants as premature as 32 gestational weeks, or weighing as little as 1,500 grams. They are also suited for infants with underdeveloped immune systems or moderate illnesses, and for infants requiring mechanical ventilation or continued care after intensive treatment.

  • Level III NICU

Level III NICUs are the next level of neonatal intensive care after Level II. In addition to the layers required of a Level II NICU, they are required to have pediatric surgeons, pediatric medical sub specialists, pediatric anesthesiologists and pediatric ophthalmologists. Level III NICUs are armed with an ecosystem tailored to provide critical life support, specialized care of infants born as early as 27 to 30 weeks, treatment for serious illnesses and full-spectrum respiratory support including high-frequency ventilation and advanced imaging.

  • Level IV NICU

A Level IV NICU is the highest standard of neonatal intensive care, comprising pediatric surgical sub specialists, in addition to all the expert care providers and specialized services of a Level III NICU. In addition, it also offers services like extra corporeal membrane oxygenation and hospital-to-home transport services. A Level IV NICU is normally anchored to a larger hospital with expertise in surgical repair of serious congenital or acquired conditions.

When it comes to choosing a hospital for your delivery, it’s always wise to err on the side of caution and choose a facility with a higher-level NICU – even if the odds of a healthy delivery are in your favor. A Level III or Level IV NICU is more than a potential lifeline for your baby. It’s a barometer of the quality of your chosen hospital (a superior NICU can be a worthy reflection of other services). If you’re evaluating hospitals, it’s a good idea to ‘level up’ and give your baby the best start to life.

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