Definitions, Capabilities, and Provider Types: Neonatal Levels of Care
| Level of Care | Capabilities | Provider Typesa |
|---|---|---|
| Level I | • Provide neonatal resuscitation at every delivery | Pediatricians, family physicians, nurse practitioners, and other advanced practice registered nurses |
| Well newborn nursery | • Evaluate and provide postnatal care to stable term newborn infants | |
| • Stabilize and provide care for infants born 35–37 wk gestation who remain physiologically stable | ||
| • Stabilize newborn infants who are ill and those born at <35 wk gestation until transfer to a higher level of care | ||
| Level II | Level I capabilities plus: | Level I health care providers plus: |
| Special care nursery | • Provide care for infants born ≥32 wk gestation and weighing ≥1500 g who have physiologic immaturity or who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis | Pediatric hospitalists, neonatologist, and neonatal nurse practitioners. |
| • Provide care for infants convalescing after intensive care | ||
| • Provide mechanical ventilation for brief duration (<24 h) or continuous positive airway pressure or both | ||
| • Stabilize infants born before 32 wk gestation and weighing less than 1500 g until transfer to a neonatal intensive care facility | ||
| Level III | Level II capabilities plus: | Level II health care providers plus: |
| NICU | • Provide sustained life support | Pediatric medical subspecialistsb, pediatric anesthesiologistsb, pediatric surgeons, and pediatric opthalmologistsb. |
| • Provide comprehensive care for infants born <32 wks gestation and weighing <1500 g and infants born at all gestational ages and birth weights with critical illness | ||
| • Provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists, and pediatric opthalmologists | ||
| • Provide a full range of respiratory support that may include conventional and/or high-frequency ventilation and inhaled nitric oxide | ||
| • Perform advanced imaging, with interpretation on an urgent basis, including computed tomography, MRI, and echocardiography | ||
| Level IV | Level III capabilities plus: | Level III health care providers plus: |
| Regional NICU | • Located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions | Pediatric surgical subspecialists |
| • Maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists, and pediatric anesthesiologists at the site | ||
| • Facilitate transport and provide outreach education |
a
Includes all providers with relevant experience, training, and demonstrated competence.
b
At the site or at a closely related institution by prearranged consultative agreement.