Definitions, Capabilities, and Provider Types: Neonatal Levels of Care

Level of CareCapabilitiesProvider Typesa
Level I• Provide neonatal resuscitation at every deliveryPediatricians, 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 IILevel 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 basisPediatric 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 IIILevel II capabilities plus:Level II health care providers plus:
NICU• Provide sustained life supportPediatric 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 IVLevel 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 conditionsPediatric 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.