Proposed Uniform Definitions for Capabilities Associated With the Highest Level of Neonatal Care Within an Institution (See Text for Details)

Level I neonatal care (basic)
    Well-newborn nursery: has the capabilities 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 to 37 weeks' gestation who remain physiologically stable
        Stabilize newborn infants who are ill and those born at <35 weeks' gestation until transfer to a facility that can provide the appropriate level of neonatal care
Level II neonatal care (specialty)
    Special care nursery: level II units are subdivided into 2 categories on the basis of their ability to provide assisted ventilation including continuous positive airway pressure
        Level IIA: has the capabilities to
            Resuscitate and stabilize preterm and/or ill infants before transfer to a facility at which newborn intensive care is provided
            Provide care for infants born at >32 weeks' gestation and weighing ≥1500 g (1) who have physiologic immaturity such as apnea of prematurity, inability to maintain body temperature, or inability to take oral feedings or (2) who are moderately ill with problems that are anticipated to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis
            Provide care for infants who are convalescing after intensive care
        Level IIB has the capabilities of a level IIA nursery and the additional capability to provide mechanical ventilation for brief durations (<24 hours) or continuous positive airway pressure
Level III (subspecialty) NICU: level III NICUs are subdivided into 3 categories
    Level IIIA: has the capabilities to
        Provide comprehensive care for infants born at >28 weeks' gestation and weighing >1000 g
        Provide sustained life support limited to conventional mechanical ventilation
        Perform minor surgical procedures such as placement of central venous catheter or inguinal hernia repair
    Level IIIB NICU: has the capabilities to provide
        Comprehensive care for extremely low birth weight infants (≤1000 g and ≤28 weeks' gestation)
        Advanced respiratory support such as high-frequency ventilation and inhaled nitric oxide for as long as required
        Prompt and on-site access to a full range of pediatric medical subspecialists
        Advanced imaging, with interpretation on an urgent basis, including computed tomography, magnetic resonance imaging, and echocardiography
        Pediatric surgical specialists and pediatric anesthesiologists on site or at a closely related institution to perform major surgery such as ligation of patent ductus arteriosus and repair of abdominal wall defects, necrotizing enterocolitis with bowel perforation, tracheoesophageal fistula and/or esophageal atresia, and myelomeningocele
    Level IIIC NICU: has the capabilities of a level IIIB NICU and also is located within an institution that has the capability to provide ECMO and surgical repair of complex congenital cardiac malformations that require cardiopulmonary bypass