Neonatal Care and NICU Levels

From Well Baby Nursery to Level 4 NICU

Many expectant moms think that all hospitals are the same, but NICU levels and levels of neonatal care vary greatly by hospital. Some hospitals can provide expert care to the smallest and sickest of babies, including micro preemies. Other hospitals are set up to provide only well-baby care for healthy-term babies and must transfer premature or sick babies to other facilities.

What do you need to know about the different types of nurseries provided whether you are choosing a hospital at which to deliver or have a baby that requires special care? What is the different between a well baby nursery, a special care nursery, and a level 3 or level 4 nursery?

 

1
Well Baby Nursery

Mother with baby in incubator
What are the different types of nurseries available for newborn babies whether healthy or premature?. Alvis Upitis/Stockbyte/Getty Images

A well baby nursery provides care to healthy babies born close to their due dates. Well, baby nurseries provide routine medical care, including assessment and state-mandated newborn screening.

Regular well baby nurseries can typically care for premature babies born at 35 weeks (called late preterm babies) and those with minor medical problems.

A well baby nursery is also equipped to stabilize babies born earlier than 35 weeks or with medical conditions which require transport to a NICU.

2
Special Care Nursery

A Special Care Nursery can care for moderately preterm babies.
A Special Care Nursery can care for moderately preterm babies. Image by Alvis Upitis / Getty Images

A special care nursery sometimes called a level 2 NICU, can care for babies born around 32 weeks gestational age or greater (often referred to as moderately preterm babies) or babies who are full-term but require close monitoring or intravenous antibiotics after birth.

Special care nurseries can treat babies with some health problems of prematurity, such as jaundice and trouble eating or staying warm. Since feeding is one of tasks which often determines when a baby can be sent home from a special care nursery, you may wish to learn more about feeding premature babies.

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 (CPAP)

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Level 3 NICU

A Level III NICU can care for the smallest and sickest babies.
A Level III NICU can care for the smallest and sickest babies. Image courtesy Getty Images / Alvis Upitis

A level 3 NICU can provide intensive care for babies born at almost all gestational ages, from "very premature babies," babies born at 27 to 30 weeks, and above.

The definition of a level 3 NICU may vary in different states or hospitals, but 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 milk feedings.

According to some classification systems, a level 3 NICU is the highest level of neonatal care. Under these classifications, a level 3 NICU can provide the same level of care as a level 4 NICU below.

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    4
    Level 4 NICU

    Level 4 NICUs can provide high-frequency ventilation when needed.
    Level 4 NICUs can provide high-frequency ventilation when needed. Image courtesy of Jerry Burdette

    For states and hospitals who use this classification, a level 4 NICU is an intensive care unit that can care for babies as young as 22 to 24 weeks gestational age. The term "micropremies" is used to describe babies born between 22 and 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 or ECMO. They also offer a wide variety of neonatal surgeries including heart surgeries for babies born with congenital heart disease.

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    Coping When Your Baby is Hospitalized in a NICU

    There are few things that are less frightening than coping with a baby who has been hospitalized in a NICU. Many parents feel they would do anything to change places with their baby and spare her this experience. Yet there are many things you can to to help both yourself and your baby cope as well as possible during this time.

    Learn as much as you can about the routines and procedures of a NICU as well as they types of monitors used. There are so many terms and a multitude of procedures that take place. Understanding some of these can remove some of the fear and help you feel more empowered in your journey.

    Bonding with your baby is every bit, if not more important, than with a full term baby or a baby born without medical problems. Thankfully, NICU staff are trained and very aware of the importance of bonding on your baby's progress and will work with you in many ways. Some of these methods, such as kangarooing (lying skin to skin with your baby) may seem foreign to you, but a multitude of studies have been performed to find the best ways of communicating love and support to these children who must spend time out of their parent's arms and in an incubator.

    Many parents find the strict protocols and guidelines in the NICU somewhat intimidating, and it can be helpful to realize that these strict practices are necessary to provide the best care for these little people who are fragile and can become ill very quickly if exposed to harmful microorganisms.

    A question most parents ask at some time is, "When can I take my baby home from the NICU?" The answer will vary for every baby, but a few conditions usually need to be met before discharge. These include:

    • A baby's ability to maintain her temperature.
    • A baby's ability to feed well by mouth (though some babies can go home with an NG tube or G tube.)
    • A baby's ability to breath without assistance (though babies may be sent home with oxygen by nasal cannula.)
    • When a baby outgrows apnea and bradycardia spells (A and B spells.)

    There are also several milestones for NICU discharge that must be achieved, including a hearing screen and car seat study.

    Learn more about coping when you have a premature baby.

    Sources:

    Baia, I., Amorim, M., Silva, S. et al. Parenting Very Preterm Infants and Stress in Neonatal Intensive Care Units. Early Human Development. 2016. 101:3-9.

    Bapat, R., McClead, R., Shepherd, E., Ryshen, G., and T. Bartman. Challenges, Successes and Opportunities for Reducing Readmissions in a Referral-Based Children’s Hospital NICU. Journal of Neonatal and Perinatal Medicine. 201. 9(4):433-440.

    Horbar, J., Edwards, E., Greenberg, L. et al. Variation in Performance of Neonatal Intensive Care Units in the United States. JAMA Pediatrics. 2017. 171(3):e164396.

    Kliegman, Robert M., Bonita Stanton, St Geme III Joseph W., Nina Felice. Schor, Richard E. Behrman, and Waldo E. Nelson. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2015. Print.

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