Levels of NICU

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The classifications of levels of NICU is defined according to the level of complexity of care provided

Level I neonatal care (basic)

This is a well-newborn nursery: and has the capability to:

  • Provide neonatal resuscitation at every delivery
  • Evaluate and provide postnatal care to healthy newborn infants
  • Apgar score < 6
  • Stabilize and provide care for infants born > 34 weeks' gestation who remain physiologically stable
  • Stabilize and provide care for infants born > 34 weeks' gestation <   2   k g 
  • Stabilize and provide care for physiologically unstable full term infants who require hemodynamic or respiratory support and birth weight <   2   k g
  • Stabilize newborn infants who are ill and those born at <34 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 based on 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 >30 weeks' gestation and weighing </= 1500 g
    • Apgar score 4 to 6
    • who have physiologic immaturity such as apnea of prematurity, inability to maintain body temperature, or inability to take oral feedings or
    • 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 III A: has the capabilities to
  • Provide comprehensive care for infants born at >28 weeks' gestation and weighing >1000 g
  • Apgar Scores 3 and below are generally regarded as critically low
  • 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 III B NICU: has the capabilities to provide
  • Comprehensive care for extremely low birth weight infants (</=1000g 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 peadiatric medical subspecialists
  • Advanced imaging, with interpretation on an urgent basis, including computed tomography, magnetic resonance imaging, and echocardiography
  • Pediatric surgical specialists and paediatric 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 III C NICU: has the capabilities of a level IIIB NICU and is located within an institution that has the capability to provide Extracorporeal membrane oxygenation and surgical repair of complex congenital cardiac malformations that require cardiopulmonary bypass