NICU Levels

As an expecting parent you have to make a lot of decisions. Sleeping arrangements, feeding, car seats, daycare and pediatricians are just a few of the dozens of topics on your mind. And what if you have to plan for your baby to spend time in the neonatal intensive care unit (NICU)? If you have a prenatal diagnosis or want to create a baby care plan in case your baby needs a higher level of care, you might also be learning more about NICUs.

Beyond that, you should know what kind of NICU is right for your baby – just in case they need it.

It can feel like a lot to consider, but we’re here to help.

Why are there different neonatal intensive care unit levels?

NICUs are classified based on their capabilities into levels by the American Academy of Pediatrics (AAP). Level IV (four) is the highest level of distinction, and Level I (one) is the lowest.

Based on your baby’s needs or condition, these levels can help guide you to the appropriate facility to ensure the best care for your family. You’ll want to discuss with your doctor which NICU level is best for you and your baby’s medical needs. Below is a brief outline of the definition and capabilities of each level.

What is a Level I NICU?

Sometimes known as newborn nurseries, Level I (one) NICUs provide basic care for preterm infants (babies born before 37 weeks of pregnancy). These NICUs provide routine care for healthy preterm babies.

A hospital with a Level I NICU is equipped to care for:

• Healthy preterm babies born between 35- and 37-weeks’ gestation, and
• Babies whose health is stable, meaning that they can breathe on their own, feed and maintain their body temperature

When necessary, Level I NICUs can stabilize preterm infants under 35 weeks and transfer them to a higher level NICU for more advanced care.

What is a Level II NICU?

Level II (two) NICUs, also called special care nurseries, care for babies born at 32 to 35 weeks’ gestation. These facilities are suited for babies who have moderate medical issues and are expected to recover fairly quickly.

A hospital with a Level II NICU can care for:

• Stable or moderately ill newborn infants born at or after 32 weeks’ gestation and who weigh at least 1,500 grams (3.3 pounds)
• Babies who are full-term but who require close monitoring for issues like jaundice or trouble staying warm
• Newborns whose problems are expected to resolve rapidly and are not expected to need sub-specialty level services (like a pediatric heart or breathing specialist) urgently

Level II NICU resources and services include:

• Assisted or mechanical ventilation (to help the patient breathe) on a short-term basis, preferably under 24 hours
• Some specialized equipment, for example a portable X-ray machine and blood gas analyzer
• Medical staff who are available continuously for ongoing care and in case of emergencies and have special training in neonatal (newborn) care

Babies who cannot breathe on their own 24 hours after birth should be transferred to a higher level of care.

What is a Level III NICU?

Level III (three) NICUs provide critical care for babies born before 32 weeks’ gestation or babies with specific medical conditions that require surgery or other specialized pediatric care.

A hospital with a Level III NICU is equipped to care for:

• Preterm infants born before 32 weeks or who weigh less that 1,500 grams (3.3 pounds) at birth
• Babies with medical or surgical conditions, regardless of age

A Level III NICU must:

• Have significant clinical experience demonstrated by large patient volumes and complexity of care
• Have neonatal and pediatric subspecialists available promptly, 24/7 (though not necessarily on-site)
• Be able to provide life support for as long as needed
• Have quick access to specialized newborn services including surgery, advanced breathing support, specialized monitoring equipment, and nutrition, pharmacy and imaging services

At Children’s Hospital Colorado, our hospital in Colorado Springs features a Level III NICU with 50 critical care beds, specialized rooms for twins and triplets and much more.

What is a Level IV NICU?

Level IV (four) NICUs offer the highest level of medical care for newborns and premature infants available. These facilities are equipped to care for the most complex neonatal conditions and the sickest and smallest newborns, no matter their gestational age at birth.

These facilities have all the capabilities of a Level III NICU, plus they employ more experienced staff with 24/7 access to medical and surgical specialists who care only for children.

Level IV NICUs provide the same services as a Level III NICU and:

• Continuous, on-site care from pediatric medical and pediatric surgery subspecialists, such as children’s heart, brain and breathing specialists
• Surgery for complex conditions present at birth (known as congenital conditions) and birth defects such as heart defects, anorectal malformations and craniofacial syndromes

They also typically employ pediatric anesthesiologists to make surgery as safe and comfortable as possible. Finally, Level IV NICUs typically coordinate education and neonatal transport within their regions.

Children’s Colorado’s Level IV NICU on Anschutz Medical Campus is one of the highest-performing and highest-volume NICUs in the country. Here, we care for any baby, no matter how rare or critical their condition.

If you have any more questions about NICU levels or want to ask our neonatal specialists about what level of care might be most appropriate for your baby, please call 303-724-2840.

Learn more about the specialized neonatal services we offer.