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What Is a Level 4 NICU?


Updated June 24, 2014

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close up of a caucasain newborn baby laying in an incubator as a nurse takes the baby by the hand
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A level 4 NICU, or level IV NICU, is the highest level of neonatal care. Although there is no official definition for a level 4 NICU, some states and hospital systems use this designation for NICUs that care for babies with the highest needs.

A level 4 NICU can provide:

  • Care for babies at the lowest ages of viability
  • Mechanical ventilation, including high frequency ventilation
  • A wide variety of surgeries, including heart surgery requiring bypass
  • Some level 4 NICUs may also provide ECMO
Although there is no standard definition for different levels of NICU care, the American Academy of Pediatrics (AAP) policy on Levels of Neonatal Care is used in many parts of the US. The AAP policy does not recognize a level 4 NICU. The highest level of NICU care recognized by the AAP is a Level IIIC NICU, or level 3C NICU. A Level IIIC NICU provides all of the same services as a level 4 NICU.


American Academy of Pediatrics Committee on Fetus and the Newborn. "Policy Statement: Levels of Neonatal Care." Pediatrics Nov. 2004. 114: 1341-1346.

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