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Neonatal Care and NICU Levels

From Well Baby Nursery to Level 4 NICU


Updated May 21, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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 micropreemies. 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.

1. Well Baby Nursery

Newborn nurseries provide care to healthy babies.
Image courtesy Diane Macdonald / 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. They can typically care for premature babies born after 35 weeks (called late preterm babies) if they have no complications, and can stabilize babies born earlier than 35 weeks for transport to a NICU.

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    2. Special Care Nursery

    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 and for full-term babies who need close monitoring or IV antibiotics after birth. Special care nurseries can treat babies with some health problems of prematurity, such as jaundice and trouble eating or staying warm.

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    3. Level 3 NICU

    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 all gestational ages. 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, can provide respiratory support for babies who are having trouble breathing, and can deliver IV 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.
      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. Level 4 NICUs can provide sophisticated types of respiratory support for very sick babies, and offer a wide variety of neonatal surgeries.

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