What Do NICU Levels Mean? Newborn Hospital Care, Explained.

All newborn babies need special attention in the first few days of life to make sure they are healthy, but some need more care and monitoring, especially if they’re born early or with certain medical problems. That’s why many hospitals have specialized nurseries or neonatal intensive care units (NICUs).  

Not all NICUs are the same. There are four main NICU levels that offer simple to complex newborn care depending on the baby’s needs. Connecticut Children’s and our Care Alliance partners follow the guidelines from the American Academy of Pediatrics.

Connecticut Children’s Dr. Annmarie Golioto explains the difference between these four levels of newborn hospital care and what families can expect.

Level I: Well-Baby Nursery or Couplet Care

What it is and what happens there:
This is not a NICU. Level 1 Nursery hospitals care for healthy babies born at 35 weeks or greater and they will receive routine care and monitoring, often in their mother’s room. If your pregnancy and delivery were pretty uncomplicated, then your baby will stay within this type of care without needing any specialized care. Minor newborn issues can often be addressed here such as low sugars or jaundice.

Your baby’s medical care team:
Expect to meet pediatricians, family physicians, nurse practitioners and other advanced practice professionals.

Level II: Special Care Nursery

What it is and what happens there:
This type of nursery offers all the care of a Level I nursery and more. Your baby may need to stay in a Level II nursery because they:

• Need breathing support for a short period.
• Have medical issues that are not urgent and expected to resolve quickly.
• Were born at or above 32 weeks gestation and at or above 1,500 grams.
• Need assistance with feeding.
• Need an incubator to help stay warm.

Your baby’s medical care team:
Expect to meet pediatric hospitalists, neonatologists and neonatal nurse practitioners.

Level III NICU

What it is and what happens there:
A Level III NICU (like this one at Connecticut Children’s at UConn Health Center) provides intensive care for almost all premature babies. Your baby may need to stay in a Level III NICU because they:

• Need comprehensive care due their low birth weight, gestational age, or both.
• Are having trouble breathing and require a full range of respiratory support.
• Will benefit from the care and evaluation of specialists.
• Have a critical illness that may require a ventilator or breathing machine.
• Need advanced imaging like CT scans, MRIs and echocardiograms.
• Might require minor surgeries or procedures.
• Need long term nutrition support in an IV.

Your baby’s medical care team:
Expect to meet pediatric hospitalists, neonatologists, neonatal nurse practitioners, pediatric medical subspecialists, pediatric anesthesiologists, pediatric surgeons and pediatric ophthalmologists.

Level IV NICU

What it is and what happens there:
A Level IV NICU (like this one at Connecticut Children’s at Hartford Hospital) provides intensive care for all babies born as young as 22 weeks gestation, or “micro-preemies.”  This may also be called a “tertiary care NICU.”   Not only premature babies need Level IV newborn care, though. Your baby may need to stay in a Level IV NICU because they:

• Need comprehensive, oftentimes urgent, care due their birth weight or gestational age.
• Require specialized equipment to treat lung, heart, kidney or brain disorders.
• Have a birth defect that requires specialist involvement.
• Need pediatric medical and surgical subspecialists available 24/7.
• Will need surgery in the newborn period. For example, Level IV NICUs can perform heart surgery if your baby was born with a heart defect.

Hospitals don’t always distinguish between Level III and Level IV, but you can expect the same quality of care and expertise.

Your baby’s medical care team:
Expect to meet pediatric hospitalists, neonatologists, neonatal nurse practitioners, pediatric medical subspecialists, pediatric anesthesiologists, pediatric surgeons and surgical subspecialists, and pediatric ophthalmologists.

Related:
>In the Best Hands: Miles’ Story
>Such a Miracle: Jack’s Story

Life After the NICU and Beyond

When your baby is ready to come home, we may recommend one of Connecticut Children’s comprehensive programs like:

• Neonatal Neurodevelopmental Follow-up Program
• Transitional Medical Care Program
• Retinopathy of Prematurity Follow-up Program
• Nutrition and Lactation Support

We know bringing a baby into the world is no easy feat, but it’s especially challenging if they need extra medical attention. That’s why Connecticut Children’s offers support that stays with you and your family.