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

This article was originally published in September 2022 and last updated in January 2024.

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 and your baby appears well at birth, 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 blood sugars or jaundice.

Your baby’s medical care team:
Expect to meet pediatricians, family physicians and advanced practice pediatric providers.

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 critical and expected to resolve within a few days or weeks.
Were born at 32 weeks gestation or greater 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 neonatologists, neonatal hospitalists and advanced practice neonatal providers.

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 all premature babies. Some Level III NICUs may have specific gestational age requirements. 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 could require a ventilator or breathing machine.
Will benefit from the care and evaluation of neonatal and pediatric specialists
Have a critical illness requiring constant monitoring and intervention
Need advanced imaging like CT scans, MRIs and echocardiograms.
Might require minor surgeries or procedures.
Need long-term nutrition support in a specialized IV.

Your baby’s medical care team:
Expect to meet neonatologists, pediatric hospitalists, advanced practice neonatal providers, pediatric medical or surgical subspecialists.

Level IV NICU

What it is and what happens there:

A Level IV NICU (like this one at Connecticut Children’s in Hartford) provides intensive care for all premature infants as well as other infants who may have complicated medical problems. This may also be called a “tertiary care NICU.” 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 similar to care provided in a Level III NICU.
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.

Your baby’s medical care team:
Expect to meet neonatologists, pediatric hospitalists, advanced practice neonatal providers, pediatric medical or surgical subspecialists.

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:

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.