Neonatal Care and NICU Levels

Medically reviewed by

on April 20, 2020

Many expectant parents think that all hospitals are the same, but NICU levels and levels of neonatal care vary greatly by the hospital. Some hospitals can provide expert care to the smallest and sickest of babies, including micro-preemies. 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.

What do you need to know about the different types of nurseries provided whether you are choosing a hospital at which to deliver or have a baby that requires special care? What is the difference between a well-baby nursery, a special care nursery, and a level 3 or level 4 nursery?

Well Baby Nursery

Mother with baby in incubator — Alvis Upitis/Stockbyte/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. Regular well baby nurseries can typically care for premature babies born at 35 weeks (called late preterm babies) and those with minor medical problems.

A well baby nursery is also equipped to stabilize babies born earlier than 35 weeks, or with medical conditions which require transport to a NICU.

Special Care Nursery

A special care nursery sometimes called a level 2 NICU, can care for babies born at 32 weeks gestational age or greater (often referred to as moderately preterm babies) or babies who are full-term but require close monitoring or intravenous antibiotics after birth.

Special care nurseries can treat babies with some health problems of prematurity, such as jaundice and trouble eating or staying warm. Since feeding is one of the tasks which often determines when a baby can be sent home from a special care nursery, you may wish to learn more about feeding premature babies.

Special care (level 2) nurseries may be further divided into:

Level 2A nurseries which do not provide respiratory assistance
Level 2B nurseries which provide some respiratory assistance, such as continuous positive airway pressure (CPAP)

Level 3 NICU

Belly sleeping can help to alleviate reflux in NICU babies. — Image copyright Vincent Oliver / Getty Images

A level 3 NICU can provide intensive care for babies born at almost all gestational ages, from "very premature babies," babies born at 27 to 30 weeks, and above.

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, are able to provide respiratory support for babies who are having trouble breathing and can deliver intravenous 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.

Level 4 NICU

Preemie Mom holding Preemie baby hand — Getty Images / Anthony Saffery

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. The term "micro-preemies" is used to describe babies born between 22 and 26 weeks of gestation or smaller than 1 pound 13 ounces.

Level 4 NICUs can provide very sophisticated types of respiratory support for very sick babies, including extracorporeal mechanical oxygenation or ECMO.

Level 4 NICUs also offer a wide variety of neonatal surgeries, including heart surgeries for babies born with congenital heart disease.

Coping

Preemie mom holding preemie baby in NICU — Getty Images / Matt Carr

There are few things that are less frightening than coping with a baby who has been hospitalized in a NICU. Many parents feel they would do anything to change places with their baby and spare her this experience. Yet there are many things you can do to help both yourself and your baby cope as well as possible during this time.

Learn as much as you can about the routines and procedures of a NICU as well as the types of monitors used. There are so many terms and a multitude of procedures that take place. Understanding some of these can remove some of the fear and help you feel more empowered in your journey.

Bonding with your baby is every bit, if not more important, than with a full term baby or a baby born without medical problems. Thankfully, NICU staff are trained and very aware of the importance of bonding on your baby's progress and will work with you in many ways.

Some of these methods, such as kangarooing (lying skin to skin with your baby) may seem foreign to you, but a multitude of studies have been performed to find the best ways of communicating love and support to these children who must spend time out of their parent's arms and in an incubator.

Many parents find the strict protocols and guidelines in the NICU somewhat intimidating, and it can be helpful to realize that these strict practices are necessary to provide the best care for these little people who are fragile and can become ill very quickly if exposed to harmful microorganisms.

A question most parents ask at some time is, "When can I take my baby home from the NICU?" The answer will vary for every baby, but a few conditions usually need to be met before discharge. These include:

A baby's ability to breath without assistance (though babies may be sent home with oxygen by nasal cannula)
A baby's ability to feed well by mouth (though some babies can go home with an NG tube or G-tube)
A baby's ability to maintain their temperature
When a baby outgrows apnea and bradycardia spells (A and B spells)

There are also several milestones for NICU discharge that must be achieved, including a hearing screen and car seat study.