The Capabilities and Staff of a Level 3 NICU

Female nurse feeding newborn baby next to incubator
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A level 3 NICU, or level III NICU, is a neonatal intensive care unit that is capable of caring for very small or very sick newborn babies. Level 3 NICUs have a wide variety of staff on-site, including neonatologists, neonatal nurses, and respiratory therapists who are available 24 hours a day. They may also be called subspecialty care centers or subspecialty NICUs.

Treatment in Level III NICU

Infants born at less than 32 weeks gestational age and weight less than 1500 grams (53 ounces or 3.3 pounds), as well as critically ill newborns of any gestational age and birth weight, should be taken care of in a level III NICU.

Studies have shown better outcomes for very low birth weight infants and premature infants who are born at level III centers, leading to recommendations that women at risk be transported to these centers to give birth.

Capabilities of Level III NICUs

A level III NICU can provide continuous life support and comprehensive care. They can provide critical medical and surgical care. They can provide mechanical ventilation and high-frequency mechanical ventilation.

A level III NICU can perform minor surgical procedures, such as umbilical vessel catheterization and have pediatric surgical centers on-site or close by to complete major surgeries, including PDA ligation and bowel surgery to treat NEC.

You can expect that a level III NICU has access to a full range of pediatric medical sub-specialists to address problems premature and critically ill newborns may have. These centers have advanced imaging and experts to interpret the scans. Premature retinopathy is a concern and these centers will have a program to monitor and treat the condition.

This unit will arrange to transport newborns to a higher level regional unit if a complex surgery is needed or to transport to a lower level facility once the baby's condition improves.

Staff in Level III NICUs

As in a level II NICU, you will see physicians such as pediatric hospitalists and neonatologists. You'll also see sub-specialists in various areas of pediatric medicine, pediatric ophthalmologists, and surgical teams including pediatric anesthesiologists and pediatric surgeons.

You may also see neonatal nurse practitioners and other advanced practice registered nurses. Level III NICU staff includes respiratory therapists, imaging technologists, registered nurses, occupational therapists, physical therapists, pharmacists, lactation consultants, social workers, chaplains, and more staff to provide support to the newborn and family.

NICU Level 3c to Level IV

The American Academy of Pediatrics updated its policy on designations for neonatal care units in 2012. Prior to that revision, level III NICU was divided into three sublevels.

With the new guidelines, these were eliminated and a level IV NICU unit was defined, taking the place of level IIIC (level 3c) in the previous guidelines. Level IV NICUs are often regional facilities with an on-site surgical repair for serious malformations. They can complete complicated surgeries that require cardiopulmonary bypass.

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  1. American Academy of Pediatrics Committee on Fetus and the Newborn. Levels of neonatal care. Pediatrics. 2012;(130)3:587-97.  doi:10.1542/peds.2012-1999.

  2. Robles D, Blumenfeld YJ, Lee HC, et al. Opportunities for maternal transport for delivery of very low birth weight infants. J Perinatol. 2017;(37)1:32-35.  doi:10.1038/jp.2016.174

Additional Reading
  • American Academy of Pediatrics Committee on Fetus and the Newborn. Levels of Neonatal Care. Pediatrics. 2012;130(3):587-597. doi: 10.1542/peds.2012-1999.