What Is a Level 3 NICU?

This type of NICU can provide comprehensive care for preemies

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 (NICU) 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. Level 3 NICUs may also be called subspecialty care centers or subspecialty NICUs.

NICU Treatment Levels

The American Academy of Pediatrics (AAP) updated its policy on designations for neonatal care units in 2012. There are currently four categories of NICUs.

  • Level 1 NICU: Well newborn nursery, which offers regular nursery care for healthy newborns
  • Level 2 NICU: Special care nursery, which cares for premature and sick newborns
  • Level 3 NICU: Neonatal intensive care unit, which cares for seriously ill newborns
  • Level 4 NICU: Regional neonatal intensive care unit, which cares for the most critically ill newborns and babies

Prior to the AAP's 2012 revision, level 3 NICUs were divided into three sublevels (level 3a, 3b, and 3c). With the new guidelines, these designations were eliminated and a level 4 NICU unit was defined, taking the place of level 3c in the previous guidelines.

Level 4 NICUs are often regional facilities with capabilities for on-site surgical repair of serious malformations and conditions. These hospitals can provide complicated surgeries that require cardiopulmonary bypass.

Which Babies Need Level 3 NICUs?

Infants born at less than 32 weeks gestational age and weighing 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 3 NICU.

Studies have shown better outcomes for very low birth weight and premature infants who are born at level 3 centers. That is why doctors recommend that pregnant people at risk of having premature or low birth weight newborns be transported to these centers to give birth.

This unit will arrange to transport newborns to a higher level regional unit (a level 4 NICU) if a complex surgery is needed or to transport them to a lower level facility (a level 2 NICU) once their condition improves if they are still in need of NICU level care.

Treatments at Level 3 NICUs

A level 3 NICU can provide continuous life support and comprehensive care. It can offer critical medical and surgical care. It can provide mechanical ventilation and high-frequency mechanical ventilation for babies who cannot breathe on their own. A level 3 NICU will monitor babies for retinopathy of prematurity (ROP, which can cause blindness) and treat the condition.

The medical team at a level 3 NICU can perform minor surgical procedures, such as umbilical vessel catheterization (in which a catheter is inserted into one of the blood vessels in the baby's umbilical cord stump, so that the baby's blood pressure can be monitored and blood can be taken without using a needle).

Level 3 NICUs also have pediatric surgical centers on-site or close by to complete major surgeries, including patent ductus arteriosus (PDA) ligation to correct this heart defect and bowel surgery to treat necrotizing enterocolitis (NEC), a serious infection of the lining of the intestines.

Staff in Level 3 NICUs

As in a level 2 NICU, a level 3 NICU will have physicians such as pediatricians and neonatologists. You can expect that a level 3 NICU has access to a full range of pediatric medical specialists, such as pediatric ophthalmologists and anesthesiologists, to address problems premature and critically ill newborns may have.

These centers have advanced imaging technology and experts to interpret the scans and assist in diagnosis.

You may also see neonatal nurse practitioners and other advanced practice registered nurses. Level 3 NICU staff also 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.

A Word From Verywell

It can be frightening and overwhelming if your baby needs level 3 NICU care. But the staff is there to help both you and your baby with the experience. While it is a difficult time, everyone is working toward the same goal of helping your baby grow, heal, and thrive.

3 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  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

  3. U.S. National Library of Medicine. Umbilical catheters.

By Cheryl Bird, RN, BSN
Cheryl Bird, RN, BSN, is a registered nurse in a tertiary level neonatal intensive care unit at Mary Washington Hospital in Fredericksburg, Virginia.