Capabilities of a Special Care Nursery

A preemie sleeping in an incubator.
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Babies born in hospital settings are usually cared for in a nursery after birth. Depending on various factors, including health at birth, weight, and number of weeks gestation, a baby may require more advanced care in a different type of nursery. Those nurseries are categorized by the American Academy of Pediatrics into four levels based on the care they are equipped to provide:

  • Level I: Well newborn nurseries
  • Level II: Special care nursery
  • Level III: Neonatal intensive care unit (NICU)
  • Level IV: Regional neonatal intensive-care unit (regional NICU)

Facilities with a neonatal intensive care unit (NICU), which provide the highest levels of care, have demonstrated that they meet healthcare standards through federal/state licensing or certification. who need extra care after birth are usually cared for in the neonatal intensive care unit (NICU).

Level II Nurseries 

Because they are born with fewer weeks of gestation, many premature babies will require care in a higher level nursery. Those born at greater than 32 weeks but less than 35 weeks will most likely require some care in a Special Care, or Level II, nursery. These nurseries have all the capabilities of a Level I nursery as well as pediatric hospitalists, neonatologists and neonatal nurse practitioners on-site. They have the equipment and capabilities to care for babies who are:

  • Born before 32-weeks gestation and weigh less than 1500g until they are transferred to a Level III neonatal intensive care facility
  • Born between 32 weeks and 35 weeks gestation or older and weigh 1500g or more
  • Physiologically immature or moderately ill with problems that are expected to resolve rapidly
  • Not expected to need subspecialty services on an urgent basis
  • Can't stay warm on their own and need to be placed in an incubator.
  • Aren't strong enough to eat well and need NG or OG feeds.
  • Have mild health problems related to prematurity, such as jaundice or apnea of prematurity.
  • Have spent time in a level 3 NICU and are recovering.

Level 2A and 2B NICUs

Special care nurseries are further broken down into Level 2A and Level 2B NICUs based on the type of respiratory support they offer:

  • Level 2A NICUs are limited in the type of respiratory support they can provide. They cannot provide CPAP or mechanical ventilation at all.
  • Level 2B NICUs can provide CPAP or mechanical ventilation for short periods of time, usually less than 24 hours.

Babies born at less than 32 weeks gestation or who have a critical illness will be cared for in a Level III nursery (NICU). Those who require surgical repair of complex congenital or acquired conditions will be cared for in the highest level NICU, a Level IV. These nurseries are housed in facilities that offer a full range of pediatric medical and surgical subspecialties on site.

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  • American Academy of Pediatrics Committee on Fetus and the Newborn. "Policy Statement: Levels of Neonatal Care." Pediatrics Nov. 2004. 114: 1341-1346.

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.