What's included in level IV?

  1. Hi all,
    I've heard that a level IV NICU (or at least a baby who qualifies as level IV) is either on ECMO or ??? There's something about Nit___? I don't remember what it was. What's the other thing and when is it used?
    Thanks much
    -kaye
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  2. 9 Comments

  3. by   Sweeper933
    I think you might be refering to Nitric Oxide (NO). It is used when babies have severe PPHN, as it is a bronchodialator.
    As far as the level is concerned, I was under the impression that there were no level IV units... that they only went up to III. This might differ state to state, I do not know.
    I work in a level III unit and we do NO, but no echmo. They only time we send babies down to the children's hospital, is when they need echmo, or have severe cardio/neuro problems that we cannot handle. Otherwise, we handle them all.
    Hope that helped!
  4. by   SteveNNP
    I've heard some units described as IIIa, IV, etc...... As far as I know, this is the units calling themselves "IV, IIIa's" because they are usually larger and do more, such as head cooling, ECMO, complex surgery than other Level III's. However, I am unaware that the healthcare system-that-be recognizes anything "official" higher than a Level III, which is the highest acuity designation for a NICU. There are Level I ER's, which are the highest acuity, and I've never heard any describe themselves as "1a" etc.... Maybe some of the RN's who work at one of these "IIIa's or IV" NICU's can clarify.....
  5. by   llg
    The state of Virginia (and maybe a few others) have designated a couple of Level IV NICU's to distinguish them from the many nurseries who have ventilators, but little else. Level IV nurseries must also have sub-specialty services available.

    Back when the "leveling" of nurseries was orignially established, only a few nurseries could handle ventilators. So, pretty much any nursery with ventilators was considered at the highest level, a Level III. But as ventilators became more common, a need devleped to distinguish those nurseries that offer "everything" from those that just have a couple of special services. Thus, people started to informally talk about Level IIIa and Level IIIb, etc. So, finally, some places are starting to make an official, distinct category for those highest level nurseries.
  6. by   Jes RN
    Quote from Sweeper933
    I think you might be refering to Nitric Oxide (NO). It is used when babies have severe PPHN, as it is a bronchodialator.
    As far as the level is concerned, I was under the impression that there were no level IV units... that they only went up to III. This might differ state to state, I do not know.
    I work in a level III unit and we do NO, but no echmo. They only time we send babies down to the children's hospital, is when they need echmo, or have severe cardio/neuro problems that we cannot handle. Otherwise, we handle them all.
    Hope that helped!
    Actually, at the concentrations used for PPHN (16-25 parts per million) Inhaeld NO acts as a potent vasodilator, rather than a bronchodilator.

    I've also heard some units refer to themselves as level IV, though I'm not quite sure how they differ from level III. I work in a level III unit as well. We do INO, but not ECMO. I wonder if offering ECMO is a level IV qualifier?
  7. by   stillpressingon
    Thanks for all the input! I've wondered for a long time but never asked!
  8. by   llg
    Quote from Jes RN
    Actually, at the concentrations used for PPHN (16-25 parts per million) Inhaeld NO acts as a potent vasodilator, rather than a bronchodilator.

    I've also heard some units refer to themselves as level IV, though I'm not quite sure how they differ from level III. I work in a level III unit as well. We do INO, but not ECMO. I wonder if offering ECMO is a level IV qualifier?

    The ECMO aspect may vary from state to state. I am not sure on that. In Virginia, ECMO is not necessary for level IV status.
  9. by   Mags4711
    Quote from stillpressingon
    Hi all,
    I've heard that a level IV NICU (or at least a baby who qualifies as level IV) is either on ECMO or ??? There's something about Nit___? I don't remember what it was. What's the other thing and when is it used?
    Thanks much
    -kaye

    I wrote a thread about this subject back in June of 2006. Here's my first two posts in that thread.

    What Level NICU are you at?
    I have seen in the threads lately frequent use of the term Level 4 or Level IV NICU and I am confused about it's use. I have been told over the past few years that Level IV is no longer a recognized distinction. Is this state specific? I found an article in the AAP from a few years ago that speaks to about 9 states that still used Level IV as a name type.

    However, that same article was regarding the reccs about change in policy to move the NICU level names to I, II, IIIa, IIIb, and IIIc.

    Here's a snippet of it:
    RECOMMENDATIONS
    Regionalized systems of perinatal care are recommended to ensure that each newborn infant is delivered and cared for in a facility appropriate for his or her health care needs and to facilitate the achievement of optimal outcomes.
    1. The functional capabilities of facilities that provide inpatient care for newborn infants should be classified uniformly, as follows:
    • Level I (basic): a hospital nursery organized with the personnel and equipment to perform neonatal resuscitation, evaluate and provide postnatal care of healthy newborn infants, stabilize and provide care for infants born at 35 to 37 weeks' gestation who remain physiologically stable, and stabilize newborn infants born at less than 35 weeks' gestational age or ill until transfer to a facility that can provide the appropriate level of neonatal care.
    • Level II (specialty): a hospital special care nursery organized with the personnel and equipment to provide care to infants born at more than 32 weeks' gestation and weighing more than 1500 g who have physiologic immaturity such as apnea of prematurity, inability to maintain body temperature, or inability to take oral feedings; who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis; or who are convalescing from intensive care. Level II care is subdivided into 2 categories that are differentiated by those that do not (level IIA) or do (level IIB) have the capability to provide mechanical ventilation for brief durations (less than 24 hours) or continuous positive airway pressure.
    • Level III (subspecialty): a hospital NICU organized with personnel and equipment to provide continuous life support and comprehensive care for extremely high-risk newborn infants and those with complex and critical illness. Level III is subdivided into 3 levels differentiated by the capability to provide advanced medical and surgical care.
    Level IIIA units can provide care for infants with birth weight of more than 1000 g and gestational age of more than 28 weeks. Continuous life support can be provided but is limited to conventional mechanical ventilation.
    Level IIIB units can provide comprehensive care for extremely low birth weight infants (1000 g birth weight or less and 28 or less weeks' gestation); advanced respiratory care such as high-frequency ventilation and inhaled nitric oxide; prompt and on-site access to a full range of pediatric medical subspecialists; and advanced imaging with interpretation on an urgent basis, including computed tomography, magnetic resonance imaging, and echocardiography and have pediatric surgical specialists and pediatric anesthesiologists on site or at a closely related institution to perform major surgery.
    Level IIIC units have the capabilities of a level IIIB NICU and are located within institutions that can provide ECMO and surgical repair of serious congenital cardiac malformations that require cardiopulmonary bypass.
    1. Uniform national standards such as requirements for equipment, personnel, facilities, ancillary services, and training, and the organization of services (including transport) should be developed for the capabilities of each level of care.
    2. Population-based data on patient outcomes, including mortality, specific morbidities, and long-term outcomes, should be obtained to provide level-specific standards for volume of patients requiring various categories of specialized care, including surgery.
    ------------------------------



    Re: What Level NICU are you at?


    We have started to call ourselves a Level IIIc as a result of these policy reccommendations, I was wondering who else is? We haven't used the term Level IV for 10-15 years, though that is the level of care we provide.
  10. by   stillpressingon
    faithMD, Thanks for your info! Do you have a link to that thread?
  11. by   Mags4711
    Quote from stillpressingon
    faithMD, Thanks for your info! Do you have a link to that thread?

    No problem:
    http://allnurses.com/forums/f33/what...ou-156806.html

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