Confused about NICU levels

[MommyandRN]

Hi! I am considering a change to NICU and am confused about the levels. Can someone explain the levels to me and what they mean? I see a lot of "level 3"s mentioned on this board.

Also, for a nurse entering into NICU for the first time, do you recommend entering into the more challenging levels? Or do you think a smaller suburban NICU with a less-acute population is still a good learning experience?

Thanks!

[SteveNNP, MSN, NP]

here's a link to the recommendations from the american academy of pediatrics on nicu level designations. you'll find differing opinions from every nicu you go to, but the aap is a pretty good source for nicu standards. hope this helps!

stephen

http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=5986&nbr=3944

stark ar, couto j. levels of neonatal care. pediatrics 2004 nov;114(5):1341-7.

excerpt** see above link

major 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.

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 neonatal intensive care unit (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 neonatal intensive care unit and are located within institutions that can provide extracorporeal membrane oxygenation (ecmo) and surgical repair of serious congenital cardiac malformations that require cardiopulmonary bypass.

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.

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.** end excerpt**

[Imafloat, BSN, RN]

Thanks Steve, I knew the difference between level I-II-III but not the differentiation between the III's.

I work in a IIIB.

To the original poster. I jumped right into the unit I work at after graduation. I say apply at all the NICUs in your area, take a tour of them, then decide. Good luck to you.

[SteveNNP, MSN, NP]

I went from a Level IIIb to a Level IIIc. BIG difference....lots to learn here!

[RainDreamer, BSN, RN]

Good info, Steve .... thanks!

I started out in a level IIIC .... been here a year and a half and I'm still learning a TON all the time. If I were you, I would start out in a big unit, as you'll most likely get a great orienatation and will encounter many learning opportunities ..... you'll get experiences you won't be able to get in a smaller unit.

Good luck to you!