Does NICU level IV exist???

Specialties NICU


hi all,

i was just wondering, if somebody knows in detail information about nicu level iv?

thanks for help!!! :kiss




Specializes in NICU/Neonatal transport.

It's a fairly recent change. Level III and IV NICUs mainly differ in their ECMO ability. IVs can do ECMO, IIIs can't.


6,620 Posts

It depends on where you live whether that term is even considered a real one or not. Some people say it's ecmo ability that makes it a level 4, others say it's surgical ability since many level 3s don't do many surgeries.

We've always used it to refer to heaven in my old unit because it was considered a made up term. We don't use it where I live now either.


1,104 Posts

I work in a level IV NICU. We're a regional referral center and we do have ECMO capability and do every surgery under the sun for wee ones. ;)

Love4Me, RN

134 Posts

Specializes in NICU.

I also work in a level IV NICU. We do all surgeries and ECMO. I never heard that level IV was a made up term. It is referred to as a level IV in the whole state of Michigan. But who knows :uhoh3:


96 Posts

My manager sent this e-mail yesterday, thought it might be helpful.


According to the American Academy of Pediatrics, nine states have defined a level IV to be a level III NICU with regional responsibilities.

To provide continuity across the US, in 2004, the AAP put out a policy statement entitled 'Levels of Neonatal Care'. I have downloaded the policy and will place it in the NICU Articles binder.

In a nutshell, here are their definitions:

TABLE 1. Definitions of Hospital-Based Newborn Services

Used for Survey Performed by Section on Perinatal Pediatrics

Basic neonatal care (level I)

Well-newborn nursery

Evaluation and postnatal care of healthy newborns

Neonatal resuscitation

Stabilization of ill newborns until transfer to a facility at

which specialty neonatal care is provided

Specialty neonatal care (level II)

Special care nursery

Care of preterm infants with birth weight _1500 g

Resuscitation and stabilization of preterm and/or ill infants

before transfer to a facility at which newborn intensive care

is provided

Subspecialty neonatal intensive care (level III)

Level IIIA

Hospital or state-mandated restriction on type and/or

duration of mechanical ventilation

Level IIIB

No restrictions on type or duration of mechanical


No major surgery

Level IIIC

Major surgery performed on site (eg, omphalocele repair,

tracheoesophageal fistula or esophageal atresia repair,

bowel resection, myelomeningocele repair,

ventriculoperitoneal shunt)

No surgical repair of serious congenital heart anomalies

that require cardiopulmonary bypass and /or ECMO for

medical conditions

Level IIID

Major surgery, surgical repair of serious congenital heart

anomalies that require cardiopulmonary bypass, and/or

ECMO for medical conditions


5 Posts

Specializes in Neonatology, Med-Surg, & Telemetry.

Hi all,

I work in a Level IV NICU in the NorthEast. I would say that I agree with all the above posts. In the Level IV where I work what distinguishes us most as a level IV is the cool-cap system, ECMO, the acuity level of the neonates we receive, the manner in which we receive them, and the ability to receive any procedure or surgery necessary to maintain life within our facility itself. The facility where I work receives neonates via helicopter and STAT team as transfers from NICUs around the region.

Hope that helped a little bit.


Dina, BSN, RN, EMT-B

umcRN, BSN, RN

867 Posts

I believe my NICU is considered a Level IIIc...but we are a regional refferal center, do ECMO, body cooling and all surgeries except for transplant however we have a "sister" hospital that does transplants as well

From what I have understood Level IIIc and Level IV are basically the same depending on where you are, never heard of IIID

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