Level 2 vs Level 3 NICU

EricJRN, MSN, RN · Apr 26, 2007

Babies in Level II NICU's have some problems that make them not quite suitable for a newborn nursery, but they generally don't have immediately life-threatening issues. Critical babies born in hospitals with Level II NICU's are generally stabilized and transferred to Level III NICU's.

Level III NICU's take care of kids that require interventions like ventilators and pressor agents. A Level III NICU generally has on-site or rapidly available pediatric surgeons and other subspecialists, but they may or may not be able to repair complex cardiac defects or utilize ECMO. (Sometimes you'll see Level III divided into IIIa, IIIb, and IIIc, depending on the services of the unit. I've even seen NICU's with ECMO capability who call themselves Level IV NICU's).

To make this more confusing, some hospitals have only Level II units, some have their Level II and III babies all on one unit, while others have completely separate Level II and III units.

Level III units are often found in suburban/outlying hospitals, but often patients will have to be transferred to an academic center for really complex problems.

crissrn27, RN · Apr 26, 2007

I work in a level II NICU, but basically we are a well newborn hospital that will keep things like 24 hour oxyhood, IV abt's, etc. We stablize and ship any complicated babies to a level III. The we will accept back any feeder/growers as part of our deal with the level III. Its kinda confusing, especially since trama centers are the other way around.

Jolie, BSN · Apr 26, 2007

Levels I and III are pretty easily defined. Level I is basically a well-baby nursery. Level III cares for the sickest of the sick.

Level II is a wide-ranging distinction that includes stabilizing and shipping critically-ill babies, keeping and caring for mildly to moderately ill babies with self-limiting conditions like r/o sepsis, unstable glucose levels, mild RDS, etc. But some level II nurseries in larger hospitals go much further than that. I worked in 2 units that had Level II status where we kept and cared for babies as young as 28 weeks gestation, because we had active and experienced support from respiratory therapy, physical therapy, speech therapy, pharmacy, lab, U/S, as well as pediatric sub-specialists including cardiology, neurology, and opthamology. One neighboring hospital with a Level II NICU even did high-frequency ventilation. In some units the only major distinction between Level II and Level III is the availability of pediatric surgery services.

Gompers, BSN, RN · Apr 27, 2007

Levels I and III are pretty easily defined. Level I is basically a well-baby nursery. Level III cares for the sickest of the sick.
Level II is a wide-ranging distinction that includes stabilizing and shipping critically-ill babies, keeping and caring for mildly to moderately ill babies with self-limiting conditions like r/o sepsis, unstable glucose levels, mild RDS, etc. But some level II nurseries in larger hospitals go much further than that. I worked in 2 units that had Level II status where we kept and cared for babies as young as 28 weeks gestation, because we had active and experienced support from respiratory therapy, physical therapy, speech therapy, pharmacy, lab, U/S, as well as pediatric sub-specialists including cardiology, neurology, and opthamology. One neighboring hospital with a Level II NICU even did high-frequency ventilation. In some units the only major distinction between Level II and Level III is the availability of pediatric surgery services.

Very true about the gray areas when it comes to Level II nurseries. Excellent post.

PEDSVA · Apr 27, 2007

Thanks for all the great posts, They really helped clear things up.

Love_2_Learn · Apr 29, 2007

I once worked in what was labeled as a "Level II Special Care Nursery licensed for 11 beds" which actually operated as a Level III NICU (took care of 24 weekers, oscillators & high frequency vents, pressors... but did not do surgery of any kind & no ECMO or Nitric) and never had less than 7 babies but often had as many as 24 babies (average 18-20 babies). Go figure...

ICUCCU1 · Apr 4, 2012

Hi Just wondering.....
What is the difference between a Level 2 and Level 3 NICU's. Is it common to see Level 3 NICU's in community hospitals?

This was very helpful distinction. Thank you

catlover314 · Apr 5, 2012

OP: Jolie's answer was great. The Board of Health, or whoever licenses hospitals in each state, can authorize different scopes of service for level 2's, so you really have to look at each state as a potentially unique set up. As Jolie said, the level 1 and 3s are more easily defined.