Spinoff, NICU levels - does the definition need changing?

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Ok, for the record, these are the definitions I'm working with:

  • 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.

Besides the fact that these definitions can be confusing, do you feel there needs to be a new classification system of NICUs?

In my city, we have 2 Lvl III and 7 lvl II NICUs. Of those two lvl IIIs, only 1 does surgery and ECMO. We have a population over 1million, and sending every baby to the Children's hospital is just not feasible. We struggle as it is to fit every baby in and we currently have 47 beds in our acute unit.

All of the lvl IIs will keep babies that are on vents. Sometimes long term vents. I know we got a baby finally who was a 24 weeker who spent over a week at one of the II+ hospitals. Don't get me started on that because I wonder how much that might contribute to the BPD around and other things.

Should though the system be revised into simpler terms? I is a newborn nursery, II keeps those transitioning babies, III keeps the vents, IV maybe HFOV/nitric, V Surgery and ECMO?

Thoughts? Ideas on different classifications? Is our city the only one with II+ NICUs?

Specializes in NICU/Neonatal transport.

Well, in my city at least, I've seen several kids who have been severely mismanaged at the 2+s because they decide to keep kids they shouldn't, and the kids have to pay the price.

We got a 24w at 2 weeks, she hadn't been stooling for 10 days, they had been using rectal stim and glycerin chips to try and make her stool. Her poor little rectum was incredibly damaged and stretched out when we got her. Plus the belly issue and possible sepsis.

And today I had a 2 week old 27w with PIE, which should really not be happening anymore. Her left lung is essentially gone. It was destroyed by the emphysema before she got to us (4 days ago) and the day before it collapsed and apparently they've not been able to reinflate it and they don't know if they will. Her right lung has severe RDS and the starts of a "healthy" case of BPD. It's frustrating and you wonder would these exist if these hospitals would only jsut transfer us the kids to begin with.

Specializes in NICU.

I work in a level 3, the regional neonatal referral center for our area. We do some surgeries (mainly PDAs, eyes, emergency surgeries), but most surgeries (cardiac kids, NEC, etc) go to Children's, just up the road. Our city doesn't have ECMO (amazing, we're a large enough city to have the capability) but we routinely have HFOV and nitric. Any baby with umbilical lines or on a vent is considered high risk and level 3.

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