What Level NICU are you at?

[Mags4711, RN]

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.

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[Mags4711, RN]

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.

[Gompers, BSN, RN]

Level III B Nicu

[Humbled_Nurse]

I guess we would be between level III A and level III B. We do everything except surgery, ECMO, and Nitric.

[2curlygirls]

We do everything. So I guess we'd be a IIIc.

[prmenrs, RN]

I retired from a level IIIb; I work @ a level IIA now.

[BittyBabyGrower, MSN, RN]

III B, the cardiacs go to our "sister" hospital .

[lovemyjob]

We do everything except transplant, so that makes us a IIIc. I think there should be a seperate level (like level IV) for those that do transplant.

[lovemyjob]

One of the problems that I see with the level III being subcategorized is that one of our competing hospitals boasts to the public that they are the same level as us when the only surgery they do a PDA ligation.

[LilPeanut, MSN, RN, NP]

The other issue is that with those categories, those of us who are going for our NNP are required to have lvl III experience for at least 2 years. That's a wide variety of lvl III experience possible.

I'm not sure you could get the same kind of experience if you weren't in the top tier with the sickest kids, especially if it's a shorter period of time you are planning to work as a nurse. That is just how it appears to me, but I could be wrong.

[RainDreamer, BSN, RN]

I think we're a Level III C, the only thing we fly out are transplants.

[Tiny1Nisolet]

Level IIIC, starting June 5th, 2006!!:w00t: