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.
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.
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.
I guess we're a level IIIc. We're a regional transport (is that the right term?) for many other hospitals in the city. We do ECMO and transplants, and have one of the best gut units around.
Level IIb describes us pretty well, but we keep mechanical vents for longer than 24 hours. We have babies with lines and intubated for over a week. If they get to a point where it seems like they are not progressing or getting worse then we ship them. But we do keep vents longer than 24 hours. We also usually ship anything less than 28 weeks.
Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.
I guess we're a level IIIc. We're a regional transport (is that the right term?) for many other hospitals in the city. We do ECMO and transplants, and have one of the best gut units around.
Where are you at, Elizabells? If you don't want to say the name, what state or city are you in?
I ask because we are also a fantastic peds surg center, and we have one of the few short gut programs around. Wondering if we're close to one another. And I always enjoy making contacts with places that see lots of gut stuff.
Thank you to everyone for responding! Keep 'em coming. It's kind of neat to know how many different levels there are out there.
Somewhere between a level IIIA and IIIB. We do HFJV and HFOV, but are just phasing in nitric with no plans to do ECMO or most sugery because we are very close to a children's hospital.
According to that info, we are a Level IIIA. We keep babies >1000 grams and technically >28 weeks. We sometimes wonder about the gestation, though. We don't do any surgeries, as we don't have the anesthesiologists available.
We don't do our own transports, but the Childrens Hospital brings them from other facilities, to us.
palesarah
583 Posts
I just started working in a level IIIB a few weeks ago, and am loving every minute of it :) !