By Brittany Araki, MD
Pediatric Hospitalist, Blanchard Valley Hospital

Did you know, there’s more than one kind of NICU? NICUs, or neonatal intensive care units, are specialized hospital units that provide around-the-clock, advanced medical treatment for newborns. They integrate state-of-the-art technology with skilled professionals to assist infants facing issues at the start of their lives. There are four categories of NICUs, which are defined by the types of babies they care for and the treatments they offer. 

Level I “Well Baby Nursery”

Level I Nurseries care for term babies or late preterm babies (35 weeks and up) without significant issues. Nurseries provide specialized care but generally don't have ICU capabilities or are limited to critical care only while awaiting transport to a higher level. They provide basic care for healthy, full-term babies and stabilize infants who are sick or premature. Most hospitals that offer maternity services have a well-baby nursery, making this specialized care highly accessible. 

Level II “Special Care Nursery” 

Level II NICUs are able to take care of preterm babies born at least 32 weeks of gestation, weighing 3 or more pounds, and with minor medical issues or short-term significant illnesses. They provide support, including intravenous medication, phototherapy for jaundice, feeding assistance for infants recovering from acute conditions, and respiratory support. There are two categories of Level II NICUs, Level IIA and Level IIB, which are distinguished by the level of respiratory care they can provide. Level IIA NICUs offer basic support, whereas Level IIB NICUs offer more advanced support, including ventilators. Level II NICUs can stabilize and care for babies born before 32 weeks while awaiting transfer to a higher-level NICU. 

Level III “Critical Care Nursery” 

Level III NICUs care for all preterm infants, including “micropremies,” and critically ill babies with long-term needs or who require certain surgeries. Level III NICUs have almost all pediatric specialists available, including surgeons, cardiologists, pulmonologists, and infectious disease specialists. Critical care nurseries are less common than Level I and Level II NICUs. They are typically found in tertiary critical care centers and larger regional hospitals. 

Level IV “Regional Care Facility” 

In addition to what a Level III NICU can offer, Level IV NICUs have access to specialized surgeons, such as pediatric open-heart surgeons, and offer additional support, including ECMO (heart-lung bypass) and neonatal dialysis. Level IV NICUs offer the highest level of neonatal care for the most critically ill newborns. These services are typically only found at major children’s hospitals. 

The NICU is an essential component of pediatric care. Access to the specialized services these nurseries provide is crucial for newborn health and family well-being. Broad availability of Level I and II NICUs enables families to remain with their babies during treatment. As pediatric hospitalists, we are committed to serving our community to keep families and their babies together.