What do Neonatal ICU levels mean?

You may have heard that Huntsville Hospital for Women & Children has a Level III Neonatal ICU and that Madison Hospital has a Level II Special Care Nursery. But what does that mean?

Neonatal refers to the first 28 days of life. Some babies require more advanced care during these first days because they were born prematurely or with certain medical conditions. Our community is fortunate to have access to this specialized care, but understanding the different levels of neonatal care can be confusing.

It’s important for expectant parents to learn about neonatal care especially if they are aware of a risk for premature birth or congenital defect. Alabama law does not require hospitals to meet certain standards in order to claim an elevated level of care, so I recommend that parents talk directly with their hospital to be sure they understand the specialty care available.

As recently as 2012, the American Academy of Pediatrics (AAP) published a policy statement which recommends “uniform, nationally applicable definitions and consistent standards of service for public health to improve neonatal outcomes.” The AAP also listed the following classifications for neonatal care:

• Level I
  A hospital nursery able to evaluate and provide care of healthy newborn infants and babies born as early as 35 weeks whose condition is stable;
• Level II
  A hospital special care nursery able to care for infants born at 32 weeks’ gestation or more and weighing 1500 g (3.3 lbs) or more at birth;
• Level III
  A hospital neonatal ICU that provides specialized care for premature babies and babies with critical illness. Level III units routinely provide ongoing assisted ventilation, have ready access to a full range of pediatric medical subspecialists, and have advanced imaging with interpretation on an urgent basis;
• Level IV
  A hospital neonatal ICU with the same capabilities as a Level III NICU but can also provide surgical repair of serious congenital or acquired malformations.

Huntsville Hospital for Women & Children has the only Level III Neonatal ICU (NICU) in North Alabama. It is staffed by a team of five board certified Neonatologists and a Neonatal Hospitalist. Our physician team is supported by neonatal nurse practitioners and neonatal registered nurses certified by the American Heart Association’s Neonatal Resuscitation Program (NRP). Many also hold an additional Neonatal Intensive Care Certification.

Also unique to North Alabama, several of our nursing team members make up an innovative dedicated Small Baby Team, which is specially trained to care for the smallest and sickest babies. The NICU routinely adopts innovative care practices like the Small Baby Team as well as advanced treatment methods including high frequency oscillatory ventilation, nitric oxide and induced therapeutic hypothermia. Recently the hospital opened the region’s only Infant Nutrition Lab.

The same highly qualified physician team at Women & Children also oversees the care of babies in Madison Hospital’s Level II Special Care Nursery, allowing families who live in communities closer to Madison more specialized services than a Level I hospital nursery.

By Lee Morris, MD

Lee Morris, M.D. Neonatologist Huntsville Hospital for Women & Children Level III Neonatal ICU