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Levels of Neonatal Care: WV Guidelines

Levels of Neonatal Care: WV Guidelines. Adapted from Guidelines of the AAP Committee on Fetus

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Levels of Neonatal Care: WV Guidelines

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Levels of Neonatal Care:WV Guidelines

Janet Graeber, MD, Chair

Neonatal Guidelines Committee

West Virginia Perinatal Partnership

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Levels of Neonatal Care:WV Guidelines

Adapted from Guidelines of the AAP Committee on Fetus & Newborn

Pediatrics 2004;114:1341-1347

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Level I Neonatal Care (Basic)

  • Provide neonatal resuscitation at every delivery

  • Evaluate and provide postnatal care to healthy newborns

  • Stabilize and provide care for infants born at 35-37 wks who remain physiologically stable

  • Stabilize newborn infants who are ill and those born at <35 wks until transfer to a facility providing an appropriate level of care

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Level II Neonatal Care (Specialty)

Special Care Nursery: level II units subdivided into IIA and IIB based on ability to provide assisted ventilation including CPAP

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Level IIA Neonatal Care

  • Resuscitate and stabilize preterm and/or ill infants before transfer to a facility providing newborn intensive care

  • Provide care for infants born at >32 wks and weighing ≥ 1500 gm

    - with physiologic immaturity such as apnea of prematurity, inability to maintain body temperature, and/or inability to take oral feedings

    - who are moderately ill with problems anticipated to resolve rapidly and are not anticipated to need subspecialty services urgently

    - who are convalescing after intensive care

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Level IIA continued

  • Maternal care of term and preterm gestations that are maternal risk appropriate

  • Supervised by Board-certified obstetricians

  • Nursery supervised by Board-certified pediatricians

  • Conventional mechanical ventilation limited to immediate stabilization of the neonate

  • No pediatric subspecialty or neonatal surgical specialty services

  • Do not receive primary infant or maternal transfers

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Level IIB Neonatal Care

  • All capabilities of level IIA

  • Provide mechanical ventilation for brief durations (<24 hrs) or CPAP

  • Neonatal units supervised by Board- certified neonatologist

  • Limited pediatric subspecialty services

  • No neonatal surgical specialty services

  • No primary infant or maternal referrals

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Level III (Subspecialty) NICU

Level III NICUs are subdivided into 2 categories based on the availability of ECMO and cardiac surgery

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  • Comprehensive care for ELBW(≤1000 g and ≤ 28 wks gestation

  • Advanced respiratory support such as HFV and inhaled NO as long as needed

  • Prompt and on-site access to a full range of pediatric medical subspecialists

  • Advanced imaging, interpretation urgently, CT, MRI, Echocardiography

  • Ped surgical specialist and anesthesiologists on site or at closely related institution to perform major surgery such as PDA ligation, abdominal wall defects, NEC with perforation, TE fistula ± esophageal atresia, myelomeningocele

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  • All capabilities of Level III NICU

  • Capability to provide ECMO and surgical repair of complex congenital heart malformations requiring cardiopulmonary bypass