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Levels of Neonatal Care: WV Guidelines. Janet Graeber, MD, Chair Neonatal Guidelines Committee West Virginia Perinatal Partnership. 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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levels of neonatal care wv guidelines

Levels of Neonatal Care:WV Guidelines

Janet Graeber, MD, Chair

Neonatal Guidelines Committee

West Virginia Perinatal Partnership

levels of neonatal care wv guidelines2

Levels of Neonatal Care:WV Guidelines

Adapted from Guidelines of the AAP Committee on Fetus & Newborn

Pediatrics 2004;114:1341-1347

level i neonatal care basic
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
level ii neonatal care specialty
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

level iia neonatal care
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

level iia continued
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
level iib neonatal care
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
level iii subspecialty nicu
Level III (Subspecialty) NICU

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

level iii nicu
Level III NICU
  • 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
level iii nicu10
Level III+ NICU
  • All capabilities of Level III NICU
  • Capability to provide ECMO and surgical repair of complex congenital heart malformations requiring cardiopulmonary bypass
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