Understanding NICU: Different Neonatal Levels of Care


During pregnancy, every mother expects a joyful and healthy experience. However, even with the proper care, some babies may be born prematurely and have significant health challenges after birth. This is when neonatal intensive care units (NICUs) come as lifesavers.

NICUs are specialized facilities that offer comprehensive care for premature and critically ill newborns. In this post, we will look at the various neonatal levels of care that NICUs provide.

Levels of NICU

1. Level 1

Level 1 unit, often known as a well newborn nursery, is the most basic neonatal level of care that provides a range of services to newborns. This unit usually includes healthcare professionals like pediatricians, family physicians, nurse practitioners, and other advanced practice registered nurses. They collectively provide the necessary expertise and care for the infants.

The well newborn nursery is equipped to:

  • Perform neonatal resuscitation(emergency life support for newborns) during deliveries
  • Give postnatal care to healthy infants
  • Stabilize and care for newborns born between 35 and 37 weeks in a stable physiological condition.
  • Stabilize neonates that are unwell or are born before 35 weeks of gestation. However, if the babies require more specialized care, they are transferred to a facility that can provide the necessary level of neonatal care.

2. Level 2

Level 2 unit, often known as the special care nursery, provides complete newborn care that includes all of the services of level 1 plus additional specialist services. In addition to level 1 healthcare providers, this unit has specialized medical professionals such as pediatric hospitalists, neonatologists, and neonatal nurse practitioners.

The special care nursery is equipped to:

  • Provide care for infants born at 32 weeks or later, weighing 1,500 grams or more, with physiologic immaturity or moderate illness that is likely to improve rapidly and does not require urgent specialized newborn screening or treatment.
  • Stabilize neonates who are born before 32 weeks and weigh less than 1,500 grams until they can be transferred to a neonatal intensive care facility.
  • Offer care to neonates who are feeding and growing or recovering and regaining strength after intensive care.
  • Provide brief mechanical ventilation or constant positive airway pressure to assist with breathing.

3. Level 3

Level 3 unit, also known as the neonatal intensive care unit, provides a specific set of medical experts to ensure the well-being of critically ill newborns. It includes the same healthcare providers as level 2, as well as additional specialists such as pediatric surgeons, pediatric medical sub-specialists, pediatric anesthesiologists, and pediatric ophthalmologists.

The neonatal intensive care unit is equipped to:

  • Provide sustained life support for newborns in critical condition.
  • Offer comprehensive care for infants born at any gestational age and birth weight who require intensive medical attention.
  • Offer immediate access to pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists, and pediatric ophthalmologists.
  • Provide various respiratory support options, including conventional or high-frequency ventilation and inhaled nitric oxide.
  • Perform advanced imaging procedures such as computed tomography (CT), magnetic resonance imaging (MRI), and echocardiography, with urgent interpretation to aid in diagnosis and treatment decisions.

4. Level 4

Level 4 unit, or regional NICU, represents the highest neonatal level of care for critically ill babies. In addition to the care providers required for Level III units, this unit should have pediatric surgical subspecialists as part of its staff.

Regional NICU possesses all the capabilities found in 1, 2, and 3 neonatal levels of care. It offers the highest level of care for newborns and has several additional features, including:

  • It is situated within a healthcare facility equipped to perform surgical procedures for complex congenital or acquired conditions.
  • It has a comprehensive team of pediatric medical subspecialists, pediatric surgical subspecialists, and pediatric anesthesiologists readily available on-site.
  • It organizes transportation services for critically ill infants and provides educational programs to outreach communities.
  • It offers ECMO (extracorporeal membrane oxygenation), a life-support technique for severe respiratory or cardiac conditions.


NICUs play a critical role in ensuring the well-being of premature and critically ill newborns. Understanding NICUs and their different neonatal levels of care can help expectant mothers prepare for their babies’ potential stay, ensuring both their well-being and peace of mind. To learn more about NICUs or if you have concerns about your baby’s health and delivery, consult a gynecologist at Apollo Cradle & Children’s Hospital.

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