Levels of medical care for your newborn
All newborns (also called neonates) need health care when they’re born. Even if they’re born healthy, they need to be checked out by health care providers to make sure everything’s OK. If a baby’s not OK, he may need additional providers and treatment to help him get better.
In the United States, hospital nurseries (where babies are cared for) are called a certain “level” depending on the kind of care and treatment babies get. Most babies go to a Level 1, Well Newborn Nursery. But if you have pregnancy complications that could affect the health of your baby, or if your baby has a condition that needs specialized medical care at birth, you may want to have your baby at a hospital that has a nursery with a higher level of care.
Hospitals also have different levels of medical care during pregnancy. If you have complications during pregnancy, labor or birth, you may want to have your baby at a hospital that has providers and services to give you the best possible care.
Talk to your health care provider about the level of care that’s available in the hospital where you plan to have your baby. Even if your pregnancy is healthy, it’s good to find out about levels of care at hospitals and medical centers in your area. You can share the information with your family and friends so they know your plans, just in case you and your baby need extra care.
If your pregnancy is healthy, your baby probably needs Level I, Well Newborn Nursery. This is where most babies are cared for. But if you have pregnancy complications, your baby may need a higher level of care after birth. Talk to your health care provider about the level of care your baby may need. Ask these questions:
- Is my pregnancy at high risk for complications?
- What kind of care do I need during pregnancy to help my baby be born as healthy as possible?
- What levels of care for my baby are available in my area?
- If my baby needs a higher level nursery, where would he go? What hospital or medical center in my area offers this level of care?
Once you know about the care your baby may need, you can ask about support programs and services available for you and your family at the nursery and in your community. Call your local March of Dimes chapter.
There are four levels of medical care for babies recommended by pediatricians (doctors who take care of children). Babies can move from one level of care to another — to a higher level if they need more care or to a lower level as they get better and ready to go home.
Level I, Well Newborn Nursery. This kind of nursery has a clinical team of health care providers who take care of:
- Babies born on time (at about 40 weeks) who are stable (for example, they can breathe on their own and can maintain their body temperature)
- Babies born at 35 to 37 weeks who are stable
- Babies who are sick or born before 35 weeks, but only until they can be moved to a nursery with a higher level of care
Level II, Special Care Nursery. This kind of nursery has a clinical team who takes care of:
- Babies born at or after 32 weeks who weigh more than 1,500 grams (3.3 pounds). These babies may have some health problems, but they’re not so serious that they need a higher level of care.
- Babies born before 32 weeks or less than 1,500 grams, but only before being moved to a higher level of care.
- Babies who have just gotten out of a newborn intensive care unit (also called NICU) and are growing and doing well before being able to go home.
- Babies who need equipment to help them breathe. These babies should stay in this kind of nursery only for about 24 hours or less; if they need breathing help longer, they should be moved to a higher level of care.
Level III, NICU. This kind of nursery has a clinical team who takes care of:
- Babies born before 32 weeks who weigh less than 1,500 grams.
- Babies of any age or weight who are critically ill.
- Babies who need equipment to help them breathe to stay alive.
Ideally, babies with conditions that are known before birth and who need this level of care are born in a Level III hospital and don’t have to be transported (moved) from a lower level nursery after birth. This nursery has a full range of health care providers, including pediatric subspecialists (for example, doctors who specialize in treating children’s heart, lungs or kidneys), specialized nurses and equipment to care for very sick babies.
Level IV, Regional NICU. This is the highest level of care for babies. This kind of nursery has a clinical team who takes care of babies who need special surgery for birth defects and other disorders. This nursery has a full range of health care providers, including pediatric subspecialists, specialized nurses and equipment to care for very sick babies.
Transport means to move. Babies may need to move from one level nursery to another depending on the care they need. A baby is transported to a higher level of care nursery if he gets sick and needs additional treatment. He may move to a lower level of care nursery as he gets better and ready to go home. Moving to a different level nursery may mean he has to move to a different hospital or medical center, or sometimes even to a different city. Higher level nurseries have ambulances and other ways to transport babies safely.
Transporting a baby can be stressful for families, especially if the baby needs to move to a nursery in a different place. Planning ahead and asking questions about where nurseries are located can help you and your family cope with a move.
Most women have healthy pregnancies without complications. But sometimes complications can cause problems for both mom and baby and make it necessary to have your baby in a nursery with a higher level of care. These complications include:
- Serious chronic medical conditions, including heart disease and severe obesity
- High blood pressure, diabetes, kidney problems, heart problems, HIV/AIDS and bleeding disorders
- Having a premature baby in the past. A premature baby is one who is born too early, before 37 weeks of pregnancy.
- Having a low-birthweight baby in the past. Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces.
- Having a baby with a birth defect in the past
- Being pregnant with a baby with a birth defect or other health condition
- Being pregnant with multiples (twins, triplets or more)
- Being physically or sexually abused
- Being addicted to drugs
Last reviewed March 2015
See also: Levels of medical care during pregnancy, Newborn care in the delivery room, Newborn screening
Frequently Asked Questions
Are vaccines safe for my baby?
Vaccines (also called immunizations) are one of the best ways to avoid serious diseases caused by some viruses or bacteria. For vaccines to be most successful, everyone needs to get their vaccine shots.
Several years ago, some people were concerned about thimerosal, a preservative used in some shots. Thimerosal contains mercury. Some people worried that thimerosal might cause autism. After a lot of careful research, medical experts found no link between thimerosal and autism. Still, to help ease some parents' concerns, thimerosal is no longer used in vaccines, except in tiny amounts in some flu shots. If you're concerned about thimerosal, ask your children's health care provider to use thimerosal-free vaccines.