Levels of medical care for your newborn

KEY POINTS

  • All newborns need some amount of health care when they’re born. Some newborns, such as those born too early or who are born with medical problems, need more specialized care.

  • Research has shown that babies who receive more specialized care when they need it are more likely to be healthy later in life.

  • Because specialized care is important, hospital nurseries in the United States offer one of four different levels of newborn medical care.

  • The timing of your baby’s birth and your baby’s birthweight help providers know what level of medical care your baby needs at birth.

  • Talk with your provider about how you can plan for the right level of care for your baby at birth. 

All newborns (also called neonates) need some amount of health care when they’re born. Even when babies are born healthy, they need to be seen 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) provide different levels of care and treatment. They are:

Level I, Well Newborn Nursery. This kind of nursery has teams of health care providers who take care of:

  • Babies who are 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 who are born at 35 to 37 weeks and 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 teams of health care providers who take care of:

  • Babies who are born at or after 32 weeks and 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 who are born before 32 weeks or who weigh less than 1,500 grams, but only until they can be moved to a nursery that provides a higher level of care.
  • Babies who have just gotten out of a neonatal 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 teams of health care providers who take care of:

  • Babies who are 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.
  • Babies who may need surgery. 

Level IV, Regional NICU. This is the highest level of care for babies. The team that works in this kind of nursery takes care of babies who may 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.

If you and/or your baby have medical complications, it’s ideal if you’re able to give birth at a hospital that can provide the right level of care for both of you.

What does it mean to transport a baby from one level nursery to another?

Transport means to move. Babies may need to move from one level nursery to another depending on the care they need. For example, if a baby gets sick and needs additional treatment, he may move from a Level 1 nursery to a Level 2 nursery. When he gets better and is almost ready to go home, he will be moved to a nursery that provides a lower level of care. Moving to a nursery that provides a different level of care may mean that your baby has to move to a different hospital or medical center, or sometimes even to a different city. Nurseries that provide more specialized care also have ambulances and other ways to transport babies safely.

Transporting a baby can be stressful, 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. 

How can you plan for the right level of care for your baby?

Talk with your health care provider about the level of care your baby may need. Ask these questions:

  1. Is my pregnancy at high risk for complications? What about my baby?
  2. What kind of care do I need during pregnancy to help my baby be born as healthy as possible
  3. What levels of newborn care are available in my area? 
  4. 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. You may want to call your local Health Care Department.

What kinds of pregnancy complications may require a higher level of care for your baby after birth?

Most pregnancies are healthy and don’t have complications. In some pregnancies though, complications increase the risk that the newborn will need to be cared for in a more specialized nursery. For example:

See also: Newborn care in the delivery room, Newborn screening

Last reviewed December 2020