Levels of Care

Maternal Levels of Care

Birth Center –

• Care for low-risk women with uncomplicated singleton (one baby) term vertex (head down) pregnancies who are expected to have an uncomplicated birth

Level I: Basic Care –

• Care for low to moderate-risk pregnancies
• Demonstrates the ability to detect, stabilize, and initiate management of unanticipated maternal-fetal or neonatal problems that occur during the antepartum, intrapartum, or postpartum period until the patient can be transferred to a higher level of care

Level II: Specialty Care – Level I, plus;

• Care for moderate- to high-risk antepartum, intrapartum, and postpartum conditions

Level III: Subspecialty Care – Levels I and II, plus;

• Care for more complex maternal medical conditions, obstetric complications, and fetal conditions
• Provide a full range of advanced imaging
• Provide access to a full range of subspecialists, surgical specialists, and anesthesiologists

Level IV: Regional Perinatal Health Care Centers – Levels I, II, III, plus;

• On-site medical and surgical care of the most complex maternal/neonatal conditions
• Full range of obstetric and pediatric subspecialists, surgical specialists, anesthesiologists, and ophthalmologists on staff
• Facilitate transport and provide outreach education

Neonatal Levels of Care

Level I: Well Newborn Nursery –

• Provide neonatal resuscitation at every delivery
• Stabilize and care for infants born 35-37 weeks gestation who remain physiologically stable
• Stabilize newborn infant who are ill and those born < 35 weeks gestation until transfer to a higher level of care

Level II: Special Care Nursery – Level I, plus;

• Provide care for infants born ≥ 32 weeks gestation and weighing ≥ 1500 g who have physiologic immaturity or who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis
• Provide care for infants convalescing after intensive care
• Provide mechanical ventilation for brief (<24 hours) or continuous positive airway pressure or both
• Stabilize infants born before 32 week gestation and weighing < 1500 grams until transfer to a Neonatal Intensive Care Unit (NICU)

Level III: NICU  – Level II, plus;

• Provide sustained life support
• Provide comprehensive care for infants born <32 weeks gestation and weighing <1500 grams and infants born at all gestational ages and birth weights with critical illness
• Provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists, and pediatric ophthalmologists
• Provide a full range of respiratory support that may include conventional and/or high-frequency ventilation and inhaled nitric oxide
• Perform advanced imaging, with interpretation on an urgent basis, including computed tomography, MRI, and echocardiography

Level IV: Regional NICU – Level III, plus;

• Located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions
• Maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists, and pediatric anesthesiologists at the site
• Facilitate transport and provide outreach education