NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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Classification
of NICUs
There is a lack of consistent definitions of levels of care in neonatal care units. The advantages of having uniform definitions would include the ability to:
Ø Compare outcomes, utilization, and costs among comparable institutions;
Ø Develop NICU standards;
Ø Inform the public of NICU capabilities;
Ø Minimize the perceived need for businesses to develop NICU standards.
To address this issue, the AAP Committee on the Fetus and Newborn will propose new uniform definitions of the levels of Neonatal Care. The proposed levels of care are:
Level 1. Newborn Nursery.
¨ Can perform neonatal resuscitation at every delivery;
¨ Care for healthy term newborns, and for infants 35-37 weeks gestation who remain physiologically stable.
¨ All other newborns would be stabilized and transported to a unit with the appropriate higher level of care.
Level 2a. Special Care
Nursery.
Can provide Level 1 care plus can care for infants > 32 weeks gestation and > 1500 grams birth weight who:
¨ Have physiologic immaturity (apnea, poor feeding, temperature instability), but not requiring mechanical ventilation or CPAP;
¨ Have medical problems that are anticipated to resolve rapidly and not require urgent sub-specialty care.
¨ Are convalescing after intensive care.
Level 2b. Special Care
Nursery.
¨
Can provide Level 2a care, and
¨
Can provide mechanical ventilation for brief duration (<24
hours) or CPAP.
Level 3a. Neonatal Intensive Care Unit.
¨ Can care for infants > 28 weeks gestation and > 1000 grams birth weight.
¨ Can provide sustained life support with conventional mechanical ventilation.
¨ May perform minor surgical procedures, such as placement of central venous catheters or repair of inguinal hernias.
Level 3b. Neonatal Intensive Care Unit.
¨ Can provide comprehensive care for infants < 28 weeks gestation and < 1000 grams birth weight.
¨ Can provide advanced respiratory support such as high-frequency ventilation or inhaled nitric oxide.
¨
Can perform major surgical
procedures on neonates (excluding ECMO and repair of complex congenital heart
defects requiring cardiopulmonary bypass).
¨ Requires prompt and on-site access to a full range of pediatric subspecialty consultants, as well as pediatric surgical and anesthesia specialists.
¨ Requires availability of advanced imaging support on an urgent basis, including CT, MRI, and echocardiography.
Level 3c. Neonatal Intensive Care Unit.
¨
Has the capabilities of a level
3b NICU
¨
Can provide ECMO and surgical
repair of complex congenital heart defects requiring cardiopulmonary bypass.
Comment. If
and when these proposed levels of care are finally published, then many of our
state agencies and medical societies will need to revise their stratification
of neonatal care to conform to the new standard.
The next steps would be to develop standards for the capabilities and
support requirements for each level of care, and to identify the minimum
volumes of patients and/or procedures for best outcomes. ABK.
Date: 18 Feb 2003
Time: 09:26:17
Hello, I read your article and understand these to be proposed levels. I
am doing research with our physicians, looking at developing a NICU. Am I
to understand that the current classification certification is Leve I, II and
III? Also, would you have any information for me on the steps to go through for
certification. Thank You.
Judy Rusch RN
Date: 21 Feb 2003
Time: 22:27
Judy, Currently there is no national or international standardization of NICU classification or certification requirements. There issues are governed largely by State regulations. I would ask your State healthcare agency what regulations apply to your hospital.
Andy Kairalla MD
Date: 23 Dec 2004
Time: 10:54:54
Could you please speak to the requirements of medical/physician coverage in the Level 2 and 3 units. Is there a 24 hour in house requirement and are they handled differently between the two levels? Thank you.
UserName: Elissa DeWolfe
Institution: Washoe Medical Center
telephone: 775-982-5825
email:
edewolfe@washoehealth.com
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