What it means to be a level 3 NICU or level 4 NICU

Some new parents find themselves grappling with unanticipated complications after their baby is born. If the baby has to spend time in the hospital, he or she likely will be in the neonatal intensive care unit, or NICU. That’s when parents may wonder what a NICU is and what’s the difference between levels of NICUs.

The American Academy of Pediatrics (AAP) developed standards for NICU designations to outline the type of care newborns can receive in a facility. Level 1 and 2 NICUs are designed to provide basic care for newborns with conditions that are expected to resolve without need for subspecialty care.

To be designated a level 3 NICU, the unit must offer prompt and readily available access to a full range of pediatric medical subspecialties. A level 3 NICU cares for babies born before 32 weeks gestation, weigh less than 3 pounds, 5 ounces, have medical conditions or need surgery. Level 3 NICUs also provide a full range of respiratory support and have available subspecialists include neonatologists and staff and equipment to provide life support as long as necessary.

Some babies may need more complex care available at the highest level of NICU — level 4.

To obtain a level 4 NICU designation, a hospital needs to meet all level 3 capabilities, plus have experience caring for the most complex and critically ill newborns. Pediatric medical and surgical specialists are available around the clock, and the hospital has the ability to surgically repair complex conditions, such as heart defects.

A level 4 NICU is equipped to perform advanced imaging, including MRI and echocardiography, among many other criteria.

Pregnant or planning?

Norton Women’s Care and Norton Children’s offer high-quality care for you and your baby.

Level 3 and level 4 NICUs in Louisville

At the level 3 NICU at Norton Women’s & Children’s Hospital in St. Matthews, neonatologists and other specialists care for 750 fragile newborns every year. Some spend just a few days in the unit, while others stay for months.

Norton Children’s Hospital is home to the region’s only level 4 NICU. Pediatric surgeons and other providers repair complex birth defects and acquired conditions. Approximately 1,300 newborns are treated annually at Norton Children’s Hospital.

“We know parents don’t often think about these things until the time comes,” said Ketan Mehta, M.D., neonatologist, Norton Children’s Neonatology. “The Level IV designation helps parents understand that Norton Children’s Hospital can provide the highest quality of care for their child during their most vulnerable time.”

In early 2017, the hospital announced a $78 million expansion, which includes creating the Jennifer Lawrence Cardiac Intensive Care Unit, as well as renovating the NICU and intermediate care nursery. The hospital is on track to finish the renovations next year.


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