What the NICU levels mean

When you or your partner goes into labor, you’re thinking about finally holding your baby in your arms and taking them home. But for some parents, things don’t go as planned. When babies need extra care right away, they’re admitted to the NICU — the neonatal intensive care unit.

Suddenly, you’re hearing terms like NICU levels and Level III NICU and being surrounded by several doctors and tons of equipment. It can all feel like a lot. But once you understand how the NICU works, you’ll see it’s a place of support and hope. 

What does NICU stand for?

NICU stands for neonatal intensive care unit, sometimes called a neonatal ICU. A NICU is a part of the hospital designed just for newborns who need extra care. This includes babies born early, with low birth weight or with certain health conditions that need immediate attention. NICU doctors, nurses and specialists have special training and use advanced equipment to give babies the care they need.

“NICU levels are a measure of the experience of the staff and the resources of an institution to be able to provide care to infants,” says Timothy Sanders, M.D., Ph.D., medical director of the Level IV NICU at Sutter Medical Center, Sacramento. 

What are the different NICU levels?

There are four NICU levels:

• Level I NICUs provide basic newborn care
• Level II offers specialized care
• Level III NICUs provide subspecialty newborn care, caring for very tiny and sick infants and can provide continuous life support and critical care
• Level IV NICUs provide the highest level of NICU care for babies with the most critical medical conditions, including caring for micro preemies

“A Level I NICU can provide exceptional care for a baby that requires that level of support. But if a child needs specialized resources, they need a Level III or Level IV NICU,” explains Sanders. “At Sutter Health, we have neonatal ICUs that span the care spectrum for newborns including NICUs with the highest care designation, which means that we can provide every mode of care that a baby may need, including specialized cardiac, respiratory and neurologic care.” 

What can you expect at a NICU? 

When you show up at the NICU, you’ll be greeted by your care team. It may feel like a flurry of activity at first. You’ll be asked a lot of questions, and the team will discuss your baby’s care plan and help you understand what to expect.  

“The NICU environment can involve a lot of equipment, a lot of monitors and a number of different care providers,” Sanders says. “And that experience can be very daunting, particularly when parents are already concerned about the health and well-being of their child.”

To help you manage the complexity of being in the NICU and access resources, NICU social workers and case managers may be part of your care team. Plus, child life specialists can help make sure siblings are taken care of as well.

Daily communication

Regardless of the NICU level, the NICU is a 24/7 operation, and parents are welcome to visit any time of the day or night. At Sutter, where the average length of a NICU stay is 14 to 17 days, doctors and nurses connect with families daily.  

“Even when our families are far away and are unable to be there every day,” Sanders says, “we talk via phone and have our social work staff touch base with them.”  

For parents who can’t be present every day, there’s also a video link so they can see their baby.

“We certainly recognize that many of our families, particularly when babies are in the hospital for weeks or months, need to carry out the routine activities of daily life,” Sanders explains. “They have other children, they may have to return to work, or they have other responsibilities that make it very difficult to be at the bedside all the time.”

For NICU doctors and nurses, the goal is to help each family get through this difficult time with a healthy baby.

“It can be a very foreign and frightening experience at times,” Sanders says. “We’re here to communicate and give parents all the information they need, to answer their questions day or night and to partner with them in the care of their child.”