Table 1: Basic Level of Perinatal Care and Level I Neonatal Care (Well-baby Nursery)*
Basic Level: Perinatal Care++
Capabilities
Surveillance and care of all patients admitted to
the OB service, with an established triage
system for identifying patients at high risk
who should be transferred to a facility that
provides specialty or subspecialty care.
Proper detection and initial care of
unanticipated maternal-fetal problems that
occur during labor and delivery.
Capability to begin and emergency cesarean
delivery within an interval based on the
timing that best incorporates maternal and
fetal risks and benefits.
Availability of appropriate anesthesia, radiology,
ultrasonography, and laboratory and blood
bank services on a 24-hour basis.
Care of postpartum conditions.
Ability to make transfer arrangements in
consultation with physicians at higher level
receiving hospitals.
Level I Neonatal Care (Well-baby Nursery)
Health Care
Provider Types
MDs:
Family Physicians
Obstetricians
Laborists
Hospitalists
Anesthesiologists
Radiologists
Advanced Practice
RNs:
Certified NurseMidwives (CNM)
Nurse
Practitioners (NP)
Advanced Practice
Registered Nurses
(APRN [WHCNP;
FNP]; CRNA)
Capabilities
Provide neonatal resuscitation at every delivery.
Evaluate and provide postnatal care to stable
term newborn infants.
Stabilize and provide care for infants born at 3537 weeks of gestation who remain
physiologically stable.
Stabilize newborn infants who are ill and those
born before 35 weeks of gestation until transfer
to a higher level care.
Health Care
Provider Types**
MDs:
Pediatricians
Family Physicians
Advanced Practice
RNs:
Nurse
Practitioners (PNP;
FNP)
Clinical Nurse
Specialists
Certified Nurse
Midwives
Ancillary:
Surgical
Assistants
Provision of accommodations and policies that
allow families, including their other children,
to be together in the hospital following the
birth of an infant.
Data collection, storage and retrieval.
Initiation of quality improvement programs,
including efforts to maximize patient safety.
*Adapted from: American Academy of Pediatrics and The American College of Obstetricians and Gynecologists: Guidelines for Perinatal Care, ed 7, 2012. ** Includes all health
care providers with relevant experience, training and demonstrated competence. ++ All institutions providing perinatal care should be capable of neonatal resuscitation and
stabilization.
Table 2: Specialty Perinatal Care and Level II Neonatal Care (Special Care Nursery)*
Specialty Perinatal Care++
Capabilities
Provision of all basic care services
Level II Neonatal Care (Special Care Nursery)
Health Care
Provider Types
All basic health
care providers
Capabilities
Level I capabilities
PLUS:
Care of appropriate women at high risk and
fetuses, both admitted and transferred from
other facilities
Health Care
Provider Types**
Level I health care
providers
PLUS:
PLUS
sometimes:
Maternal-fetal
medicine
specialists (MFM)
Provide care for infants born at 32 weeks of
gestation or later and weigh 1500 grams or
more 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.
PLUS:
MDs:
Pediatric
Hospitalists
Neonatologists
Advanced Practice
Nurses:
Neonatal Nurse
Practitioners (NNP)
Provide mechanical ventilation for brief duration
(less than 24 hours) or continuous positive
airway pressure or both.
Stabilize infants born before 32 weeks of
gestation and weigh less than 1500 grams
until transfer to a neonatal intensive care
facility.
*Adapted from: American Academy of Pediatrics and The American College of Obstetricians and Gynecologists: Guidelines for Perinatal Care, ed 7, 2012. ++ All institutions
providing perinatal care should be capable of neonatal resuscitation and stabilization.
**Includes all health care providers with relevant experience, training and demonstrated competence.
Table 3: Subspecialty Perinatal Care and Level III Neonatal Care (Neonatal Intensive Care Unit [NICU])*
Subspecialty Perinatal Care++
Capabilities
Provision of all basic and specialty care services
PLUS:
Level III Neonatal Care ( NICU)
Health Care
Provider Types
Capabilities
All Specialty health
care providers
PLUS:
Level II capabilities
PLUS:
Provide sustained life support.
Maternal-fetal
medicine
specialists (MFM)
Provide comprehensive care for infants born
before 32 weeks of gestation and weigh less
than 1500 grams and infants born at all
gestational ages and birth weights with
critical illness.
Health Care
Provider Types**
Level II care
providers
PLUS:
Evaluation of new technologies and therapies
Provide prompt and readily available access to a
full range of pediatric medical subspecialists,
pediatric surgical specialists, pediatric
anesthesiologists, and pediatric
ophthalmologists.
Pediatric medical
subspecialists#
Pediatric
anesthesiologists#
Pediatric surgeons
Pediatric ophthalmologists#
Provide a full range of respiratory support that
may include conventional ventilation and/or
high-frequency ventilation and inhaled nitric
oxide.
Perform advanced imaging, with interpretation
on an urgent basis, including computed
tomography (CT), magnetic resonance imaging
(MRI), and echocardiography.
*Adapted from: American Academy of Pediatrics and The American College of Obstetricians and Gynecologists: Guidelines for Perinatal Care, ed 7, 2012. # At the site or at a
closely related institution by prearranged consultative agreement.
++ All institutions providing perinatal care should capable of neonatal resuscitation and stabilization.
Table 4: Regional Subspecialty Perinatal Health Care Center and Level IV Neonatal Care (Regional NICU)*
Regional Subspecialty Perinatal Health Care Center
Capabilities
Health Care
Provider Types
Provision of comprehensive perinatal health care
services at and above those of subspecialty
care facilities.
All subspecialty
health care
providers
Responsibility for regional perinatal health care
service organization and coordination, including
the following areas:
 Maternal and neonatal transport
 Regional outreach support and
education programs
 Development and initial evaluation of
new technologies and therapies
 Training of health care providers with
specialty and subspecialty qualifications
and capabilities
 Analysis and evaluation of regional data,
including perinatal complications and
outcomes.
PLUS:
Level IV Neonatal Care (Regional NICU)
Capabilities
Level III capabilities
Health Care
Provider Types**
Level III health care
providers
PLUS:
PLUS:
Other
subspecialists
including obstetric
and surgical
subspecialists
Located within an institution with the capability
to provide surgical repair of complex congenital
or acquired conditions.
Pediatric surgical
subspecialists
Maintain a full range of pediatric medical
subspecialists, pediatric surgical subspecialists,
and pediatric anesthesiologists at the site.
Facilitate transport and provide outreach
education.
*Adapted from: American Academy of Pediatrics and The American College of Obstetricians and Gynecologists: Guidelines for Perinatal Care, ed 7, 2012. **Includes all health
care providers with relevant experience, training and demonstrated competence. ++ All institutions providing perinatal care should be capable of neonatal resuscitation and
stabilization.