A beginner’s guide to understanding Neonatal Intensive Care Unit (NICU) and its levels of care

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A beginner’s guide to understanding Neonatal Intensive Care Unit (NICU) and its levels of care

Witnessing the power and beauty of a tiny life is awe-inspiring. Every new mom aspires this experience of delivering a healthy baby to be a smooth one but sometimes things don’t go as planned; babies can be born prematurely, with a serious health issue or can become critically ill after delivery. Hence, when parenting a preemie, learning all about the neonatal intensive care unit (NICU) and what NICU levels mean can help you feel more aware and in charge of your baby’s care.

A child under 28 days of age is referred to as a neonate. A neonatal intensive care unit (NICU) is an area of comprehensive care in a hospital which specializes in caring for premature, ill newborn babies or neonates. The team of NICU consists of neonatologists, respiratory therapists, doctors, trained nurses, and dietitians that specialize in newborn care. Not all NICUs are created equal when considering all the factors in the choice of what hospital to birth a baby. Different hospitals have different levels of NICU which denotes the hospital’s expertise. You may think that the NICU is just for preemies, but many are full-term babies, from healthy pregnancies, that unexpectedly have a condition that needs immediate attention.

The level of NICU care in India is decided on the gestational age and weight of the neonate. India has 4-tier system.

Level I care

It takes care of neonates who weigh more than 1800 grams or have a gestational maturity of 34 weeks or more. Here they are provided with all facilities required at birth, for breastfeeding and also provision to keep the neonate warm in an aseptic environment. It is found at any primary health hospital.

Level II care

It takes care of neonates who weigh 1200-1800 grams or have a gestational maturity of 30–34 weeks. The area has all equipment’s for resuscitation of the neonate, maintenance of thermoneutral environment, intravenous infusion, gavage feeding, phototherapy and exchange blood transfusion. This type of care is facilitated usually at district hospitals, teaching institutions, and nursing homes.

Level III care

It takes care of neonates weighing less than 1200 grams or having a gestational maturity of fewer than 30 weeks. This type of care has a wide range of facilities like availability of oxygen services, infusion pumps, suction facilities, ventilators, incubators, vital stats monitors, TC monitors, etc. They have full-time availability of skilled nurses and neonatologists.

Level IV care: Highest Level of Neonatal Care

Level 4 NICUs is an assurance of care of the highest level. These nurseries are equipped to perform complex surgeries found by birth or acquired conditions. They have availability of highly-skilled experts including pediatricians, anesthesiologists, respiratory experts, surgeons, and trained nurses.

Usually, level 3 and 4 are exchangeable.

Choose a Hospital with a Higher Level NICU

When it is a question of saving your newborn’s life, you will never want to compromise on the level of care provided. You would want to ensure to reach the closest NICU without any hindrance of a difficult transfer situation. Here is why you want to deliver your baby at a higher level NICU (Level 3 or 4).

  • In facilities that see the most complex cases, there is a better likelihood of identifying the risk factors and applying the best strategies.
  • Higher level NICUs are equipped with the most experienced nursing staff. This nurse (or team of nurses) cares for your baby 24/7.
  • Sometimes a smooth, full-term pregnancy which does not seem high-risk, can have conditions that affect babies when they are born. A heart defect is one of the most common birth defects goes often undetected in vitro and calls for the most advanced medical treatment.
  • Parents find themselves trying to figure out what to do from the hospital bed only at the eleventh hour. Timing becomes very critical and you end up relying on doctors in that facility to advise you, diagnose and decide if a transfer is warranted.
  • Sometimes NICU at the desired facility maybe full and call for a transfer situation that might become difficult. The infant might have to wait for a bed to become available or may need transfer to a facility even further away.
  • Unless the transfer is clearly warranted, you may end up in a situation where the transfer is needed, but not granted.
  • If an infant is transferred to another facility, the mother is likely to still be admitted to the original hospital, just having given birth. This creates emotional issues for the parents and makes breastfeeding the baby and bonding impossible.

Last words…

The best way to find out what Level NICU is at your hospital is to call them or know from the obstetrician. Being in the know of the level of intensive care offered by the hospital closest to you can help make the entire process of caring for the health of your baby less overwhelming. Also, knowing in advance the do’s and don’ts of a NICU can equip you in becoming more patient and providing the right care for your little one.

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