Seattle Children's Level IV NICU Offers the Highest Level of Neonatal Intensive Care in Washington

Seattle Children's was the first hospital in Washington state to have been designated a Level IV Neonatal Intensive Care Unit (NICU), the highest designation possible. Equipped to care for the tiniest and most critically ill newborns, Children's 19-bed Level IV NICU receives patients from nearly all Level III NICUs in Washington and Montana.

What does “levels of care” mean?

The Washington State Department of Health and the American Academy of Pediatrics define four levels of neonatal care:

Level I (well newborn nursery)

Pediatricians, family doctors and advanced practice nurses stabilize and provide care for low-risk newborns who are born as early as 35 weeks' gestation, and are prepared to stabilize sick newborns for transfer to a higher-level NICU.

Level II (special care nursery)

A Level II special care nursery must have the same capabilities as a Level I nursery, and more. Pediatric hospitalists (pediatricians working primarily, or only, in hospitals), neonatologists and neonatal nurse practitioners must be able to care for infants born as early as 32 weeks' gestation; to provide care for infants recovering after intensive care; to provide brief mechanical ventilation or continuous positive airway pressure, or both; and, sometimes, to provide intravenous nutrition for babies not yet able to feed. In Washington, Seattle Children's pediatric hospitalists provide care 24 hours a day, seven days a week in the Level II special care nurseries at Skagit Valley Hospital and Providence St. Peter Hospital.

Level III (NICU)

A Level III NICU must have all of the Level II capabilities, and more. It must have quick access to a full range of pediatric medical subspecialists, pediatric surgical subspecialists, pediatric anesthesiologists and pediatric ophthalmologists. A Level III NICU must be able to provide sustained life support, sustained respiratory (breathing) support and advanced imaging, with interpretation on an urgent basis. In addition, it must either be able to provide surgery for common complications of prematurity and common birth defects or have an affiliation with a Level IV NICU, such as the NICUs at the University of Washington, Providence Everett, Overlake Medical Center, St. Joseph Medical Center and Kadlec Regional Medical Center have with Children's NICU.

Level IV (regional NICU)

A Level IV NICU, such as Seattle Children's, must have all of the Level III capabilities, and more. It must be located within a hospital that can provide surgery for complex conditions that are present at birth or that develop soon after delivery. A full range of pediatric medical subspecialists, pediatric surgical subspecialists and pediatric anesthesiologists must be available on-site 24 hours a day, seven days a week. Level IV NICUs must also facilitate patient transport and provide outreach education to other providers.

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