Every newborn needs nurturing care and attention. But when a baby arrives early or with a medical condition, they sometimes need extra support. That’s where the NICU comes in.
A hospital NICU, or neonatal intensive care unit, provides expert, around‑the‑clock care for premature and critically ill babies. Preterm births account for about 12% of all births in the U.S., and another 4% of babies are born with congenital conditions that may require specialized care.
If you’re expecting twins, triplets, or higher multiples, the likelihood of preterm birth rises to nearly 60%, according to the American Academy of Pediatrics (AAP).
All NICUs are not alike
Parents consider many factors when choosing where to deliver their baby, including whether the hospital has a NICU.
What they may not realize is that both the AAP and Virginia law define 4 levels of NICU, and there’s a big difference in the care they can offer from one level to the next.
Level I
A Level I nursery isn’t technically a NICU. The newborn nursery provides routine monitoring, testing, and care for healthy full‑term and late pre-term babies before they go home.
Level II
A Level II special care nursery provides basic intensive care for babies born at 32 weeks gestation or later who weigh at least 3.3 pounds. These babies may need:
- Short‑term breathing or feeding support
- Help maintaining their body temperature
- Treatment for non‑urgent medical concerns
Level III
Level III NICUs care for babies born earlier than 32 weeks gestation and/or weighing less than 3.3 pounds, as well as babies with more complex medical needs. Babies in a Level III NICU may require:
- Full respiratory support with a ventilator
- Advanced imaging such as CT, MRI, or echocardiograms
- Minor surgeries or procedures
- Long‑term IV nutrition
A Level IIIB NICU offers the most advanced Level III care. It can support babies born as early as 22 weeks gestation and those weighing less than 500 grams (just over 1 pound), providing sustained life support and access to a large team of specialists.
Level IV
Level IV NICUs provide the highest level of newborn care. They offer everything available in Levels I–IIIB, plus:
- Major surgical procedures
- Care for the most critically ill newborns
- Comprehensive, multidisciplinary support
Carilion Roanoke Memorial Hospital, home to Carilion Children’s Hospital, hosts the region’s only Level IV NICU. The NICU team consists of neonatal specialists, respiratory therapists, in-house social workers and case managers, child life specialists, and more.
“The goal of our NICU is to improve the quality of life for all the babies and families who come into our care," says Ghislaine Cady, senior director for inpatient services at Carilion Children's.
"No parent or caregiver wants their baby to be in the NICU. Our highly experienced, compassionate team is continually inspired by these tiny humans and are dedicated to providing them the best care possible."
For babies born at other hospitals that aren’t equipped to provide the special care a higher-level NICU offers, dedicated neonatal/pediatric transport vehicles can safely transport them in the experienced hands of a specially trained team.
When your baby needs NICU care
All new parents experience big emotions—feeling overwhelmed, anxious, under‑prepared, or even depressed is common. Parents whose babies need NICU care often experience these same feelings, plus additional emotions like:
- Fear
- Anger
- Guilt
- Loss
- Powerlessness
- Feeling judged or exposed
These reactions are normal. The NICU journey can be stressful, but there are ways to cope and stay connected to your baby and care team.
1. Stay involved in your baby’s care: Even small actions can make you feel more connected and empowered. Touch or hold your baby when able and take part in diaper changes or feedings.
2. Ask questions: NICUs involve complex technology and fast‑paced decisions. It’s okay to ask things like “Can you explain that in simpler terms?” or “What does that number mean?”
3. Take care of yourself, too: Self care isn’t selfish—it helps you stay strong for your baby. Take regular breaks to rest, eat nutritious meals, and stay hydrated.
4. Lean on your support system: NICUs can feel isolating. Stay connected to your partner or co‑parent, trusted friends and family, or NICU support groups (both in‑person and online).
5. Celebrate small wins: In the NICU, progress often happens in tiny steps like gaining an ounce or breathing with less support. Acknowledging these milestones can bring hope and encouragement.
6. Give yourself grace: There is no “right” way to feel in the NICU. Your emotions may change by the hour. Remind yourself:
- You didn’t cause this
- You’re doing your best
- Your baby is receiving excellent care
- You are not alone
To learn more about Carilion Children’s, including the specialty care available, visit CarilionClinic.org/kids.
