- The NICU levels defined by the American Academy of Pediatrics
- The specialized interventions available at each level
- How Carilion Clinic’s Level IIIB NICU cares for the tiniest, sickest babies in our region
Every newborn baby needs special care.
When babies are born early or with certain medical conditions, they need intensive care. That’s where NICUs come in.
A hospital NICU, or neonatal intensive care unit, provides specialized care for critically ill newborns, including preterm babies born before 37 weeks of pregnancy. Preterm births account for about 12% of overall births in the U.S., and another 4% of babies are born with congenital conditions.
If you are pregnant with twins, triplets or other multiples, that percentage soars to 60% of all births, according to the American Academy of Pediatrics (AAP).
All NICUs Are Not Alike
Thoughtful parents consider many factors when choosing 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 four levels of NICU, and the specialty care they can offer fragile newborns varies significantly from one level to the next.
Level I
A Level I nursery isn’t technically a NICU. Level I nurseries provide the care, monitoring and testing healthy babies receive before going home for the first time.
Hospitals that have higher level NICUs—such as the Level IIIB NICU at Carilion Roanoke Memorial Hospital—also provide this level of nursery care for healthy babies.
Caregivers in a Level I nursery include pediatricians, advanced care practitioners (ACPs) like nurse practitioners and physician assistants, and the “nursery” itself may be right there in their mother’s room. Newborns and their mothers staying at teaching hospitals like Carilion might also engage with resident physicians who are gaining experience in their chosen area by accompanying specialists on their rounds.
Level II
A Level II special care nursery provides basic intensive care for sick and premature infants born at 32 weeks or later who weigh at least 3.3 pounds. These babies’ needs may include short-term breathing or feeding support, non-urgent medical issues and an incubator to help them stay warm.
Families at Level II NICUs may also meet neonatologists, specially trained ACPs and pediatric hospitalists—a specialist who coordinates care and acts as a primary care physician for inpatients.
Especially in our region, babies may be born at other area hospitals or rural community hospitals that are not equipped to provide the specialized care a higher-level NICU offers. In those cases, Carilion Clinic’s dedicated neonatal/pediatric transport vehicle can safely transport them in the experienced hands of a specially trained team.
Level III
A Level III NICU provides comprehensive care for more seriously ill newborns and those born earlier than 32 weeks and weighing less than 3.3 pounds. These babies require the expert evaluation of neonatal specialists and may:
- Require a full range of respiratory support
- Need advanced imaging like CT scans, MRIs and echocardiograms
- Require minor surgeries or procedures
- Need long-term IV nutrition support
Carilion Roanoke Memorial Hospital has the region’s only Level III NICU. More specifically, it is a Level IIIB NICU, which means it can care for all degrees of prematurity, has a large team of experts on staff and can provide sustained life support. The extra “B” designation means Carilion’s NICU has the ability to competently care for newborns born at 22 weeks gestation and those who weigh less than 500 grams (a little over one pound).
“The goal of our NICU is to improve the quality of life for all the babies and families who come into our care," said Alicia McAllister-Daniels, senior director for Carilion Children's.
"No parent or caregiver wants their baby to be in the NICU. Our highly experienced, compassionate team of specialists and support staff is continually inspired by these tiny humans and are dedicated to providing them the best care possible."
In addition to the care team offered at lower level NICUs, families at Level IIIB NICUs may also engage with pediatric medical subspecialists, pediatric anesthesiologists, pediatric surgeons and pediatric ophthalmologists.
Level IV
Level IV NICUs offer, in addition to other levels, more major surgeries, surgical repair of serious congenital heart conditions or extracorporeal membrane oxygenation (ECMO) for certain medical conditions. Since they care for the most complex and critically ill newborn infants, Level IV NICUs are often located in large metropolitan areas. Level IV NICUs in Virginia are located in Charlottesville, Norfolk, Northern Virginia and Richmond.
When Your Baby Needs NICU Care
Any new parent may experience feeling overwhelmed, under-prepared, anxious and even depressed after their baby is born.
Parents whose new babies need extra care experience those emotions as well as a range of additional reactions. According to the AAP, these can include:
- Fear
- Anger
- Guilt
- Loss
- Powerlessness
- Exposed and judged
Carilion Clinic’s NICU team includes comprehensive support for parents who may be reeling from the shock of a premature birth, or exhausted after carrying their newborn to term knowing they would immediately need significant medical care.
Your Baby's NICU Team
At Carilion, the experienced NICU nursing team collaborates 24/7 with an interdisciplinary team of:
- Physicians
- Pediatric and neonatal specialists
- Subspecialists for services and treatments like EEGs and cardiac imaging
- Palliative care as needed
- Respiratory therapists
- Neonatologists
- In-house social workers and case managers
- Child life specialists
Also on the NICU team are parent/family educators, formula techs, lactation consultants, neonatal vascular access specialists and more.
Parents are able and encouraged to visit their baby 24 hours a day throughout their NICU stay. They can also take advantage of the AngelEye camera system, a secure, live-stream video feed.
Parents are further supported through Carilion’s Healing Arts program, visiting therapy dogs and accommodations at the nearby Ronald McDonald House for those who live far away.
As they prepare to bring their baby home, Carilion offers parent care rooms where families can stay together prior to discharge—an essential step that inspires confidence in caring for their new family member. And the NICU Bridge Clinic offers additional support as families adjust and follow up with their child’s caregivers.
The wraparound pediatric care offered at Carilion Children's means NICU babies can grow up continuing to receive the expert, specialized care they need to thrive, right in our region.
