The revised statement updates previous definitions published in 2004, which established three different levels with subdivisions in the latter two levels. After a review of literature, the AAP created classifications of four basic levels based on the availability of appropriate personnel, physical space, equipment, technology and organization.
For example, level I, a well newborn nursery, requires pediatricians, family physicians, nurse practitioners and other advanced practice registered nurses. Level II, a special care nursery, requires pediatric hospitalists, a neonatologist and neonatal nurse practitioners in addition to level 1 providers. Building on this requirement, level III, a neonatal intensive care unit, also requires pediatric medical subspecialists, pediatric anesthesiologists, pediatric surgeons and pediatric ophthalmologists. Level IV, a regional NICU, requires pediatric surgical subspecialists in addition to providers required in Level III.
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