How NICU Level I Through IV Affects Care in New York

When a baby needs more than routine care after birth, the level of the hospital’s neonatal intensive care unit can make all the difference. New York State uses a four-tier system to match newborns with the right level of medical support, and understanding these levels helps explain why some babies are transferred between hospitals and what kind of care they’ll receive.

What Do NICU Levels Mean and Why Do They Matter?

Not all hospitals are equipped to handle every newborn medical situation. New York’s Department of Health designates hospitals into four levels based on their capabilities, staffing, and equipment. This designation system, aligned with guidelines from the American Academy of Pediatrics and the Centers for Disease Control and Prevention, ensures that babies receive care matched to their medical needs.

The level system creates a safety net. A baby born at a smaller community hospital who develops complications can be quickly transferred to a facility with the specialists and technology needed to treat them. This regionalized approach has measurably improved survival rates and long-term outcomes for New York’s most vulnerable newborns.

Level I Perinatal Centers Provide Basic Newborn Care

Level I centers care for healthy, full-term babies born after normal or low-risk pregnancies. These facilities do not have NICUs.

What Level I hospitals can do:

• Monitor healthy newborns after uncomplicated deliveries
• Provide routine nursery care
• Identify problems early through standard newborn screenings
• Stabilize an infant who unexpectedly develops complications

What happens when a baby needs more:

If a newborn at a Level I center shows signs of distress, needs breathing support, or requires intensive monitoring, the medical team stabilizes the baby and arranges immediate transfer to a Level II, III, or IV facility. The receiving hospital is chosen based on what the baby needs. A moderately premature infant might go to a Level II, while a baby needing surgery would go directly to Level III or IV.

You can find New York’s designated Level I centers on the NYS Department of Health website.

Level II NICUs Handle Moderately Premature and Ill Newborns

Level II centers operate NICUs designed for babies with moderate complications or those born moderately premature.

Typical patients at Level II:

• Babies born between 32 and 36 weeks gestation
• Newborns with mild breathing difficulties
• Infants needing help with feeding
• Babies requiring observation for infection or jaundice

Services available:

• Continuous positive airway pressure (CPAP) for breathing support
• Intravenous nutrition and medications
• Short-term monitoring and stabilization
• Care for babies weighing more than 1,500 grams (about 3.3 pounds)

When Level II isn’t enough:

Babies born before 32 weeks, those with very low birth weight (under 1,500 grams), and newborns needing surgery or mechanical ventilation are transferred to Level III or IV facilities. About 15 to 40 percent of babies admitted to Level II NICUs eventually need transfer to higher-level care.

Level III NICUs Provide Advanced Care for Critically Ill Newborns

Level III centers handle complex, high-risk cases that require specialized interventions. These hospitals have the staff, equipment, and expertise to care for the sickest babies.

Who receives care at Level III:

• Very premature babies born before 32 weeks
• Very low birth weight infants (under 1,500 grams)
• Newborns requiring surgery
• Babies with serious heart, lung, or neurological problems
• Infants needing mechanical ventilation

Available capabilities:

• Full-time neonatologists and subspecialists
• Mechanical ventilation and advanced respiratory support
• Surgical services, including access to pediatric surgeons
• Subspecialty consultations (cardiology, neurology, genetics)
• Advanced imaging and diagnostic technology
• Long-term intensive monitoring

Level III facilities can manage nearly all neonatal emergencies and complications. In rare cases requiring the most specialized interventions, they coordinate transfer to a Level IV center.

You can view New York’s designated Level III centers on the NYS Department of Health website.

Level IV Regional Perinatal Centers Offer the Highest Level of Neonatal Care

Level IV facilities, officially called Regional Perinatal Centers (RPCs), provide the most comprehensive care available. These hospitals serve as regional hubs, accepting the most medically complex babies from across their geographic area.

What makes Level IV different:

• ECMO (extracorporeal membrane oxygenation) for babies whose hearts or lungs cannot function adequately
• Pediatric cardiac surgery
• Pediatric neurosurgery
• Complex congenital anomaly repair
• Specialized transport teams that can bring critically ill babies from other hospitals
• 24/7 availability of all pediatric subspecialists

Role beyond patient care:

Regional Perinatal Centers do more than treat patients. They oversee quality standards for lower-level facilities in their region, provide training and education, develop clinical protocols, and coordinate emergency response planning. This supervision helps ensure consistent, high-quality care across all hospitals in the region.

How New York’s Regionalized System Protects Newborns

New York’s tiered approach creates clear pathways for escalating care when babies need it. Rather than every hospital trying to handle every situation, the system efficiently moves babies to facilities equipped for their specific needs.

The transfer process:

When a baby’s condition exceeds their current hospital’s capabilities, the medical team contacts the appropriate higher-level center. Transport is arranged quickly, often within hours. Specialized neonatal transport teams, usually dispatched from Level IV centers, bring portable intensive care equipment and can provide advanced life support during the journey.

Why this matters for outcomes:

Research consistently shows that very premature and critically ill babies have better outcomes when cared for at higher-level NICUs. The difference isn’t small. Babies with very low birth weight who receive care at Level III or IV facilities have significantly lower mortality rates, fewer severe complications, shorter hospital stays, and better neurodevelopmental outcomes compared to similar babies treated at lower-level facilities.

Currently, about 95 percent of very low birth weight babies in New York are admitted immediately after birth to Level III or IV centers, either because the mother delivers at one of these hospitals or because the baby is transferred within hours of birth.

NICU Admission Rates and What They Tell Us

Nearly 10 percent of babies born in the United States are admitted to NICUs, according to recent CDC data. This percentage has risen over the past decade, not necessarily because more babies are sick, but because medical advances allow survival of babies who would not have survived in previous years.

Very premature babies (born before 28 weeks), babies with birth weights under 1,000 grams (about 2.2 pounds), and those with serious congenital conditions now have survival chances that would have been unthinkable a generation ago. This progress depends directly on the availability of Level III and IV care.

Which Babies Go to Which NICU Level?

The following table summarizes how babies are matched to NICU levels based on their medical needs:

What Parents Should Know About NICU Levels Before Delivery

If you’re expecting and know your baby may need NICU care, understanding hospital levels helps you make informed decisions about where to deliver.

High-risk pregnancies:

If your pregnancy is considered high-risk (multiple babies, known fetal anomalies, expected prematurity, maternal health conditions), your obstetrician may recommend delivering at a Level III or IV hospital. Delivering where advanced care is already available avoids the stress and risk of transferring a newborn.

Unexpected complications:

Most NICU admissions aren’t planned. Healthy pregnancies can have unexpected complications during labor and delivery. When this happens at a Level I or II hospital, staff are trained to stabilize newborns and arrange rapid transfer. While separation is difficult, transfer to the right facility gives babies the best chance at good outcomes.

Distance and access:

New York’s regionalized system means that advanced NICU care may not be available at the hospital closest to home. Level IV centers are concentrated in major population centers. Families in rural areas may face longer travel times to visit babies who need transfer, but the system prioritizes medical need over convenience because outcomes depend on it.

How to Find NICU Level Information for New York Hospitals

Before delivery, you can check the NICU level of any New York hospital:

• Visit our hospital profiles website
• Ask your obstetrician or midwife about the NICU level at your planned delivery hospital
• Call the hospital’s labor and delivery or nursery unit directly
• During prenatal appointments, discuss whether your pregnancy risk factors suggest delivering at a higher-level center

If your baby is already in a NICU and you have questions about whether they’re at the appropriate level of care, the neonatology team can explain why they’re at their current facility and whether transfer might become necessary.

The Bottom Line on NICU Levels and Newborn Care

New York’s four-level system exists to match sick and premature babies with the right resources at the right time. While Level I centers handle the majority of healthy births, the infrastructure of Level II, III, and IV hospitals creates a safety net for the roughly 10 percent of babies who need more.

The system isn’t perfect. Transfers separate families. Distance creates hardship. But data shows it works. Very premature babies and those with serious medical complications have dramatically better survival and long-term outcomes when cared for at hospitals with appropriate expertise and technology.

Understanding these levels doesn’t change what happens to a baby who needs intensive care, but it does help explain the why behind transfer decisions and the system designed to give every newborn the best possible chance.