Standards for Level of Neonatal Care: II, III, and IV
The American Academy of Pediatrics (AAP) has recently published an updated policy statement and complementary tool to assure all infants receive risk-appropriate neonatal care. The update is based on existing AAP policy, evidence-based literature, standards of professional practice from national organizations, and expert opinion. The 31-page document identifies new minimum required standards for facilities and the professionals working in a level II, III, or IV NICU. Below are highlights of the new standards addressing areas we found highly relevant to NTMC professionals.
Family-Centered Care: Recommended for all levels of care, including skin-to-skin care, appropriate developmental positioning based on gestational age, lactation and breastfeeding support, and engagement of families in their infant’s care.
- The facility will:
- Allow all parents to have reasonable access to their infants, at all times
- Have access to the services personnel, and equipment needed to provide the appropriate level of care for all infants
- Support the physiologic, developmental, and psychosocial needs of infants and their families
- Have a process to screen every family for social determinants, depression, and cultural needs
- Refer patients and families to appropriate resources as needed
- Professional staff roles to support family-centered care will include:
- Clinical Nurse Staff
- Neonatal Therapists
- Child Life Services (Level IV)
Nursing Education: Annual nursing education must be completed and documented by the facility at all levels of care to address needs assessment and complete skill-based simulations for the safe care of the infants at each level of care.
- The Clinical Nurse Specialists role in Level III and IV NICUs is to develop and educate staff to provide evidence-based nursing care
- The Clinical Nurse Educator in a Level II, III, and IV NICU is to collaborate with neonatal nurse leader and facility leadership to improve the quality of care and patient care outcomes and have experience and expertise to evaluate the education needs of the clinical staff, develop didactic and skill-based education tools, oversee education, skills verification, and evaluate retention of content, critical thinking skills, and competency relevant to level II, III, or IV neonatal care
Neonatal Therapists: Level III and IV facilities are required to provide on-site consultative services. Level II facilities must have a formal process to provide access to neonatal therapy expertise. On-site consultative services should be provided by:
- An occupational or physical therapist with neonatal expertise (neonatal therapy certification preferred)
- At least 1 individual skilled in the evaluation and management of neonatal feeding and swallowing concerns (SLP with neonatal expertise, neonatal therapy certification preferred, is recommended for a Level III and IV NICU)
- Annual review of neonatal therapist personnel to maintain adequate multidisciplinary neonatal therapist coverage, based on the need and volume of the neonatal population served.
It is amazing to see more standardization for neonatal practice! As family-centered care, clinical nurse specialists, and qualified neonatal therapists become the minimum requirements for NICUs across the country, we are thrilled to continue to provide the growing NTMC family with ongoing mentoring, education, hands-on trainings, and up-to-date literature. Utilize these new AAP Standards to advocate for continuing education for your entire NICU team, and changes to your unit’s policies!
Stark, A. R., Pursley, D. M., Papile, L. A., Eichenwald, E. C., Hankins, C. T., Buck, R. K., Wallace, T. J., Bondurant, P. G., & Faster, N. E. (2023). Standards for levels of neonatal care: II, III, and IV. Pediatrics, 151(6), e2023061957. https://doi.org/10.1542/peds.2023-061957
All of these articles support the principles of NTMC through neuroprotective care and therapeutic interventions. Thank you for improving the lives of babies and families worldwide!