Hand to Hold's Official Blog: Written by Parents for Parents

What is a Level III NICU?

The following is the definition of a Level III NICU according to two separate sources.  It’s interesting to me that there are so many sublevels…why didn’t they just make NICU Levels IV, V, and VI?  Just curious…

“Level III: Subspecialty Newborn Care: Level III NICUs care for the sickest babies and offer the greatest variety of support.

  • Level IIIA: These nurseries care for babies born greater than 28 weeks. They offer mechanical ventilation and minor surgical procedures such as central line placement.
  • Level IIIB: Level IIIB NICUs can offer different types of mechanical ventilation, have access to a wide range of pediatric specialists, can use imaging capabilities beyond x-ray, and may provide some surgeries requiring anesthesia.
  • Level IIIC: The most acute care is provided in level IIIC NICUs. These nurseries can provide advanced ventilation, including ECMO, and can provide advanced surgeries including “open-heart” surgeries to correct congenital heart defects.”


And in slightly more detail…

“Level III (subspecialty): a hospital NICU organized with personnel and equipment to provide continuous life support and comprehensive care for extremely high-risk newborn infants and those with complex and critical illness. Level III is subdivided into 3 levels differentiated by the capability to provide advanced medical and surgical care.

Level IIIA units can provide care for infants with birth weight of more than 1000 g and gestational age of more than 28 weeks. Continuous life support can be provided but is limited to conventional mechanical ventilation.
Level IIIB units can provide comprehensive care for extremely low birth weight infants (1000 g birth weight or less and 28 or less weeks’ gestation); advanced respiratory care such as high-frequency ventilation and inhaled nitric oxide; prompt and on-site access to a full range of pediatric medical subspecialists; and advanced imaging with interpretation on an urgent basis, including computed tomography, magnetic resonance imaging, and echocardiography and have pediatric surgical specialists and pediatric anesthesiologists on site or at a closely related institution to perform major surgery. Level IIIC units have the capabilities of a level IIIB NICU and are located within institutions that can provide ECMO and surgical repair of serious congenital cardiac malformations that require cardiopulmonary bypass.”


I imagine to many people these different sublevels wouldn’t mean very much, but to those of us who stared all of these medical situations in the face we can probably guess what level of NICU our preemies were in if we didn’t know before.

Next post…Is there a Level IV NICU?

Discussion:  Was your preemie stationed in a Level III NICU?  Do you know what sublevel?  What facilities were available for parents in these high-tech NICUs?

Afton Mower About Afton Mower

After Mower (UT) lost her firstborn son at 21 weeks.  Her daughter was born a year and a half later at 27 weeks.  The NICU was overwhelming and isolating and it was through those two experiences she was led to found this social hub for parents to find the support they needed. Afton also gave birth to another daughter, born two days overdue after four months of strict bedrest. She believes it is a tender experience to hold a special baby in your arms when his spirit returns to his heavenly home, a miracle to watch tiny babies survive the risks of prematurity and a blessing to hold a healthy full-term baby after months of difficulty and sacrifices.


  1. I think my babe was in a level IIIB NICU. while my little babe luckily was not on high frequency vent. her neighbor was. There are 3 level III NICUs in my area. Cincinnati Children’s is the only one that performs surgical procedures beyond central line insertions and feeding tubes. Although I delivered 9 weeks early, my hospital and staff were AMAZING! The nurses explained everything is such detail, the chairs were comfy, they had 2 pumping rooms, and LOTS of support staff. The residents would even call you after rounds if you missed it so they could talk to you and ask if you had any questions. It was the best possible scenario for a bad situation. We had our own little pod with her and could easily have privacy for Kangaroo Care. The staff was so great…I didn’t have a camera the first time I got to hold her, so they took a picture and printed it out right there for me! I love Good Samaritan Hospital in Cincinnati, OH!

  2. We were in a Level IIIC unit…our daughter was only 10 weeks early, but we made great friends with the other families. One we became very close with, had a 23 weeker that had several surgeries, including heart surgery to fix his PDA. .So we got to see first hand how important it was for him to be where he was…WONDERFUL staff, wonderful Doctors, we all became a family. We only had to stay 6 weeks as opposed to the 10 that was estimated. I think they are remodeling soon to allow much more privacy/pumping rooms etc…Missoula MT NICU @ Community Hospital gets patients from all over the area, including Idaho and even Washington.

  3. Brittany says:

    My little guy was in a Level IIIa NICU in a smaller hospital. He was born at 29.5 weeks and we were there 53 days. He did require a vent for a few days. We had absolutely fantastic nurses, and the neonatologists were the same ones who saw kids at our local Children’s Hospital. When he needed things the hospital didn’t provide, such as ophthalmology… See More visits, special x-rays and a few echos, they all came to him. We had a really great experience, more stress-free than I ever imagined an extended NICU stay would be.

  4. My little one (28 weeker) was in a Level III NICU from pre-birth (I was transferred with a mag sulfate drip at 26 weeks so he could be there when born) and for 4 weeks after, when we stepped down to Level II, local to home. Fortunately, we never needed to return. Of course, there was an issue at the Level II that was not addressed and it seems … See Morelike it was beyond their capacity for dealing with it, but so too was there no mention of going back to the Level III — they just ignored the problem. 🙂

  5. our 28 week daughter was in a level III nicu. Although our little one did fairly well, she was there for 10 weeks. The level III can be quite stressful. There is always “something” happening, and lots of emergency surgeries, code alarms, and crying parents 🙁 Fortunately, we all had private rooms


  1. […] care for a micro-premie born this small, there are are very few hospitals that do.  In fact, most Level 3 NICU’s are not even equipped to care for a baby born before 28 weeks gestation.  With only a handful of […]

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