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What is a Level IV NICU?

Now, most sources I found did not describe a Level IV NICU, but I have heard a few people say their preemie was in a Level IV NICU, so I was curious.  I also read somewhere that a Level IV qualification was discontinued 15-20 years ago.  I guess it’s confusing to a lot of people.

But, to share what I could find on the subject, here is one definition of a Level IV NICU:

“Level IV – Regional Subspecialty NICU’s (Level IV is a designation about the Level II, only found in a limited number of the states).  The Level IV NICU’s are often found in regional academic medical centers and can provide the most complex level of neonatal care including advance diagnoses [and] treatment of fetuses, preemies and newborns with complicated conditions.”


Another source that mentioned Level IV NICUs was a New York Magazine article “Best Hospitals 2006”:

“Cornell is one of just eight institutions in New York City with a Level 4 (the highest rating) neonatal intensive-care unit (NICU) and one of just two hospitals in the city with an extracorporeal membrane oxygenator (ECMO), essentially an infant heart-lung machine, said to be the state-of-the-art technology in emergency neonatal care.”


In 2007 there was a Neonatology forum that discussed this very question:

“[User 1]:  “What is the criteria to make a NICU a level III and level IV and how long has the level IV been around?”

[User 2]:  “That is a good question. The line between Level III and Level IV can be a little “gray”. I’m really not sure if the term Level IV is used in all parts of the country. Basically, my understanding is if you are going to be identified as a Level IV NICU then you have no limitations. You would have the ability to do any kind of surgery (cardio, neuro, transplants, etc…), ECMO capability etc…

Usually Level IV capabilities are found at large Children’s Hospitals…  [Apparently] the AAP does not recognize a Level IV category, but it does break down Level III units based on what they can do. I think we could all agree that there is quite a variance on what a Level III NICU can handle.”

[User 3]:  “There is some debate as to whether facilities that call themselves level IV or V’s are creating their own label.””


For anyone who is exceptionally curious about a Level IV NICU, you are free to do more research on your own.  I’m sure there is more information out there about it :).

Did anyone have their preemie at what you were told was a Level IV NICU?  What was it like to be there?

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. My daughter was born in NY presbyterian hospital at 168 street . She was a 25 weeker and thx god she has been doing great, she is 13. I had her early due to preeclampsia. However RSH which is a level 3 nicu they did not help my baby she passed away 12 week ago.

  2. My twin daughters were born in Crouse hospital in Syracuse, NY at a level IV NICU. I was told, although they were born at 28 weeks, they wouldn’t need the care associated with level IV such as special surgeries. Two people did approach me about conducting a study on my girls and I gave consent on one. I guess level IV’s can have the ability to perform studies on preemies.

  3. Marissa Wilson says:

    My daughter, Kylie Mae, was born in Missoula, MT. She had a very tough delivery, that caused a hemorrhage around her head. After a day she was doing better, then the news started getting even worse. She was rejecting the drugs, and she was starting to have way high cortisol levels, and very high blood glucose. The doctor had no idea what was wrong with her. She was in level 4 care for 5 out of her 6 days on earth. At least that was what the hospital bill described it as.

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