General Requirements

General Requirements The Level III neonatal designated facility shall maintain all Level I and II capabilities as well as the following: 1. Level III NICUs are defined by having continuously available personnel (neonatologists, neonatal nurses, and respiratory therapists) and equipment to provide life support for as long as necessary. 2. Provide comprehensive care for infants born less than 32 weeks gestation and weighing less than1500 grams and infants born at all gestational ages and birth weights with critical illness. 3. Provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists or anesthesiologists with experience in neonatal surgical care and pediatric ophthalmologists, on site or by prearranged consultative agreements. 4. Provide a full range of respiratory support and physiologic monitoring that may include conventional and/or high-frequency ventilation, inhaled nitric oxide delivery, and/or therapeutic hypothermia or have policies and procedures in place to facilitate neonatal transfer to a higher level of care. 5. Perform advanced imaging with interpretation on an urgent basis, including computed tomography, MRI and echocardiography. 6. Social and family support including social services and pastoral care. 7. If geographic constraints for land transportation exist, the Level III facility should ensure availability of rotor and fixed-wing transport services to transfer infants requiring subspecialty intervention from other regions and facilities. 8. Consultation and transfer agreements with both lower-level referring hospitals and regional centers, including back-transport agreements. 9. Prompt diagnosis and appropriate referral of all conditions requiring surgical intervention. Major surgery should be performed by pediatric surgical specialists (including anesthesiologists with pediatric expertise) on–site within the hospital or at a closely related institution, ideally in close geographic proximity if possible. Level III facilities should be able to offer complete care, management, and evaluation for high-risk neonates 24 hours a day. A neonatologist should be available either in-house or on- call with the capacity to be in-house in a timely manner, 24 hours a day. 10. Level III facilities should maintain a sufficient volume of infants less than 1500 grams to meet professionally accepted guidelines to achieve adequate experience and expertise. 11. Enrollment in the Vermont Oxford Network to report and monitor data regarding outcomes of infants born less than 32 weeks and weighing less than 1500 grams. 12. Participation in and evaluation of quality improvement initiatives.