Key messages

  • Neonatal services provide care for sick and preterm babies in the first few weeks and months of life.
  • Neonatal intensive care units treat critically ill babies during the perinatal period and sometimes beyond.
  • Special care nurseries treat moderately unwell or preterm babies.
  • There are six levels of neonatal care in Victoria.

Most babies do not need medical care after birth. However, some require additional care that cannot be provided at their mother’s bedside or within the local health service.

Treatment for sick babies

Sick babies may need to be transferred to a higher level of care.

Neonatal services provide care for sick and preterm babies in the first few weeks and months of life. These babies may be premature, of low birth weight, or have congenital or other conditions that impact upon their health or survival.

If during the pregnancy it is clear a baby needs specialised care, health professionals will make arrangements for the birth to occur in a hospital that can provide the appropriate level of care.

Statewide tertiary neonatal services

There are four hospitals that provide statewide tertiary neonatal services in Melbourne for the most complex neonatal care needs:

  • Mercy Hospital for Women, Heidelberg
  • Monash Medical Centre, Clayton
  • Royal Children’s Hospital, Parkville
  • Royal Women’s Hospital, Parkville.

Neonatal intensive care units

Neonatal intensive care units (NICUs) deliver services to babies who need specialised treatment for critical illnesses during the perinatal period (and sometimes beyond).

Neonatal intensive care units provide dedicated medical and nursing care, and advanced life-support equipment.

Special care nurseries

Special care nurseries (SCNs) look after babies who are born moderately preterm and/or with low birth weight, or who require care for problems arising in the neonatal period. Special care nurseries provide step-down care across metropolitan and regional Victoria for babies who no longer need the highest level of care provided by a neonatal intensive care unit.

A number of private hospitals have special care nurseries (predominantly in metropolitan Melbourne) but their operation and admission criteria can differ from public nurseries.

Levels of neonatal care

The maternity system provides neonatal care so that babies who need more complex care are cared for in nurseries that are equipped and staffed to safely manage them.

Victoria has six levels of neonatal care, with level six being for the most critically ill babies.

Defining levels of care for Victorian newborn services (2015) identifies the workforce, infrastructure and clinical support services recommended for each level of service.

Primary newborn services

Level 1

Provides care for well, uncomplicated, term newborns (postnatal care only)
- care of newborn ≥ 37 + 0 weeks gestation
- usually correlating to newborn birthweight ≥ 2,500 grams.

Level 2

Provides care for mildly unwell, uncomplicated newborns at birth or during immediate postnatal period
- care of newborn ≥ 37 + 0 weeks gestation
- usually correlating to newborn birthweight ≥ 2,500 grams
May accept care of newborns marginally below the gestational age/birthweight listed above, when clinically appropriate or following specialist consultation with emergency retrieval or tertiary service.

Secondary newborn services

Level 3

Provides care for mild-moderately unwell, uncomplicated newborns
- care of newborn ≥ 34 + 0 weeks gestation
- usually correlating to newborn birthweight ≥ 2,000 grams
Includes growing preterm and convalescing newborns and infants
May accept care of newborns marginally under the gestational age/birthweight listed above, when clinically appropriate or following specialist consultation with emergency retrieval or tertiary service.

Level 4

Provides care for moderately unwell, uncomplicated newborns
- care of newborn ≥ 32 + 0 weeks gestation
- usually correlating to newborn birthweight ≥ 1,500 grams
Includes growing preterm and convalescing newborns and infants
May accept care of newborns marginally under the gestational age/birthweight listed above, when clinically appropriate or following specialist consultation with emergency retrieval or tertiary service.

Level 5

Provides care for moderately unwell or preterm newborns, including some moderately complex newborns
- care of newborn ≥ 31 + 0 weeks gestation
- usually correlating to newborn birthweight ≥ 1,250 grams
Includes growing preterm and convalescing newborns and infants
May accept care of newborns marginally under the gestational age/birthweight listed above, when clinically appropriate or following specialist consultation with emergency retrieval or tertiary service.

Tertiary newborn services

Level 6A

Provides continuous life support and comprehensive multidisciplinary care for extremely premature newborns and those with non-surgical critical illness.

Level 6B

Provides continuous life support and comprehensive multidisciplinary care for extremely high-risk newborns and those with complex and critical conditions, and provides statewide specialist services.

The highest level of care that a neonatal service provides defines its service level or classification.

This means it will care for babies who need less complex care, as well as babies who need the higher level of care.

In a similar way to neonatal services, maternity services have six levels, although the levels do not directly correlate. They are outlined in the Capability framework for Victorian maternity and newborn services (2010).

The different service levels can:

  • delineate areas of responsibility
  • define referral and transport practices
  • establish professional and technical infrastructure within hospitals.

Sometimes the needs of individual patients and other factors such as resources will dictate variations to services.

Variations in service provision outside the levels of care guidance must be documented and accompanied by an appropriate risk management strategy.

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