Table 1

International summary of organisation of neonatal care services, extracted from national guidelines and relevant reviews

Level 1Level 2Level 3
USA51
  • Care for babies born >35 weeks

  • Care for babies born >32 weeks and weight >1500 g

  • Stabilise babies born <32 weeks or <1500 g, and brief periods of mechanical ventilation, before transfer to a NICU

  • Level 3 NICU care for babies of all gestational ages and birth weight

  • Level 4 regional NICU have level 3 capabilities and are located within an institution with surgical and paediatric medical capabilities

Canada52
  • Tier 1a care for babies ≥37 weeks and ≥2500 g

  • Tier 1b care for babies ≥35 weeks and ≥1800 g

  • Tier 2a care for babies ≥32 weeks and ≥1500 g

  • Tier 2b care for babies ≥30 weeks and ≥1200 g

  • Tier 3 care for babies of all gestational ages and birth weight with non-life-threatening conditions

  • Tier 4 provide tier 3 services to babies of all gestational ages and birth weight, including those with life-threatening conditions and requiring paediatric subspecialty input

Australia53–56
  • Previously labelled level one now includes level 1, 2 and 3

  • Level 1 and 2 do not provide routine neonatal care

  • Level 3 care for babies >36/>37 weeks (>2000 g/>2500 g)

  • Previously labelled level 2a and 2b now includes level 4 and 5

  • Level 4 care for babies >32/>34 weeks (>1500/>1700 g)

  • Level 5 care for babies >31/>32 weeks (>1250/>1350 g)

  • Previously labelled level 3 now includes level 6

  • Care for babies of all gestational ages and birth weight, including surgery and congenital and metabolic diseases

  • May be split into 6a and 6b, with only the latter providing surgical and specialty services

New Zealand57
  • Care for babies >36 weeks

  • Care for babies >32 weeks

  • Some units (level 2+) care for babies >28 weeks

  • Care for babies of all gestational ages and birth weight

Finland58
  • Smaller, non-university hospitals provide care to babies >32 weeks and >1500 g

  • University hospitals care for babies of all gestational ages and birth weight

Sweden59
  • Smaller, non-regional centres provide care to babies >28 weeks

  • Regional centres care for babies of all gestational ages and birth weight

France60
  • No neonatal ward

  • Not required to have a paediatrician on-site

  • Care for babies >32 weeks

  • Paediatrician must be present during the day, can be on-call at nights and weekends

  • Care for babies of all gestational ages and birth weight

  • Neonatologist must always be present

  • NICU, neonatal intensive care unit.