Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.02 - Neonatal Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Discussion
(a) A leading indicator of the
			 health status of a state's citizens is the infant mortality rate. Alabama has
			 one of the highest rates in the country. In order to have an impact on infant
			 mortality, the State must make neonatal care accessible and enhance that care
			 which is available.
(b) In an
			 effort to see that babies are delivered at the most appropriate hospital
			 depending on the level of care needed, the Alabama Department of Public Health
			 (ADPH) convened a multidisciplinary stakeholder group to review the most recent
			 perinatal guidelines published by the American Academy of Pediatrics (AAP) and
			 provided recommendations. The group developed the Alabama Perinatal
			 Regionalization System Guidelines to help clarify the expectations of hospitals
			 and their staff for each level of care, and these Guidelines were approved by
			 both the State Perinatal Advisory Committee and the State Committee of Public
			 Health. Each year, hospitals will use the Alabama Perinatal Regionalization
			 System Guidelines, along with the accompanying verbiage from the AAP-Levels of
			 Neonatal Care, to self-declare the level of neonatal services provided (by
			 completion of the State Health Planning and Development Agency (SHPDA) Hospital
			 Annual Report.
			 (http:www.alabamapublichealth.gov/perinatal/assets/perinatal_regionalization_system_guidelines.pdf).
(c) Neonatal service providers are designated
			 as Well Newborn Nursery (Level I); Special Care Nursery (Level II); NICU (Level
			 III); or Regional NICU (Level IV) depending on their capabilities and
			 expertise.
1. A Well Newborn Nursery (Level I)
			 should have the following capabilities and provider types:
(i) Capabilities. Evaluate and provide
			 postnatal care to stable term newborn infants; stabilize and provide care for
			 infants born 35 - 37 weeks gestation that remain physiologically stable;
			 stabilize newborn infants who are ill and those born at less than 35 weeks
			 gestation until transfer to a higher level of care; and have staff trained in
			 neonatal resuscitation in house for deliveries.
(ii) Provider Types. Pediatricians, family
			 physicians, nurse practitioners, and other advanced practice registered nurses
			 (with relevant experience, training, and demonstrated competence in perinatal
			 care).
(iii) Responsibilities.
			 Surveillance and care of all patients admitted to the obstetric service, with
			 an established triage system for identifying high-risk patients who should be
			 transferred to a facility that provides specialty or subspecialty care; proper
			 detection and initial care of unanticipated maternal-fetal problems that occur
			 during labor and delivery; capability to perform cesarean delivery within 30
			 minutes of the decision to do so; availability of appropriate anesthesia,
			 radiology, ultrasound, laboratory and blood bank services on a 24-hour basis;
			 care of postpartum conditions; resuscitation and stabilization of all neonates
			 born in the hospital; evaluation and continuing care of healthy neonates in a
			 nursery or with their mothers until discharge; adequate nursery facilities and
			 support for stabilization of small or ill neonates before transfer to a
			 specialty or subspecialty facility; consultation and transfer arrangements;
			 parentsibling-neonate visitation; and data collection and retrieval.
2. Special Care Nursery (Level II)
			 providers should have:
(i) Capabilities. Level
			 I capabilities plus: provide care for infants born greater than or equal to 32
			 weeks gestation and weighing greater than or equal to 1,500 grams who have
			 physiologic immaturity or who are moderately ill with problems that are
			 expected to resolve rapidly and are not anticipated to need subspecialty
			 services on an urgent basis; provide care for infants convalescing after
			 intensive care; provide mechanical ventilation for brief duration (less than 24
			 hours) or continuous positive airway pressure or both; and stabilize infants
			 born before 32 weeks gestation and weighing less than 1,500 grams until
			 transfer to a neonatal intensive care facility.
(ii) Provider Types. Level I health care
			 providers plus: pediatric hospitalists, neonatologists, and neonatal nurse
			 practitioners.
(iii)
			 Responsibilities. Provision of some enhanced services as well as basic care
			 services as described in 1(c); care of appropriate high-risk women and fetuses,
			 both admitted and transferred from other facilities; stabilization of severely
			 ill newborns before transfer; treatment of moderately ill larger preterm and
			 term newborns; and data collection and retrieval.
3. Subspecialty (Level III) providers should
			 have:
(i) Capabilities. Level II capabilities
			 plus: provide sustained life support; provide comprehensive care for infants
			 born less than 32 weeks gestation and weighing less than 1,500 grams and
			 infants born at all gestational ages and birth weights with critical illness;
			 provide prompt and readily available access to a full range of pediatric
			 medical subspecialists, pediatric surgical specialists, pediatric
			 anesthesiologists, and pediatric ophthalmologists at the site or by prearranged
			 consultative agreement; provide a full range of respiratory support that may
			 include conventional and/or high-frequency ventilation and inhaled nitric
			 oxide; and perform advanced imaging, with interpretation on an urgent basis,
			 including computed tomography, MRI, and echocardiography.
(ii) Provider Types. Pediatric medical
			 subspecialists, pediatric anesthesiologists, pediatric surgeons, and pediatric
			 ophthalmologists at the site or a closely related institution by prearranged
			 agreement.
(iii) Responsibilities.
			 Provision of comprehensive perinatal care services for both admitted and
			 transferred women and neonates of all risk categories, including basic and
			 specialty care services as described previously; evaluation of new technologies
			 and therapies; and data collection and retrieval. Neonatal services must
			 continue to receive regional planning.
4. Regional NICU (Level IV) providers should
			 have:
(i) Capabilities. Level III capabilities
			 plus: located within an institution with the capability to provide surgical
			 repair of complex congenital or acquired conditions (e.g. congenital cardiac
			 malformations that require cardiopulmonary bypass with or without
			 extracorporeal membrane oxygenation; maintain a full range of pediatric medical
			 subspecialists, pediatric surgical subspecialists, and pediatric
			 anesthesiologist consultants continuously available 24 hours a day; facilitate
			 transport, and provide outreach education.
(ii) Provider Types. Level III health care
			 providers plus pediatric surgical subspecialists.
(iii) Responsibilities. Provision of
			 comprehensive perinatal health care services at and above those of NICU (Level
			 III) facilities; responsibility for regional perinatal health care service
			 organization and coordination including: maternal and neonatal transport;
			 outreach support and regional educational programs, research support and
			 initial evaluation of new technologies and therapies; and analysis and
			 evaluation of regional data, including those on perinatal complications and
			 outcomes.