Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 8 - Office of Health Policy and Planning › Subpart 90 - Planning and Resource Development › Chapter 04 - Perinatal Care › Section 15-8-90-04-405 - Guidelines for the Operation of Perinatal Units (Obstetrics and Newborn Nursery) › Section 15-8-90-04-405.03 - Perinatal Levels of Care

Current through June 25, 2024
Level 1- Basic Care, Well Newborn
						Nursery
Neonatal Guidelines
1. Provide neonatal resuscitation at every
					 delivery.
2. Evaluate and provide
					 postnatal care to stable term newborn infants.
3. Stabilize and provide care for infants
					 born at 35-37 weeks gestation who remain physiologically stable.
4. Stabilize newborn infants who are ill and
					 those born at less than 35 weeks gestation until transfer to a facility that
					 can provide the appropriate level of care.
5. Maintain a staff of providers including
					 pediatricians, family physicians, nurse practitioners with newborn training,
					 registered nurses with newborn training including being current with Neonatal
					 Resuscitation Program Certification and S.T.A.B.L.E.
Maternal Guidelines
1. 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 sub-specialty care.
2. Capability to begin an emergency cesarean
					 delivery within 30 minutes of the decision to do so.
3. Mothers that are stable and likely to
					 deliver before 35 weeks gestation or have a fetus that is likely to require
					 specialty services and mothers who themselves are likely to require specialty
					 services should be transferred prior to delivery, when possible.
4. Proper detection and supportive care of
					 known maternal conditions and unanticipated maternal-fetal problems that occur
					 during labor and delivery.
5. Care
					 of postpartum conditions.
6.
					 Maintain a staff of providers certified to perform normal and operative vaginal
					 deliveries and cesarean sections including obstetricians and family physicians
					 with advanced training in obstetrics, providers certified to perform normal
					 vaginal deliveries including certified nurse midwives, and registered nurses
					 with training in labor and delivery, post-partum care or inpatient obstetrics.
Hospital Resources
1. Availability of anesthesia, radiology,
					 ultrasound, blood bank and laboratory services available on a 24-hour
					 basis.
2. Consultation and transfer
					 agreement with specialty and/or subspecialty perinatal centers.
3. Parent-sibling-neonate
					 visitation.
4. Data collection and
					 retrieval.
5. Quality improvement
					 programs, maximizing patient safety.
Level II- Specialty Care, Special Care
						Nursery
Neonatal Guidelines
1. Performance of all basic care services as
					 described above.
2. Provide care
					 for infants born at more than 32 weeks and weighing more than 1500g who have
					 physiological 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.
3.
					 Provide care for infants convalescent care after intensive care.
4. Provide mechanical ventilation for brief
					 duration (less than 24 hours) and/or continuous positive airway
					 pressure.
5. Stabilize infants born
					 before 32 weeks gestation and weighing less than 1500 grams until transfer to a
					 Level III or Level IV neonatal intensive care facility.
6. Maintain a staff of providers including
					 those listed in Basic Care plus pediatric hospitalists, neonatologist, and
					 neonatal nurse practitioners.
7.
					 Referral to a higher level of care for all infants when needed for pediatric
					 surgical or medical subspecialty intervention.
8. Level II nurseries must have equipment
					 (e.g., portable x-ray machine, blood gas analyzer) and personal (e.g.,
					 physicians, specialized nurses, respiratory therapists, radiology technicians
					 and laboratory technicians) to provide ongoing care of admitted infants as well
					 as to address emergencies.
Maternal Guidelines
1. Perform all basic maternal services listed
					 above.
2. Mothers that are stable
					 and likely to deliver before 32 weeks gestation or have a neonate that is
					 likely to require sub-specialty services, or mothers who themselves are likely
					 to require sub-specialty services should be transferred prior to delivery, when
					 possible.
3. Access to maternal
					 fetal medicine consultation and antenatal diagnosis technology including fetal
					 ultrasound.
Level III- Sub-specialty Care/Neonatal Intensive
						Care Unit
Neonatal Guidelines
1. Provision of all Level I and Level II
					 services.
2. 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.
3. Provide
					 comprehensive care for infants born less than 32 weeks gestation and weighing
					 less than 1500 grams and infants born at all gestational ages and birth weights
					 with critical illness.
4. 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.
5. Provide a full range of respiratory
					 support and physiologic monitoring that may include conventional and/or
					 high-frequency ventilation and inhaled nitric oxide.
6. Perform advanced imaging with
					 interpretation on an urgent basis, including computed tomography, MRI and
					 echocardiography.
7. Social and
					 family support including social services and pastoral care.
8. 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.
9. Consultation and transfer agreements with
					 both lower level referring hospitals and regional centers, including
					 back-transport agreements.
10.
					 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.
11. 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.
12. 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.
13. Participation in and evaluation of
					 quality improvement initiatives.
Maternal Guidelines
1. Manage complex maternal and fetal
					 illnesses before, during and after delivery.
2. Maintain access to consultation and
					 referral to Maternal-Fetal Medicine specialists.
Level IV- Regional Care
Neonatal Guidelines
1. All level III capabilities listed
					 above.
2. Located within an
					 institution with the capability to provide surgical repair of complex
					 congenital or acquired conditions.
3. Maintain a full range of pediatric medical
					 subspecialists, pediatric surgical subspecialists and pediatric
					 anesthesiologists at the site.
4.
					 Facilitate transport and provide outreach education including community taught
					 NRP and S.T.A.B.L.E. classes.
Maternal Guidelines
1. All level III capabilities listed
					 above.
2. Maintain a full range of
					 surgical and medical specialists including Maternal-Fetal Medicine specialists
					 at the site.
3. Facilitate maternal
					 transport and provide outreach education.