For expectant parents, the possibility that their newborn might require intensive medical care can feel overwhelming. Whether due to premature birth, unexpected complications or congenital conditions, some babies need extra support after delivery. This is where Level 4 Neonatal Intensive Care Units (NICU), also known as Level IV NICUs, provide the highest level of critical care.
Designated by the American Academy of Pediatrics, Level 4 NICUs offer the most advanced neonatal care available.
“A Level 4 NICU provides highly complex care by offering multiple specialty services, advanced imaging and full surgical capability,” said Dr. Sanjie Garza-Cox, neonatal transport medical director at Methodist Children’s Hospital.
These units are specially equipped to care for the most critically ill and medically complex newborns, including those needing surgery, advanced imaging or specialized heart-lung support.
What sets Level 4 NICUs apart?
Unlike lower-level NICUs, Level 4 units provide:
- On-site pediatric surgical specialists.
- Advanced imaging tools such as MRI, CT scans and echocardiograms.
- Extracorporeal membrane oxygenation (ECMO), a heart-lung bypass system for critically ill infants.
- Long-term intravenous nutrition and respiratory support.
- Neonatal transport services with specialized flight-trained staff.
These resources make Level 4 NICUs, like the one at Methodist Children’s Hospital, among the best-equipped facilities to care for newborns facing serious health challenges.
Why might a baby need NICU care?
While many babies are born healthy, some need intensive medical support immediately after birth. Some risk factors are identified during pregnancy; others become apparent during or shortly after delivery.
Common reasons for NICU admission include:
- Prematurity: Babies born before 37 weeks often require help with breathing, feeding and temperature regulation.
- Breathing difficulties: Premature lungs may be underdeveloped, requiring respiratory support.
- Low blood sugar (hypoglycemia): Newborns can struggle to maintain healthy blood sugar levels.
- Jaundice: High bilirubin levels may require phototherapy or additional treatment.
- Infection: Infections such as chorioamnionitis (affecting the placenta or amniotic fluid) can pose serious risks.
- Birth complications: Issues during delivery may lead to low oxygen levels, requiring emergency care.
- Congenital conditions: Heart defects or organ abnormalities may require early surgery or specialized treatment.
Premature babies aren’t the only ones who might need NICU care; while uncommon, even full-term babies might require NICU care from time to time.
According to Garza-Cox, “About 3–5% of full-term or near-term infants require NICU care unexpectedly.”
She added that these cases often involve respiratory distress, low glucose levels, severe jaundice or unanticipated birth defects.
“Some of these problems may not be seen immediately at delivery but will become clear when the baby is a few hours old,” Garza-Cox said. “The baby’s doctor will then make a decision on whether baby will be transferred to their hospital’s NICU or another hospital, based on their evaluation.”
Identifying risks before birth
In many cases, the need for NICU care can be anticipated during pregnancy. Advanced prenatal ultrasounds, maternal health conditions, or genetic testing may reveal concerns.
Mothers experiencing high-risk issues -- such as severe fetal growth restriction, high blood pressures, infections, diabetes, substance exposure, signs of fetal stress or poor placental flow -- are often referred to a hospital with a Level 4 NICU before delivery.
“Coordination of care and counseling begins with early identification of risks during pregnancy,” Garza-Cox said. “Once the infant is born, the neonatologist and a pediatrician specialized in critical care will provide a full evaluation of the baby and coordinate care by the specialists and the hospital services as appropriate for that baby and family. A multidisciplinary team is assembled for each infant, with family participation at the center of the care plan.”
[Related: Why are prenatal and postnatal care so important? An OB-GYN explains.]
What to expect during a Level 4 NICU stay
At Methodist Children’s Hospital, the NICU team prioritizes both medical care and the emotional well-being of families. Parents are encouraged to participate in their baby’s care to promote bonding and support the baby’s development.
Methodist’s Level 4 NICU features and services include:
- Advanced in-house care, such as surgical repair for serious congenital heart conditions.
- Incubators to help regulate body temperature.
- Respiratory support tailored to the baby’s condition.
- Advanced imaging (including MRI, CT scans and echocardiograms).
- Lactation consultants to support breastfeeding, milk expression and feeding assistance to ensure proper nutrition.
- Hands-on parent involvement in diapering, feeding and bathing.
- Skin-to-skin contact (kangaroo care) to enhance connection and healing.
Education is a core part of the NICU experience. Parents receive training on caring for their infant’s specific needs, including any equipment or medications required at home. CPR training and safety education are also provided before discharge.
Planning for life after the NICU
Discharge planning begins well before a baby leaves the NICU. Methodist Children’s Hospital uses a multidisciplinary approach to ensure a smooth transition from hospital to home.
Some babies -- particularly those born very early or with complex medical needs -- might face long-term developmental challenges. These can include motor delays, cerebral palsy, learning or speech difficulties, sensory processing challenges, and vision or hearing issues.
“The developmental team is equipped to monitor and anticipate these challenges and to support the pediatrician in coordinating therapies, equipment, nursing, support services and specialty follow-up,” Garza-Cox explained.
Empowering parents every step of the way
Parents are never alone in the Methodist Children’s Hospital NICU. From day one, the care team encourages open communication and shared decision-making.
Before discharge, many parents participate in “rooming-in” -- a chance to care for their baby independently in a private NICU room with staff support nearby. This experience builds confidence and ensures caregivers are fully prepared to transition home.
“The goal of education and training is for caregivers to feel confident, competent, and ready to leave the safety net of the NICU,” Garza-Cox said.
Methodist Children’s Hospital: Leading NICU care with heart
With one of the few Level 4 NICUs in the region, Methodist Children’s Hospital provides life-saving care to newborns who need it most. The hospital’s advanced technology, surgical expertise, and compassionate, family-centered approach ensure even the tiniest patients receive the best possible start in life.
In addition to Methodist Children’s Hospital, Methodist Healthcare offers NICU services across several accredited hospital locations, including:
- Methodist Hospital | Metropolitan – Level III Accredited NICU
- Methodist Hospital | Stone Oak – Level III Accredited NICU
- Methodist Hospital | Westover Hills – Level I Accredited NICU
These locations provide varying levels of neonatal care to meet the needs of families throughout the region.
To learn more about Methodist Healthcare’s Women’s Services and NICU locations, visit SAHealth.com/womens.