I have a question: What is the criteria to make a NICU a level III and level IV and how long has the level IV been around?

That is a good question. The line between Level III and Level IV can be a little "gray". I'm really not sure if the term Level IV is used in all parts of the country. Basically, my understanding is if you are going to be identified as a Level IV NICU then you have no limitations. You would have the ability to do any kind of surgery (cardio, neuro, transplants, etc...), ECMO capability etc...

Usually Level IV capabilities are found at large Children's Hospitals.

This article may be helpful:

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;114/5/1341

Based on this article the AAP does not recognize a Level IV category, but it does break down Level III units based on what they can do. I think we could all agree that there is quite a variance on what a Level III NICU can handle.

Hope that helps you!

Thanks for the reference! No reference to level IV tho, or V (Which are turning up).

I agree with humblednurse. There is some debate as to whether facilities that call themselves level IV or V's are creating their own label. I am aware that there are a few sublevels of level III nurseries, Level IIIa units being able to handle everything except complicated surgeries and ECMO, and Level IIIb's being able to offer ECMO and all neonatal surgical procedures. This may vary from state to state, but that's my understanding.