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Lisa Black

The American Academy of Pediatrics has developed the first national standards for neonatal care, recognizing the importance of consistency in offering risk-appropriate care of newborns in medical facilities. The AAP policy statement, “Standards for Levels of Neonatal Care: II, III, & IV,” published in the June 2023 Pediatrics (published online May 22), observes that while all states regulate health care facilities, specifications for levels of neonatal care and adherence to requirements vary widely. Leaders in perinatal health first proposed establishing levels of risk-appropriate care in 1976, so that infants with mild to complex critical illness or physiologic immaturity received care with the personnel and resources appropriate for their needs and condition. The AAP established a Neonatal Intensive Care Unit (NICU) Verification Program in 2013 to provide third-party surveys that are led by experienced and credentialed neonatologists, neonatal nurses, and pediatric surgeons to assess compliance with state regulations. The new national standards are considered a complementary implementation tool and are based on existing AAP policy; evidence-based literature; standards of professional practice from national neonatal, perinatal, and surgical organizations; published data; and, when no data existed, expert opinion. While the standards are identified as minimum requirements for each level of neonatal care, the AAP encourages facilities to go beyond the minimum. The AAP notes its commitment to equity and encourages facilities to assess the health disparities of their patients, families, and community as a step toward improving health outcomes.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit or follow us on Twitter @AmerAcadPeds.

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