Types of neonatal units

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Neonatal Care in the NHS

Whist all neonatal units deliver specialist care to premature and sick infants, babies should be admitted to a neonatal unit that delivers the level of care which corresponds to their care needs.  

Sometimes, the level of care a baby requires may change during their neonatal journey, which can mean that they may move to a unit in a different hospital to access more specialised care or return to a hospital closer to the family home. This is often known as a transfer, being transferred or repatriation. 

More information on this can be found in the ‘If Your Baby Needs a Transfer’ section. 

Neonatal care in the NHS is organised into 3 main types of neonatal units;  

  • Special Care Unit (SCU)  
  • Local Neonatal Unit (LNU) 
  • Neonatal Intensive Care Unit (NICU)  

We recognise that the reality of having to move around can be unsettling and confusing for families.  

If your baby does need to be transferred, below is some useful information that we hope will help you to navigate this period of transition.  Here you will be able to find out more about the different neonatal units, what they are often referred to, and some examples of the care they provide (please note that these examples include some, but not all care that can be offered at different level units). 

Special Care Unit (SCU), sometimes referred to as a Level 1 Unit

The Special Care Unit (also known as a SCU) is for babies who do not need intensive or a high level of medical care, and for babies born after 32 weeks’ gestation. 

Care on a Special Care Unit can include: 

  • Monitoring of their breathing or heart rate 
  • Giving some additional oxygen 
  • Treating low temperatures 
  • Supporting with feeding, sometimes by using a tube 
  • Treating low blood sugar 
  • Phototherapy (neonatal jaundice), that cannot be cared for on the postnatal or transitional care units 
  • Initial support for unwell babies before they are transferred to a neonatal intensive care unit (please see ‘If your baby needs a transfer’ for more information) 

Local Neonatal Unit (LNU), sometimes referred to as a Level 2 Unit

The Local Neonatal Unit (also known as an LNU) is for babies who need a higher level of medical care and for babies born after 27 weeks’ gestation and weigh over 1000 grams.  

Some babies who are currently in a NICU and are now above 800 grams and above 27 weeks’ gestation, who are well, can be cared for in a local neonatal unit. This means you may be transferred here when your baby is ready. 

You may be transferred to another maternity ward in a different hospital that has a Local Neonatal unit. This will be discussed with you by your obstetric team and local neonatal team, as it may be safer for your baby would benefit from this level of care, and it is safer to transfer your baby before they are born. This is known as an In-Utero Transfer. 

Care on a Local Neonatal Unit includes what a SCU can provide, but also: 

  • Short term intensive care (usually up to 48 hours) 
  • Support during periods when breathing pauses briefly, also known as apnoea’s (pronounced ap-knee-ya) 
  • Short-term non-invasive ventilation such as continuous positive airway pressure (CPAP) or high flow nasal cannula oxygen, for breathing support 
  • Supporting with feeding, sometimes by using a tube  
  • Receiving nutrition by a drip via a vein (also known as parenteral nutrition) 
  • Initial support for unwell babies before they are transferred to a neonatal intensive care unit (please see ‘If your baby needs a transfer’ for more information) 

Neonatal Intensive Care Unit (NICU), sometimes referred to as a Level 3 Unit

The Neonatal Intensive Care Unit (also known as a NICU) is for babies needing the highest level of medical care, or for babies that do not fit the criteria for an LNU or SCU. Babies admitted to this unit are usually born before 27 weeks’ gestation and/or are very sick.  

If your local maternity hospital does not have a Neonatal Intensive Care unit attached, and your obstetric and neonatal team think that you will have your baby either before 27 weeks, is expected to have a low birth weight or has a known medical/surgical need prior to being born, you may be transferred to another maternity hospital that does have a Neonatal Intensive Care unit. This means your baby can be provided the level of care they need when they have been born. This decision is often made before your baby is born as it is safer to do the transfer when they’re still in your tummy. This is known as an In-Utero Transfer (IUT). 

Care on a Neonatal Intensive Care Unit includes what a SCU and an LNU can provide, but also: 

  • All forms of breathing support (invasive ventilation and non-invasive ventilator) 
  • Support for all vital systems such as breathing, cardiac, blood pressure 
  • Babies born at very low birth weights  
  • Babies that are born very early (from 22-23 weeks’ gestation) 
  • Long-term feeding support 
  • Babies who require cooling therapy to reduce brain injury 
  • Some Neonatal Intensive Care Units specialise in Surgery, Cardiology, Gastroenterology, metabolic conditions and other condition specific care.

You may find you stay at the same Neonatal Intensive care unit through-out your journey if it is your local hospital as they also provide non intensive care such as that found in an LNU and SCU.  

Your local hospital for neonatal care will be determined by either your home or GP postcodes. 

Transitional Care, sometimes referred to as TC

In addition to the 3 levels of medical care within neonatal units, you may also come across Transitional Care (TC). TC means your baby is almost ready to go home, but still requires some monitoring/support, such as: 

  • General observations 
  • Blood sugar monitoring 
  • Phototherapy treatment for mild jaundice 
  • Antibiotics 
  • Feeding support (sometimes requiring nasogastric tube feeding)

In TC, your baby is well enough to stay with you, either in the postnatal ward or a room on the neonatal unit, with support from hospital staff. Some babies born between 34 and 37 weeks’ gestation may be cared for in TC, depending on their weight and if they do not require any form of respiratory support.   

If you are re-admitted into hospital after going home, this is where you and your baby might be cared for. Not all hospitals have a designated TC, so please speak to your care team if they have not spoken to you about it. 

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