Perinatal Designation Levels

NYS Hospitals and Perinatal Designation Level

Research strongly supports regionalization as a means of improving maternal and infant outcomes. Perinatal regionalization represents the continuum of care that ensures that all pregnant women, fetuses and newborns have timely access to care. New York State's system of regionalized perinatal services includes a hierarchy of three levels of perinatal care provided by the hospitals within a region and led by a Regional Perinatal Center (RPC). All hospital-based perinatal care services shall participate in the statewide perinatal regionalization system.

The levels of perinatal care within the regionalization system vary by the types of patients that are treated, availability of sub-specialty consultation, qualifications of staff, types of equipment available and volume of high-risk perinatal patients treated:

  • Level I Perinatal Care 
    Level I perinatal care is provided by hospitals caring for normal low-risk pregnant women and newborns, and provide care for convalescing babies who have been transferred from Level II, III, and RPC perinatal care hospitals. They do not operate neonatal intensive care units (NICU), nor do they contain mechanical ventilators. Must transfer infants who:  
    • Gestation < 36 weeks 
    • Birth weight < 2500 grams
    • Major problems requiring "advanced laboratory, radiologic, or consultation services"
    • Require ventilation above immediate resuscitation 
  • Level II Perinatal Care 
    Level II perinatal care is provided by hospitals caring for moderately high risk women and newborns, as well as women requiring care normally provided at level I perinatal care services. They can receive back transports, meaning transports of patients no longer needing level III or RPC care. They would typically transfer <1% of all births requiring more complex care. Must consult RPC if:  
    • Assisted ventilation by the fourth day 
    •  FiO2 > or =  50% by the fourth day
    •  Must transfer infants: 
      •  By the seventh day of assisted ventilation or FiO2 > 50%,
      • Gestation < 30 weeks 
      • Birth weight < 1250 grams
  • Level III Perinatal Care 
    Level III perinatal care is provided by hospitals caring for high-risk mothers and newborns, as well as women requiring care normally provided at level I and level II perinatal care services. These hospitals operate NICU's and can receive transports from other hospitals. Level III hospitals and RPCs shall return a newborn to the sending hospital when the condition has been stabilized and return is medically appropriate.
    Must transfer infants who: 
    • Require specialized services such as high frequency ventilator or ECMO.

The Regional Perinatal Center

The Regional Perinatal Center is a hospital that provides perinatal care center which meets the standards of a Level III perinatal care services but also includes highly specialized service that may not be available at all Level III hospitals. These services include sophisticated ventilation techniques (e.g. high-frequency ventilation and extracorporeal membrane oxygenation ECMO), cardiac surgery, in utero procedures, or neurosurgery.

A RPC serves a geographic area or a group of perinatal affiliates. They are capable of providing all the services and expertise required by the most acutely sick or at-risk pregnant women and newborns. The concentration of high-risk patients makes it possible to enhance and maintain the level of expertise in the care of high-risk obstetric and neonatal patients, as well as justify the substantial expense required to establish and maintain neonatal intensive care units and attending-level subspecialty consultation.

Additional responsibilities include: 

  • Transport of high risk patients.
  • Attend consultations regarding patient transfer and clinical management.
  • Coordination/improvement of quality of perinatal care among affiliates.
    • RPC representatives participate in the affiliate hospital's quality assurance committee and other reviews of the quality of care provided by the affiliate and in the provision of recommendations for quality improvement or perinatal services. 
  • Responsible for support, education, and improvements in the quality of care in the affiliate hospitals within their region. 
  • Education and training shall be designed to update and enhance staff knowledge and familiarity with relevant procedures and technological advances.
    • Data collection, evaluation, and analysis within it's region; database management for its network of hospitals. 
    • Formulate an infrastructure using the "Regional Perinatal Forum" to enhance integration of perinatal health care services.