August 7, 2014

Levels of Care

As one of three states with no designated NICU criteria, the Perinatal Advisory Committee was formed by Dr. Paul Halverson of the Arkansas Department of Health to study and recommend whether Arkansas should adopt a classification system.  The committee, chaired by Dr. Jon Bates of Arkansas Children’s Hospital, consisted of a cross section of healthcare providers including the Arkansas Department of Health, members of academic and community OB and neonatal providers, and support from Arkansas Medicaid, the Arkansas Medical Society, the Arkansas Foundation for Medical Care, March of Dimes, Arkansas Hospital Association, and parents.

Although the primary focus was to be NICU classification, it rapidly became apparent to the committee that expansion to include perinatal classification was necessary to help lower the state’s high Infant Mortality Rate (IMR) and better coordinate regionalization of resources.  By getting the right pregnant mother to the right hospital for delivery, it has been calculated [ADH unpublished data]  that Arkansas can reduce its current IMR, of almost one baby dying every day in Arkansas before reaching their first birthday, by 20 babies each year.

Over two years, regulations were unanimously approved by the committee and presented to the Board of Health.  The committee’s overall recommendation was to adopt the AAP’s 2012 recommendations [1] with slight modifications due to Arkansas being a rural state. The most important point of these recommendations is to have evidence-based requirements for designating facilities for specific levels based on the resources of their physical facilities and professional staff.

The Arkansas Department of Health has approved the document and will be responsible for the level designations and inspection of all Arkansas hospital nurseries and NICUs. The next step to implementing these designations is to get approval from the state legislature. The committee is now charged with responsibility of quality assessment and improvement on a statewide basis.



1.    Levels of Neonatal Care; COMMITTEE ON FETUS AND NEWBORN; Pediatrics 2012;130;587; originally published online August 27, 2012