Ala. Admin. Code r. 410-2-3-.02

Current through Register Vol. 43, No. 1, October 31, 2024

Section 410-2-3-.02 - Neonatal Services

(1) Discussion

(a) A leading indicator of the health status of a state's citizens is the infant mortality rate. Alabama has one of the highest rates in the country. In order to have an impact on infant mortality, the State must make neonatal care accessible and enhance that care which is available.

(b) In an effort to see that babies are delivered at the most appropriate hospital depending on the level of care needed, the Alabama Department of Public Health (ADPH) convened a multidisciplinary stakeholder group to review the most recent perinatal guidelines published by the American Academy of Pediatrics (AAP) and provided recommendations. The group developed the Alabama Perinatal Regionalization System Guidelines to help clarify the expectations of hospitals and their staff for each level of care, and these Guidelines were approved by both the State Perinatal Advisory Committee and the State Committee of Public Health. Each year, hospitals will use the Alabama Perinatal Regionalization System Guidelines, along with the accompanying verbiage from the AAP-Levels of Neonatal Care, to self-declare the level of neonatal services provided (by completion of the State Health Planning and Development Agency (SHPDA) Hospital Annual Report. (http:www.alabamapublichealth.gov/perinatal/assets/perinatal_regionalization_system_guidelines.pdf).

(c) Neonatal service providers are designated as Well Newborn Nursery (Level I); Special Care Nursery (Level II); NICU (Level III); or Regional NICU (Level IV) depending on their capabilities and expertise.

1. A Well Newborn Nursery (Level I) should have the following capabilities and provider types:

(i) Capabilities. Evaluate and provide postnatal care to stable term newborn infants; stabilize and provide care for infants born 35 - 37 weeks gestation that remain physiologically stable; stabilize newborn infants who are ill and those born at less than 35 weeks gestation until transfer to a higher level of care; and have staff trained in neonatal resuscitation in house for deliveries.

(ii) Provider Types. Pediatricians, family physicians, nurse practitioners, and other advanced practice registered nurses (with relevant experience, training, and demonstrated competence in perinatal care).

(iii) Responsibilities. Surveillance and care of all patients admitted to the obstetric service, with an established triage system for identifying high-risk patients who should be transferred to a facility that provides specialty or subspecialty care; proper detection and initial care of unanticipated maternal-fetal problems that occur during labor and delivery; capability to perform cesarean delivery within 30 minutes of the decision to do so; availability of appropriate anesthesia, radiology, ultrasound, laboratory and blood bank services on a 24-hour basis; care of postpartum conditions; resuscitation and stabilization of all neonates born in the hospital; evaluation and continuing care of healthy neonates in a nursery or with their mothers until discharge; adequate nursery facilities and support for stabilization of small or ill neonates before transfer to a specialty or subspecialty facility; consultation and transfer arrangements; parentsibling-neonate visitation; and data collection and retrieval.

2. Special Care Nursery (Level II) providers should have:

(i) Capabilities. Level I capabilities plus: provide care for infants born greater than or equal to 32 weeks gestation and weighing greater than or equal to 1,500 grams who have physiologic immaturity or who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis; provide care for infants convalescing after intensive care; provide mechanical ventilation for brief duration (less than 24 hours) or continuous positive airway pressure or both; and stabilize infants born before 32 weeks gestation and weighing less than 1,500 grams until transfer to a neonatal intensive care facility.

(ii) Provider Types. Level I health care providers plus: pediatric hospitalists, neonatologists, and neonatal nurse practitioners.

(iii) Responsibilities. Provision of some enhanced services as well as basic care services as described in 1(c); care of appropriate high-risk women and fetuses, both admitted and transferred from other facilities; stabilization of severely ill newborns before transfer; treatment of moderately ill larger preterm and term newborns; and data collection and retrieval.

3. Subspecialty (Level III) providers should have:

(i) Capabilities. Level II capabilities plus: provide sustained life support; provide comprehensive care for infants born less than 32 weeks gestation and weighing less than 1,500 grams and infants born at all gestational ages and birth weights with critical illness; provide prompt and readily available access to a full range of pediatric medical subspecialists, pediatric surgical specialists, pediatric anesthesiologists, and pediatric ophthalmologists at the site or by prearranged consultative agreement; provide a full range of respiratory support that may include conventional and/or high-frequency ventilation and inhaled nitric oxide; and perform advanced imaging, with interpretation on an urgent basis, including computed tomography, MRI, and echocardiography.

(ii) Provider Types. Pediatric medical subspecialists, pediatric anesthesiologists, pediatric surgeons, and pediatric ophthalmologists at the site or a closely related institution by prearranged agreement.

(iii) Responsibilities. Provision of comprehensive perinatal care services for both admitted and transferred women and neonates of all risk categories, including basic and specialty care services as described previously; evaluation of new technologies and therapies; and data collection and retrieval. Neonatal services must continue to receive regional planning.

4. Regional NICU (Level IV) providers should have:

(i) Capabilities. Level III capabilities plus: located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions (e.g. congenital cardiac malformations that require cardiopulmonary bypass with or without extracorporeal membrane oxygenation; maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists, and pediatric anesthesiologist consultants continuously available 24 hours a day; facilitate transport, and provide outreach education.

(ii) Provider Types. Level III health care providers plus pediatric surgical subspecialists.

(iii) Responsibilities. Provision of comprehensive perinatal health care services at and above those of NICU (Level III) facilities; responsibility for regional perinatal health care service organization and coordination including: maternal and neonatal transport; outreach support and regional educational programs, research support and initial evaluation of new technologies and therapies; and analysis and evaluation of regional data, including those on perinatal complications and outcomes.

(2) Planning Policies

(a) In order to ensure that appropriate prenatal and neonatal services are available in Alabama:

1. Each of the five (5) ADPH designated regional perinatal centers will have a high-risk nursery.

2. The State Perinatal Advisory Committee will continue to advise the State Health Officer in the planning, organization, and evaluation of the Perinatal Program, which will address the coordination of services to improve pre-conceptional, inter-conceptional and prenatal health for women at high risk for poor outcomes of pregnancy.

3. The Alabama Perinatal Program will facilitate state, regional and local/community collaboration, interest and action regarding health care needs and services to reduce maternal, and childhood morbidity and mortality.

4. The Alabama Perinatal Program will assess the quality and effectiveness of the health care systems for women and infants through the collection, analysis and reporting of data.

5. The State should continue to strengthen the Alabama Perinatal Program to implement programs that address recommendations issued by the State Perinatal Advisory Council (SPAC) in 2002:

(i) Public Awareness Campaigns

(ii) Smoking Cessation Interventions

(iii) Statewide Fetal Infant Mortality Review Teams

(iv) Evidence-Based Medicine/Best Practices

(v) Regionalization of Perinatal Care

(vi) Care Coordination Services

(vii) Transportation for Women and Infants

(viii) Comprehensive Care for Women of Childbearing Age

(ix) UAB MCH Program Endowed Chair

6. The State should implement the strategies introduced by the Alabama Perinatal Program in the Alabama Perinatal Health Act Annual Progress Report for FY2018 Plan for FY 2019:

(i) Expand evidence-based home visitation services.

(ii) Increase utilization of the Screening, Brief Intervention and Referral to Treatment (SIBRT) tool to identify and refer women at risk for alcohol, substance abuse, domestic violence, and post-partum depression for treatment and services.

(iii) Promote safe sleep awareness through education and collaboration.

(iv) Expand the Well-Woman Program so that women of child-bearing age receive pre-conception and interconception health as a means to address chronic health conditions before and between pregnancies.

7. Provide education to women and families on the benefits of breastfeeding for both mom and baby.

8. Promote and improve the system of perinatal regionalization which is designed to ensure women have access to hospitals equipped to provide the most appropriate level of care for their pregnancy needs.

9. Educate healthcare providers and women who have experienced a spontaneous preterm birth about benefits, processes, and access to 17P (Hydroxyprogesterone Caproate), a hormone treatment prescribed to reduce the risk of a subsequent spontaneous preterm birth.

10. The State should continue to implement all sections of the federal Omnibus Budget Reconciliation Act that affect prenatal and neonatal services.

11. The State should improve the accessibility of services for maternity and pediatric patients through expansion and improvement of services to women and children.

The State should work to improve the percentage of overall participation in newborn screenings.

Ala. Admin. Code r. 410-2-3-.02

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 03, December 31, 2014, eff. 1/6/2015.

Amended by Alabama Administrative Monthly Volume XXXVIII, Issue No. 06, March 31, 2020, eff. 5/15/2020.

Adopted by Alabama Administrative Monthly Volume XLII, Issue No. 07, April 30, 2024, eff. 6/14/2024.

Author: Statewide Health Coordinating Council (SHCC)

Statutory Authority:Code of Ala. 1975, § 22-21-260(4).