As NICUs proliferated in hospitals throughout the United States, high-risk perinatal services did not always develop in parallel. In addition, specialized technology such as high-frequency ventilation, extracorporeal membrane oxygenation, and surgical correction of potentially lethal congenital anomalies became available in the 1990s at some, but not all institutions further contributing to inconsistencies of capabilities in NICUs. A voluntary reporting survey conducted by the AAP Section of Perinatal Pediatrics in 2000 revealed considerable variability among the 880 units in the United States that self-reported as Level III/subspecialty or Level II/specialty NICUs.
As state governments regulate health care facilities and services, differences among state regulatory requirements could explain the variation in capabilities and practice documented in the Section of Perinatal Pediatric survey. In 2002, we began a review of operational terminology and regulatory status for hospital neonatal care services in the United States and reported the results through 2004 in preliminary form. We report here the results of an analysis of current state documents that contain definitions and criteria language regarding hospital neonatal services.