Obstetric and neonatal

Neonatology

Level 1
A neonatal service is not applicable, but for postnatal care of newborn infants, the standards within Level 2 (on-site Level 1 neonatal facilities) should be applied

Level 2
Level 1 neonatal facilities Normal low risk pregnancies and births and management of newborns > 37 weeks gestation with minimal complications 24/7 on-site access to a health professional skilled in (accredited) initiating neonatal resuscitation Phototherapy for physiological jaundice Telephone access to emergency care and transport Access to some allied health services

Level 2

Level 1 neonatal facilities

Normal low risk pregnancies and births and management of newborns > 37 weeks gestation with minimal complications
24/7 on-site access to a health professional skilled in (accredited) initiating neonatal resuscitation
Phototherapy for physiological jaundice
Telephone access to emergency care and transport
Access to some allied health services

Level 3
As for Level 2.

Level 4;
Level 2A neonatal facilities As for Level 2 plus: On-site Level 2A neonatal facilities with low dependency patients and apnoea monitoring, low- level oxygen therapy (including monitoring) and nasal/oral-gastric feeding Paediatricians on- call 24/7 Low to moderate risk pregnancies and births and management of newborns > 34 weeks gestation with minimal complications Short term intravenous therapy available All patients are referred for management by attending paediatrician Access to designated allied health services Some allied health undergraduate education

Level 4;

Level 2A neonatal facilities

As for Level 2 plus:

On-site Level 2A neonatal facilities with low dependency patients and apnoea monitoring, low- level oxygen therapy (including monitoring) and nasal/oral-gastric feeding
Paediatricians on- call 24/7
Low to moderate risk pregnancies and births and management of newborns > 34 weeks gestation with minimal complications
Short term intravenous therapy available
All patients are referred for management by attending paediatrician
Access to designated allied health services
Some allied health undergraduate education

Level 5
Level 2B neonatal facilities As for Level 4 plus: On-site Level 2B neonatal facilities with high dependency patients and provision of short- term mechanical ventilation (< 6 hours) pending transfer, nasal CPAP with facilities for arterial blood gas monitoring Non-invasive BP monitoring Access to clinical and diagnostic paediatric sub- specialties Service led by neonatal paediatricians Paediatricians on- call 24/7 Paediatric registrar or above on-site 24/7 Moderate to high- risk pregnancies and births and management of newborns > 32 weeks gestation with minimal complications Access to specialist SRN Role in post graduate medical and nursing education Careful consideration to receiving transfers from Level 1 Neonatal facilities (Level 2 or Level 3 hospital) Access to specialised allied health services

Level 5

Level 2B neonatal facilities

As for Level 4 plus:

On-site Level 2B neonatal facilities with high dependency patients and provision of short- term mechanical ventilation (< 6 hours) pending transfer, nasal CPAP with facilities for arterial blood gas monitoring
Non-invasive BP monitoring
Access to clinical and diagnostic paediatric sub- specialties
Service led by neonatal paediatricians
Paediatricians on- call 24/7
Paediatric registrar or above on-site 24/7
Moderate to high- risk pregnancies and births and management of newborns > 32 weeks gestation with minimal complications
Access to specialist SRN
Role in post graduate medical and nursing education
Careful consideration to receiving transfers from Level 1 Neonatal facilities (Level 2 or Level 3 hospital)
Access to specialised allied health services

Level 6
Level 3 NICU As for Level 5 plus: On-site Level 3 NICU with high dependency patients and provision of medium-long term mechanical ventilation and full life-support Neonatal paediatricians on- call 24/7 High-risk, high dependency pregnancies and births Management of newborns < 32 weeks gestation Undertakes neonatal surgery and care for complex congenital, metabolic and renal diseases of the newborn Coordinates statewide retrieval service Coordinates post graduate medical and nursing neonatal education Has neonatology research Coordination of NETS interstate transfers for cardiac surgery

Level 6

Level 3 NICU

As for Level 5 plus:

On-site Level 3 NICU with high dependency patients and provision of medium-long term mechanical ventilation and full life-support
Neonatal paediatricians on- call 24/7
High-risk, high dependency pregnancies and births
Management of newborns < 32 weeks gestation
Undertakes neonatal surgery and care for complex congenital, metabolic and renal diseases of the newborn
Coordinates statewide retrieval service
Coordinates post graduate medical and nursing neonatal education
Has neonatology research
Coordination of NETS interstate transfers for cardiac surgery

Obstetrics

Level 1
No planned births If required, inpatient care following birth elsewhere Antenatal, postnatal care is carried out by visiting public, Aboriginal community controlled health organisation or RFDS GPs with or without the assistance of aboriginal health workers or RNs/RMs depending on the type of patient care needed

Level 2
As for Level 1 plus: Normal low-risk pregnancies and births and management of newborns > 37 weeks gestation with minimal complications Service by GPs/GP obstetricians/DMOs and midwives Caesarean section transferred elsewhere but must be within safe timeframe Access to 24/7 telephone support from obstetricians Access to allied health Access to e-health or Telehealth On-site Level 1 neonatal facilities

Level 2

As for Level 1 plus:

Normal low-risk pregnancies and births and management of newborns > 37 weeks gestation with minimal complications
Service by GPs/GP obstetricians/DMOs and midwives
Caesarean section transferred elsewhere but must be within safe timeframe
Access to 24/7 telephone support from obstetricians
Access to allied health
Access to e-health or Telehealth
On-site Level 1 neonatal facilities

Level 3
As for Level 2 plus: Elective and emergency caesarean capability 24/7 anaesthetic service provided Visiting obstetrician Access to some allied health services

Level 3

As for Level 2 plus:

Elective and emergency caesarean capability
24/7 anaesthetic service provided
Visiting obstetrician
Access to some allied health services

Level 4;
As for Level 3 plus: Planned births of low and moderate risk mothers Access to specialist obstetricians, paediatricians and anaesthetists On-call roster for obstetricians and anaesthetists Access to designated allied health services Some allied health undergraduate education On-site Level 2A neonatal facilities Access to ultrasound service

Level 4;

As for Level 3 plus:

Planned births of low and moderate risk mothers
Access to specialist obstetricians, paediatricians and anaesthetists
On-call roster for obstetricians and anaesthetists
Access to designated allied health services
Some allied health undergraduate education
On-site Level 2A neonatal facilities
Access to ultrasound service

Level 5
As for Level 4 plus: Births of low, moderate and high risk mothers Service provided to high risk mothers by specialist obstetricians, neonatal paediatricians and anaesthetists On-site 24/7 medical officer obstetric cover by registrar or above 24/7 cover by specialist obstetricians, paediatricians and anaesthetists Access to HDU/ ICU facility Regional referral role Access to specialised allied health services On-site Level 2B neonatal facilities

Level 5

As for Level 4 plus:

Births of low, moderate and high risk mothers
Service provided to high risk mothers by specialist obstetricians, neonatal paediatricians and anaesthetists
On-site 24/7 medical officer obstetric cover by registrar or above
24/7 cover by specialist obstetricians, paediatricians and anaesthetists
Access to HDU/ ICU facility
Regional referral role
Access to specialised allied health services
On-site Level 2B neonatal facilities

Level 6
As for Level 5 plus: Tertiary obstetric services Specialist obstetric services including subspecialty maternal fetal medicine, obstetric medicine, genetic services Dedicated HDU facilities On-site access to ICU Has facilities to undertake obstetric and fetal research Coordinates training of specialist obstetricians and specialist midwives On-site Level 3 NICU