NICU Levels for Maryland Hospitals

elow is a breakdown of NICU levels for hospitals in Maryland. This may be an important factor when deciding where to deliver your baby, especially if you have a high-risk pregnancy.

Choosing a hospital and an obstetrician should involve assessing the risks of managing complications. Access to a high-level NICU is a crucial part of that decision. The best hospital for a healthy, routine delivery may not be the best place for a complicated birth or serious postnatal concerns.

The American Academy of Pediatrics (AAP) classifies NICUs by the complexity of care they provide. The levels range from Level I to Level IV, with Level IV being the most advanced. Babies are transferred between these levels based on their medical needs.

Level I NICU

Level I units provide basic neonatal care. These units care for healthy, full-term infants and can stabilize newborns experiencing minor complications. They may also care for infants born at 35 to 37 weeks who are otherwise stable and can stabilize younger or ill infants until transfer.

Hospital with a Level I Unit in Maryland:

• MedStar St. Mary’s Hospital

Level II NICU

Level II units offer specialty neonatal care for infants born at or after 32 weeks of gestation and weighing more than 1,500 grams who may need monitoring or treatment for problems that are expected to resolve quickly. These units may provide short-term mechanical ventilation and support for infants recovering from more serious conditions treated in higher-level NICUs.

Hospitals with Level II Units in Maryland:

• Baltimore Washington Medical Center

• Carroll Hospital

• Holy Cross Germantown Hospital

• MedStar Southern Maryland Hospital Center

Level III NICU

Level III NICUs provide comprehensive care for very premature or critically ill newborns. They have access to a wide range of pediatric subspecialists and are equipped to provide long-term mechanical ventilation and advanced imaging. These hospitals care for infants born before 32 weeks or weighing less than 1,500 grams and are staffed by neonatologists, respiratory therapists, and nurses experienced in intensive care.

Hospitals with Level III NICUs in Maryland (Accredited through 2027 unless noted):

• Adventist HealthCare Shady Grove Medical Center (2022–2027)

• Anne Arundel Medical Center (2021–2026)

• Frederick Memorial Hospital (2022–2027)

• GBMC (Greater Baltimore Medical Center) (2022–2027)

• Holy Cross Hospital – Silver Spring (2022–2027)

• Howard County General Hospital (2022–2027)

• Mercy Medical Center (2021–2026)

• Saint Agnes Hospital (2022–2027)

• University of Maryland Capital Region Health (2023–2028)

• University of Maryland Prince George’s Hospital Center (2023–2028)

• Johns Hopkins Bayview Medical Center (2022–2027)

• MedStar Franklin Square Medical Center (2021–2026)

• Sinai Hospital of Baltimore (2022–2027)

• University of Maryland St. Joseph Medical Center (2022–2027)

• Walter Reed National Military Medical Center

Level IV NICU

Level IV NICUs provide the highest level of neonatal care. These hospitals are equipped to treat the most critically ill and complex newborns. In addition to the services offered at Level III NICUs, Level IV centers have on-site pediatric surgical subspecialists, can perform advanced procedures such as ECMO (extracorporeal membrane oxygenation), and serve as regional referral centers. They are expected to offer transport services and coordinate outreach education.

Hospitals with Level IV NICUs in Maryland (Accredited 2025–2030):

• Johns Hopkins Hospital

• University of Maryland Children’s Hospital

For families located closer to Washington, D.C., Children’s National Hospital is widely regarded as one of the top Level IV NICUs in the country.

While no hospital is immune to error, both Johns Hopkins and University of Maryland Children’s Hospital are considered the best-equipped facilities for managing the most serious neonatal complications.

Frequently Asked NICU Questions

What Is a NICU?

The Neonatal Intensive Care Unit, or NICU, is where hospitals treat the most medically vulnerable newborns. This includes babies who are born too early, have difficulty breathing, suffered birth trauma, or show signs of infection or organ dysfunction. NICUs are not just more equipment-heavy than a regular nursery—they are staffed by neonatologists, neonatal nurses, respiratory therapists, and other specialists who are trained to intervene immediately when a baby’s condition becomes unstable. In Maryland, Level III and IV NICUs are typically found in large teaching hospitals like Johns Hopkins and the University of Maryland Medical Center.

Why Would a Baby Need to Be in the NICU?

The most common reason is prematurity, but that is just one piece of the puzzle. A baby may be admitted to the NICU because of birth asphyxia, low Apgar scores, meconium aspiration, sepsis, seizures, or injuries sustained during a difficult delivery.

In Maryland, babies often go straight to the NICU following complications like shoulder dystocia, delayed C-section, or prolonged labor that puts stress on the baby. A NICU admission is not a good feeling, but it is not always a sign that something has gone wrong.

NICU Level	Description	Maryland Hospitals
Level I	Basic care for healthy newborns; can stabilize infants with minor issues before transfer.	MedStar St. Mary’s Hospital
Level II	Specialty care for babies born at or after 32 weeks with short-term health concerns.	BWMC, Carroll Hospital, Holy Cross Germantown, MedStar Southern Maryland
Level III	Advanced care for very premature or critically ill infants; access to neonatologists and ventilation.	Shady Grove, GBMC, Sinai, Johns Hopkins Bayview, MedStar Franklin Square, and more
Level IV	Highest level NICU care with pediatric surgeons and full specialty support.	Johns Hopkins Hospital, UM Children’s Hospital

What Is the Difference Between a NICU and a PICU?

The NICU is designed for newborns in their first weeks of life. It is where the smallest and most fragile infants, especially those born under 37 weeks or under 5.5 pounds, receive around-the-clock care. The PICU, or Pediatric Intensive Care Unit, serves older infants, toddlers, and children with critical medical needs. If your baby started in the NICU and was later moved to the PICU at a Maryland hospital, it usually means they survived the neonatal period but still need intensive support due to lingering complications from birth or underlying health conditions.

What Are the NICU Levels?

NICUs are divided into levels based on the complexity of care they can provide. A Level I nursery handles healthy, full-term babies. A Level II unit can care for moderately ill or premature infants who need more observation and support. Level III NICUs are equipped to handle infants who are very sick or very small, requiring ventilation, surgery, or continuous monitoring. Level IV is the highest designation and includes the full range of subspecialty care, including complex surgeries and access to neonatal surgeons and specialists 24/7.

In Maryland, Level IV NICUs include Johns Hopkins Children’s Center and the University of Maryland Medical Center. These facilities are equipped for the most complex cases, including babies born at the edge of viability or those suffering from serious birth trauma. If your baby was transferred to one of these hospitals after birth, that in itself may suggest your original delivery hospital was not prepared to handle a high-risk labor.

Are NICU Admissions Becoming More Common?

Yes. A 2025 report from the National Center for Health Statistics shows that NICU admissions have increased from 8.7% in 2016 to 9.8% in 2023. This rise spans every category, including gestational age, race, maternal age, and location. For Maryland families, this means more newborns are being admitted to NICUs than ever before, but not always for the same reasons. While some admissions reflect better monitoring and earlier intervention, others may point to delivery mistakes that could have been prevented.

Do Longer NICU Stays Mean Worse Outcomes?

There is some correlation between length of stay and severity of injuries, as you would expect.  A 2025 study published in BMC Pediatrics found that more extended NICU stays were significantly associated with higher mortality. The average NICU stay was 12.4 days, but babies who stayed longer were more likely to experience complications.  This study reinforces how critical early diagnosis and immediate, competent care are, especially when a baby has suffered a birth injury.

What Are My Rights as a NICU Parent in Maryland?

Maryland parents have rights—legal and ethical—when their child is in the NICU. You have the right to receive complete, timely, and understandable updates about your baby’s condition and care plan. You have the right to review your baby’s medical records and to be involved in treatment decisions, especially when long-term outcomes are on the line. You are also entitled to privacy, to respectful treatment by hospital staff, and to visitation consistent with medical policy and safety protocols.

Perhaps most importantly, if you believe your baby was harmed due to medical negligence, you have the right to seek an independent legal review. NICU teams rarely document errors directly. But when something goes wrong, especially in the delivery room, you are entitled to answers. Our firm can help you investigate whether a preventable mistake contributed to your child’s condition and explore your legal options.

What Is Best Hospital in Maryland to Deliver a Baby?

If you are planning for delivery in Maryland, there is no one “best hospital” choice.  It largely depends on you and what you want.  But  it helps to know which hospitals are recognized for labor, delivery, and neonatal care.

Johns Hopkins Hospital in Baltimore and the University of Maryland Medical Center both operate Level IV NICUs and consistently rank among the state’s most advanced hospitals for high-risk deliveries. Anne Arundel Medical Center, Sinai Hospital of Baltimore, and Johns Hopkins Bayview also received “High Performing” designations from U.S. News & World Report for maternity care.

Of course, no hospital is immune from mistakes. Even at top-rated centers, birth injuries can and do happen, especially when care teams miss red flags, fail to act quickly, or panic under pressure. If your child was transferred to a NICU after delivery and you have questions about what went wrong, we can help you find answers.

Can a NICU Admission Be a Sign of Medical Malpractice?

Not every NICU admission means something went wrong during labor or delivery.  In fact, the vast majority of children in a NICU are not there because of a mistake that was made in labor and delivery.

But sometimes, it is the first clue. When a baby is rushed to the NICU with low oxygen levels, signs of brain injury, or unexplained trauma, it can indicate that something in the delivery process failed. Delays in performing a C-section, improper use of forceps or vacuum extractors, failure to respond to fetal distress, or excessive traction during shoulder dystocia can all lead to injuries that land a baby in the NICU. If you are being told your baby’s condition was unpredictable or unavoidable but something does not add up, it may be worth having a malpractice lawyer review the medical records.