(a) Level II (Special Care). The Level II neonatal designated facility must:
(1) provide care for mothers and their infants of generally more than or equal to 32 weeks gestational age and birth weight more than or equal to 1500 grams who have physiologic immaturity or problems that are expected to resolve rapidly and are not anticipated to require subspecialty services on an urgent basis; and
(2) provide care, either by including assisted endotracheal ventilation for less than 24 hours or nasal continuous positive airway pressure (NCPAP) until the infant's condition improves or arrange for appropriate transfer to a higher-level designated facility; and
(3) have skilled medical staff and personnel with documented training, competencies, and annual continuing education specific for the patient population served.
(b) Neonatal Medical Director (NMD). The NMD must be a physician who:
(1) is a board-eligible/certified neonatologist, with experience in the care of neonates/infants and maintains a current status of successful completion of the Neonatal Resuscitation Program (NRP) or a department-approved equivalent course; or
(2) is a pediatrician or neonatologist by the effective date of this section who:
(c) Program Functions and Services.
(1) The neonatal program must collaborate with the maternal program, consulting physicians, and nursing leadership to ensure pregnant patients who are at high risk of delivering a neonate that requires a higher-level of care are transferred to a higher-level facility before delivery unless the transfer would be unsafe.
(2) The facility provides appropriate, supportive, and emergency care delivered by trained personnel, for unanticipated maternal-fetal or neonatal problems that occur during labor and delivery through the disposition of the patient.
(3) The on-call physician, advanced practice nurse, or physician assistant must have documented special competence in the care of neonates, privileges and credentials to participate in neonatal/infant care reviewed by the NMD, and:
(4) The neonatal program ensures if surgeries are performed for neonates/infants, a surgeon privileged and credentialed to perform surgery on a neonate/infant is on-call and must arrive at the patient bedside within a time period consistent with current standards of professional practice and neonatal care. Surgeon response times must be reviewed and monitored through the neonatal QAPI Plan.
(5) Anesthesia providers with pediatric experience and competence must provide services in compliance with the requirements in §133.41 of this title (relating to Hospital Functions and Services).
(6) Dietitian or nutritionist with appropriate training and experience in neonatal nutrition provides services for the population served in compliance with the requirements in §133.41 of this title.
(7) Laboratory services must be in compliance with the requirements in §133.41 of this title and must have:
(8) The facility must provide neonatal/infant blood gas monitoring capabilities.
(9) Pharmacy services must be in compliance with the requirements in §133.41 of this title and must have a pharmacist with experience in neonatal/pediatric pharmacology available at all times.
(10) A speech, occupational, or physical therapist with sufficient neonatal expertise must provide therapy services to meet the needs of the population served.
(11) Radiology services must be in compliance with the requirements in §133.41 of this title, incorporate the "As Low as Reasonably Achievable" principle when obtaining imaging in neonatal patients, and must have:
(12) A respiratory therapist, with experience and specialized training in the respiratory support of neonates/infants, whose credentials have been reviewed by the NMD, must be immediately available on-site when:
(13) The facility must have staff with appropriate training for managing neonates/infants, written policies, procedures, and guidelines specific to the facility for the stabilization and resuscitation of neonates based on current standards of professional practice. Variances from these standards are monitored through the neonatal QAPI Plan.
(14) A registered nurse with experience in neonatal care, including special care, or perinatal care must provide supervision and coordination of staff education.
(15) Social services, supportive spiritual care, and counseling must be provided as appropriate to meet the needs of the patient population served.
(16) Written and implemented policies and procedures to ensure the timely evaluation of retinopathy of prematurity, documented referral for treatment, and follow-up of an at-risk infant, which must be monitored through the neonatal QAPI Plan.
(17) The neonatal program ensures the availability of support personnel with knowledge and expertise in breastfeeding and lactation to assist and counsel mothers.
(18) The neonatal program ensures provisions for follow-through care at discharge for infants at high risk for neurodevelopmental, medical, or psychosocial complications.
Source Note: The provisions of this §133.187 adopted to be effective June 9, 2016, 41 TexReg 4011; amended to be effective June 22, 2023, 48 TexReg 3226