Sometimes a newborn needs more care than a standard well-baby nursery can offer. A Special Care Nursery (SCN) serves as a transitional space between routine post-delivery care and intensive medical intervention. The SCN is designed for infants who are generally stable but require close observation and specialized support before they can safely go home. It provides modest medical assistance and specialized care without requiring admission to a higher-acuity setting.
Defining the Special Care Nursery
The Special Care Nursery is formally classified as providing Level 2 Neonatal Care. This designation means the unit handles moderately ill infants whose conditions are expected to improve relatively quickly. Babies admitted must typically be born at 32 weeks gestation or later and weigh at least 1,500 grams, though requirements vary by hospital. The primary function of this nursery level is to provide continuous monitoring and short-term medical support that exceeds the capacity of a well-baby nursery.
The SCN focuses on stabilization and growth rather than complex, sustained life support. Staff manage physiological immaturity, such as difficulty maintaining body temperature or establishing oral feedings. Respiratory assistance is usually limited to devices like Continuous Positive Air Pressure (CPAP) or mechanical ventilation for very brief periods, generally less than 24 hours. The SCN also serves as a step-down unit for infants recovering from more intensive care who are not yet ready for discharge.
Who Qualifies for Special Care
Admission to the Special Care Nursery is determined by specific patient conditions. One large group includes late preterm infants, born between 34 and 36 completed weeks of gestation. Although they appear nearly full-term, these babies are at increased risk for complications like respiratory distress, temperature instability, and feeding difficulties. The SCN provides the necessary setting for their bodies to fully adapt to life outside the womb.
Another common reason for SCN admission is the need for phototherapy to treat hyperbilirubinemia, or jaundice. This condition results from an excess of bilirubin, and the SCN allows for continuous monitoring of blood levels while the infant is under specialized lights. Infants who struggle to establish effective oral feeding also frequently qualify for SCN care. This includes babies needing temporary gavage (tube) feedings to ensure adequate nutrition while they learn to suck and swallow efficiently.
The nursery also cares for newborns with stable, non-critical medical issues, such as resolving mild respiratory distress or those being observed for a suspected infection treated with antibiotics. These infants require close monitoring of their vital signs and blood sugar levels. The goal is rapid resolution, allowing the baby to transition home as soon as they achieve physiological stability.
Essential Services and Staffing
The care provided in the SCN centers on continuous monitoring and supporting the baby’s maturation process. Infants are placed on monitors that track their heart rate and oxygen saturation levels (oximetry). This surveillance helps the team detect subtle changes, such as episodes of apnea (temporary cessation of breathing) or bradycardia (slowing of the heart rate). Temperature regulation is managed using incubators or radiant warmers until the infant can maintain a stable body temperature.
A major focus is establishing successful feeding before discharge, involving extensive support from specialized staff. This includes lactation consultants and nurses skilled in administering gavage feedings. The SCN team is multidisciplinary, led by neonatologists and pediatric hospitalists, and includes specialized neonatal nurses.
Rounding out the team are respiratory therapists, who manage necessary breathing support, social workers, who provide support and resources to the family, and registered dietitians, who ensure the baby’s nutritional needs are met. This comprehensive staffing model addresses all aspects of the baby’s medical, developmental, and social needs.
SCN Versus the Neonatal Intensive Care Unit
The Special Care Nursery differs significantly from the Neonatal Intensive Care Unit (NICU), which provides Level 3 or 4 care. The fundamental distinction lies in the level of illness and the types of life support available. Babies in the NICU are severely ill, often born before 32 weeks gestation or weighing less than 1,500 grams, requiring comprehensive, sustained life support. The NICU is equipped for complex interventions, such as full mechanical ventilation, major surgery, and specialized care for complex congenital conditions.
Infants in the SCN must be hemodynamically stable, meaning their heart and circulatory system function well without pharmacological support. They must also be breathing independently or require only minimal, non-invasive support. The SCN manages moderate, temporary issues and focuses on the final stages of recovery and growth, while the NICU handles sustained, life-threatening instability.