Virginia Law

A. The support services and other resources required for the general level newborn service and all higher levels of newborn services shall be as follows:

1. Clinical laboratory services and blood bank services available in the hospital on a 24-hour basis. Laboratory and blood bank personnel available on-site or on-call on a 24-hour basis;

2. Group O Rh negative blood available from the blood bank at all times and the blood bank's ability to provide correctly matched blood within 45 minutes of request;

3. Hospital laboratory and blood bank personnel capability to perform the following tests with less than 1.0 ml of blood within one hour or less of request if specified: (i) blood group and Rh type determination/cross-matching, (ii) arterial blood gases within 20 minutes, (iii) blood glucose within 20 minutes, (iv) complete blood count, (v) total protein and albumin, (vi) total and direct bilirubin, (vii) direct Coombs' test, (viii) electrolytes, (ix) blood urea nitrogen, (x) clotting profile (may require more than one ml of blood); and

4. Portable radiological services for basic radiologic studies in the nursery available on-call, within 30 minutes of request, on a 24-hour basis.

B. The additional support services and resources required of the intermediate level newborn service shall be as follows:

1. A respiratory therapist in-house 24 hours a day. The therapist shall have orientation to the neonatal nursery, including orientation to the appropriate level of care. The therapist shall have documented competence in neonatal respiratory care;

2. A radiology technician in-house 24 hours a day;

3. An ultrasound technician available on-call 24 hours a day;

4. A laboratory technician in-house 24 hours a day;

5. A blood bank technician available on call within 30 minutes of request;

6. A licensed physical therapist or certified occupational therapist available for consultation;

7. A registered dietitian with documented competence in neonatal nutrition available for consultation;

8. A biomedical technician, available to the nursery, responsible for the maintenance and safe functioning of specialized medical equipment;

9. Microvolume assays for xanthines and aminoglycosides available within 12 hours of request;

10. Blood gases to be performed on 0.25 ml or less heparinized blood within 20 minutes of request;

11. Blood components available within two hours of request; and

12. Portable chest x-ray within 20 minutes of request.

C. The specialty level support services and resources that are required in addition to the requirements for the lower level nurseries are as follows:

1. A blood bank technician in-house 24 hours a day;

2. A pharmacist with documented competence in neonatal pharmacology on staff;

3. A licensed physical therapist or certified occupational therapist with documented competence in neonatal care;

4. A medical social worker as a participating member of the service;

5. An ultrasound technician on-call 24 hours a day; and

6. A registered dietitian with documented competence in neonatal nutrition as a participating member of the service.

D. The subspecialty level support services and resources that are required in addition to the requirements of the lower level nurseries are as follows:

1. A radiologist with documented competence in the interpretation of pediatric and neonatal films readily available for providing pediatric and neonatal x-ray procedures and ultrasound interpretation;

2. A developmental pediatrician on staff;

3. A cardiothoracic surgeon with documented competence in pediatric surgical procedures on staff and on-call 24 hours a day;

4. A pediatric surgeon on staff and on-call 24 hours a day;

5. An anesthesiologist with documented competence in neonatal anesthesiology on-call 24 hours a day;

6. The following pediatric subspecialists on staff available to be on-site within 30 minutes of request 24 hours a day:

a. Cardiology;

b. Endocrinology;

c. Gastroenterology;

d. Genetics;

e. Hematology;

f. Immunology;

g. Infectious diseases;

h. Metabolism;

i. Nephrology;

j. Neurology;

k. Nutrition;

l. Pharmacology; and

m. Pulmonology;

7. The following pediatric surgical subspecialists on staff available to be on-site within 30 minutes of request 24 hours a day:

a. Neurosurgeon;

b. Ophthalmologist;

c. Orthopedic surgeon;

d. Otolaryngologic surgeon; and

e. Urologic surgeon;

8. An echocardiography technician on staff;

9. An American College of Medical Genetics certified or eligible genetics counselor on staff;

10. In-house 24-hour capability for microchemistries;

11. Hospital resources to provide for the medical follow up of discharged, high-risk neonates that incorporate a parent education program that includes, but is not limited to, the following:

a. Pediatric cardiopulmonary resuscitation training;

b. Home cardiopulmonary monitoring;

c. Home oxygen monitoring; and

d. Lactation instruction;

12. Hospital resources to provide comprehensive, neonatal continuing education to health professionals external to the hospital;

13. A referral network for cardiovascular surgical consultation; and

14. The operation of a neonatal transport system on a 24-hour basis. Transports shall be initiated within 30 minutes of request. The neonatal transport system shall operate in accordance with the most current editions of the Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients published by the American Academy of Pediatrics and the Neonatal Transport Standards and Guidelines published by the National Association of Neonatal Nurses.