Committee advances bill to set statewide neonatal care levels; debate over stricter-than‑AAP language

Representative Ross Levin opened HB 3 27 as a measure to establish statewide, accountable standards for levels of neonatal care aligned with nationally recognized guidelines. "HB 3 27 establishes clear statewide standards for levels of neonatal care by moving from a voluntary self assessment system with no accountability to a system aligned with nationally recognized guidelines from the American Academy of Pediatrics," Ross Levin said.

Multiple clinical witnesses told the committee that codified standards will improve infant outcomes by ensuring hospitals have appropriate staff, technology and subspecialists. Dr. Daniel Derenberger, a neonatology director participating by phone, said Delaware has no statute defining neonatal capabilities and that retrospective tools like CDC’s LOCATE do not ensure correct care in the moment. Dr. Aaron Eckhauser, Nemours cardiac surgery chief, described cases where immediate surgical availability (including ECMO) is lifesaving and urged integrated on‑site teams for level‑4 care.

Lawmakers questioned whether portions of the bill go ‘‘above and beyond’’ AAP level‑4 language. Representative Jones Geltner pressed whether the bill’s line references (noted by witnesses as lines 44–67) require on‑site pediatric subspecialists and whether that could restrict partnerships such as ChristianaCare’s collaborations with out‑of‑state children’s hospitals. Nemours witnesses, including Dr. Lauren Berman and Kristen Dwyer, said the bill incorporates children’s surgery verification and higher verification standards to reduce transfers and to benchmark surgical outcomes.

Public commenters included clinicians and representatives from hospital systems; testimony was mixed. Some local hospital representatives urged aligning strictly with AAP guidance rather than codifying more specific clinical lists in statute, arguing guidelines change more quickly than laws. Nemours clinicians and partner hospitals argued the higher standards are achievable and necessary to protect the sickest infants.

After questioning and public comment, committee members moved and carried a motion to release HB 3 27 to the full House; the transcript records one 'No' vote but the chair announced the motion carried. The bill integrates the Department of Health and Social Services in implementation language and supporters said rulemaking can address implementation details and oversight.