Abstract

Objective To examine the association of admission NICU strain with neonatal mortality and morbidity.

Study Design 2008-2021 South Carolina cohort using linked vital statistics and discharge data of 22-44 weeks GA infants, born at hospitals with ≥ level 2 unit and ≥5 births of infants <34 weeks GA/year. The exposure was tertiles of admission NICU strain, defined as the sum of infants <44 weeks GA with a congenital anomaly plus all infants born <33 weeks GA at midnight on the day of birth. We used Poisson generalized linear mixed models to examine the association of exposure to strain with the primary outcome of a composite of mortality and term and preterm morbidities adjusting for patient and hospital characteristics.

Results We studied 64,647 infants from 30 hospitals. High strain was associated with increased risk of mortality and morbidity adjusting for patient/hospital factors (aIRR 1.07, 95% CI 1.01 – 1.12).

Conclusion NICU strain is associated with increased adverse outcomes.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

T32HL098054 (to EGS). R01HD084819 (to CSP, SAL).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Children's Hospital of Philadelphia institutional review board determined that the abstracted data did not meet the requirements of human subjects research. Data use was approved by the South Carolina Department of Health.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Footnotes

Financial Disclosure: The authors have no financial relationships relevant to this article to disclose.

Potential Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Funding Source: T32HL098054 (to EGS). R01HD084819 (to CSP, SAL).

Data Availability

All data produced in the present study are available should a data use agreement be reached with the source and a reasonable request made to the authors.

AbbreviationsCLDChronic Lung DiseaseGAGestational AgeIVHIntraventricular hemorrhageNECNecrotizing enterocolitisNICUNeonatal Intensive Care UnitPMAPost Menstrual AgeROPRetinopathy of prematuritysIVHSevere intraventricular hemorrhageVLBWVery low birth weight