The association of NICU capacity strain with neonatal mortality and morbidity.

OBJECTIVE: To examine the association of admission NICU capacity 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 <34 weeks GA/year. The exposure was deciles of admission capacity strain, defined as the sum of infants ≤44 weeks GA with a congenital anomaly plus infants <34 weeks GA. The primary outcome was a composite of mortality and term and preterm complications. We used Poisson generalized linear mixed models to examine the association of exposure with outcome adjusting for patient and hospital characteristics. RESULTS: We studied 64,647 infants from 30 hospitals. High capacity strain was associated with increased risk of mortality and morbidity adjusting for patient/hospital factors (for example, tenth decile aIRR 1.14, 95% CI 1.03-1.27). CONCLUSION: Capacity strain is associated with adverse NICU outcomes.