Background:
Neonatal intensive care unit (NICU) admission is often due to specific cardiovascular conditions. Low birthweight, another common reason for NICU admission, is also linked to later cardiovascular risk. Within the past decade, the rate of NICU admissions in the United States has significantly increased. Identification of emerging risk factors for NICU admission will help inform efforts to reduce the number of newborns requiring intensive care.
Methods:
The objective of this study was to identify risk factors for NICU admission in all infants born in West Virginia (WV), 2012-2017, via Project WATCH. Fifteen exposure variables including demographics, maternal and infant characteristics, were included in multivariable logistic regression analyses, stratified by preterm and term births.
Results:
Of 120,894 neonates, 6,393 (5.3%) were admitted to NICU. Among preterm infants (Table 1), predictors included male sex (OR: 1.11), insurance status (OR: 1.29), APGAR scores less than or equal to 3 (OR: 2.57), maternal diabetes (OR: 1.68 and 2.01), residence outside WV (OR: 1.27), intrauterine substance exposure (OR: 1.94), congenital abnormalities (OR: 2.58), and low birthweight (OR: 1.73 and 6.64). Risk factors in term infants included all factors identified for preterm infants, as well as maternal smoking, maternal age, and number of previous pregnancies.
Conclusions:
In addition to infant characteristics predictive of NICU admission (e.g., birthweight and APGAR score), socioeconomic factors (e.g., insurance status and rurality) and preventable risk factors (e.g., maternal smoking and substance use) provide an opportunity for intervention during pregnancy, with the goal to decrease the number of newborns requiring intensive care.
Quantile contours and allometric modelling for risk classification of abnormal ratios with an application to asymmetric growth-restriction in preterm infants
