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Updated: Jan 14, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The association of NICU capacity strain with neonatal mortality and morbidity
Elizabeth G Salazar1,2,3, Molly Passarella4, Brielle Formanowski4
1Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. salazare@email.chop.edu.
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.
