# Very preterm, very low birth weight infants not admitted to the neonatal intensive care unit, National Vital Statistics Surveillance Data, United States 2021

## TL;DR

This study examines why some very preterm and very low birth weight infants in the U.S. are not admitted to neonatal intensive care units.

## Contribution

It identifies demographic and clinical factors associated with NICU non-admission among vulnerable infants using national data.

## Key findings

- 10% of very preterm and very low birth weight infants were not admitted to the NICU in 2021.
- Non-Hispanic Native Hawaiian/Other Pacific Islander infants had a 61% higher adjusted prevalence of not being admitted to the NICU.
- Infants with a 5-minute Apgar score of 0–3 were over three times more likely to not be admitted to the NICU.

## Abstract

The objective of this analysis is to examine characteristics of very preterm (VPT), very low birth weight (VLBW) infants not admitted to neonatal intensive care units (NICU). In this cross-sectional study assessing VPT (<32 weeks gestation) and VLBW (<1500 grams) infants, we used birth records from the National Vital Statistics System, 2021. Crude and adjusted prevalence ratios (aPR) with modified Poisson regression models were used to calculate prevalence of infants not admitted to the NICU by selected characteristics. Among 38,693 VPT, VLBW infants, 10% were not admitted to the NICU. In the adjusted model, characteristics associated with a higher prevalence of not being admitted to the NICU compared with analytical reference groups included non-Hispanic Native Hawaiian/Other Pacific Islander (aPR = 1.61;95% confidence interval [CI]:1.13–2.29), gestational age 22–24 weeks (aPR = 1.17;CI:1.08–1.26), vaginal delivery (aPR = 1.83;CI:1.73–1.94), and 5-minute Apgar score of 0–3 (aPR = 3.48;CI:3.18–3.82). Exploration of reasons infants were not admitted to the NICU may elucidate strategies to address barriers.