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2025 NICU DATA COLLECTION
3.
Contact Information
Please enter numbers and do not leave blanks. N/A is equal to 0.
*
1.
Contact Information
(Required.)
Facility
*
Name
*
Title
Email Address:
*
*
2.
Please select the month you are entering NICU data for
(Required.)
January 2025
February 2025
March 2025
April 2025
May 2025
June 2025
July 2025
August 2025
September 2025
October 2025
November 2025
December 2025
*
3.
Total Number of
admissions
to the
NICU
this month
.
(Required.)
Direct admissions
Transfer to NICU
*
4.
How many of the
admissions
this month were
transferred newborns
from WBN to NICU
had the following PRIMARY reason for the transfer?
(Required.)
N/A
Respiratory
Glucose
Hyperbilirubinemia
Chorioamnionitis
Rule out sepsis
Seizures
Other
*
5.
How many of the
NICU
admissions
this month
were
discharged
this month?
(Required.)
*
6.
How many of the
NICU
admissions
this month
were discharged on
(Required.)
Exclusive breastmilk (including bottled breastmilk)
Mixed
Formula only
N/A -not discharged this month
*
7.
How many of the
NICU
admissions
this month had a
birth weight
of
less than 1500 grams
(Required.)
*
8.
Of the total
NICU
admissions
this month, how many identified the following ethnicity (check your totals)
(Required.)
Hispanic or Latino or Spanish origin
Not Hispanic or Latino or Spanish Origin
Did not specify
*
9.
Of the total
NICU
admissions
this month, how many identified the following race (check your totals)
(Required.)
White or Caucasian
Black or African American
Asian of Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Other
Did not specify
