2025 NICU DATA COLLECTION

1. Contact Information

Please enter numbers and do not leave blanks. N/A is equal to 0.

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* 1. Contact Information

Facility *

Name *

Title

Email Address: *

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* 2. Please select the month you are entering NICU data for

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* 3. Total Number of admissions to the NICU this month.

Direct admissions

Transfer to NICU

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* 4. How many of the admissions this month were transferred newborns from WBN to NICU had the following reasons for the transfer?

N/A

Respiratory

Glucose

Hyperbilirubinemia

Chorioamnionitis

Rule out sepsis

Seizures

Other

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* 5. How many of the NICU admissions this month were discharged this month?

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* 6. How many of the NICU admissions this month were discharged on

Exclusive breastmilk (including bottled breastmilk)

Mixed

Formula only

N/A -not discharged this month

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* 7. How many of the NICU admissions this month had a birth weight of less than 1500 grams

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* 8. Of the total NICU admissions this month, how many identified the following ethnicity (check your totals)

Hispanic or Latino or Spanish origin

Not Hispanic or Latino or Spanish Origin

Did not specify

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* 9. Of the total NICU admissions this month, how many identified the following race (check your totals)

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