Babies without preexisting conditions are identified using a combination of Patient Discharge Diagnosis data and either Birth Certificate or Medical Record data to add/confirm a few additional elements. The Denominator is comprised of singleton live born babies who by best Obstetric Estimate are at least 37.0 weeks of gestation, over 2500gms in birthweight (normally grown), do not have any significant congenital malformations or fetal conditions, and are not exposed to maternal drug use or to selected maternal conditions (see Figures 1-2 in Algorithm Flowcharts; for a list of codes and descriptions see Appendix 2 for ICD‐9 and Appendix 7 for ICD-10). This is a group who are expected to do well and go home routinely with the mother.
The numerator is divided into two categories: severe complications and moderate complications.
- neonatal death
- transfer to another hospital for higher level of care
- extremely low Apgar Score (5 minutes ≤3, or 10 minutes ≤3 if 5 min Apgar score is missing)
- severe birth injuries such as intracranial hemorrhage or nerve injury
- neurologic damage
- severe respiratory neurologic or infectious complications
Parents of such babies may often worry about short and long-term infant outcomes. (See Figure 3 in Algorithm Flowcharts; for a list of codes and descriptions see Appendix 3 for ICD‐9 and Appendix 8 for ICD-10)
Moderate complications include diagnoses or procedures that raise lower levels of concern than the list for severe (e.g. use of CPAP or bone fracture). Most require an infant LOS that exceeds that of the mother, validating that these are indeed significant complications. Examples include less severe respiratory complications (e.g. Transient Tachypnea of the Newborn), or infections with a longer LOS but not sepsis. As a "safety net" to capture cases who were under‐coded, the numerator also includes cases from these seemingly normal infants who had a LOS >5 days with neither any form of jaundice nor a social reason for staying in the hospital (e.g. family disruption or adoption). (See Figure 4 in Algorithm Flowcharts; for a list of codes and descriptions see Appendix 4-5 for ICD‐9 and Appendix 9-10 for ICD-10)
The measure is reported as Total Unexpected Newborn Complications per 1,000 births and has subdivisions of Serious and Moderate Complications (see Figure 5 in Algorithm Flowcharts).