Metric / Definition / Numerator / Denominator / Type
1. VLBW volume / Total number of VLBW admissions per year. / # VLBW infant admissions / Year / Continuous
2. Antenatal steroids / Administration of corticosteroids (IM or IV) to the pregnant mother at any time prior to delivery. Corticosteroids include betamethasone, dexamethasone, and hydrocortisone. / # mothers who received antenatal steroids prior to delivery of VLBW infant / Inborn VLBW admissions of less than 1500g birth weight, and between 25 and 32 weeks GA at birth / Binary
3. Temperature measured within 1 hour of NICU admission / VLBW infant core body temperature was measured and recorded within the first hour of NICU admission (in degrees centigrade to the nearest tenth of a degree). May be measured by rectal, esophageal, tympanic or axillary temperature (in order of desirability). / # VLBW infants who had a temperature measured within one hour of NICU admission / All VLBW admissions / Binary
4. Hypothermia at NICU admission (moderate to severe) / This measure uses WHO criteria for at least moderate hypothermia, defined as <36.0°C
WHO criteria:
1. 36.0-36.4°C - cold stress
2. 32.0-35.9°C - moderate hypothermia
3. below 32°C - severe hypothermia
First VLBW infant core body temperature measured and recorded within the first hour of NICU admission (in degrees centigrade to the nearest tenth of a degree). If the infant’s temperature is measured multiple times within the first hour after NICU admission, the first temperature measurement is used. May be measured by rectal, esophageal, tympanic or axillary temperature (in order of increasing desirability). / # VLBW infants with Temperature <36.0°C / All VLBW NICU admissions with temperature measurement in the first hour / Binary
5. Surfactant within 2 hours of birth / Administration of surfactant to the VLBW infant within 2 hours of birth or as part of the stabilization immediately after birth, even if administration occurred in a location other than the delivery room (e.g., a resuscitation area, hospital room, emergency room, operating room, ambulance, or at the birth hospital prior to transfer to your center).
This measure includes surfactant administered during stabilization and resuscitation within 2 hours of birth, regardless of location. This measure excludes outborn infants. / # VLBW infants receiving surfactant within 2 hours of birth / Inborn VLBW infants receiving exogenous surfactant / Binary
6. Timely Retinopathy of prematurity (ROP) exam / VLBW infants receiving an indirect ophthalmologic examination who were in the hospital at the age when a ROP exam is recommended by the AAP3.
GA at birth, wks Target GA at initial exam, wks
25 31
26 31
27 31
28 32
29 33
Infants above 29 weeks GA at birth are excluded due to variability in provider decision making regarding the necessity for screening. This metric does not differentiate whether the actual exam occurred in a timely manner, nor whether more than one exam was performed. Only that an exam was done on a patient in the hospital at the time of recommended ROP exam. / # of VLBW infants in hospital at time of target exam and <30 weeks GA at birth, examined for ROP / VLBW survivors in hospital at time of target exam and <30 weeks GA at birth / Binary
7. ROP severity >stage 2 / If a retinal examination was performed, the worst stage documented on any exam in the eye with the most advanced stage should be recorded as:
- Stage 0: No evidence of ROP
- Stage 1: Presence of demarcation line (± abnormal vascularization)
- Stage 2: Presence of intraretinal ridge
- Stage 3: Presence of ridge with extraretinal fibrovascular proliferation
- Stage 4: Partial retinal detachment
- Stage 5: Total retinal detachment
8. ROP surgery / VLBW infants receiving retinal cryosurgery and/or laser surgery for ROP. / # of VLBW infants, <30 weeks GA at birth, requiring ROP surgery / VLBW survivors, <30 weeks GA at birth with an eye exam / Binary
9. Any Intracranial hemorrhage (IH) / The most advanced grade of IVH determined from neural imaging (CT scan, cranial ultrasound, or MRI) performed on or before day 28 of life:
- Grade 0: No subependyma or intraventricular hemorrhage
- Grade 1: Only subependymal germinal matrix hemorrhage
- Grade 2: Intraventricular blood, no ventricular dilation
- Grade 3: Intraventricular blood, ventricular dilation
- Grade 4: Intraparenchymal hemorrhage
10. IH severity >grade 2 / The most advanced grade of IH determined from neural imaging (CT scan, cranial ultrasound, or MRI) performed on or before day 28 of life:
- Grade 0: No subependyma or intraventricular hemorrhage
- Grade 1: Only subependymal germinal matrix hemorrhage
- Grade 2: Intraventricular blood, no ventricular dilation
- Grade 3: Intraventricular blood, ventricular dilation
- Grade 4: Intraparenchymal hemorrhage
11. Cystic periventricular leukomalacia (PVL) / Evidence of PVL indicated by multiple small periventricular cysts as shown by any neural imaging (cranial ultrasound, CT, or MRI).
Periventricular echogenicity without cysts should not be coded as PVL. A porencephalic cyst in the area of previously identified intraparenchymal hemorrhage is not coded as PVL. Periventricular abnormalities on CT or MI are not coded as PVL unless multiple small periventricular cysts are identified. / # VLBW infants diagnosed with PVL / All VLBW admissions with neural imaging / Binary
12. Use of assisted ventilation / VLBW infants receiving continuous mechanical ventilation for > 4 hours for any reason (surgery or the need for controlled sedation to perform imaging studies is included). Mechanical ventilation includes nasal IMV/SIMV and high frequency/jet ventilation. Continuous positive airway pressure (CPAP) alone is not included in this measure. / # VLBW infants requiring the use of assisted ventilation for > 4 hours / All VLBW admissions / Binary
13. Duration of initial mechanical ventilation / Total days and hours spanning the initiation of mechanical ventilation (other than CPAP) for > 4 continuous hours.
For infants with multiple ventilations of > 4 hours, the initial episode is used. Infants ventilated > 4 hours, then extubated, but re-intubated within 24 hours are designated as extubation failures and the time on subsequent course of ventilation is added. / Days and hours
on assisted ventilation / All VLBW admissions / Continuous
14. Pneumo-thorax / Extrapleural air diagnosed by chest radiograph or needle aspiration (thoracentesis) at your hospital. Also diagnosed for infants who had thoracic surgery and then later developed extrapleural air diagnosed by CXR or needle thoracentesis.
Excludes infants who had thoracic surgery and a chest tube was placed at the time of surgery OR if free air was only present on a CXR taken immediately after thoracic surgery and was not treated with a chest tube. / # VLBW infants diagnosed with a pneumothorax / Inborn VLBW admissions / Binary
15. Postnatal steroids for CLD or BPD / Administration of postnatal systemic corticosteroids after birth. Indications for therapy include chronic lung disease (CLD) or bronchopulmonary dysplasia (BPD).
This measure excludes use of steroids for hypotension, ease of trauma or irritation due to extubation, and inhaled or topical steroids (this is true for CPQCC data, VON data due not include specific indication fields). / # VLBW infants who received postnatal steroids for treatment or prevention of CLD or BPD / All VLBW admissions / Binary
16. Supple-mental oxygen on day 28 / Hospitalized VLBW infants either continuously or intermittently receiving supplemental oxygen on day 28. "Blow-by" oxygen qualifies as intermittent supplemental oxygen, even when given only with feeds or occasional apneic spells.
- If the infant is discharged home before day 28 of life and the infant was not on oxygen at the time of discharge, supplemental oxygen at 28 days is coded NO.
- If the infant is discharged home before day 28 of life and the infant was on oxygen at the time of discharge, supplemental oxygen at 28 days is coded YES.
- This measure excludes infants who die prior to day 28 of life.
17. Oxygen at 36 weeks adjusted gestational age (GA) / VLBW infants either continuously or intermittently receiving supplemental oxygen at 36 weeks GA.
The algorithm for CLD, described below, makes certain assumption those emails about infants who are not in the reporting hospital on the date of week 36 adjusted GA. These assumptions have been tested using actual data and provide more accurate estimates of the rates of oxygen at 36 weeks versus estimates based on infants actually hospitalized at 36 weeks.
- If the infant is hospitalized at 36 weeks, CLD is based on whether the infant was on oxygen at 36 weeks, as answered on the Discharge Form.
- If the infant is discharged between 34 and 36 weeks CGA, CLD is coded YES if the infant was on oxygen at the time of discharge and is coded No if the infant was not on oxygen at the time of discharge.
- If the infant is discharged home before 36 weeks adjusted GA and the infant was not on oxygen at the time of discharge, CLD is coded NO.
- If the infant's gestational age is unknown, or if the infant is discharged home before 34 weeks adjusted GA and the infant was on oxygen at the time of discharge, CLD is coded as unknown and the case is not considered in calculating CLD rates.
18. Oxygen at initial discharge / VLBW infants who were discharged to home or a long-term care facility on supplemental oxygen. “Discharge” refers to initial disposition in most cases.
This measure includes:
- Infants who remained in the hospital on their first birthday, if the infant was on supplemental oxygen on the date of the infant’s first birthday.
- Infants who died prior to discharge who received supplemental oxygen at any time on the day of death.
- This is a modification of the CPQCC/VON definition. As mortality would need to be included in a composite indicator, including infants that die while on oxygen in the numerator would represent double counting.
19. Discharged home or to long-term care facility on mechanical ventilation / VLBW infants who were discharged to home or a long-term care facility on mechanical ventilation. “Discharge” refers to initial disposition in most cases. Mechanical ventilation includes Nasal IMV/SIMV and High Frequency/Jet ventilation. NCPAP is not included.
This measure includes:
- Infants who remained in the hospital on their first birthday who were on mechanical ventilation on the date of the infant’s first birthday.
- Infants who died prior to discharge who received supplemental oxygen at any time on the day of death.
- This is a modification of the CPQCC/VON definition. As mortality would need to be included in a composite indicator, including infants that die while on mechanical ventilation in the numerator would represent double counting.
20. Necrotizing enterocolitis (NEC) / Infants with NEC diagnosed at surgery, at postmortem examination, or clinically and radiographically using the following criteria:
1. One or more of the following clinical signs present:
- Bilious gastric aspirate or emesis
- Abdominal distention
- Occult or gross blood in stool with no apparent rectal fissure.
2. One or more of the following radiographic findings present:
- Pneumatosis intestinalis
- Hepato-biliary gas
- Pneumoperitoneum
21. NEC surgery / Infants with one or more of the following procedures performed at your hospital: laparotomy, bowel resection or intraperitoneal drain placement was performed for necrotizing enterocolitis, suspected necrotizing enterocolitis, or bowel perforation. / # VLBW infants requiring NEC surgery / VLBW admissions / Binary
22. Enteral feeding at discharge: human milk only / All VLBW infants who received only human milk at the time of discharge, either by being breastfed and/or by receiving pumped human milk. Enteral feedings may be given by any method including breast, bottle, gavage tube, gastrostomy tube, feeding cup, etc. Parenteral feedings are not considered when answering this item.
The 6 month cut-off reflects goals of the World Health Organization, the Department of Health and Human Services, and the American College of Obstetrics and Gynecology.
“Discharge” refers to initial disposition in most cases.
This measure is based on enteral feedings received during the 24 hour period prior to discharge, transfer, or death. For infants who remained in your hospital on their first birthday, this measure is based on enteral feedings received on that day. / # VLBW infants who received only human milk at discharge / All VLBW survivors to discharge or age 6 months / Binary
23. Enteral feeding at discharge: any human milk / All VLBW infants who received any human milk at discharge. Enteral feedings may be given by any method including breast, bottle, gavage tube, gastrostomy tube, feeding cup, etc. Parenteral feedings are not considered when answering this item.
The 6 month cut-off reflects WHO, DHHS, and ACOG health goals.
“Discharge” refers to initial disposition in most cases.
This measure is based on enteral feedings received during the 24 hour period prior to discharge, transfer, or death. For infants who remained in your hospital on their first birthday, this measure is based on enteral feedings received on that day. / # VLBW infants who received human milk plus fortifier or formula at discharge / All VLBW survivors to discharge or age 6 months / Binary
24. Growth velocity (gm/kg/day) / Growth velocity is estimated with the exponential method to be the daily change in weight (in grams) per kilogram birth weight. It is reported as the mean growth velocity for the NICU.4 / Change in weight (in grams) per kilogram birth weight / Day / Continuous
25. Health care associated infection - late sepsis/meningitis / EITHER Bacterial infection (A list of bacterial infections can accessed via the Vermont Oxford Network Manual of Operations)2
- If the infant has multiple infections, only consider the first bacterial pathogen recovered from a blood and/or CSF culture obtained after day 3 of life from the hospital.
- If a bacterial pathogen and coagulase negative staph are recovered simultaneously after day 3, consider only bacterial pathogen. If a bacterial pathogen and coagulase negative staphylococcus are recovered during different episodes of sepsis after day 3, consider both Bacterial Pathogen and coagulase negative staphylococcus.
- Includes infants who develop coagulase negative staph at the hospital
- Diagnosed in infants with ALL 3 of the following: 1) Coagulase negative staphylococcus recovered from a blood culture obtained from a central line or peripheral blood sample and/or recovered from cerebrospinal fluid obtained by lumbar puncture, ventricular tap or ventricular drain, 2) Signs of generalized infection (such as apnea, temperature instability, feeding intolerance, worsening respiratory distress or hemodynamic instability), 3) Treatment with ≥5 days of IV antibiotics after the above cultures were obtained (if the infant died, was discharged or transferred prior to the completion of 5 days of IV antibiotics, this condition would still be met if the intention was to treat for ≥5 days).
- Infants with fungus recovered from a blood culture obtained from either a central line or peripheral blood sample and/or recovered from CSF obtained by lumbar puncture, ventricular tap or ventricular drain after Day 3 of life at the hospital.
26. Total length of stay / The Total Length of Stay is the number of days from the date the infant was first admitted to your hospital until discharge home, death or first birthday, whichever occurs first.
Total Length of Stay = ([Date of Final Discharge or Death] -[Date of Admission] +1)
The maximum value of Total Length of Stay is 366 because tracking ends on the infant’s first birthday. For inborn infants, the Date of Admission is the Date of Birth. For outborn infants, the Date of Admission is the date the infant was admitted to the NICU plus the difference between birth and day of transfer. If an infant is still hospitalized on his or her first birthday, and has not been home, the date of the infant’s first birthday as the Date of Final Discharge or Death is used. / Days / VLBW survivor to discharge / Continuous
27. Neonatal mortality <28 days of life / VLBW infant deaths prior to 28 days of life. This measure includes eligible outborn VLBW infants. This measure excludes deaths before 12 hours of life. / # VLBW deaths prior to 28 days of life / All VLBW NICU admissions / Binary
28. Infant mortality during NICU admission / VLBW infant deaths prior to the initial discharge. This measure includes eligible outborn VLBW infants. If an infant has not died at age 1 year but is still hospitalized this measure will be coded as a NO. This measure excludes deaths before 12 hours of life. / # VLBW deaths prior to discharge for infants less than 1 year of age / All VLBW NICU admissions / Binary
1CPQCC Network Database Manual of Definitions For Infants Born in 2008. Palo Alto, CA: CPQCC; 2007. Available at: Accessed February 6, 2008.
2Vermont Oxford NetworkManual of Operations for Infants Born in 2008. Burlington, VT: VON; 2007. Available at: Accessed February 6, 2008.
3American Academy of Pediatrics, AmericanAcademy of Ophthalmology American Association for Pediatric Ophthalmology and Strabismus. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2006;117(2):572-6.
4 Patel AL, Engstrom JL, Meier PP, Kimura RE. Accuracy of Methods for Calculating Postnatal Growth Velocity for Extremely Low Birth Weight Infants. Pediatrics 2005;116;1466-73.