Item 10. Maternal Race and Ethnicity
Item 10a. Is mother of hispanic origin?
Item 10b. Maternal Race
Q: We have difficulty determining the mother's name. Do you have any suggestions?
A: If the mother's name is not immediately known, review the newborn screening form or maternal face sheet.
Q: We have difficulty determining the mother's race and ethnicity.
A: It is critical to use the CPQCC definition for determining race and ethnicity, and to ask the mother how she self-identifies and to record this accordingly.
Q: How should I code a mother who speaks Spanish, was born in Mexico, and says that she's not Hispanic, but claims to be Native American?
A: It is important to record using self-identification. In this case you would record the mother as Native American since this is how she identifies herself.
Item 12. Group B Strep Positive
Q: Why was the Not Applicable choice changed to Not Done for this Item?
A: This item accounted for a high percentage of Unknown data for significant number of Centers. Upon further investigation, it became apparent that some centers might not perform the test on the mom due to the baby's gestational age. To capture this situation, we changed N/A to Not Done. Not Applicable/Not Done is enumerated differently from Unknown. As some hospitals do not test their moms until 34 weeks GA. In this situation, you would mark "Not Done" for this infant.
Q: What if the mom is between 35 to 40 weeks and have had multiple tests? Which one do we use?
A: Use the last status known. Infants less than 36 weeks are usually "Not Done".
Item 13. Antenatal Steroids
Q: Check "Yes" if corticosteroids were administered IM or IV to the mother using pregnancy at any time prior to delivery. Corticosteroids include betamethasone, dexamethasone, and hydrocortisone. There was some concern that there should be a Cortisol level for steroids.
A: Both CPQCC and VON cannot require this level of detail at this time.
Item 15a. Multiple Births
Q: We have a set of conjoined twins that will not be separated. How do I handle them?
A: Conjoined wins would be handled as 2 live births, since each twin is assigned a name and birth certificate. However, the weight would be divided evenly between the two infants. For example, if the combined weight is 1,500 grams then you would record 750 grams for each infant separately.
Item 16. Mode of Delivery
Q: How would you mark an induced labor under Item #16 Delivery Mode?
A: Spontaneous vaginal (the spontaneous here does not refer to lack of induction - just not instrumented)
Item 17. Antenatal Conditions
Q: If the record talks about maternal fever and uterine tenderness, but doesn't say specifically "uterine infection", can they still count it as a uterine infection?
Q: Oligohydraminos and Polydramnios- does it go in Ostetrical or Material conditions?
A: Both would be marked as Obstetrical Conditions.
Q: Where do we put positive drug screens for infants of substance abusing mother? Outcomes may be different.
A: Code mother's substance abuse under Maternal Conditions - Other. We recognize that this is an important issue affecting neonates. However, this is considered a maternal issue. Our sister project, CMQCC, is investigating this issue in more depth.
Item 19a-e. Delayed Cord Clamping
Q: For Item 19 - Delayed Cord Clamping, if item 19a was answered "no" for "Was delayed cord clamping performed", what should we select for item 19e. "Did Breathing begin before umbilical cord clamping"?
A: Per Dr. Henry Lee: Even if they don't do DCC, it is still possible to assess whether the baby breathed before the clamping or not and this could still be an interesting physiologic question.
So I would say they can answer 'yes' even if DCC was not performed. (Our question 19e doesn't specify whether the cord clamping was delayed or not)
So you can still answer this question as "Yes" "No" or "Unk"
Q. 19e "Did breathing begin before umbilical cord clamping?". This seems to be our largest "Unknown" percentage. I have asked other centers how they answer and many use the (1) minute apgar score to make the determination. i.e. if apgar 8 or greater then yes the infant did breath before umbilical clamping. The retired physician who use to enter data for our center in 2018 also used the (1) minute apgar.
This exact question is not addressed in our electronic health record. How would you prefer I proceed? I did note that 2018 is the first year this question was asked.
A. Using the Apgar 1 min to determine the if breathing began is not correct. Please try your best to follow the definition. It's ok to have unknowns in the first year or two of data collection - please request that the clinicians try to document this better in their notes. Some centers have put a checkbox in their EHR to facilitate that.
Item 20. Apgar Scores
Q: If an infant receives an APGAR score at 18 minutes, which box should be checked on the form?
A: If the APGAR score at 10 minutes was not performed, check Not Done.
Item 21b. Cord Blood Gases
Q: How do we capture the cord gas with unknown origin (since cord gases are the most important piece of initial blood gas)?
A: If you don't know which cord gas it is, then put "Unknown" for the source.
Item 21d. pH within 1 hour of life
Q: For pH would you put the lowest pH or first pH?
A: You would choose the first pH.
Q: Do you always prefer umbilical arterial (UA) to umbilical venous (UV)?
A: Yes, we always prefer umbilical arterial (UA).
Q: Form 21d does not allow for documenting "negative" base deficit.
A: This can be confusing - but base deficit is defined in such a way that it is usually talking about a negative number, but expressed as positive. Some places call it base excess in which case it is actually written negative. So a base excess of "-10" would be a base deficit of 10. So it shouldn't really be a negative number.
Item 22. Delivery Room Resuscitation
Q: Check 'Yes' or 'No' for each of the following interventions: (a) Oxygen, (b) CPAP, (c) Bag/Mask, (d) Endotracheal Tube Ventilation, (e) Epinephrine, (f) Cardiac Compression. How would you code CPAP, bag mask, nasal prongs or both?
A: If a CPAP is given by face mask and no breaths are given, this would not be coded as face mask ventilation which is defined to require positive pressure breaths.
Q: How would you document an infant on intubated CPAP?
A: If no positive breaths were received then it would not be coded. If positive pressure breaths were given, it would be coded as endotracheal tube ventilation.
Q: Does using a bag mask mean the baby received oxygen?
A: Referring to delivery room interventions. If the bag mask was used to provide ventilation (Face Mask Ventilation) then it should be noted as [DRBM]. If the bag mask were used to provide oxygen (and this has to be >21%)-then this would count as receiving oxygen. If the bag mask was used for anything like face mask ventilation/CPAP, but it was always at 21% - then this would NOT mean tha tthe baby received oxygen. The answer to this question is: not necessarily.