Item 24a. Temperature Measured Within the First Hour After Admission to Your NICU
Q: Does this really matter 28 days out? Does it refer to within one hour of admit to your NICU or the first NICU the infant was placed in?
A: This item is trying to get at temperature maintenance in the Delivery Room. This refers to the first temperature measured within an hour of life of the initial admission to your NICU, even if the infant is being re-admitted.
Q: What is the lowest temp that can be collected? As a default, can members use the lowest temp in the EDS Specs?
A: There is a note in the EDS instructions, which indicates that if the temperature is measured and is lower or higher than range on the thermometer being used then record the lowest or highest value that the thermometer is capable of recording. The range of accepted values is 20.0 to 45.0 degrees centigrade.
Q: If i know that the temp was done but I don't know what it is, how should I record it?
A: Record "yes" that it was done, and unknown for the temperature.
Item 25. Respiratory Support (After Leaving the Delivery Room)
Q: How can Item 25. Respiratory Support (after leaving the delivery room) be answered when an infant is discharged home from the DR and then later readmitted to the NICU?
A: Item 25 is asking for Respiratory support (after leaving the Delivery Room or Initial Resuscitation Area). "After leaving the delivery room" does not mean right after the baby is delivered. Specifically, these items refer to Respiratory Support after the infant is first admitted to the NICU. So for the baby who went home right after being delivered, AND then was readmitted to your NICU on or before Day 28, Item 25 refers to the Respiratory Support that the baby receives in the NICU.
Q: Can you change the wording - after delivery room to "Any time after moving from delivery room until the time of discharge?"
A: "After leaving the delivery room" sets the starting point for collecting this item. The end point for data collection applies to all items and not just this one.
Item 25d. High Flow Nasal Cannula
Q: What constitutes "High Flow" Nasal Cannula?
A: If the infant received air or oxygen (any FiO2) at a flow rate of one liter per minute or more via nasal cannula at any time after leaving the delivery room or the Initial Resuscitation Area, this constitutes as High Flow Nasal Cannula.
Q: When a baby is sent home on oxygen, they are not sent home on a blender. They are sent home on low flow cannula which is 100% oxygen at 0.03 flow, on up. So a baby sent home on 0.03 low flow cannula is between 21-22% per my RCP who I am working with tonight. so we are wondering. Are we skewing our numbers by saying "no O2" on babies sent hom on 0/03 low flow. Because they are going home on O2 which is not true. Should we only count them going home on O2 if they go home on higher than 0.03?
A: CPQCC: It sounds like you are coding the data correctly. VON defines "21% oxygen is room air. This is not considered supplemental oxygen, no matter how administered." So the baby who was sent home at 21% oxygen, wouldn't be considered discharged on supplemental oxygen. However, if you discharged the baby on 22% oxygen, then you would mark Yes to Oxygen at Discharge.
- Follow up Q: I guess the confusion stems from the kids who are sent home on 0.03 Low Flow Nasal Canula, which my respiratory therapist (RT) is telling me can be a mix of 0.21 or 0.22 O2. So RT and her team are suggesting that if the flow is 0.04 or higher, chances are that also equates to .22% FiO2 or higher as well. Do you agree?
- A: CPQCC: Agree, but we will very with VON. Per VON, "the issue is what the gas source is. If it is pure room air then that is not supplemental oxygen. If any additional oxygen is mixed, now matter how little, then it is supplemental oxygen".
Q: If baby is on HFNC 1 LPM, at 21% and at 36 weeks, does that count as continuous O2?
A: In reviewing the definitions, as 21% is not really supplemental oxygen that would not count if it was only 21% for that period. However, it would be yes for High Flow Nasal Cannula at 36 weeks.
Item 25e. Nasal IMV or SIMV (or any other form of non-intubated ventilation)
Q: Does Nasal IMV or SIMV also refer to Nasal CPAP with a back-up rate?
A: No, CPAP alone doesn't qualify as non-intubated assisted ventilation. However, CPAP with a back-up rate whether administered through the nose, face mask, etc. that is triggered as a back-up rate or intermittently would qualify. Please see page 48 of the 2010 CPQCC Manual for more detailed information.
Item 26a. Use of Nasal CPAP
Q: Does Nasal Cannula count as CPAP in the DR?
A: No, nasal cannula doesn't count as CPAP
Nasal CPAP is defined as the infant was given continuous positive airway pressure applied through the nose at any time after leaving the delivery room or the initial Resuscitation Area.
Note: If a Big Baby infant is on CPAP with a back-up rate for > four continuous hours, then this infant qualifies under the Big Baby selection criteria of Nasal IMV/SIMV (or any form of non-intubated assisted ventilation) greater than four continuous hours. CPAP alone does not qualify as non-intubated assisted ventilation.
High flow nasal cannula oxygen is NOT considered nasal CPAP for the purpose of this definition.
Q: If an infant has an oxygen hood and there is a rate, i.e 78, written in the chart for the parameters how can that be? How can a hood have rate?
A: There is no way a hood can have a rate that we are aware of. There must be an error in the charting.
Item 27a. Use of Intubated Assisted Ventilation
Q: Why doesn't Nasal IMV/SIMV count in Item 25? Give specific example.
A: In 2010, we have clarified "Use of Assisted Ventilation" as "Use of Intubated Assisted Ventilation" which is delivered by an endotracheal tube and therefore intubated. This is different from "non-intubated assisted ventilation" or for example Nasal IMV/SIMV (or any other form of non-intubated assisted ventilation) is usually delivered by nasal prongs and therefore NOT intubated. For this reason, the hours collected for Nasal IMV/SIMV (or any other form of non-intubated ventilation should NOT be collected in item 27.
Q: When there is a transported baby, and he is intubated, when does the time of intubation goes. Only count the hours from pick-up on transport to the end of ventilation.
A: Duration of ventilation starts on the day of admission.
Q: Issues around intubation and transport. If the baby is transported from you to another facility that was intubated and they are extubated there, you do not need to calculate the total time on vent.
A: Agree, only ventilation at your hospital counts.
Item 28. Infant Death Within 12 Hours of Admission to the NICU
Q. We had a baby who was transferred to Rady's for surgical consultation, readmitted to SMBHWN and then expired within 12 hours of life. When I click "yes" on Item 28: Infant Death within 12 hours of NICU Admission, then all the Post-Transfer Status questions (Items 61 - 67) are unavailable. Please let me know how I should reconcile these items.
A. If they get transported out and re-admitted death within 12 hours has to be checked No. Since that question only applies to the initial admission.
Item 54. Initial Disposition from your Hospital
Item 63. Ultimate Disposition
Q: Does CPQCC assign death rates to our hospital if the child died at another facility?
A: CPQCC assigns the death of an infant to the hospital where the death occurs.
Item 30. Pneumothorax
Q: How do we code for an isolated pneumomediastinum? The manual says "Pneumothorax - Check yes" if the infant had extrapleural air diagnosed by chest radiograph or needle aspiration (thoracentesis)." I have always interpreted that to mean any extrapleural air (either pneumothorax or pneumomediastinum) should be scored as pneumothorax. However, strictly speaking a pneumodmediastinum is not the same thing is a pneumothorax.
A: Pneumomediastinum is not pneumothorax.
Q: I'd like some clarification about item #28, pneumothorax. Would a pneumomediastinum qualify for CPQCC as extrapleural air?
A: Pneumomediastinum is not pneumothorax.
Item 34. Inhaled Nitric Oxide
Q: Does that also mean nitrous washout with a headbox/hood? OR, is that something different?
A: We believe that this is something different, but we are unsure of what the washout test was for.
Item 37. Supplemental Oxygen on Day 28
Q: If an infant received "blow-by" oxygen during feeds (otherwise on room air), does this count as supplemental oxygen?
A: Yes, if blow-by is at >21%, you would mark "intermittent". If oxygen is 21%, it is considered room air and therefore is NOT considered oxygen, no matter how administered.
Q: If an infant received nasal cannula 1/4L at 100% with feedings only until discharge on Day 35, does this count as supplemental oxygen?
A: Yes, you would mark "continuous".
Q: If an infant received Nasal CPAP with room air, does this count as supplemental oxygen?
A: No, you would mark "none".
Q: What if a baby received continuous supplemental oxygen, but was discharged or transferred out before Day 28?
A: Then you would mark "NA".
Item 39a. Respiratory Support at Discharge - Oxygen
Q: At the time of discharge - day of death - what support was the baby receiving. Why is it done the way it is? Please provide a rationale because it's very confusing.
A: This allows us to have data for all infants on their final day and do not need a separate rule to code as "not applicable" for deaths.
Q: "At any time on the day of death" - by "day of death" do you mean the calendar day or a 24 hour period.
A: Calendar day similar to the rule for those in hospital on the first birthday.