Q: In the NICU database the ROP question is for patients GA less than 32 weeks. With the AAP recommendations for ROP screening GA 30 weeks. If we do not perform a screen between the 30 and 32 weeks, will it appear as a fall out for this category?


A: For CPQCC reports like the CCS report, risk adjusted, and other comparison charts, we restrict the denominator to 22 6/7 to 29 6/7 weeks GA or < 1500 grams (as you noted, this would be in line with the AAP recommendations for those who they say all babies in those categories should get exam).


However, we take into account some centers will want to see metrics for < 32 week babies and therefore have this data available on the report site.  This is because for some babies up to 32 weeks, the AAP also notes eye exam may be reasonable. 

But for the main CPQCC reports, the data used only includes those babies < 30 weeks (as per AAP).

Q. I am wondering if positive blood cultures secondary to NEC or GI perforations are included in the nosocomial infection reported for a center. I have traditionally understood nosocomial infections to typically be limited to infections such as VAP or CLABSI. 

A. CPQCC has had this definition for quite a long time of "nosocomial infection" including all late infections (i.e. positive cultures), including the type that you mentioned when associated with 'something else'. I think the gist of your question is that this might not be an infection that was due to a healthcare system causing it which could be one interpretation of 'nosocomial'. The definition of "nosocomial infection" can be broad - and could be defined as any infection acquired in a hospital that was not present at admission. In that sense, I think one could agree that this falls under this definition because of the E. coli positive culture - which was acquired during the hospitalization. But others might interpret it as something more specific that was preventable. 

There could be some who argue that if this was associated with NEC, that this might not get at the spirit of what is classified as "nosocomial infection". I can understand that perspective. But so far in CPQCC, over the years, we have used the approach of including all late positive cultures as "nosocomial infection". 

As in everything in CPQCC, these reports are meant to help you / our centers assess their quality and track it. Couple things come to mind in this regard. If you noticed that your rate was high one period of time, and you noted that it may be due to this case where you can attribute to  perforation or NEC and this satisfies your concern about quality of care, then perhaps it's ok to leave things as is.