NICU Data Manual of Definitions
Total Page:16
File Type:pdf, Size:1020Kb
NICU Data Manual of Definitions 2020 2 Table of Contents Table of Contents ............................................................................................................... 2 Introduction ....................................................................................................................... 12 NICU Data Eligibility ......................................................................................................... 13 NICU Data DRD Form and Admission/Discharge Form ................................................. 17 Demographics ............................................................................................................... 17 Hospital ID [HOSPNO] .............................................................................................. 17 Infant ID [ID] .............................................................................................................. 17 Year of Birth [BYEAR] ............................................................................................... 17 Deleted Flag .............................................................................................................. 17 Item 1. Birth Weight [BWGT] .................................................................................... 17 Item 2. Head Circumference at Birth [BHEADCIR] .................................................. 18 Item 3. Best Estimate of Gestational Age [GAWEEKS], [GADAYS] ....................... 18 Infant's Date and Time of Birth ................................................................................. 18 Item 4a. Infant's Date of Birth [BDATE] ................................................................ 18 Item 4b. Infant's Time of Birth [BTIME] ................................................................. 19 Item 5. Infant Sex [SEX] ............................................................................................ 19 Item 6. Delivery Room Death [DELDIE] ................................................................... 19 Item 7a. Location of Birth [LOCATE] ........................................................................ 20 Item 7b. Day of NICU Admission [DAYADMISS] ..................................................... 21 Item 7c. Hospital Location of Birth [BIRTHLOCATION] ........................................... 21 Hospital Admission History ....................................................................................... 21 Item 8a. Previously Discharged Home [PDH] ...................................................... 21 Item 8b. Re-Admission After Previous Discharge Home [READMIT].................. 22 Maternal History ............................................................................................................ 22 Item 9. Maternal Birth Date and Age ........................................................................ 22 Maternal Birth Date [MDATE] ............................................................................... 22 Maternal Age [MAGE] ........................................................................................... 22 Item 10a. Mother's Hispanic Origin [HISP] ............................................................... 23 Item 10b. Mother's Race [MATRACE] ...................................................................... 23 Item 11. Prenatal Care [PCARE] .............................................................................. 25 Item 12. Group B Strep Positive [GROUPBSTREP] ................................................ 25 Antenatal Steroid Therapy ........................................................................................ 25 Item 13a. Antenatal Steroids Used [ASTER] ........................................................ 25 3 Item 13b. Is there documentation in the medical record of reasons for NOT initiating antenatal steroid therapy before delivery? [ASTERDOCUMENT] ........ 26 Item 13c. What was the documented reason for NOT administering antenatal steroids? [ASTERREASON] ................................................................................. 26 Item 14. Spontaneous Labor [SPLABOR] ................................................................ 27 Item 15a. Multiple Gestation [MULT] ........................................................................ 27 Item 15b. If Multiple Gestation, Number of Infants Delivered [NBIRTHS] ............... 28 Item 15c. If Multiple Gestation, Birth Order among all Multiple Infants Delivered [BIRTHORDER]......................................................................................................... 28 Item 16. Delivery Mode [DELMOD] .......................................................................... 28 Item 17a Maternal. Antenatal Maternal Conditions .................................................. 29 Hypertension [ANCMHYP] .................................................................................... 29 Chorioamnionitis [ANCMCHORIO] ....................................................................... 29 Other Infection [ANCMOINF] ................................................................................ 29 Diabetes [ANCMDIA] ............................................................................................. 29 Antenatal Magnesium Sulfate [ANCMAMAGSULF] ............................................. 30 Previous Cesarean [ANCMCES] .......................................................................... 30 Other [ANCMOTH], [ANCMDESC] ....................................................................... 30 Item 17b. Fetal Conditions ........................................................................................ 30 IUGR [ANCFIUGR] ................................................................................................ 31 Non-reassuring Fetal Status [ANCFDIS] .............................................................. 31 Anomaly [ANCFANO] ............................................................................................ 31 Other [ANCFOTH], [ANCFDESC] ......................................................................... 31 Item 17c. Obstetrical Conditions ............................................................................... 31 Preterm Labor [ANCOLABOR] ............................................................................. 32 Preterm Premature ROM [ANCOPREPROM] ...................................................... 32 Premature ROM before onset of labor [ANCOPREROM] .................................... 32 Prolonged ROM (>18 hours) [ANCOPROM] ........................................................ 32 Malpresentation/Breech [ANCOMAL] ................................................................... 33 Bleeding/Abruption/Previa [ANCOBLEED] ........................................................... 33 Other [ANCOOTH], [ANCODESC]........................................................................ 33 Item 18. Cesarean Section Indications ..................................................................... 33 Malpresentation/Breech [INDCESBR] .................................................................. 33 Multiple Gestation [INDCESMG] ........................................................................... 33 Fetal Distress [INDCESFD] ................................................................................... 34 4 Elective [INDCESER] ............................................................................................ 34 Dystocia / Failure to Progress [INDCESDY] ......................................................... 34 Placental Problems [INDCESPP].......................................................................... 34 Hypertension [INDCESHTN] ................................................................................. 35 Other [INDCESOTH], [INDCESDESC] ................................................................. 35 Delivery Room .............................................................................................................. 35 Delayed Cord Clamping ............................................................................................ 35 Item 19a. Was delayed umbilical cord clamping performed? [DCCDONE]......... 36 Item 19b. How long was umbilical cord clamping delayed? [DCCTIME]............. 36 Item 19c. If DCC was not done, reason why [OPTIONAL]? [DCCNOTWHY], [DCCNOTWHYDESC] ........................................................................................... 36 Item 19d. Was umbilical cord milking performed? [DCCCORDMILK] ................. 37 Item 19e. Did breathing begin before umbilical cord clamping? [DCCBREATH] 37 Item 20. APGAR Scores ........................................................................................... 37 1-Minute APGAR [AP1] ......................................................................................... 37 5-Minute APGAR [AP5] ......................................................................................... 37 10-Minute APGAR [AP10] ..................................................................................... 37 Perinatal Asphyxia .................................................................................................... 38 Item 21a. Suspected Encephalopathy or Suspected Perinatal Asphyxia or Low 5- Min and/or 10-Min Apgar Score [PA] .................................................................... 38 Item 21b. Is an Umbilical Cord Blood Gas or a Baby Blood Gas in the First Hour of Life Available? [GAS] .......................................................................................