This form is currently used by RPICC centers
for Tracking Morbidity and Mortality. It has been suggested that
FSN recommend to ACHA that this system of reporting morbidity and
mortality data be required for all level II and level III NICUs
in the state. This would give ACHA an objective measure to
compare outcomes between units. If you have comments, please post
them in the discussion section.
Morbidity Index Benchmarks for Quarter _________ ,
Fiscal Year ________
| Birth Weight |
<500g |
500-749g |
750-999g
|
1000-1249g |
1250-1499g |
1500-7999g |
| # Live Births |
|
|
|
|
|
|
| # Discharges |
|
|
|
|
|
|
| # Discharged Alive |
|
|
|
|
|
|
| Discharges Only |
Lived |
Died |
Lived |
|
Lived |
|
Lived |
|
Lived |
|
Lived |
|
| IVH |
|
|
|
|
|
|
|
|
|
|
|
|
| Hydrocephalus +/- shunt |
|
|
|
|
|
|
|
|
|
|
|
|
| Grade IV |
|
|
|
|
|
|
|
|
|
|
|
|
| Grade III |
|
|
|
|
|
|
|
|
|
|
|
|
| Grade II |
|
|
|
|
|
|
|
|
|
|
|
|
| Retinopathy |
|
|
|
|
|
|
|
|
|
|
|
|
| -Cryo or Laser Tx |
|
|
|
|
|
|
|
|
|
|
|
|
| -Stage III or worse |
|
|
|
|
|
|
|
|
|
|
|
|
| -Stage II |
|
|
|
|
|
|
|
|
|
|
|
|
| -Stage I |
|
|
|
|
|
|
|
|
|
|
|
|
| NEC |
|
|
|
|
|
|
|
|
|
|
|
|
| -Medical Rx Only |
|
|
|
|
|
|
|
|
|
|
|
|
| -Surgical Rx |
|
|
|
|
|
|
|
|
|
|
|
|
| Short Gut or
chronic TPN* |
|
|
|
|
|
|
|
|
|
|
|
|
| Chronic Lung
Disease** |
|
|
|
|
|
|
|
|
|
|
|
|
| PDA |
|
|
|
|
|
|
|
|
|
|
|
|
| -Medical Rx Only |
|
|
|
|
|
|
|
|
|
|
|
|
| -Surgical Ligation |
|
|
|
|
|
|
|
|
|
|
|
|
| Sepsis - Culture
Proven |
|
|
|
|
|
|
|
|
|
|
|
|
| -at Birth (1st 24h) |
|
|
|
|
|
|
|
|
|
|
|
|
| - 24-72 hours |
|
|
|
|
|
|
|
|
|
|
|
|
| - > 72 hrs (nosocomial) |
|
|
|
|
|
|
|
|
|
|
|
|
* Chronic TPN = > 3 months TPN or D/C Home on TPN.
** Chronic Lung Disease = Oxygen dependent at Discharge
Back to Top | Back to
Hot Topics Listing