SAMPLE. V.12.1 Special Report: Very Low Birthweight Neonates. I. Introduction

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1 I. Introduction V.12.1 Special Report: Very Low Birthweight Neonates The delivery of a very low birth weight infant continues to present many challenges to families and health care providers in spite of the advances of technology and new treatment modalities. The World Health Organization classifies very low birth weight infants (VLBW) as an infant born with birth weight lower than 1500g (up to and including 1499g), regardless of gestational age. Extremely low birth weight (ELBW) is defined as an infant born with birth weight lower than 1000g (up to and including 999g), regardless of gestational age. 1 According to the 2010 National Vital Statistics Report, in 2006 the mortality rate among infants with VLBW was per 1,000 live births. 2 Guidelines set forth from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists call for neonatal intensive care (NICU) for all infants with VLBW. 3 In order to determine how closely the guidelines were being met, the CDC analyzed birth data from 2006 from 19 states. The analysis reports that 79.3 infants with VLBW were admitted to NICUs (range: 63.7% in California to 93% in North Dakota). The report represents only 19 states since the needed data available was limited. These 19 states encompass 49 live birth in the US for A meta-analysis by Lasswell et al. indicates the survival rate is highest when infants with VLBW are born at level III facilities, citing a study that VLBW infants born at a level III facility were 51% more likely to survive than infants born at a lower-level facility. 5 This underlines the need for regionalized perinatal centers with access to level III nurseries. Many health issues confront the VLBW infant. Bronchopulmonary dysplasia (BPD) is one of the complications occurring in VLBW infants. It has been associated with a six fold risk for delayed discharge. 6 This longer NICU stay has a significant impact on families from a multitude of perspectives. A population-based study of 10,134 infants, 19% who were diagnosed with BPD, identified BPD as a significant factor in length of hospitalization for VLBW infants. 7 The actual LOS of infants with BPD was approximately double of that of infants without BPD, and after adjustment for potential confounders an excess LOS of almost 4 weeks was present. 8 Infection is an on-going concern with VLBW infants. The CDC defines late-onset neonatal sepsis as a systemic disease that occurs after 48 hours of age and is a major cause of morbidity and mortality in VLBW infants. 9 Hypothermia is an important risk factor for VLBW infants. The California Perinatal Quality Care Collaborative (CPQCC) studied hypothermia in a cohort of 8,782 VLBW infants born in a NICU from January 1, 2006 to December 31, Results showed 56.2 infants were Page 1

2 hypothermic with moderate hypothermia associated with higher risk of intraventricular hemorrhage (IVH) and moderate and severe conditions were associated with death. 10 Respiratory distress syndrome (RDS) is a frequent complication in the VLBW infant. The use of corticosteroids to accelerate lung maturity before birth and exogenous surfactant treatment of RDS has contributed to advances in management of the disease. 11 In a study by Shani et al, the risks of early onset sepsis in VLBW infants was associated with higher mortality and poor long term outcomes related to increased incidence of RDS and IVH. 12 While antibiotics may assist in prevention of some infections in the VLBW infant with RDS, these drugs may also increase the risk of infection by resistant strains of bacteria and fungal infections. 13 Systemic fungal infections have been associated with the development of all degrees of retinopathy of prematurity (ROP) and severe ROP in VLBW infants. 14 Markers of fetal condition (abnormal biophysical profile score), intrapartum conditions (cord artery acidosis, severe metabolic or hematological issues) and transition to neonatal life (low Apgar score at 10 minutes relate to frequency of IVH. 15 In extremely low birth weight infants, left to right shunting through a patent ductus arteriosis (PDA) increases the risk of pulmonary hemorrhage and IVH. 16 The long term consequences for VLBW infants experiencing IVH remains a major research focus. In conclusion, the threats to the health and well-being of the VLBW infant are multiple and require the skills of a highly qualified team of health care providers with expertise in managing these high risk neonates. Certainly the efforts to reduce the incidence of VLBW infants through comprehensive, accessible prenatal care for high-risk pregnant women should be a major focus of health care initiatives nationwide. II. Descriptions of Tables and Graphs This V12.1 Special Report: Very Low Birthweight (VLBW) Neonates is designed to provide your with a focused analysis of your highest risk neonates in comparison to the averages found in all five NPIC/QAS subgroups and the NPIC/QAS. Since many pre-viable infants do not make it to the special care nursery, we further refined this analysis to look only at those VLBW infants who did receive care in the special care nursery (Tables 2-7). Special care is defined as those discharges having neonatal intensive care (NICU) or neonatal intermediate care (NINT) accommodation days or charges on the data submission. Medical record numbers of those cases driving your rates are available by ing mservices@npic.org; we are also happy to answer any questions you may have regarding this analysis. Table 1: Overview Table 1 displays data for your neonatal population by birthweight category. While the focus in this report is very low birthweight (VLBW) infants, subdivided into inborns and those that are Page 2

3 transferred in, Table 1 puts your neonatal VLBW population (highlighted) in the context of your entire neonatal population. We identify your total neonatal discharges 0-28 days old at admission for the period 4/1/2011-3/31/2012, the subset of those that are inborn and those that are transferred in from a referring hospital. Table 1 displays the count and percent of total of your neonatal cases by birthweight category and admission source subdivided into inborns and transfers in. The table also displays the average count and percent of total for each of the five NPIC/QAS subgroups (please refer to page 108, Appendix B in your V12.1 Quarterly Report for the subgroup definitions) and the NPIC/QAS database. Graph 1: Very Low Birthweight (VLBW) Neonatal Trend Rates (Q1) Graph 1 displays five years and one quarter of VLBW trend data for all neonates (inborns and transfers in) by BW category from our Trend, a subset of 52 hospitals that have been NPIC/QAS members for at least this 5 year and 1 quarter period. The table at the bottom of the graph shows the percent of total neonates for the period by category and the percent change from 2007 to Table 2 and 3: Utilization VLBW Special Care Inborns/Transfers In Table 2 (Inborns) and Table 3 (Transfers In) display average length of stay and average charge by VLBW category for your hospital, all the NPIC/QAS subgroups and the data base. The tables also identify your case mix index (CMI) by VLBW category and the resulting adjusted length of stay and adjusted charge calculated by dividing the ALOS and actual charge by the case mix index. Please refer to pages 3-4 of V12.1 Quarterly Report for a discussion of the case mix index and adjustment process. (If your hospital has no cases in a particular birthweight category, there will be only dashes displayed. Some subgroup averages will round down to 0, but there will be average LOS or charge data that can be calculated.) Table 4 and 5: VLBW Special Care Inborns/Transfers In by Discharge Disposition Tables 4 and 5 displays your inborns and transfers in by discharge disposition within VLBW category. There are four categories displayed: home (with/without home health services), transferred out within 3 days (generally considered to be up transfers for a higher level of care or service you do not provide), died, and all other. The all other category includes infants transferred out after 3 days, likely back transfers. Table 6 and 7: Complications - VLBW Special Care Inborns/ Transfers In Tables 6 and 7 display data on seven complications often see in this VLBW population subdivided into those that are inborns and those transferred in. Each table identifies your count of cases with the coded complication and the percent of total within the VLBW category. These groupings are not mutually exclusive since VLBW infants generally have multiple complications. Please refer to the Glossary for the ICD-9-CM diagnosis codes for each complication. Page 3

4 Table 8 and 9: Procedures VLBW Special Care Inborns/Transfers IN Table 8 (Inborns) and Table 9 (Transfers In) displays rates of procedures frequently performed on VLBW infants for your hospital and average rates for the five NPIC/QAS subgroups and the data base average. The procedures are not mutually exclusive since these VLBW infants can have multiple procedures during the course of their hospital stay. The Glossary contains the ICD-9-CM codes for each procedure. Graph 2: VLBW Neonatal Analysis of NPIC/QAS Recorded Numeric Birthweight vs. Recorded Numeric Gestational Age Graph 2 is a scatter gram that displays the correlation of VLBW and gestational age (GA) for the entire NPIC/QAS population of neonates with numeric birthweight and numeric gestational age. The graph also displays the correlation coefficient for the entire population. GLOSSARY COMPLICATIONS (DISPLAYED IN TABLES 6 AND 7) BRONCHOPULMONARY DYSPLASIA (BPD): ICD-9 Code 770.7: Chronic respiratory disease arising in the perinatal period. Bronchopulmonary dysplasia Interstitial pulmonary fibrosis of prematurity Wilson-Mikity syndrome RESPIRATORY DISTRESS SYNDROME (RDS): ICD-9 Code 769: Respiratory distress syndrome. Cardiorespiratory distress syndrome of newborn Hyaline membrane disease (pulmonary) RETINOPATHY OF PREMATURITY(ROP) ICD-9 Codes Stage Stage Stage 5 With eye procedure 14.2x Destruction of Lesion of Retina and Choroid Or 14.3x Repair of Retinal Tear NECROTIZING ENTEROCOLITIS ICD-9 Codes Unspecified Stage I broad spectrum with non-specific signs including feeding intolerance, sepsis, gastroenteritis, ileus, metabolic abnormalities (without pneumatosis, without perforation) Stage II NEC with pneumatosis, without perforation Stage III NEC with perforation, NEC with pneumatosis and perforation With surgery: ICD-9 Procedure Codes 45.6x other excision of small intestine 45.7x open and other partial excision of large intestine 45.9 intestinal anastomosis Page 4

5 46.0x-46.9x other operations of intestine INTRAVENTRICULAR HEMORRHAGE (IVH): ICD-9 Codes Grade III Bleeding with enlargement of ventricle Grade IV Bleeding into cerebral cortex PATENT DUCTUS ARTERIOSUS (PDA) ICD-9 Code 747.0: Patent ductus arteriosus Patent ductus Botalli Persistent ductus arteriosus PROCEDURES (DISPLAYED IN TABLES 8 AND 9) ICD-9 Codes Arterial catheterization Umbilical vein catheterization Venous catheterization, not elsewhere classified Non-invasive mechanical ventilation Continuous invasive mechanical ventilation for less than 96 consecutive hours Continuous invasive mechanical ventilation for 96 consecutive hours or more REFERENCES 1. World Health Organization. Department of Reproductive Health and Research. Kangaroo Mother Care: A practical guide Geneva, World Health Organization Available at 2. National Vital Statistics Report. National Center for Health Statistics. March 31, 2010; 58 (14): American Academy of Pediatrics and the American College of Obstetricians and gynecologists. Guidelines for perinatal care. 6 th ed. Elk Grove Village, IL: American Academy of Pediatrics; Centers for Disease Control. Morbidity and Mortality Weekly. Neonatal Intensive Care Unit Admissions of Infants with Very Low Birth weight- 19 States, Weekly November 12, 2010; 59(44): Lasswell. SM, Barfield, WD, Rochat RW, Blackmon L. Perinatal Regionalization for very low-birth-weight and very preterm infants: a meta-analysis. JAMA 2010; 301: Klinger G., Reichman B., Sirota l., Lusky A., Linder N. in collaboration with the Israel Neonatal Network. Delayed discharge in very low birth weight infant. ACTA Paediatrica 2005; 94: Klinger, G., Sirota L., Lusky A., Reichman B., in collaboration with the Page 5

6 Israel Neonatal Network. Bronchopulmonary dysplasia in very low weight infants is associated with prolonged hospital stay. Journal of Perinatology 2006;26: Ibid, pg Bizzarro, M., Raskind, C., Baltimore R et al. Seventy five years of neonatal sepsis at Yale: Pediatrics 2005; 116: Miller, S.S., Lee, H.C., Gould, J.B. Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. Journal of Perinatology 2011; 31: Halliday, H.L..History of surfactant from Biol Neonate. 2005; 87 (4): Shani, L., Weitzman, D, Melamed, R., Zmora, E., Marks, K. Risk factors for early sepsis in very low birth weight neonates with respiratory distress syndrome. Acta Paediatrica. 2008; 97: Ibid 14. Bharwani, S.K., Dhanireddy, R. Systemic fungal infection is associated with the development of retinopathy of prematurity in very low birth weight infants: a Metareview. Journal of Perinatology. 2008; 28: Baschat, A.A., Gembruch, R., Viscardi, R.M., Gortners, L., Harman, C.R. Antenatal prediction of intraventricular hemorrhage in fetal growth restriction: what is the role of Doppler? Ultrasound Obstetrics Gynecology. 2002; 19: Hitomi, S., Sakai, H., Ueda, M, Yoshikata, M., Mizobuchi, M., Nakao, H. Prophylactic Indomethacin in extremely premature infants between 23 and 24 weeks gestation. Pediatrics International 2010; 52: Page 6

7 Total Neonates 1 Total Inborns 2 Total Transfers In 3,901 Inborns by BW Category Total Total Less than 500 grams 6 0.2% 7 0.2% % 2 0.1% % 9 0.4% 9 0.2% grams % % % 4 0.1% % % % grams % % % 4 0.1% % % % 1,000-1,249 grams % % % 5 0.2% % % % 1,250-1, % % % 7 0.3% % % % Subtotal VLBW Inborns % % % % % % % 1,500-1,749 grams % % % % % % % 1,750-1,999 grams % % % % % % % 2,000-2,499 grams % % % % % % % 2,500 grams and over 3, % 3, % 3, % 2, % 8, % 2, % 3, % Unspecified 3 0.1% % % % % % % Total Inborns 3,667 3,944 4,299 2,245 9,135 2,540 4,266 Transfers In by BW Category Total Total Less than 500 grams 0 0.0% 0 0.5% 0 0.0% 0 0.0% 0 0.1% 1 0.2% 0 0.2% grams 0 0.0% 1 2.7% 1 3.6% 0 0.9% 1 5.5% 4 5.8% 1 3.6% grams 0 0.0% 1 6.4% 1 1.5% 0 1.2% 1 3.0% 5 2.0% 1 2.8% 1,000-1,249 grams 0 0.0% 1 4.9% 1 1.4% 0 1.2% 1 3.2% 4 2.3% 1 2.6% 1,250-1, % % 2 5.8% 0 6.6% 1 3.8% 3 3.3% 1 6.2% Subtotal VLBW Transfers In 2 2.2% % % 1 9.8% % % % 1,500-1,749 grams 2 2.2% 1 3.4% 2 5.0% 0 3.4% 2 4.8% 3 2.7% 1 4.0% 1,750-1,999 grams 4 4.4% % 3 4.8% % 2 4.2% 6 5.6% 2 8.8% 2,000-2,499 grams % 2 7.1% % % % % % 2,500 grams and over % % % % % % % Unspecified 3 3.3% % % % % % % Total Transfers In Total Neonates includes inborns and other neonatal admits (e.g. readmits and transfers in <= 28 days old at admission). 2 Subgroup and averages exclude hospitals that do not have inborns. V12. 1 Special Report: Very Low Birthweight Neonates Table 1: Overview 4,037 4,513 2,540 4, Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. 2,297 9,318 3,667 3,944 4,299 2,245 9, ,538 4,358 Subgroup: AR - Academic, Regional Perinatal Centers Page 7

8 Total Neonates 1 Total Inborns 2 Total Transfers In 3,901 V12. 1 Special Report: Very Low Birthweight Neonates Table 1: Overview 4,037 4,513 2,297 9,318 3,667 3,944 4,299 2,245 9, ,538 4,358 2,540 4, Total Inborns/Transfers In by BW Category Total Total Less than 500 grams 6 0.2% 7 0.2% % 2 0.1% % 9 0.4% 9 0.2% grams % % % 4 0.1% % % % grams % % % 4 0.1% % % % 1,000-1,249 grams % % % 5 0.2% % % % 1,250-1, % % % 7 0.3% % % % Subtotal VLBW Neonates % % % % % % % 1,500-1,749 grams % % % % % % % 1,750-1,999 grams % % % % % % % 2,000-2,499 grams % % % % % % % 2,500 grams and over 3, % 3, % 3, % 2, % 8, % 1, % 3, % Unspecified 6 0.2% % % % % % % Total Inborns/Transfers In 3,759 3,968 4,377 2,250 9,179 2,369 4,256 1 Total Neonates includes inborns and other neonatal admits (e.g. readmits and transfers in <= 28 days old at admission). 2 Subgroup and averages exclude hospitals that do not have inborns. Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 8

9 Graph 1: Very Low Birthweight (VLBW) Neonatal Trend Rates (Q1)Percent of Total Neonates by Birthweight Category Graph 1: Very Low Birthweight (VLBW) Neonatal Trend Rates (Q1) (Q1) Percent of Total Neonates by Birthweight Category Total Neonates 0.9% Total VLBW 0.8% Neonates Percent of total neonates 2.9% 2.7% 2.8% 2.7% 2.7% 2.5% Less than 0.7% 500 grams Percent of total neonates 0.3% 0.3% 0.3% 0.2% 0.3% 0.2% 0.6% grams Percent of 0.5% total neonates 0.6% 0.5% 0.5% 0.5% 0.5% 0.4% grams % Percent of total neonates 0.6% 0.5% 0.6% 0.6% 0.6% 0.5% 1,000-1, % grams Percent of total neonates 0.6% 0.6% 0.7% 0.6% 0.6% 0.6% 1,250-1, % Percent of total neonates 0.1% 0.8% 0.8% 0.8% 0.8% 0.8% 0.7% Percent of Total Neonates 0.0% (Q1) Pct Change Total Neonates * 4,947 4,914 4,720 4,564 4,513 1, % VLBW < 1,500 grams Trend Rate 2.88% 2.66% 2.78% 2.73% 2.65% 2.46% -7.99% Less than 500 grams 0.27% 0.26% 0.25% 0.22% 0.25% 0.20% -7.41% grams 0.58% 0.49% 0.52% 0.54% 0.48% 0.41% % grams 0.60% 0.51% 0.62% 0.57% 0.56% 0.54% -6.67% 1,000-1,249 grams 0.64% 0.64% 0.65% 0.64% 0.62% 0.61% -3.13% 1,250-1, % 0.77% 0.75% 0.76% 0.75% 0.71% -5.06% * Trend Inborns and Transfers In (Q1) Less than 500 grams grams grams 1,000-1,249 grams 1,250-1,499 grams Page 9

10 Table 2: Utilization - VLBW Special Care Inborns Total Inborns 3,667 3,944 4,299 2,245 9,135 2,540 4,266 Total Inborns with Special Care , Percent of Total Inborns 13.7% 14.6% 16.0% 10.8% 14.3% 16.0% 14.3% Total Very Low Birthweight (VLBW) Inborns VLBW Inborns with Special Care Percent of Total VLBW Inborns 90.0% 89.5% 90.5% 90.9% 87.6% 92.0% 89.2% VLBW Special Care Inborns by BW Category Less than 500 grams grams grams ,000-1,249 grams ,250-1, VLBW Special Care Inborn ALOS by BW Category Less than 500 grams grams grams ,000-1,249 grams ,250-1, VLBW Special Care Inborn Total Charge by BW Category $418,553 $295,622 $397,939 $101,125 $353,731 $191,926 $270,801 Less than 500 grams $226,389 $237,959 $354,408 $111,767 $368,707 $114,529 $271, grams $541,852 $469,958 $520,868 $123,563 $527,259 $283,439 $410, grams $586,769 $378,562 $543,229 $156,762 $450,507 $256,438 $379,976 1,000-1,249 grams $446,894 $316,897 $378,060 $110,261 $317,364 $186,997 $269,067 1,250-1,499 $298,619 $188,101 $279,261 $91,812 $224,629 $108,305 $187,798 Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 10

11 Table 2: Utilization - VLBW Special Care Inborns Total Inborns 3,667 3,944 4,299 2,245 9,135 2,540 4,266 Total Inborns with Special Care , Percent of Total Inborns 13.7% 14.6% 16.0% 10.8% 14.3% 16.0% 14.3% Total Very Low Birthweight (VLBW) Inborns VLBW Inborns with Special Care Percent of Total VLBW Inborns 90.0% 89.5% 90.5% 90.9% 87.6% 92.0% 89.2% VLBW Special Care Inborn Case Mix Index by BW Category Less than 500 grams grams grams ,000-1,249 grams ,250-1, VLBW Special Care Inborn CMI Adjusted ALOS by BW Category Less than 500 grams grams grams ,000-1,249 grams ,250-1, VLBW Special Care Inborn CMI Adjusted Total Charge by BW Category $40,421 $32,278 $35,793 $18,559 $32,609 $18,062 $29,614 Less than 500 grams $26,693 $21,587 $28,211 $12,430 $33,921 $16,244 $25, grams $25,728 $27,887 $27,673 $13,759 $28,557 $16,239 $25, grams $46,068 $31,767 $36,397 $16,445 $31,222 $17,273 $29,031 1,000-1,249 grams $40,406 $34,296 $39,138 $19,482 $35,757 $19,958 $31,950 1,250-1,499 $57,860 $34,899 $43,306 $23,206 $37,462 $20,251 $34,541 Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 11

12 V12. 1 Special Report: Very Low Birthweight Infants Table 3: Utilization - VLBW Special Care Transfers In Total Transfers In Total Transfers In with Special Care Percent of Total Transfers In 83.7% 70.8% 88.5% 80.0% 84.1% 69.2% 77.6% Total Very Low Birthweight (VLBW) Transfers In VLBW Transfers In with Special Care Percent of Total VLBW Transfers In 100.0% 100.0% 100.0% 100.0% 83.3% 100.0% 85.7% VLBW Special Care Transfers In by BW Category Less than 500 grams grams grams ,000-1,249 grams ,250-1, VLBW Special Care Transfers In ALOS by BW Category Less than 500 grams grams grams ,000-1,249 grams ,250-1, VLBW Special Care Transfers In Total Charge by BW Category $235,121 $411,306 $373,510 $76,327 $347,458 $190,574 $307,012 Less than 500 grams -- $511,865 $99,889 $0 $12,026 $228,723 $265, grams -- $558,559 $462,153 $237,751 $187,479 $252,018 $340, grams -- $578,155 $424,833 $220,932 $359,429 $381,250 $424,664 1,000-1,249 grams -- $273,748 $463,819 $52,695 $311,816 $264,338 $314,639 1,250-1,499 $235,121 $96,114 $271,365 $32,137 $286,063 $98,574 $190,271 Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 12

13 V12. 1 Special Report: Very Low Birthweight Infants Table 3: Utilization - VLBW Special Care Transfers In Total Transfers In Total Transfers In with Special Care Percent of Total Transfers In 83.7% 70.8% 88.5% 80.0% 84.1% 69.2% 77.6% Total Very Low Birthweight (VLBW) Transfers In VLBW Transfers In with Special Care Percent of Total VLBW Transfers In 100.0% 100.0% 100.0% 100.0% 83.3% 100.0% 85.7% VLBW Special Care Transfers In Case Mix Index by BW Category Less than 500 grams grams grams ,000-1,249 grams ,250-1, VLBW Special Care Transfers In CMI Adjusted ALOS by BW Category Less than 500 grams grams grams ,000-1,249 grams ,250-1, VLBW Special Care Transfers In CMI Adjusted Total Charge by BW Category $14,300 $27,789 $29,568 $14,840 $29,566 $16,525 $26,038 Less than 500 grams -- $69,535 $6,299 $0 $1,418 $24,938 $27, grams -- $23,086 $23,997 $16,126 $12,590 $15,055 $19, grams -- $33,549 $27,845 $10,157 $20,806 $21,570 $25,207 1,000-1,249 grams -- $24,953 $35,241 $14,723 $34,520 $19,628 $28,081 1,250-1,499 $14,300 $10,071 $33,815 $27,608 $39,097 $14,400 $27,528 Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 13

14 Table 4: VLBW Special Care Inborns by Discharge Disposition Total Inborns 3,667 3,944 4,299 2,245 9,135 2,540 4,266 Total Inborns with Special Care , Percent of Total Inborns 13.7% 14.6% 16.0% 10.8% 14.3% 16.0% 14.3% Total Very Low Birthweight (VLBW) Inborns VLBW Inborns with Special Care Percent of Total VLBW Inborns 90.0% 89.5% 90.5% 90.9% 87.6% 92.0% 89.2% VLBW Special Care Inborns < 1500 grams % Discharged to home with/without home health services 90.1% 74.4% 79.3% 53.3% 77.8% 80.7% 71.1% % Transferred out within 3 days 0.0% 11.6% 0.5% 33.6% 0.9% 0.9% 11.8% % Died 7.4% 5.2% 8.9% 4.8% 7.6% 10.6% 7.0% % Other/missing 2.5% 8.8% 11.3% 8.3% 13.7% 7.8% 10.1% VLBW Special Care Inborns < 500 grams % Discharged to home with/without home health services 0.0% 13.5% 19.8% 35.7% 26.0% 14.3% 21.6% % Transferred out within 3 days 0.0% 0.0% 0.0% 0.0% 2.0% 0.0% 0.4% % Died 100.0% 70.8% 65.1% 57.1% 63.1% 71.4% 65.4% % Other/missing 0.0% 15.6% 15.2% 7.1% 9.0% 14.3% 12.5% VLBW Special Care Inborns grams % Discharged to home with/without home health services 50.0% 61.9% 49.3% 15.4% 57.7% 52.0% 47.1% % Transferred out within 3 days 0.0% 8.3% 0.5% 56.0% 1.7% 0.0% 13.1% % Died 41.7% 17.1% 27.7% 8.2% 20.7% 29.2% 20.6% % Other/missing 8.3% 12.6% 22.5% 20.4% 20.0% 18.8% 19.2% VLBW Special Care Inborns grams % Discharged to home with/without home health services 100.0% 68.7% 76.2% 43.1% 72.8% 76.4% 66.8% % Transferred out within 3 days 0.0% 14.6% 0.2% 32.9% 0.9% 1.2% 10.6% % Died 0.0% 4.9% 7.7% 9.8% 9.1% 11.4% 8.2% % Other/missing 0.0% 11.9% 16.0% 14.3% 17.2% 11.0% 14.4% VLBW Special Care Inborns 1,000-1,249 grams % Discharged to home with/without home health services 100.0% 87.8% 89.9% 71.0% 85.9% 95.6% 84.6% % Transferred out within 3 days 0.0% 0.3% 0.4% 23.3% 0.7% 0.4% 6.3% % Died 0.0% 2.7% 2.7% 0.0% 2.7% 0.3% 1.8% % Other/missing 0.0% 9.1% 7.0% 5.8% 10.8% 3.7% 7.4% VLBW Special Care Inborns 1,250-1,499 grams % Discharged to home with/without home health services 97.0% 81.7% 90.8% 70.4% 87.6% 93.3% 83.5% % Transferred out within 3 days 0.0% 11.7% 1.2% 22.8% 0.5% 1.9% 8.7% % Died 0.0% 0.3% 1.0% 0.0% 1.3% 2.1% 0.8% % Other/missing 3.0% 6.3% 7.0% 6.9% 10.6% 2.8% 7.0% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 14

15 Table 5: VLBW Special Care Transfers In by Discharge Disposition Total Transfers In Total Transfers In with Special Care Percent of Total Transfers In 83.7% 70.8% 88.5% 80.0% 84.1% 69.2% 77.6% Total Very Low Birthweight (VLBW) Transfers In VLBW Transfers In with Special Care Percent of Total VLBW Transfers In 100.0% 100.0% 100.0% 100.0% 83.3% 100.0% 85.7% VLBW Special Care Transfers In < 1,500 grams % Discharged to home with/without home health services 100.0% 63.0% 68.4% 67.7% 54.4% 57.8% 62.3% % Transferred out within 3 days 0.0% 0.0% 2.0% 12.5% 0.0% 1.3% 2.1% % Died 0.0% 4.5% 13.7% 3.1% 18.0% 21.3% 13.5% % Other/missing 0.0% 32.5% 15.9% 16.7% 27.6% 19.6% 22.1% VLBW Special Care Transfers In < 500 grams % Discharged to home with/without home health services % 0.0% 0.0% 0.0% 20.0% 23.3% % Transferred out within 3 days % 0.0% 0.0% 0.0% 20.0% 6.7% % Died % 100.0% 0.0% 100.0% 60.0% 53.3% % Other/missing % 0.0% 0.0% 0.0% 0.0% 16.7% VLBW Special Care Transfers In grams % Discharged to home with/without home health services % 39.6% 66.7% 28.6% 38.1% 42.1% % Transferred out within 3 days % 0.0% 0.0% 0.0% 1.1% 0.3% % Died % 39.6% 33.3% 66.7% 24.4% 41.5% % Other/missing % 20.8% 0.0% 4.8% 36.4% 16.1% VLBW Special Care Transfers In grams % Discharged to home with/without home health services % 37.5% 100.0% 66.7% 66.4% 59.4% % Transferred out within 3 days % 0.0% 0.0% 0.0% 2.9% 0.5% % Died % 25.0% 0.0% 16.7% 19.9% 16.7% % Other/missing % 37.5% 0.0% 16.7% 10.8% 23.5% VLBW Special Care Transfers In 1,000-1,249 grams % Discharged to home with/without home health services % 85.7% 100.0% 54.0% 74.2% 71.3% % Transferred out within 3 days % 0.0% 0.0% 0.0% 1.2% 0.3% % Died % 0.0% 0.0% 0.0% 23.4% 5.6% % Other/missing % 14.3% 0.0% 46.0% 1.2% 22.8% VLBW Special Care Transfers In 1,250-1,499 grams % Discharged to home with/without home health services 100.0% 50.0% 75.5% 58.3% 55.6% 73.7% 66.8% % Transferred out within 3 days 0.0% 0.0% 7.4% 16.7% 0.0% 0.0% 4.3% % Died 0.0% 20.0% 1.4% 0.0% 16.7% 5.9% 7.2% % Other/missing 0.0% 30.0% 15.7% 25.0% 27.8% 20.5% 21.7% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 15

16 Table 6: Complications - VLBW Special Care Inborns Total Inborns 3,667 3,944 4,299 2,245 9,135 2,540 4,266 Total Inborns with Special Care , Percent of Total Inborns 13.7% 14.6% 16.0% 10.8% 14.3% 16.0% 14.3% Total Very Low Birthweight (VLBW) Inborns VLBW Inborns with Special Care Percent of Total VLBW Inborns 90.0% 89.5% 90.5% 90.9% 87.6% 92.0% 89.2% VLBW Special Care Inborns < 1,500 grams BPD/RDS/Proportion of BPD to RDS % BPD 7.4% (6) 15.9% (15) 16.7% (16) 7.4% (4) 20.8% (38) 15.4% (16) 14.6% (16) % RDS 44.4% (36) 63.8% (53) 63.1% (59) 49.2% (14) 67.8% (114) 62.5% (67) 60.2% (56) % BPD/RDS 11.1% (4) 19.1% (13) 19.4% (12) 8.4% (4) 24.2% (29) 18.2% (14) 17.1% (13) Retinopathy of Prematurity % ROP with eye procedure 1.2% 0.2% 0.4% 0.1% 0.4% 0.2% 0.3% % ROP without eye procedure 1.2% 1.1% 2.4% 1.2% 1.6% 2.6% 1.7% Necrotizing Enterocolitis % NEC with surgery 1.2% 0.5% 1.7% 0.1% 1.0% 2.1% 0.9% % NEC without surgery 4.9% 5.8% 6.5% 1.6% 5.8% 6.6% 4.9% Intraventricular Hemorrhage % IVH 34.6% 17.5% 20.6% 9.9% 23.9% 18.4% 17.4% % IVH Grade III 4.9% 2.0% 3.3% 0.4% 3.0% 3.3% 2.2% % IVH Grade IV 1.2% 1.9% 2.8% 0.6% 3.2% 3.7% 2.2% % Patent Ductus Arteriosus (PDA) 14.8% 27.4% 31.2% 13.7% 29.3% 21.1% 24.4% % Central venous catheter Infections Dx % 0.3% 0.8% 0.3% 0.2% 0.1% 0.4% Dx % 0.1% 0.3% 0.0% 0.1% 0.0% 0.1% VLBW Special Care Inborns < 500 grams BPD/RDS/Proportion of BPD to RDS % BPD 0.0% (0) 11.5% (0) 17.1% (1) 14.3% (0) 31.1% (2) 0.0% (0) 16.2% (1) % RDS 100.0% (1) 46.9% (2) 74.2% (2) 14.3% (0) 75.0% (3) 57.6% (1) 58.0% (2) % BPD/RDS 0.0% (0) 14.6% (0) 17.9% (0) 0.0% (0) 31.0% (1) 0.0% (0) 14.7% (0) Retinopathy of Prematurity % ROP with eye procedure 0.0% 0.0% 0.0% 0.0% 5.0% 0.0% 1.1% % ROP without eye procedure 0.0% 2.1% 0.0% 0.0% 1.4% 0.0% 0.7% Necrotizing Enterocolitis % NEC with surgery 0.0% 0.0% 5.0% 0.0% 2.6% 0.0% 2.1% % NEC without surgery 100.0% 12.0% 15.0% 0.0% 22.1% 0.0% 11.5% Intraventricular Hemorrhage % IVH 100.0% 5.2% 35.7% 7.1% 41.5% 7.1% 23.0% % IVH Grade III 100.0% 0.0% 16.9% 0.0% 4.8% 7.1% 7.3% % IVH Grade IV 0.0% 3.7% 3.6% 7.1% 18.6% 0.0% 6.9% % Patent Ductus Arteriosus (PDA) 0.0% 46.9% 39.2% 35.7% 26.1% 42.9% 37.7% % Central venous catheter Infections Dx % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Dx % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 16

17 Table 6: Complications - VLBW Special Care Inborns Total Inborns 3,667 3,944 4,299 2,245 9,135 2,540 4,266 Total Inborns with Special Care , Percent of Total Inborns 13.7% 14.6% 16.0% 10.8% 14.3% 16.0% 14.3% Total Very Low Birthweight (VLBW) Inborns VLBW Inborns with Special Care Percent of Total VLBW Inborns 90.0% 89.5% 90.5% 90.9% 87.6% 92.0% 89.2% VLBW Special Care Inborns grams BPD/RDS/Proportion of BPD to RDS % BPD 16.7% (2) 36.7% (6) 34.8% (5) 19.9% (3) 41.4% (14) 31.5% (6) 33.2% (6) % RDS 66.7% (8) 75.5% (11) 70.8% (10) 55.2% (5) 84.0% (23) 62.4% (13) 70.3% (12) % BPD/RDS 25.0% (2) 30.8% (5) 34.3% (3) 19.8% (2) 42.0% (10) 32.4% (5) 32.1% (5) Retinopathy of Prematurity % ROP with eye procedure 8.3% 0.5% 1.9% 0.0% 0.5% 1.1% 0.9% % ROP without eye procedure 8.3% 0.5% 4.5% 3.8% 2.8% 4.4% 3.2% Necrotizing Enterocolitis % NEC with surgery 8.3% 0.6% 5.6% 0.0% 1.8% 1.4% 2.3% % NEC without surgery 8.3% 7.5% 9.2% 5.6% 10.1% 7.1% 8.1% Intraventricular Hemorrhage % IVH 66.7% 34.4% 31.9% 8.7% 36.2% 36.6% 29.2% % IVH Grade III 8.3% 7.0% 6.2% 0.8% 5.1% 6.9% 5.2% % IVH Grade IV 8.3% 5.1% 7.7% 0.8% 6.4% 12.4% 6.1% % Patent Ductus Arteriosus (PDA) 33.3% 45.8% 51.7% 23.8% 47.6% 30.8% 41.9% % Central venous catheter Infections Dx % 0.6% 0.7% 0.0% 1.1% 0.0% 0.5% Dx % 0.8% 1.3% 0.0% 0.7% 0.0% 0.7% VLBW Special Care Inborns grams BPD/RDS/Proportion of BPD to RDS % BPD 16.7% (2) 24.0% (5) 30.4% (6) 19.1% (2) 34.1% (13) 23.7% (6) 26.6% (6) % RDS 50.0% (6) 76.6% (13) 73.5% (15) 61.8% (4) 79.8% (30) 78.4% (18) 73.3% (15) % BPD/RDS 16.7% (1) 22.7% (4) 31.5% (5) 20.8% (2) 34.3% (10) 25.4% (5) 27.2% (5) Retinopathy of Prematurity % ROP with eye procedure 0.0% 0.7% 0.3% 0.0% 0.3% 0.0% 0.3% % ROP without eye procedure 0.0% 0.6% 1.4% 0.0% 3.0% 0.8% 1.2% Necrotizing Enterocolitis % NEC with surgery 0.0% 0.8% 2.4% 0.3% 1.4% 2.2% 1.4% % NEC without surgery 16.7% 8.3% 8.0% 2.4% 5.6% 14.4% 7.1% Intraventricular Hemorrhage % IVH 58.3% 20.2% 31.3% 16.3% 31.3% 24.2% 24.9% % IVH Grade III 8.3% 1.9% 5.5% 1.1% 5.3% 4.7% 3.7% % IVH Grade IV 0.0% 2.8% 4.6% 1.9% 5.7% 7.3% 4.1% % Patent Ductus Arteriosus (PDA) 16.7% 39.9% 44.8% 25.4% 42.5% 39.2% 38.5% % Central venous catheter Infections Dx % 0.4% 2.3% 2.4% 0.0% 0.0% 1.2% Dx % 0.3% 0.1% 0.0% 0.0% 0.0% 0.1% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 17

18 Table 6: Complications - VLBW Special Care Inborns Total Inborns 3,667 3,944 4,299 2,245 9,135 2,540 4,266 Total Inborns with Special Care , Percent of Total Inborns 13.7% 14.6% 16.0% 10.8% 14.3% 16.0% 14.3% Total Very Low Birthweight (VLBW) Inborns VLBW Inborns with Special Care Percent of Total VLBW Inborns 90.0% 89.5% 90.5% 90.9% 87.6% 92.0% 89.2% VLBW Special Care Inborns 1,000-1,249 grams BPD/RDS/Proportion of BPD to RDS % BPD 8.7% (2) 17.5% (4) 13.0% (3) 3.9% (1) 14.0% (6) 14.1% (4) 11.9% (3) % RDS 39.1% (9) 64.0% (15) 66.0% (18) 58.3% (4) 68.5% (30) 66.7% (20) 64.2% (16) % BPD/RDS 11.1% (1) 24.3% (4) 14.2% (3) 5.9% (1) 15.5% (5) 16.6% (4) 14.5% (3) Retinopathy of Prematurity % ROP with eye procedure 0.0% 0.0% 0.0% 0.7% 0.7% 0.0% 0.3% % ROP without eye procedure 0.0% 2.1% 4.5% 0.0% 0.9% 2.4% 2.0% Necrotizing Enterocolitis % NEC with surgery 0.0% 0.6% 1.1% 0.0% 0.6% 4.2% 1.0% % NEC without surgery 0.0% 7.2% 6.9% 1.5% 4.1% 4.0% 4.8% Intraventricular Hemorrhage % IVH 30.4% 16.5% 14.8% 8.5% 19.8% 14.5% 14.4% % IVH Grade III 4.4% 3.8% 1.1% 0.3% 2.6% 1.9% 1.8% % IVH Grade IV 0.0% 1.6% 1.7% 0.0% 1.2% 0.0% 1.0% % Patent Ductus Arteriosus (PDA) 17.4% 32.8% 27.1% 12.6% 23.9% 15.5% 22.7% % Central venous catheter Infections Dx % 0.2% 0.7% 0.0% 0.0% 0.0% 0.2% Dx % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% VLBW Special Care Inborns 1,250-1,499 grams BPD/RDS/Proportion of BPD to RDS % BPD 0.0% (0) 3.7% (1) 4.6% (1) 1.3% (0) 6.4% (3) 3.1% (1) 3.8% (1) % RDS 36.4% (12) 56.7% (15) 49.4% (14) 52.1% (5) 52.4% (28) 48.5% (15) 52.0% (14) % BPD/RDS 0.0% (0) 5.5% (1) 6.2% (1) 1.8% (0) 9.0% (3) 2.7% (1) 5.1% (1) Retinopathy of Prematurity % ROP with eye procedure 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% % ROP without eye procedure 0.0% 0.6% 1.7% 2.5% 0.4% 2.8% 1.5% Necrotizing Enterocolitis % NEC with surgery 0.0% 0.0% 0.5% 0.0% 0.2% 0.6% 0.2% % NEC without surgery 0.0% 2.3% 3.3% 1.2% 4.7% 3.2% 2.8% Intraventricular Hemorrhage % IVH 15.2% 15.0% 12.5% 10.2% 15.0% 9.2% 12.5% % IVH Grade III 0.0% 0.8% 1.5% 0.0% 1.0% 1.2% 0.8% % IVH Grade IV 0.0% 0.2% 0.5% 0.0% 0.3% 0.0% 0.2% % Patent Ductus Arteriosus (PDA) 6.1% 12.6% 15.3% 7.9% 13.3% 6.9% 11.7% % Central venous catheter Infections Dx % 0.0% 0.3% 0.0% 0.0% 0.4% 0.1% Dx % 0.0% 0.2% 0.0% 0.0% 0.0% 0.1% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 18

19 Table 7: Complications - VLBW Special Care Transfers In Total Transfers In Total Transfers In with Special Care Percent of Total Transfers In 83.7% 70.8% 88.5% 80.0% 84.1% 69.2% 77.6% Total Very Low Birthweight (VLBW) Transfers In VLBW Transfers In with Special Care Percent of Total VLBW Transfers In 100.0% 100.0% 100.0% 100.0% 83.3% 100.0% 85.7% VLBW Special Care Transfers In < 1,500 grams BPD/RDS/Proportion of BPD to RDS % BPD 50.0% (1) 38.4% (2) 19.9% (1) 15.6% (1) 40.4% (2) 10.0% (3) 25.2% (2) % RDS 50.0% (1) 83.6% (5) 69.6% (4) 38.5% (2) 73.0% (4) 75.7% (8) 70.9% (5) % BPD/RDS 100.0% (1) 39.4% (2) 21.2% (1) 17.9% (1) 40.7% (2) 12.0% (2) 26.5% (1) Retinopathy of Prematurity % ROP with eye procedure 0.0% 0.7% 0.0% 0.0% 0.0% 0.0% 0.1% % ROP without eye procedure 0.0% 7.1% 2.0% 0.0% 0.0% 4.6% 2.7% Necrotizing Enterocolitis % NEC with surgery 0.0% 0.7% 1.1% 0.0% 3.9% 6.2% 2.5% % NEC without surgery 0.0% 14.7% 7.4% 0.0% 1.1% 6.0% 6.3% Intraventricular Hemorrhage % IVH 50.0% 48.9% 29.0% 7.3% 32.2% 28.2% 30.8% % IVH Grade III 0.0% 1.4% 5.7% 3.1% 5.9% 3.7% 4.4% % IVH Grade IV 0.0% 10.4% 6.5% 0.0% 0.9% 10.5% 6.1% % Patent Ductus Arteriosus (PDA) 50.0% 65.7% 46.3% 15.6% 31.5% 40.0% 42.1% % Central venous catheter Infections Dx % 0.0% 0.0% 0.0% 0.0% 0.2% 0.0% Dx % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% VLBW Special Care Transfers In < 500 grams BPD/RDS/Proportion of BPD to RDS % BPD % (1) 50.0% (1) 0.0% (0) 0.0% (0) 20.0% (1) 31.7% (1) % RDS % (1) 100.0% (2) 0.0% (0) 0.0% (0) 20.0% (1) 40.0% (1) % BPD/RDS % (0) 50.0% (1) 0.0% (0) 0.0% (0) 25.0% (1) 16.7% (0) Retinopathy of Prematurity % ROP with eye procedure % 0.0% 0.0% 0.0% 0.0% 0.0% % ROP without eye procedure % 0.0% 0.0% 0.0% 0.0% 0.0% Necrotizing Enterocolitis % NEC with surgery % 50.0% 0.0% 0.0% 0.0% 8.3% % NEC without surgery % 50.0% 0.0% 0.0% 0.0% 25.0% Intraventricular Hemorrhage % IVH % 0.0% 0.0% 0.0% 60.0% 36.7% % IVH Grade III % 0.0% 0.0% 0.0% 0.0% 0.0% % IVH Grade IV % 0.0% 0.0% 0.0% 50.0% 33.3% % Patent Ductus Arteriosus (PDA) % 100.0% 0.0% 0.0% 90.0% 63.3% % Central venous catheter Infections Dx % 0.0% 0.0% 0.0% 0.0% 0.0% Dx % 0.0% 0.0% 0.0% 0.0% 0.0% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 19

20 Table 7: Complications - VLBW Special Care Transfers In Total Transfers In Total Transfers In with Special Care Percent of Total Transfers In 83.7% 70.8% 88.5% 80.0% 84.1% 69.2% 77.6% Total Very Low Birthweight (VLBW) Transfers In VLBW Transfers In with Special Care Percent of Total VLBW Transfers In 100.0% 100.0% 100.0% 100.0% 83.3% 100.0% 85.7% VLBW Special Care Transfers In grams BPD/RDS/Proportion of BPD to RDS % BPD % (1) 14.6% (0) 66.7% (2) 28.6% (1) 6.1% (1) 22.6% (1) % RDS % (2) 75.0% (2) 100.0% (3) 71.4% (1) 75.3% (2) 78.9% (2) % BPD/RDS % (1) 15.0% (0) 66.7% (2) 21.4% (0) 4.2% (0) 20.3% (1) Retinopathy of Prematurity % ROP with eye procedure % 0.0% 0.0% 0.0% 0.0% 0.6% % ROP without eye procedure % 6.3% 0.0% 0.0% 1.1% 2.2% Necrotizing Enterocolitis % NEC with surgery % 0.0% 0.0% 4.8% 2.8% 2.6% % NEC without surgery % 2.1% 0.0% 0.0% 6.9% 7.4% Intraventricular Hemorrhage % IVH % 20.8% 33.3% 23.8% 47.2% 35.9% % IVH Grade III % 0.0% 33.3% 19.1% 3.6% 7.9% % IVH Grade IV % 12.5% 0.0% 0.0% 30.3% 15.3% % Patent Ductus Arteriosus (PDA) % 64.6% 66.7% 40.5% 72.8% 56.5% % Central venous catheter Infections Dx % 0.0% 0.0% 0.0% 0.0% 0.0% Dx % 0.0% 0.0% 0.0% 0.0% 0.0% VLBW Special Care Transfers In grams BPD/RDS/Proportion of BPD to RDS % BPD % (1) 37.5% (1) 75.0% (3) 50.0% (1) 38.4% (3) 48.1% (1) % RDS % (2) 58.3% (1) 75.0% (3) 83.3% (2) 65.8% (4) 75.2% (2) % BPD/RDS % (1) 37.5% (1) 100.0% (3) 50.0% (1) 40.6% (1) 49.6% (1) Retinopathy of Prematurity % ROP with eye procedure % 0.0% 0.0% 0.0% 0.0% 0.0% % ROP without eye procedure % 6.3% 0.0% 0.0% 1.1% 6.4% Necrotizing Enterocolitis % NEC with surgery % 0.0% 0.0% 16.7% 5.4% 5.1% % NEC without surgery % 6.3% 0.0% 8.3% 14.8% 11.6% Intraventricular Hemorrhage % IVH % 45.8% 0.0% 44.5% 70.5% 51.5% % IVH Grade III % 25.0% 0.0% 0.0% 13.8% 11.5% % IVH Grade IV % 16.7% 0.0% 16.7% 30.1% 14.7% % Patent Ductus Arteriosus (PDA) % 77.1% 75.0% 55.6% 58.0% 72.4% % Central venous catheter Infections Dx % 0.0% 0.0% 0.0% 1.1% 0.2% Dx % 0.0% 0.0% 0.0% 0.0% 0.0% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 20

21 Table 7: Complications - VLBW Special Care Transfers In Total Transfers In Total Transfers In with Special Care Percent of Total Transfers In 83.7% 70.8% 88.5% 80.0% 84.1% 69.2% 77.6% Total Very Low Birthweight (VLBW) Transfers In VLBW Transfers In with Special Care Percent of Total VLBW Transfers In 100.0% 100.0% 100.0% 100.0% 83.3% 100.0% 85.7% VLBW Special Care Transfers In 1,000-1,249 grams BPD/RDS/Proportion of BPD to RDS % BPD % (1) 35.7% (0) 0.0% (0) 49.0% (1) 23.0% (1) 28.7% (1) % RDS % (1) 92.9% (1) 50.0% (1) 90.0% (2) 76.6% (3) 77.7% (2) % BPD/RDS % (0) 35.7% (0) 0.0% (0) 54.0% (1) 19.5% (1) 27.5% (1) Retinopathy of Prematurity % ROP with eye procedure % 0.0% 0.0% 0.0% 0.0% 0.0% % ROP without eye procedure % 0.0% 0.0% 0.0% 8.3% 2.0% Necrotizing Enterocolitis % NEC with surgery % 0.0% 0.0% 0.0% 11.1% 2.7% % NEC without surgery % 21.4% 0.0% 0.0% 7.1% 8.7% Intraventricular Hemorrhage % IVH % 35.7% 0.0% 30.0% 18.7% 26.8% % IVH Grade III % 7.1% 0.0% 0.0% 2.4% 2.6% % IVH Grade IV % 14.3% 0.0% 0.0% 11.1% 11.7% % Patent Ductus Arteriosus (PDA) % 35.7% 0.0% 25.0% 32.1% 30.7% % Central venous catheter Infections Dx % 0.0% 0.0% 0.0% 0.0% 0.0% Dx % 0.0% 0.0% 0.0% 0.0% 0.0% VLBW Special Care Transfers In 1,250-1,499 grams BPD/RDS/Proportion of BPD to RDS % BPD 50.0% (1) 0.0% (0) 12.5% (0) 0.0% (0) 30.6% (1) 2.0% (0) 11.5% (0) % RDS 50.0% (1) 56.7% (3) 59.3% (2) 25.0% (1) 75.0% (1) 75.2% (2) 62.9% (2) % BPD/RDS 100.0% (1) 0.0% (0) 14.8% (0) 0.0% (0) 38.9% (1) 4.8% (0) 14.8% (0) Retinopathy of Prematurity % ROP with eye procedure 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% % ROP without eye procedure 0.0% 0.0% 1.9% 0.0% 0.0% 0.0% 0.6% Necrotizing Enterocolitis % NEC with surgery 0.0% 0.0% 1.4% 0.0% 0.0% 1.4% 0.8% % NEC without surgery 0.0% 10.0% 3.7% 0.0% 0.0% 7.6% 4.0% Intraventricular Hemorrhage % IVH 50.0% 26.7% 23.6% 8.3% 33.3% 1.4% 18.6% % IVH Grade III 0.0% 0.0% 1.4% 0.0% 0.0% 0.0% 0.5% % IVH Grade IV 0.0% 10.0% 0.0% 0.0% 0.0% 0.0% 0.7% % Patent Ductus Arteriosus (PDA) 50.0% 10.0% 38.4% 0.0% 16.7% 12.8% 20.6% % Central venous catheter Infections Dx % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Dx % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 21

22 Table 8: Procedures - VLBW Special Care Inborns Total Inborns 3,667 3,944 4,299 2,245 9,135 2,540 4,266 Total Inborns with Special Care , Inborns with Special Care as a percent of Total Inborns 13.7% 14.6% 16.0% 10.8% 14.3% 16.0% 14.3% Total Very Low Birthweight (VLBW) Inborns VLBW Inborns with Special Care Percent of Total VLBW Inborns 90.0% 89.5% 90.5% 90.9% 87.6% 92.0% 89.2% VLBW Special Care Inborns < 1,500 grams Umbilical Catheterization 70.4% 49.9% 45.9% 39.1% 44.5% 52.3% 45.3% Arterial Catheterization 56.8% 39.8% 38.3% 30.6% 41.7% 48.3% 38.1% Venous Catheterization 14.8% 34.1% 35.5% 19.7% 34.9% 42.4% 31.5% Continuous invasive mechanical vent < 96 hours 19.8% 35.6% 26.9% 39.1% 35.8% 28.5% 33.6% Continuous invasive mechanical vent 96 hours % 18.5% 24.4% 7.2% 19.0% 21.5% 17.4% Non-invasive mechanical vent 28.4% 41.1% 28.8% 21.6% 29.9% 15.4% 28.1% VLBW Special Care Inborns < 500 grams Umbilical Catheterization 100.0% 40.1% 58.8% 21.4% 47.9% 61.9% 47.9% Arterial Catheterization 100.0% 36.5% 46.8% 14.3% 55.3% 61.9% 44.2% Venous Catheterization 0.0% 9.4% 11.2% 7.1% 31.0% 0.0% 12.9% Continuous invasive mechanical vent < 96 hours 0.0% 20.8% 15.7% 7.1% 31.2% 19.1% 19.2% Continuous invasive mechanical vent 96 hours % 29.7% 50.4% 7.1% 48.6% 32.1% 37.1% Non-invasive mechanical vent 0.0% 14.1% 3.6% 7.1% 6.5% 0.0% 6.0% VLBW Special Care Inborns grams Umbilical Catheterization 58.3% 62.5% 50.6% 47.8% 61.5% 77.6% 57.7% Arterial Catheterization 66.7% 53.4% 50.8% 53.4% 61.5% 77.1% 56.9% Venous Catheterization 8.3% 32.7% 27.2% 20.3% 34.0% 36.7% 29.3% Continuous invasive mechanical vent < 96 hours 33.3% 38.7% 26.3% 52.1% 35.8% 23.4% 35.3% Continuous invasive mechanical vent 96 hours % 51.1% 53.7% 25.1% 50.5% 51.2% 46.7% Non-invasive mechanical vent 16.7% 33.9% 16.3% 7.6% 19.0% 3.8% 17.2% Birthweight ranges are determined using the numeric birthweight provided or the fifth digit of diagnosis codes 764.x, and If an infant record does not have numeric birthweight or one of these codes, the birthweight defaults to >=2,500 grams. Subgroup: AR - Academic, Regional Perinatal Centers Page 22