Neonatal Intensive Care Unit Performance
What Is the Vermont Oxford Network?
The Vermont Oxford Network is a widely respected national nonprofit group that collects data on infants treated in neonatal intensive care units (NICU) who were born at UK HealthCare or transferred from another facility.
Data collected represents babies born with very low birth weight (VLBW), less than 3.3 pounds. Its role is to use that data to improve the quality of care those infants receive.
For Kentucky Children’s Hospital, participation in Vermont Oxford is just one way we track and review the care infants in our NICU receive. We track six Vermont Oxford measures, overall mortality and five more specific conditions.
This measure includes inpatient NICU babies who are born alive but who do not reach their first birthday.
Academic medical centers such as UK HealthCare including Kentucky Children's Hospital take care of the very sickest patients. That’s why patient survival rates are adjusted to account for just how sick the patients are when they come to the hospital, considering the seriousness of their illness plus complicating factors like age, obesity or chronic conditions.
Observed-to-expected mortality (death) compares two numbers:
1. Observed mortality is the actual number of patients who died during a particular period. For example, 10 deaths among 1,000 patients would be a rate of 1 percent.
2. Some people are so sick they are not reasonably expected to survive. More of these patients are seen at places like UK HealthCare because they are better equipped to help. Expected mortality adjusts for how sick patients are compared with patients seen at other hospitals in the United States.
To reach the final number, the observed rate is divided by the expected rate, meaning that the number of actual deaths is compared to how many people were so sick that they were not expected to live.
A score of 1.00 would mean exactly the same number of patients who might have been expected to die did in fact die.
A score higher than 1.00 means more patients died than were statistically expected to. For instance, a mortality index of 1.10 would mean 10 percent of people who were expected to survive, did not.
A score lower than 1.00 means that more patients survived than were statistically expected to. For instance, if the ratio is .75, it means that for every 100 people expected to die, only 75 actually did. Twenty-five of those very sick people survived.
Chronic lung disease
Infants are considered to have chronic lung disease (CLD) if they are receiving oxygen at 36 weeks gestational age*, whether they are in the hospital or have been discharged home.
Gestational age is the common term used during pregnancy to describe how far along the pregnancy is. It is measured in weeks, from the first day of the woman's last menstrual cycle to the current date. A normal pregnancy can range from 38 to 42 weeks.
The gestational age of a baby born prematurely in the mother’s 34th week of pregnancy would be considered 34 weeks.
*Gestation is the period of time between conception and birth. During this time, the baby grows and develops inside the mother's womb.
In babies who are born early, usually at 32 weeks or earlier, the internal organs are not always fully formed.
These babies are at risk of a serious intestinal disease known as necrotizing enterocolitis, in which parts of the intestine stop functioning. The intestines become inflamed and sometimes develop small holes called perforations. This can lead to severe infections and even the infant’s death.
Nosocomial infections occur when babies are exposed to bacteria in the hospital and become sick. Efforts to reduce these infections result in significantly better outcomes.
Severe intraventricular hemorrhage
Severe intraventricular hemorrhage means a baby has bleeding in his or her brain. The blood vessels inside a premature baby’s brain are extremely small and fragile, and at birth, when they are suddenly exposed to oxygen or sudden changes in blood flow, these blood vessels may burst and cause bleeding. Severe bleeding can lead to long-term problems such as cerebral palsy, hearing loss, vision problems and learning difficulties.
Severe retinopathy of prematurity
Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants born before 31 weeks of gestation. The smaller a baby is at birth, the more likely that baby is to develop ROP. Ninety percent of babies who develop ROP will have a mild case and no long-term vision damage. This measure includes only babies who have severe (Stage III or IV) ROP.