Newborn Intensive Care

Newborn intensive care units provide specialized, intensive care and treatment to newborns that are critically ill. Patients can be seen in this unit with a variety of conditions including those associated with premature birth. The American Academy of Pediatrics provides criteria for designation of level care that a hospital nursery can provide. These levels range from Level 1 to Level 3 with Level 3 nurseries providing the most intensive care. NICUs are further divided into 3A, 3B, and 3C NICUs. Level 3C nurseries are capable of providing the most advanced care such as heart lung bypass, also known as ECMO.

Our Newborn Intensive Care Unit is a Level 3C, 46-bed unit. The NICU accepts babies from all over the Midwest and routinely accept transfers from other NICUs for specialized medical, cardiac and general and specialty surgical care. The UM fetal diagnostic and treatment center sees several high risk pregnancies that provide the NICU with a number of infants with challenging conditions, located in our new C.S. Mott Children's Hospital.

To meet our commitment to provide the best care possible, we evaluate our performance over time and against national benchmarks. We measure many different outcomes of care, including our mortality rate, central line-associated blood stream infection, and the growth of our newborn patients while under our care.

Outcomes

This following graphs display measures of our success in treating intensive care patients, including measures of patient mortality and occurrence of complications. Lower values indicate better performance. The risk of mortality and of complications depends on many factors, including the patient's health condition. Because the risks differ between patients, we try to compare our performance to benchmarks for similar types of patients.

Mortality
Lower Value = Better Performance

Details

Why is This Measure Important?

Patients treated in ICUs are critically ill and have a high risk of death. However, each patient's risk is different. So, for this measure, we compare our observed mortality rate to an expected mortality rate. The expected rate is calculated using a national NICU benchmarking system provided by the Vermont Oxford NICU Quality Consortium. Many hospitals across the country use this system to evaluate their success in managing critically ill patients and to help identify potential areas of need.

This measure is expressed as a ratio of observed-to-expected mortality. A number less than 1.0 is a good result and means that fewer patients died than expected. Although this rate is "risk adjusted" the adjustment may not work well for units that treat a relatively large number of patients with rare serious diseases.

How is UMHS Performing?

In general the NICU is performing as expected. Every NICU death is reviewed in detail in order to identify opportunities to improve care practices. A large percentage of deaths come from the transfer of patients whose condition and severity of illness put them at high risk for dying. The higher risk of death in such patients is not always captured in the risk adjusted rates, which causes the observed-to-expected mortality rate to be higher.

UMHS Source: Hospital chart review.
Comparison Group Source: Vermont Oxford NICU Quality Consortium.

Slow Premature Infant Growth Rate
Lower Value = Better Performance

Details

Why is This Measure Important?

This graph depicts the percentage of infants discharged home from the University of Michigan Health System with slow growth rates compared to the Vermont-Oxford average. A lower score is better.

Babies that are born prematurely are no longer able to benefit from the balanced nutrition provided by the mother through the placenta. These infants are dependent upon clinicians to provide them with key nutrients, either intravenously (IV) or through a tube feeding the stomach. Insufficient nutrition can affect growth and cognitive outcome, and prolonged reliance on IV nutrition can also increase the risk of infection. Despite the potential risks of insufficient nutrition, providing optimal nutrition is difficult in premature infants, especially those that are ill.

Extrauterine growth restriction (EUGR) is defined as having very low growth (at or below the 10th percentile) at the time the infant is discharged from the hospital. Smaller, more immature infants often have the slowest growth. Studies have shown that up to 50-70% of the smallest, most immature babies are discharged home with growth rates at or below the 10th percentile.

How is UMHS Performing?

Over the course of the last 4 years, our NICU has placed significant emphasis on improving the nutrition of our premature infants. These interventions include modifications to the initiation and composition of IV nutrition, staffing by two neonatal dieticians, and standardization of feeding practices. Because of these interventions, the percentage of premature infants discharged with low growth rates is falling. Our improvement in growth outcomes has been dramatic - we are now performing better than 90% of the NICUs in the Vermont Oxford network.

UMHS Source: Hospital chart review and Infection Control & Epidemiology department findings.
Comparison Group Source: Vermont Oxford NICU Quality Consortium.

Blood Stream Infections
Lower Value = Better Performance

Details

Why is This Measure Important?

Central lines are special IVs often used in ICUs to provide physicians and nurses access to the patient's bloodstream in order to administer medications. In sick newborns they are routinely used to provide long term nutrition to those who are not yet capable of taking milk. Central lines are inserted through the skin, making infection with bacteria possible. Infection may spread to the bloodstream, which can increase the risk of organ failure and death.

Rates of central line associated bloodstream infections (CLA-BSI) are expressed as the number of CLA-BSI per 1,000 central line days. Our rates are compared to rates from the Centers for Disease Control (CDC) National Healthcare Safety Network (NHSN) national average for newborn intensive care units. Some critically ill patients, particularly those with compromised immune systems, are more susceptible to infection. Unfortunately, the CDC national average is not adjusted to correct for the patients' risk for infection. The risk of the patients we treat may be greater than the risk of patients represented in the CDC national average, because the University of Michigan Health System treats many complex patients.

How is UMHS Performing?

Since the inception of the NICU "Bug Zapper" workgroup in 2009, the CLA-BSI rate in the NICU has been steadily falling. The unit went over 100 days without a CLA-BSI in 2010. The improvement steps implemented in the unit have been proven effective. All staff should be commended as they work continuously to keep the CLA-BSI rate low in our NICU.

UMHS Source: Hospital chart review and Infection Control & Epidemiology department findings.
Comparison Group Source: Centers for Disease Control (CDC) National Healthcare Safety Network (NHSN).