APPENDIX 2

Aggregate Data–Reporting Template

Date of reporting period:
Hospital name:
Total
(1) Number of live births born at birthing facility during current reporting perioda
(2) Number of live births screened with pulse oximetry during current reporting perioda
(3) Number of failed screens
Explanation of live births screened and not screened in current reporting period
 Live births who were screened at your birthing facility in current reporting period
  (a) Number born and screened at your birthing facility in current reporting period
  (b) Number born at your birthing facility in previous reporting period, but screened in current reporting period
  (c) Number not born at your birthing facility, but transferred into your birthing facility and screened in current reporting period
   –Name(s) of hospital(s) transferred from and number of infants transferred
  (d) Other explanation(s), provide number of infants for each explanation:
 Live births born at your birthing facility during current reporting period who were not screened in current reporting period
  (e) Number of expirations
  (f) Number not medically appropriate to screen
  (g) Number born at birthing facility, but <24 hours of age at end of current reporting period
  (h) Number transferred out of your birthing facility at <24 hours
   –Name(s) of hospital(s) transferred to and number of infants transferred
  (i) Number transferred out of your birthing facility at ≥24 hours
  –Name(s) of hospital(s) transferred to and number of infants transferred
  (j) Other explanation(s), provide number of infants for each explanation:
  • Definitions for data items above:(1) Number of infants in the WBN and NICU/SCN who were born at your birthing facility during the current reporting period. This number does not represent all admissions (ie, excludes those transferred into your facility).(2) Number of infants screened at your birthing facility during the current reporting period. This number includes infants born at your facility and those transferred into your facility who were screened.(3) Number of infants who failed the pulse oximetry screening at your birthing facility in the current reporting period.

  • (a) Number of infants both born and screened at your birthing facility during the current reporting period.

  • (b) Number of infants born at your birthing facility during the previous reporting period, but who were screened in the current reporting period. This number is likely to represent infants who were previously medically unstable or too young to be screened in the previous reporting period.

  • (c) Number of infants not born at your birthing facility but who were transferred into your birthing facility and screened during the current reporting period. Below list the name of the hospital the infant was transferred from. If transfers were received from multiple hospitals, create a row for each hospital. Include the number of infants who were admitted.

  • (d) Explanation of why an infant was screened in the current reporting period, if not listed above (eg, home births).

  • (e) Number of infants born at your birthing facility during the current reporting period that expired before conducting the pulse oximetry screening.

  • (f) Number of infants born at your birthing facility during the current reporting period who were not medically appropriate for pulse oximetry screening. This number is primarily applicable to NICU infants.

  • (g) Number of infants born at your birthing facility during the current reporting period who were <24 hours of age at the end of the current reporting period and were therefore were not screened during the current reporting period.

  • (h) Number of infants born at your birthing facility during the current reporting period who were not screened and were transferred out at <24 hours. Below list the name of the hospital the infant was transferred to. If infants were transferred to different hospitals, create a row for each hospital. Include the number of infants who were transferred.

  • (i) Number of infants born at your birthing facility during the current reporting period who were not screened and were transferred out of your birthing facility at ≥24 hours. Below list the name of the hospital the infant was transferred to. If infants were transferred to different hospitals, create a row for each hospital. Include the number of infants who were transferred.

  • (j) Explanation of why an infant was not screened, if not listed (eg, discharged, 24 hours, parents refused screen, etc).

  • a Important: Infants who were in both the WBN and the NICU or SCN during the current reporting period should only be counted once for all reporting items above.