15.

2 Classification of Morbidity in Newborns

Unit 15 – Newborns
HIMP 2210 – Health Data Classification II
Conditions originating in Perinatal Period

• Conditions that have their origin in the perinatal period are

coded to Chapter XVI - Certain conditions originating in the
perinatal period (birth to 28 completed days)

• The condition may persist beyond the perinatal period

• Whenever the condition originates in the perinatal period,

regardless of the current age of the patient a code from
Chapter XVI is assigned
Conditions originating in Perinatal Period

• Exceptions are listed in the Alphabetical Index

• Enter the Lead Term ‘Condition’ and the following note is found:
Birth Trauma
Significant Birth Trauma – Mandatory to code as MRDx or Type 1
• Intracranial laceration & hemorrhage
• Cerebral edema
• Cranial, spinal or peripheral nerve injury
• Cephalohematoma that becomes infected, or
• Is severe enough to cause
• Anemia
• Shock,
• Hemolytic jaundice requiring phototherapy
• Meningitis, or
• Osteomyelitis
• Subgaleal hematoma (epicranial subaponeurotic hemorrhage)
• Fracture including those of skull, long bones or clavicle
• Dislocation
• Intraabdominal injury
• Sternomastoid injury
Birth Trauma

Minor Birth Trauma

• Only coded when documentation states minor injury has become complicated
or requires observation in special care unit
• Uncomplicated minor injuries can be coded (optional) – Type 0
• Cephalhematoma NOS
• Chignon (artificial caput due to vacuum)
• Caput succedaneum
• Superficial abrasions ad lacerations
• Monitoring injuries (from fetal scalp electrodes)
• Subcutaneous fat necrosis
• Subconjunctival hemorrhage
 Fetal Acidemia
• Uterine contractions cause temporary asphyxia during labour
and delivery….
• This is normal a situation
• A healthy fetus will recover until the next contraction

• Fetal asphyxia that is of a sufficient degree many lead to

hypoxic acidemia

• This may be detected when fetal monitoring during labour

reveals a fetus with abnormal tracings
• Fetal blood sampling via the fetal scalp may be obtained to
confirm the diagnosis
Fetal Acidemia

• In cases of hypoxic asphyxia interventions such as cesarean

section are done occurs before hypoxic cell death

• In most cases, the physician will not perform a fetal scalp

blood sampling, but will proceed directly to surgery
• An emergent situation with no time to await results of this test

• Hypoxic acidemia can only be diagnosed by fetal arterial blood

pH

• An arterial pH < 7.0 and/or base deficit > 12 mmol/L is an

objective measurement of acidemia in the fetus
Fetal Acidemia

• Example

• Newborn female delivered by emergency Cesarean section due to

late decelerations during active labour. The physician recorded
fetal scalp blood gases as arterial pH of 6.4

• P20.1 - Intrapartum fetal acidaemia first noted during labour and

delivery (M)
• Z38.101 - single liveborn, C-section (0)
Respiratory Depression

• On delivery it is expected that the newborn will establish

spontaneous respirations
• Failure to do so may result in newborn asphyxia

• May need to suction the airway immediately after delivery to

facilitate the process

• This must be specifically documented on the Resuscitation

report
Infant Respiratory Distress Syndrome

• Also known as hyaline membrane disease

• Life threatening condition due to immaturity of infant’s lungs

• Occurs almost exclusively in premature infants

• Surfactant which reduces surface tension in alveoli and promotes
expansion is mot produced until 28 to 36 weeks gestation
• When premature delivery is unavoidable, glucocorticoids administered to
mother to accelerate pulmonary maturity

• A diagnosis of respiratory distress syndrome must be clearly

documented

• Treatment is CPAP – continuous positive airway pressure

• Intervention is coded
Transient Tachypnea of Newborn

• Due to a delay in clearance of the fetal lung liquid

• Sometimes called wet lung syndrome

• Condition presents itself within first hours of life

• Approximately 35% of fetal lung fluid begins to clear a few days

before birth
• Approximately 30% clears during compression action caused by labour
and delivery
• Remaining 35% clears postnatally

• Transient tachypnea of newborn usually resolves within 72 hours after

birth

• If not, CPAP or other mechanical ventilation may be required

Perinatal Jaundice

• May be caused by hemolytic disease such as Rh or ABO

incompatibility

• May lead to hydrops fetalis or kernicterus

• Must be documented
• Mandatory to code

• Some physiological jaundice is normal in newborns

• Usually resolves without treatment and is not considered to be

significant…therefore not coded

• Treatment is phototherapy
• No national requirement to code
Infections in Newborn

• Infection may be acquired in utero or during birth

• Coded to P35 – P39 - Infections specific to perinatal period

• There are several exceptions listed as an Excludes Note at the
beginning of this code block
• Review carefully before coding

• Infections which develop after birth, and not related to the

birthing process are classified to the appropriate chapter, for
example, Chapter I – Certain Infectious and Parasitic Diseases
Infections in Newborn

• Example

• E.coli sepsis of newborn due to choriomnionitis in mother Baby

was transferred to Special Care Unit and given antibiotics. Baby
had been delivered by vaginal birth

• P36.4 (M) Sepsis of newborn due to Escherichia coli

• Z38.000 (0)
Infections in Newborn

• Example

• Preterm infant, 2200 grams, vagina birth. E coli septicemia

developed on 8th hospital day in special care unit

• P07.1 (M) Other low birth weight

• P07.3 (1) Other preterm infants
• A41.50 (2) E Coli septicemia
• Z38.000 (0)
Fetus Affected by Maternal Alcohol Intake

• Fetus may be affected by maternal alcohol intake without

evidence of fetal alcohol syndrome
• May be described as fetal alcohol effect

• When infant is diagnosed with fetal alcohol syndrome

• Mandatory to code the specific manifestation of alcohol effect
(e.g. P05.- Slow fetal growth and fetal malnutrition), coded as
MRDx or type 1 diagnosis.

• If an infant experiences alcohol withdrawal, code to P96.1 as

MRDx or type 1 diagnosis.
Stillborn

• CIHI data collection requires completion of stillborn abstract

for fetal demise at or after 20 weeks gestation

• When a fetus first shows signs of life at birth and subsequently

dies, a newborn abstract is completed

• On stillborn abstract, MRDx indicates underlying cause of

death when known

• When not known, P95 – Fetal death of unspecified cause is

assigned