Unexpected Complications in Term Newborns

This measure assesses the unexpected complications among full term newborns with no preexisting conditions (California Maternal Quality Care Collaborative (CMQCC), n.d.).
Severe complications include neonatal death, severe birth injuries such as intracranial hemorrhage or nerve injury, neurologic damage, severe respiratory and infectious complications such as sepsis. It also includes transfer to another hospital for higher level of care with severe complication codes or NO moderate or severe complication codes.
Moderate complications include diagnoses or procedures that raise concern but at a lower level than the list for severe e.g., use of continuous positive airway pressure (CPAP) or bone fracture. Examples include less severe respiratory complications e.g., Transient Tachypnea of the Newborn, or infections with a longer length of stay not including sepsis, infants who have a prolonged length of stay of over 5 days. Transfer to another hospital for higher level of care with any moderate complication codes are also included.

Measure specifications are in the Public Domain.
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This material includes SNOMED Clinical Terms (R) (SNOMED CT [R]) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT (R), was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
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These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

Stratification 1 - Severe Complications
Stratification 2 - Moderate Complications

None

Aggregate rate generated from count data reported as a rate per 1000 live births.
Overall performance rate = (Number of encounters in Numerator / (Number of encounters in Denominator – Number of encounters in Denominator Exclusions)) * 1000
Stratification 1 = (Number of encounters with severe complications / (Number of encounters in Denominator – Number of encounters in Denominator Exclusions)) * 1000
Stratification 2 = (Number of encounters with moderate complications / (Number of encounters in Denominator – Number of encounters in Denominator Exclusions)) * 1000

The most important childbirth outcome for families is bringing home a healthy baby. While there have been measures developed to assess clinical practices and outcomes in preterm infants, there is a lack of metrics that assess the health outcomes of term infants who represent over 90% of all births. This measure addresses this gap and gauges adverse outcomes resulting in severe or moderate morbidity in otherwise healthy term infants without preexisting conditions (Fleischman et al., 2010; Arham et al., 2025). This measure also uses length of stay (LOS) modifiers to guard against overcoding and undercoding of diagnoses. Importantly, this metric also serves as a balancing measure for other maternal measures such as Nulliparous, Term, Singleton, Vertex (NTSV) Cesarean rates and early elective delivery rates. The purpose of a balancing measure is to guard against any unanticipated or unintended consequences of quality improvement activities for these measures.

The birth of a baby is the most common reason for hospitalization in the United States and accounts for over half of all hospital admissions. Since childbirth comprises such a large portion of US hospital care, the quality of health care delivered to mothers and their babies should be a focal point for hospitals and health care providers. This hospital level performance metric captures and quantifies neonatal morbidity while accounting for severity of the condition, delivery route (vaginal or cesarean) and neonatal length of stay. There are significant opportunities to improve care for healthy term infants (Teitler et al., 2019). Labor, birth management and delivery type can lead to birth injuries, trauma, respiratory complications, hypoxia/asphyxia events and neurologic complications. The ability to evaluate trends and risks across the spectrum of term gestation is limited for mortality and morbidity. This measure addresses this gap by capturing and quantifying severe and moderate neonatal morbidities in term infants that could possibly be reduced or prevented by modifying obstetric and neonatal care practices at the hospital level.

Decreased score indicates improvement

Reference Type: Citation

Reference Text: 
American College of Obstetricians and Gynecologists. (2017). Practice Bulletin No. 178: Shoulder dystocia. Obstetrics & Gynecology, 129(5), e123–e133. https://doi.org/10.1097/AOG.0000000000002043

Reference Type: Citation

Reference Text: 
American College of Obstetricians and Gynecologists. (2020). Operative vaginal delivery (Practice Bulletin No. 219). Obstetrics & Gynecology, 135(4), e149–e159. https://doi.org/10.1097/AOG.0000000000003764

Reference Type: Citation

Reference Text: 
Arham, M., & Wróblewska‑Seniuk, K. (2025). Short‑ and long‑term consequences of late‑preterm and early‑term birth. Children, 12(7), 907. https://doi.org/10.3390/children12070907

Reference Type: Citation

Reference Text: 
California Maternal Quality Care Collaborative. (n.d.). Unexpected complications in term newborns. Retrieved March 30, 2026, from https://www.cmqcc.org/focus-areas/quality-metrics/unexpected-complications-term-newborns

Reference Type: Citation

Reference Text: 
Clark, S. L., Miller, D. D., Belfort, M. A., Dildy, G. A., Frye, D. K., & Meyers, J. A. (2009). Neonatal and maternal outcomes associated with elective term delivery. American Journal of Obstetrics and Gynecology, 200(2), 156.e1–156.e6. https://doi.org/10.1016/j.ajog.2008.08.068

Reference Type: Citation

Reference Text: 
Fleischman, A. R., Oinuma, M., & Clark, S. L. (2010). Rethinking the definition of “term pregnancy.” Obstetrics & Gynecology, 116(1), 136–139. https://doi.org/10.1097/AOG.0b013e3181e24f28

Reference Type: Citation

Reference Text: 
Gregory, K. D., Fridman, M., Shah, S., & Korst, L. M. (2009). Global measures of quality‑ and patient safety‑related childbirth outcomes: Should we monitor adverse or ideal rates? American Journal of Obstetrics & Gynecology, 200(6), 681.e1–681.e7. https://doi.org/10.1016/j.ajog.2009.02.033

Reference Type: Citation

Reference Text: 
Hansen, A. K., Wisborg, K., Uldbjerg, N., & Henriksen, T. B. (2008). Risk of respiratory morbidity in term infants delivered by elective cesarean section: Cohort study. BMJ, 336(7635), 85–87. https://doi.org/10.1136/bmj.39405.539282.be

Reference Type: Citation

Reference Text: 
Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J. K., Wilson, E. C., & Mathews, T. J. (2012). Births: Final data for 2010. National Vital Statistics Reports, 61(1), 1–72.

Reference Type: Citation

Reference Text: 
Profit, J., Zupancic, J. A., Gould, J. B., & Petersen, L. A. (2007). Implementing pay‑for‑performance in the neonatal intensive care unit. Pediatrics, 119(5), 975–982. https://doi.org/10.1542/peds.2006-1565

Reference Type: Citation

Reference Text: 
Puopolo, K. M., Lynfield, R., Cummings, J. J., Committee on Fetus and Newborn, & Committee on Infectious Diseases. (2019). Management of infants at risk for group B streptococcal disease. Pediatrics, 144(2). https://doi.org/10.1542/peds.2019-1881

Reference Type: Citation

Reference Text: 
Reddy, U. M., Bettegowda, V. R., Dias, T., Yamada‑Kushnir, T., Ko, C. W., & Willinger, M. (2011). Term pregnancy: A period of heterogeneous risk for infant mortality. Obstetrics & Gynecology, 117(6), 1279–1287. https://doi.org/10.1097/AOG.0b013e3182179e28

Reference Type: Citation

Reference Text: 
Spong, C. Y. (2013). Defining “term” pregnancy: Recommendations from the Defining “Term” Pregnancy Workgroup. Journal of the American Medical Association, 309(23), 2445–2446. https://doi.org/10.1001/jama.2013.6235

Reference Type: Citation

Reference Text: 
Teitler, J. O., Plaza, R., Hegyi, T., Kruse, L., & Reichman, N. E. (2019). Elective deliveries and neonatal outcomes in full-term pregnancies. American Journal of Epidemiology, 188(4), 674–683. https://doi.org/10.1093/aje/kwz014

Reference Type: Citation

Reference Text: 
Tita, A. T. N., Landon, M. B., Spong, C. Y., Lai, Y., Leveno, K. J., Varner, M. W., Moawad, A. H., Caritis, S. N., Meis, P. J., Wapner, R. J., Sorokin, Y., Miodovnik, M., Carpenter, M., Peaceman, A. M., O’Sullivan, M. J., Sibai, B. M., Langer, O., Thorp, J. M., Ramin, S. M., & Mercer, B. M. (2009). Timing of elective repeat cesarean delivery at term and neonatal outcomes. New England Journal of Medicine, 360(2), 111–120. https://doi.org/10.1056/NEJMoa0803267

Reference Type: Citation

Reference Text: 
Wilmink, F. A., Hukkelhoven, C. W., Lunshof, S., Mol, B. W., van der Post, J. A., & Papatsonis, D. N. (2010). Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: A 7‑year retrospective analysis of a national registry. American Journal of Obstetrics & Gynecology, 202(3), 250.e1–250.e8. https://doi.org/10.1016/j.ajog.2010.01.052

Reference Type: Citation

Reference Text: 
Zhang, X., & Kramer, M. S. (2009). Variations in mortality and morbidity by gestational age among infants born at term. Journal of Pediatrics, 154, 358–362. https://doi.org/10.1016/j.jpeds.2008.09.013

None

A discharge to a designated cancer center or children's hospital should be captured as a discharge to an acute care facility.
Data show that the majority of newborns with gestational age 37 weeks or more have a birth weight 3000 grams or more. Birth weight 3000 grams or more is a proxy to capture term newborns without gestational age recorded in the electronic health record (EHR) system. Only one birth weight value should be recorded. In cases where there is conflicting data, use the document recording the birth weight closest to the start of encounter.
This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.
For newborns born in the hospital, the newborn's inpatient encounter begins at birth. Therefore, the inpatient admission date and time must match the newborn's birth date and time.
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Inpatient hospitalization for single newborns with a principal diagnosis of a single live born newborn born in the hospital, with a discharge date during the measurement period, and with either of the following conditions:

 

  
Gestational age at birth of >=37 weeks
 
 

  
Birth weight 3000 grams or more without gestational age at birth
 

Equals Initial Population

Inpatient hospitalization for newborns who were born with congenital malformations and genetic diseases, pre-existing fetal conditions, or maternal drug use exposure in-utero

Inpatient hospitalization for newborns with severe or moderate complications:
Severe Complications as any of the following conditions:

 

  
Discharge status of patient expired or discharged to a health care facility for hospice care
 
 

  
Discharged to an acute care facility (ACF) or other health care facility (HCF) with severe complications or without any complications
 
 

  
Severe morbidities diagnoses, including:
  

   

    
Neonatal severe birth trauma
   
   

    
Neonatal severe hypoxia or asphyxia
   
   

    
Neonatal severe shock and resuscitation
   
   

    
Neonatal severe respiratory complications
   
   

    
Neonatal severe infection
   
   

    
Neonatal severe neurological complications
   
  
 
 

  
Severe morbidities procedures, including:
  

   

    
Neonatal severe shock and resuscitation procedures
   
   

    
Neonatal severe respiratory procedures
   
   

    
Neonatal severe neurological procedures
   
  
 
 

  
Severe septicemia with length of stay more than 4 days or discharged to an ACF or other HCF
 

Moderate Complications as any of the following conditions:

 

  
Moderate complications diagnoses, including:
  

   

    
Neonatal moderate birth trauma
   
   

    
Neonatal moderate respiratory complications
   
  
 
 

  
Moderate complications procedures, including:
  

   

    
Neonatal moderate respiratory complications procedures
   
  
 
 

  
Vaginal delivery with length of stay more than 2 days OR cesarean birth with length of stay more than 4 days, with any of the following moderate length of stay complications:
  

   

    
Moderate complications diagnoses, including:
    

     

      
Neonatal moderate birth trauma
     
     

      
Neonatal moderate respiratory complications
     
     

      
Neonatal moderate infection
     
    
   
   

    
Moderate complications procedures, including:
    

     

      
Neonatal moderate neurological complications procedures
     
     

      
Neonatal moderate respiratory complications procedures
     
    
   
  
 
 

  
Discharged to an ACF or other HCF with any moderate diagnoses, moderate procedures, or moderate length of stay complications
 
 

  
Length of stay more than 5 days without jaundice and social indications
 

None

None

For every patient evaluated by this measure also identify payer, race, ethnicity, and sex

eMeasure Perinatal Care (ePC)