Tennessee Birth Defects Surveillance System (TNBDSS) Reporting Portal

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

rjbKSxMGBuDmTX7ABjHeJLJy5BomZEJASqCDSTST7WwEQpxnMYgNCwjgrCh

Tennessee Birth Defects Surveillance System (TNBDSS) Reporting Portal

This site is for the reporting of cases of specified birth defects to the Tennessee Department of Health. Due to the risk of microcephaly and other neurologic birth defects associated with Zika virus, there is an important need for timely identification and comprehensive follow-up. With support from CDC, the Tennessee Birth Defects Surveillance System (TNBDSS) data will be used to monitor any changes in the incidence of these birth defects, ensure timely referral to services, and enhance care coordination for affected children in Tennessee.

Thank you for your efforts to protect, promote, and improve the health and prosperity of people in Tennessee.

To continue directly to the reporting form, click here.

Case Definition for Reporting

For an infant/fetus to be included in the birth defects system, the following criteria must be met:

The infant must be a Tennessee resident at the time of report.
The child must be under 5 years of age.
The child must be born on or after January 1, 2017.
The infant/fetus must have a confirmed diagnosis of at least one of the conditions in the following table.

Birth Defect	ICD-10-CM
Brain abnormalities with and without microcephaly
Confirmed or possible congenital microcephaly	Q02
Intracranial calcifications	No specific code; may be included under Q04.8, Q04.9
Cerebral atrophy	No specific code; may be included under Q04.3
Abnormal cortical formation (e.g., polymicrogyria, lissencephaly, pachygyria, schizencephaly, gray matter heterotopia)	Q04.3, Q04.6, Q04.8
Corpus callosum abnormalities	Q04.0
Cerebellar abnormalities	No specific code; may be included under Q04.3
Porencephaly	Q04.6
Hydranencephaly	No specific code; should be included in Q04.3
Ventriculomegaly / hydrocephaly	Q03.0-Q03.9
Fetal brain disruption sequence (collapsed skull, overlapping sutures, prominent occipital bone, scalp rugae)	No specific code. This might be coded as microcephaly or another single brain malformation, or all the components that might be coded individually: Q02, Q04.8, Q04.9 Include the following abnormalities only if co-existing abnormalities of the brain have been diagnosed: Q67.4, Q75.8, Q75.9, Q82.8
Other major brain abnormalities, including intraventricular hemorrhage in utero (excluding postnatal IVH)	Q04.0, Q04.3-Q04.9, Q07.00, Q07.02
Neural tube defects and other early brain malformations
Anencephaly / Acrania	Q00.0-Q00.2
Encephalocele	Q01.0-Q01.9
Spina bifida	Q05.0-Q05.9, Q07.01, Q07.03
Holoprosencephaly / Arhinencephaly	Q04.1, Q04.2
Eye abnormalities
Microphthalmia / Anophthalmia	Q11.0-Q11.2
Coloboma	Q12.2, Q13.0, Q14.1-Q14.8
Cataract	Q12.0
Intraocular calcifications	Q13.8, Q13.9, Q14.1-Q14.9
Chorioretinal anomalies involving the macula (e.g., chorioretinal atrophy and scarring, macular pallor, gross pigmentary mottling and retinal hemorrhage); excluding retinopathy of prematurity	No specific code. This might be coded under the affected part of the eye: Q14.1-Q14.9
Optic nerve atrophy, pallor, and other optic nerve abnormalities	Q14.2, H47.03
Consequences of central nervous system (CNS) dysfunction
Congenital contractures (e.g., arthrogryposis, club foot, congenital hip dysplasia) with associated brain abnormalities	Q65.0-Q65.9, Q66.0-Q66.9, Q68.8, Q74.3
Confirmed congenital deafness documented by postnatal testing	H90.0-H90.8, H90.A, H91.0-H91.9, Q16.0-Q16.9

For issues or questions about Tennessee Birth Defects Surveillance, contact the Division of Family Health and Wellness at Birth.Defects@tn.gov or call 615-741-7353 & 615-532-8494.

See the CDC Birth Defects website for more information about the conditions listed above.

Date report initiated

M-D-Y

Infant Medical Record Number

Infant First Name

Infant Last Name

* must provide value

Infant Sex

* must provide value

Male

Female

Ambiguous/Undetermined

reset

Infant DOB

* must provide value

M-D-Y

Gestational Age at Delivery

State of Birth

County of Birth

County or Independent City of Birth

Pregnancy Outcome

* must provide value

Live birth

Stillbirth ≥ 20 weeks

Intrauterine fetal demise

reset

Infant Current Status

* must provide value

Living

Expired

Discharged to hospice care

reset

Date of death

M-D-Y

Date of discharge to hospice

M-D-Y

Brain abnormalities with and without microcephaly

Confirmed or possible congenital microcephaly

Intracranial calcifications

Cerebral atrophy

Abnormal cortical formation (e.g., polymicrogyria, lissencephaly, pachygyria, schizencephaly, gray matter heterotopia)

Corpus callosum abnormalities

Cerebellar abnormalities

Porencephaly

Hydranencephaly

Ventriculomegaly / hydrocephaly

Fetal brain disruption sequence (collapsed skull, overlapping sutures, prominent occipital bone, scalp rugae)

Other major brain abnormalities, including intraventricular hemorrhage in utero (excluding postnatal IVH)

Date of diagnosis of congenital microcephaly

M-D-Y

Date of diagnosis of intracranial calcification

M-D-Y

Date of diagnosis of cerebral atrophy

M-D-Y

Date of diagnosis of abnormal cortical formation

M-D-Y

Date of diagnosis of corpus callosum abnormalities

M-D-Y

Date of diagnosis of cerebellar abnormalities

M-D-Y

Date of diagnosis of porencephaly

M-D-Y

Date of diagnosis of hydranencephaly

M-D-Y

Date of diagnosis of ventriculomegaly/hydrocephaly

M-D-Y

Date of diagnosis of fetal brain disruption sequence

M-D-Y

Other major brain abnormality, specify

Date of diagnosis of other major brain abnormality

M-D-Y

Neural tube defects and other early brain malformations

Anencephaly / Acrania

Encephalocele

Spina bifida

Holoprosencephaly / Arhinencephaly

Date of diagnosis of anencephaly/acrania

M-D-Y

Date of diagnosis of encephalocele

M-D-Y

Date of diagnosis of spina bifida

M-D-Y

Date of diagnosis of holoprosencephaly/arhinencephaly

M-D-Y

Eye abnormalities

Microphthalmia / Anophthalmia

Coloboma

Cataract

Intraocular calcifications

Chorioretinal anomalies involving the macula (e.g., chorioretinal atrophy and scarring, macular pallor, gross pigmentary mottling and retinal hemorrhage); excluding retinopathy of prematurity

Optic nerve atrophy, pallor, and other optic nerve abnormalities

Date of diagnosis of microphthalmia/anophthalmia

M-D-Y

Date of diagnosis of coloboma

M-D-Y

Date of diagnosis of cataract

M-D-Y

Date of diagnosis of intraocular calcifications

M-D-Y

Date of diagnosis of chorioretinal anomaly

involving the macula

M-D-Y

Date of diagnosis of optic nerve atrophy,

pallor, and/or other optic nerve abnormality(ies)

M-D-Y

Consequences of central nervous system (CNS) dysfunction

Congenital contractures (e.g., arthrogryposis, club foot, congenital hip dysplasia) ONLY with associated brain abnormalities

Confirmed congenital deafness documented by postnatal testing

Date of diagnosis of congenital contracture(s)

M-D-Y

Date of diagnosis of congenital deafness

M-D-Y

Definitive Diagnosis (ICD-10-CM)

Mother Medical Record Number

Mother First Name

* must provide value

Mother Last Name

* must provide value

Mother DOB

* must provide value

M-D-Y

Mother SSN

Mother Residential Street Address

Mother Residential Zip Code

State of Mother's Residence

* must provide value

County of Residence

County or Independent City of Residence

Mother's telephone number

Did the mother travel to an area of active Zika transmission during pregnancy?

For a complete list of countries/territories currently affected by Zika, please see CDC's Travel Notices: (http://wwwnc.cdc.gov/travel/notices)

* must provide value

Yes

Question not asked

reset

To which country or territory did the mother travel?

Please list all that apply.

Did the father of the infant and/or the mother's partner travel to an area of active Zika transmission during pregnancy?

For a complete list of countries/territories currently affected by Zika, please see CDC's Travel Notices: (http://wwwnc.cdc.gov/travel/notices)

* must provide value

Yes

Question not asked

reset

To which country or territory did the father and/or partner travel?

Please list all that apply.

Name of Mother's OB

* must provide value

Name of Infant's PCP

* must provide value

Name of Reporting Provider

* must provide value

Type of Provider

* must provide value

Mother's OB

Child's PCP

Child's Neurologist

Child's Geneticist

Other

reset

Other Type of Provider, Please Specify

Name of Reporting Facility

* must provide value

Name of Infant's Primary Care Provider

* must provide value

Best contact method

(in case we need to get back in touch with you or your office)

* must provide value

Phone

Contact Phone

* must provide value

Email Address

* must provide value

Additional Comments

Expand

Duplicate?

Yes

reset

Meets Case Inclusion Criteria

* must provide value

Yes

reset

Maternal Health History Form

Attachment:Maternal Health History Form.pdf

Maternal Health History Form Upload

Upload file

Neonate Assessment Form

Attachment:Neonate Assessment Form.pdf

Neonate Assessment Form Upload

Upload file

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.