SPSAH/126

Accredited by :

Patient Label

NEONATAL RECORD
Name : B/O Sex :
Date Time of Birth :
Weight Gestation :
Obstetrician : Neonatologist :

Maternal History

Age : Blood Group : Parity

Antenatal :
Medical Problem :
Present Pregnancy : LMP

DELIVERY

MODE
Normal Vaginal / Froceps / Ventouse Extraction LSCS (Emergency / Elective)

Indication :
Maternal sedation / Analgesia / Anaesthesia / Pethidine / Epidural / Spinal / General Anaesthesia - None

ONSET OF LABOUR
Spontaneous / Induced / Augmented

RUPTURE OF MEMBRANE
Spontaneous / Artifical / Premature / Prolonged

LIQUOR
Clear / Infected / Meconium Stained / Other

RESUSCITATION

APGAR SCORE 1" 5"

HR
DRUGS Resp.
Colour
Reflex
Tone
Total

12/05
EXAMINATION DONE AT AGE
Gestation : AGA / LGA / SGA Weight Lenght
OFC
HR RR TEMP (Rectal) :
Colour : Pink / Acrocyanosis / Pale Saturation :...............% in Fio2.................%
Cap - Refill Four Limb Bp (mean) : Rt. Lt.
Spontaneous Activity : Upper Limb :
Good / Fair / Sluggish Lower Limb :
Dysmaphesia :

SYSTEMIC EXAMINATION

R/S : Normal Distress Retractions B/L Breath Sounds

Any Abnormality

P/A Shape : Normal / Scaphoid / Distended Umbilical Vessels :

Liver : Spleen : Kidney :
Bowel Sound :

CVS : Heart Sound : S1/ /S2 B/L Peripheral Pulses :

Murmur :

CNS : A/F : Depresses / At level / Full / Bulging Cry : Normal / Weak / Shrill
Tone : Flaccid / Normal / Rigid Reflexes : Moro's / Rooting
Any Abnormality : Head Spine

EYES : Cornea : Clear / Opacity / Clouding Pupils : Red Reflex :

Miscellaneous : Patency : Oral / Rectal / Nasal Musculoskeletal : Feet / Hips

Cephalhematoma / Caputsuccedaneum : Genitalia :

Oral Cavity : Lips / Palate

Anthropometry : Weight : Head Circumference : Length :

12/05
Modified Ballard :

Neuromuscular Maturity
Apgars 1min 5min
Age at Exam hrs
Race Sex
B. D.
LMP
EDC
Gest. age by dates wks
Gest. age by Exam wks
o
B.W. gm. ile
o

o
Lenght cm. o ile
o
Head Circum. cm. oile
Clin Dist. None Mild
Mod. Severe

PHYSICAL MATURITY
superficial parchment
gelatinuos smooth cracking leathery MATURITY RATING
peeling deep
Skin red.trans- pink vis- pale area cracked
&/or rash cracking
parent ible veins few veins rare veins wrinkled Score Wks
no vessels
5 26
bald mostly
Lanugo none abundant thinning 10 28
areas bald
15 30
anterior creases
Plantar creases
transverse cover 20 32
no crease faint ant.
Creases redmarks crease 2/3
entire
only sole 25 34
stippled raised 30 36
barely full areola
flat areola areola areola
Breast 5-10 mm
percept. no bud 1-2 mm 3-4 mm 35 38
bud
bud bud
40 40
sl. curved well-curv. formed & thick
pinna flat.
pinna: soft pinna:soft firm with cartilage 45 42
Ear stays
with slow but ready instant ear
folded recoil 50 44
recoil recoil stiff
testes tests tests
scrotum
descend- down pendulous
Genitals empty
ing. few good deep
no rugae
rugae rugae rugae
Prominent majora majora clitoris
clitoris & & minora large & minora
Genitals
labia equally minora completely
minora prominent small covered
DIAGNOSIS
Investigations Advised : (tick the relevant ones)

Blood Sugar Blood Group G6PD S. Bilirubin (T/D)

DCT CBC Periph. Smear Retic count
CRP Micro ESR TFT Blood Culture
Lumbar Puncture CXR Echocardiogram
P. Smear for Sepsis (Toxic granules / band cells)

IDENTIFYING FOOT PRINT

ADVICE Print Here

Admit in NICU

Routine Care

Transfer to Mother

Breast Feeding

Early Feeding

Dextrostix at age of one hour

Inj. Vitamin K1 1mg Stat 1/M at birth

(Neonatal Registrar)
(Date / Time)

Consultant
(Date / Time)

12/05