8/14/2019 neonatology.doc

1/4

8/14/2019 neonatology.doc

2/4

Fa"ily history

#ny history of si"ilar illness in the siblings

Treatment

2reat"ent so far

3ection $Pregnancy, Birth & Neonatal History

Pregnancy arity

#ntenatal care where did you book?

Duration of pregnancy to rule out preterm

Fever 0 Rash during first tri"ester

Drug ingestion during pregnancy

Radiation 2etanus tooid

istory of antepartu" hae"orrhage

Delivery 4here

Duration of seeing or passing water .a"niotic fluid/ R5(

4as the water foul-s"elling or "econiu" stained .greenish/

Duration of labour

(ode of delivery 3!D, forceps to rule out intracranial haemorrhage

4as the birth induced? oytocin

Did the child cry i""ediately after birth or after resucitation

'irth weight

$ord care

Immunisation

Did the child receive any i""uni6ation

#t birth, 7 "onths

4hat route*site of ad"inistration? oral or I(

4here is the i"unisation card?

#ny adverse reactions

If atient was not i""uni6ed, ask why?

Section D

Deelopmental !ilestone

Nutritional history

8/14/2019 neonatology.doc

3/4

Feeding since birth breast "ilk * cow"ilk, Fre&uency of feeds8

Refusal of feeds - Is the child sucking well?

"amily & Social History

(onoga"ous or polyga"ous Father 0 (other)s age, occupation, educational status

'irth order of the patient

3iblings 1u"ber, alive 0 well

- Death age 0 cause of death

- #ny si"ilar illness

Treatment

Treatment offered so far

Ina#ility to suck $ Neck sti%%ness&Neonatal tetanusSection A

Section B

Symptoms clerking Duration

Associated Symptoms Fever autonomic sign

Any spas"s unprovoked or provoked by light sound- duration ! to first sign trismus"- Fre#uency- Aggravating or relieving factors- $o% long does each episode last&

'eriod bet%een the inability to suck and the first spasm 'eriod ononset

Triggering factors e(g bright light touching noise(

Ear pulling or discharge

)rritability or crying

Breathlessness from aspiration

*aundice

+hen last did the child eat& - hypoglycaemia

8/14/2019 neonatology.doc

4/4

Aetiology

Ear discharge ,hronic suppurative otitis media

,ircumcision Ear piercing or tribalscarification marks

Blood transfusion

Trauma

'regnancy birth . /eonatal history

'regnancy- 'arity- 0ength of pregnancy- A/, %here . %hen&- TT- Drug ingestion during pregnancy- $istory of antepartum hemorrhage intrauterine hypo1ia- $istory of fever or rash T23,$ES- 4se of social drugs !drug %ithdra%al" alcohol intake

Delivery- Duration of seeing or passing %ater !amniotic fluid" '325- +as the %ater foul-smelling or meconium stained !greenish"- Duration of labour- 5ode of delivery- Birth %eight- ,rying after birth )mmediately or after resuscitation- +hat %as used to cut the cord&- ,ord care

/eonatal- *aundice-

Treatment so far