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Neonatology
Namibia
How we work
Reports
About us
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Namibian MNDS
Health care facility
Name of hospital
Rundu State Hospital
Onandjokwe State Hospital
Patient identification
First name
Family name
Sex
male
female
Date of birth
Europe/Berlin
Date of admission to Prem Unit
Europe/Berlin
Mother
Age (years)
Gravidity
Parity
HIV status
pos
neg
HIV treatment
yes
no
Antenatal corticosteroids
yes
no
Delivery
Place of delivery
Inborn
Outborn - other health care facility
Outborn - home delivery
Mode of delivery
Normal vaginal delivery
Vacuum/forceps delivery
Primary Cesarean section
Secondary Cesarean section
Apgar score
5 minutes
10 minutes
Resuscitation
Select all that apply
None
Supplemental oxygen
Bag-mask ventilation
Intubation
Chest compressions
Adrenaline
Information on admission
Birth weight (grams)
Weight on admission to Prem Unit (grams)
Estimated gestational age at birth (weeks)
Admission temperature (°C)
Confirmed diagnoses
Respiratory disorders (select all that apply)
Wet lung
Hyaline membrane disease
Meconium aspiration
Pneumonia
Air leak - pneumothorax, pneumomediastinum
Other causes of respiratory distress
If other, describe diagnosis (please, be specific)
Infectious disorders - early-onset sepsis (EOS; < 72 hours of life)
EOS, proven - positive culture
EOS, suspected - elevated CRP, but negative culture
If culture positive, list organism identified
Infectious disorders - late-onset sepsis (LOS; > 72 hours of life)
LOS, proven - positive culture
LOS, suspected - elevated CRP, but negative culture
If culture positive, list organism identified
If other infection, describe (please, be specific)
Hypoxic ischemic encephalopathy (HIE)
Sarnat stage I
Sarnat stage II
Sarnat stage III
PDA (patent ductus arteriosus) (select all that apply)
yes, no treatment
yes, medical treatment
yes, referred for surgical ligation
NEC (necrotizing enterocolitis)
NEC, suspected
NEC, proven (pneumatosis, perforation)
Neonatal jaundice (select all that apply)
Yes, phototherapy
Yes, exchange transfusion
Other diagnosis I
Other diagnosis II
Other diagnosis III
Therapies
Antibiotics
yes
no
If yes, number of days
Respiratory support (select all that apply)
Supplemental oxygen
CPAP (please, fill out CPAP patient registry form)
Surfactant
Invasive mechanical ventilation (please, fill out MV patient registry form)
Anticonvulsants
yes
no
If yes, number of days
Other therapy I
Other therapy II
Other therapy III
Outcome
Discharged alive
yes
no
If yes, date of discharge
Europe/Berlin
If yes, weight at discharge (grams)
If yes, type of nutrition (select all that apply)
Mother's milk
Mother's milk with fortifier
Formula
Transferred
yes
no
If yes, date of transfer
Europe/Berlin
If yes, destination of transfer
Died
yes
no
If yes, date of death
Europe/Berlin
If yes, cause(s) of death (please, describe in detail)
Additional comments
Please, describe in detail
Submit Data
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