Medical admission to SCN/ICU Whether the baby was for in a special care nursery, or intensive care unit because of a medical condition. Tick the box that corresponds to the baby’s SCN/ICU admission status. Code: Tick one of the No Yes Guide to use: If to this question, record the number of days spent in the special care nursery or neonatal intensive ‘yes’ care unit. Congenital abnormalities Any structural or anatomical abnormalities of the baby that is present at in either a liveborn or stillborn baby, and diagnosed before separation from care. If no congenital abnormalities were diagnosed, tick Where is ticked, please provide further ‘None’. ‘Other’ detail in the box provided. Please also complete the Congenital Abnormality Notification Form if any of the congenital abnormalities is ticked. More than one abnormalities can be selected, except where applies. ‘None’ Code: Tick one or more of the boxes. None Malformation of nervous system Malformation of eye, ear, face & neck Malformation of circulatory system Cleft lip and cleft palate Malformation of digestive system Malformation of genital organs Malformation of urinary system Malformation of musculoskeletal system Chromosomal malformations Inborn errors of metabolism Other NOTE: The congenital abnormalities form should be completed.
Medical admission to SCN/ICU Whether the baby was for in a special care nursery, or intensive care unit because of a medical condition. Tick the box that corresponds to the baby’s SCN/ICU admission status. Code: Tick one of the No Yes Guide to use: If ‘yes’ to this question, record the number of days spent in the special care nursery or neonatal intensive care unit. Congenital abnormalities Any structural or anatomical abnormalities of the baby that is present at in either a liveborn or stillborn baby, and diagnosed before separation from care. If no congenital abnormalities were diagnosed, tick ‘None’. Where ‘Other’ is ticked, please provide further detail in the box provided. Please also complete the Congenital Abnormality Notification Form if any of the congenital abnormalities is ticked. More than one abnormalities can be selected, except where ‘None’ applies. Code: Tick one or more of the boxes. None Malformation of nervous system Malformation of eye, ear, face & neck Malformation of circulatory system Cleft lip and cleft palate Malformation of digestive system Malformation of genital organs Malformation of urinary system Malformation of musculoskeletal system Chromosomal malformations Inborn errors of metabolism Other NOTE: The congenital abnormalities form should be completed.
Tasmanian_Perinatal_Data_Collection_Guideline_1_January_2018.docx