Reporting format for New Born Stabilization Units (NBSUs)
(All New Born Stabilization Units (NBSUs) should submit this monthly report to the District. A compiled report from all NBSUs in the district)
Month ________________________ Year ____________ of reporting
State ______________ District ______________ HPD (Yes/No) Block ____________________
Type of the Health Facility : (CHC/FRU/SHD/PHC) Tick one
Name and address of the facility : ___________________________________
Date of Operationalization (DD/MM/YYY) of NBSU _________________________ (One time)
Total number of beds (Radiant Warmer) : ____________ (One time-to be updated if any changes)
Number of MO designated for NBSU (1 / 2 / 3 / 4) Tick any one.
Number of Staff Nurses designated for NBSU (1 / 2 / 3 / 4) Tick any one.
Number of Live births at the facility in the reporting period : Total _____ Male ____ Female ____
Total No. of admissions in NBSU | Inborn | Outborn | Birth weight | Duration of stay | |||||
Male | Female | Male | Female | More than & equal to 25000gm | Less than 2500gm | Within 24hrs | 1-3 days | More than 3 days | |
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Outcome (Number of babies) | |||
Discharged | Referred | Lama | Died |
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Signature of Unit Incharge _______________________________
