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

 

 

 

 

 

 

 

 

 

 

 

 

Outcome (Number of babies)

Discharged

Referred

Lama

Died

 

 

 

 

 

 

 

 

 

Signature of Unit Incharge _______________________________