PATIENT FOLLOWING FORM .pdf

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PATIENT FOLLOWING FORM (RAM cannule & Hudson cannule)

Protocol No:
PATIENT GROUP: RAM cannula ( )

Hudson cannula ( )

Birth weight;
Pregnancy week (If the pregnancy week is suspicious, the new Ballart score) :
SGA: Y ( ) N ( )
Way of Birth: NVD ( ) C&S ( )
Apgar score 1.dk:
Gender:
Male ( ) Female ( )
Apgar score 5. dk:
Antenatal steroid:
Y( ) N( )
PPROM:
Y( ) N( )
SNAP-PE II score:
Pre-eclamsia:
Y( ) N( )
Multiple pregnency: Y ( ) N ( )
İnitially FiO2 requirement:
PDA:
Y( ) N( )
İntracranial hemorrhage (degree 3): Y ( ) N ( )
İntracranial hemorrhage (degree 4): Y ( ) N ( )
Invasive ventilation was required in the first 72 hours: Y ( )

N( )

if yes at the following hour:

NEC:

Is there a need for surfactant treatment? :

Y( )

N( )

Do you need ≥2 doses of surfactant ?:

Y( )

N( )

Y( ) N( )

Pulmonary hemorrhage: Y ( ) N ( )
ROP:

Y( ) N( )

BPD:

Y( ) N( )

Time of full enteral feeding time (day):
Hospitalizatiion duration (day):

Nasal IPPV duration (days):
Invasive ventilation duration (days):
Oxygen delivery duration (days):
Pneumothorax?:
Y( ) N( )
Pulmonary interstitial emphysema ?: Y ( )
Nasal septum injury :
Y( ) N( )
(bleeding, mild necrosis, severe deformity)

N( )


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