New Nicu Blue Book

7/28/2019 New Nicu Blue Book

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Prepared by KIMS and CDC, Trivandrum forPerinatal risk stratification of preterm neonates and

developmental outcomes - multi - centre study

Neurodevelopmental Assessment

Early Intervention


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GROWTH MONITORING Very Low Birth Weight Chart

Fetal - infant growth chart for preterm infants( weight , head circumference, and length). Reproduced with permission from Fenton

TR; licensee BioMed Central Ltd. This is an Open Access article: Verbatim copying and redistribution of this article are permi tted in all

media for any purpose, provided this notice is preserved along with the article's original URL. http://www.biomedcentral.com/1471-

2431/3/13.)


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4 MONTHS(corrected age) Date: _________________________

Hb

DDST:

Gross motor

Fine motor

Language

Personal social

AT angles: Hyper/Hypotonia Asymmetry

Adductor

Heel to ear

Popliteal

Dorsiflexion

Scarf sign

Differential tone

Muscle tone

Neck Increased / decreased / normal

Trunk Increased / decreased / normal

DTR Decreased 4 mo corrected age


AT angles: Hyper/ Hypotonia Asymmetry

Adductor

Heel to ear

Popliteal

Dorsiflexion

Scarf sign

Differential tone

Muscle tone



DTR decreased 9 months corrected age


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Hb

Iron supplementation may be stopped

Refraction

AT angles: Hyper/ Hypotonia Asymmetry

Adductor

Heel to ear

Popliteal

Dorsiflexion

Scarf sign

Differential tone

Muscle tone



DTR Decreased 85 is Normal

85 is Normal


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FOLLOW UP ASSESSMENT


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Summary Statement of FU Visits


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Percent of children passing

May Pass by reportTEST ITEM

Footnote no.(Seebackof form)

25

R1

86%

88%

50 75 90

Regard face

Follow to midline

Responseto bell

Equal movements

Lifthead

Head up 45

Head up 90

Sit- Headsteady

Bear weighton legs

Chestup-arm support

Roll over

Pull to sit-no head lag

Sit-nosupport

Standholdingon

Pull tostand

Get2sitting

Stand-2seconds

Stand alone

Stoop andrecover

Walkwell

Walkbackwards

Runs

Walkup steps

Kickball forwards

Jump up

Throw ball overhead

Broad jump

Balanceeachfoot1second

Balanceeachfoot2second

Hops

Balanceeachfoot3 seconds


Balanceeach

foot5 seconds

Heel-to toewalk


Vocalizes

Ooolah

Laughs

Squeals

Dada/Mamanon-specific

Combinesyllables

Jabbers

1word

2word

3word

6word

Point2pictures

Combinewords

Name1picture

Bodyparts6

Point4pictures

Speech half understandable

Name4pictures

Know 2actions

Know 2adjectives

Name1colour

Useof 2objects

Count1block

Useof 3objects

Speech all understandable

Understand 4prepositions

Name4colours

Define5words

Know 3adjectives

Count5 blocks

Opposite-2

Define7words

Know 4actions

Dada/mamaspecific

Turn to rattlingsound

Turn to voice

Singlesyllables

Imitatespeech sound

Follow pastmidline

Grasprattle

Handstogether

Follow 180

Regard raisin

Reaches

Lookfor yarn

Rakeraisin

Passcube

Take2cubes

Thumb-finger grasp

Bang 2cubes heldin hands

Putblockin cup

Scribbles

Dump raisindemonstrated

Tower of 2cubes

Tower of 4cubes

Tower of6cubes

Tower of8cubes

Thumb wiggle

Picklonger line

Copydemon stated

Draw person 6parts

Draw person3parts

Copy

Copy+

Imitatevertical line

Smileresponsively

Smilespontaneously

Regard own hand

Workfortoy

Feed self

Playpat-a-cake

Indicatewants

Wavebye-bye

Playball withexaminer

Imitateactivities

Drinkfrom cup

Help in house

Usespoon/fork

Removegarment

Feed doll

Puton clothing

Brush teeth with help

Wash and dryhands

Namefriends

Puton T-shirt

Dressno help

Playboard/card games

Brush teeth no help

Preparecereal

Copy

(Check boxes for 1st,2nd or 3rd test)

Typical

Yes

No

Compliance (See Note 31)

AlwaysComplies

UsuallyComplies

RarelyComplies

Interestin Surroundings

Alert

SomewhatDisinterestedSeriouslyDisinterested

Fearluiness

None

Mild

Extreme

AttentionSpan

Appropriate

SomewhatDistractable

VeryDistractable

1 2 3

1 2 3

1 2 3

1 2 3

1 2 3

1969,1990W.KFrankenburgan

dJ.BDodds1978W.K.Frankenburg


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GROWTH RECORD - BOYS


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New Nicu Blue Book