Neonatal Respiratory Distress - Bedside Clinical Proforma

1. Patient Demographics & Maternal Risk Factors

Baby's Name: Baby of ... | Sex: Male / Female | Age: Hours of Life
Gestational Age: Weeks (Preterm <37w / Term 37-41w / Post-term ≥42w)
Birth Weight: Grams | Delivery Mode: Normal Vaginal / Emergency LSCS / Elective LSCS
Maternal Medical Risk Factors:
- Gestational Diabetes Mellitus (GDM) on Diet / Insulin (Delays surfactant synthesis)
- Hypertension / Pre-eclampsia (Accelerates surfactant synthesis)
- Maternal Fever / Chorioamnionitis / Foul-smelling liquor (Congenital Pneumonia)
- Prolonged Rupture of Membranes (PROM >18 hours)
- Antenatal Corticosteroids: Inj. Betamethasone 12 mg IM (2 doses, complete ≥24h prior to birth)
Amniotic Fluid Character: Clear / Meconium-Stained (Thin / Thick pea-soup)

Time of Onset of Respiratory Distress: At birth / First 2-4 hours / After 12-24 hours
Silverman-Anderson Retraction Score (Preterm Neonate):
- Upper Chest Movement: Synchronized (0) / Lag on inspiration (1) / See-saw breathing (2)
- Lower Chest Retractions: None (0) / Just visible (1) / Marked (2)
- Xiphoid Retractions: None (0) / Just visible (1) / Marked (2)
- Nares Flaring: None (0) / Minimal (1) / Marked (2)
- Expiratory Grunt: None (0) / Audible with stethoscope (1) / Audible to naked ear (2)
- Total Score: ... / 10 (0-3: Mild | 4-6: Moderate | ≥7: Severe / Impending Failure)
Downe Score (Term Neonate):
- Cyanosis / Air Entry / Respiratory Rate / Retractions / Grunt | Total Score: ... / 10

Vitals: HR: ... /min | RR: ... /min (Tachypnea >60/min) | CRT: ... s | Temp: ... °C
Pre-ductal SpO2 (Right Hand): ... % | Post-ductal SpO2 (Feet): ... % (Gradient >5-10% indicates PPHN)
Chest Examination: Symmetrical / Bell-shaped / Barrel-shaped | Trachea: Central / Shifted
Air Entry: Bilateral symmetrical / Decreased on Left (CDH/Pneumothorax) / Crackles / Bronchial breathing
Abdominal Examination: Normal / Scaphoid (Congenital Diaphragmatic Hernia) / Distended

Arterial Blood Gas (ABG):
- pH: ... (Acidosis <7.25?) | PaCO2: ... mmHg (Hypercapnia >55-60?) | PaO2: ... mmHg | HCO3: ... | BD: ...
Chest Radiograph (AP View):
- Reticulogranular ground-glass appearance + air bronchograms (RDS Stage I-IV)
- Hyperexpansion + fluid in fissures + prominent vascular markings (TTNB)
- Patchy coarse infiltrates + hyperinflation + flattened diaphragm (MAS)
- Bowel loops in hemithorax + mediastinal shift (Congenital Diaphragmatic Hernia)
- Lucency + collapsed lung margin + mediastinal shift to opposite side (Pneumothorax)
Infection Markers: CBC | Total WBC: ... | I:T Ratio: ... (<0.20?) | CRP: ... mg/L | Blood Culture

Bubble CPAP: PEEP ... cm H2O (5-7 cm H2O) | Blender FiO2: ... (Target SpO2: 90-94%)
Surfactant Indication on CPAP: Preterm requiring FiO2 >0.30 to maintain SpO2 >90%
Surfactant Preparation: Poractant alfa (200 mg/kg) / Beractant (100 mg/kg) | Dose: ... mg = ... mL
Administration Technique: LISA / MIST (Thin catheter under direct laryngoscopy) vs INSURE vs In-ETT
Post-Surfactant Response: Drop in FiO2 requirement / Rapid improvement in chest compliance
Caffeine Citrate: Loading 20 mg/kg IV/oral | Maintenance 5-10 mg/kg/day