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Neonatal Jaundice Severity Scoring
NNJ Referral Form
Patient Details
Name:
Mother's Ic No:
From:
KK Mersing Kanan
KD Seri Pantai
KK Nitar 1
KD Nitar 2
KK Jemaluang
No Tel:
Date Referred:
Time Referred:
Plan
1) Refer H. Mersing for further management.
Neonatal Jaundice Severity Scoring
Week of Gestation Upon Delivery:
38 weeks and above
35 weeks to 37 weeks 6 days
Mother's Blood Group O:
No
Yes but baby also blood group O
Yes but already >96 Hours of life
Yes
Mother's Rhesus Status:
Positive
Negative with baby Rhesus negative
Negative with unknown baby status
Negative with baby Rhesus positive
G6PD Status:
No
Yes
Signs and Symptoms of Sepsis:
No
Yes
History of Asphyxia:
No
Yes
Calculate Severity
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Age Calculator
Patient's birthdate and time:
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TSB Calculator
Hours of life:
TSB (mg/dL):
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