NICU Monitoring Checklist
Checklist for monitoring newborns in the Neonatal Intensive Care Unit.
Date and Time of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Patient Name
*
First Name
Last Name
Vital Signs
Temperature (°C)
*
Heart Rate (bpm)
*
Respiratory Rate (breaths per minute)
*
Oxygen Saturation (%)
*
Feeding Details
Feeding Type
*
Breastfeeding
Bottle feeding
Tube feeding
Parenteral nutrition
Feeding Amount (ml)
*
Medications Administered
Observations and Notes
Nurse/Doctor Signature
*
Submit
Should be Empty: