Neonatal Monitoring Log Form
Record routine monitoring details for newborns. Do not enter sensitive identifiers or confidential health information.
Baby ID (Initials or Assigned Code)
*
Monitoring Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Gestational Age at Birth (weeks)
*
Birth Weight (grams)
*
Current Weight (grams)
*
Vital Signs
*
Rows
Value
Temperature (°C)
Heart Rate (bpm)
Respiratory Rate (breaths/min)
Feeding Details
*
Breastfeeding
Formula Feeding
Mixed Feeding
Other
Elimination Details
*
Urine output normal
Stool passed
Abnormal findings
General Observations
*
Caregiver/Clinician Notes
Submit Log
Should be Empty: