Part 1 General History

Yes No

Yes No

Yes No

Cytomegalovirus Rubella (German Measles) Meningitis Herpes Simplex Toxoplasmosis Fever None

1 2 3 4 5 6 7 8 9

Low grade fever/High fever skin rashes swelling in the neck cough or cold swollen lymph nodes none

Yes No

1 2 3 4 5 6 7 8 9

skin rash nausea headache loss of apetite

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

1 2 3 4 5 6 7 8 9

Yes No

Yes No

Yes No

Yes No

Yes No

Normal C-section,

Pre-term delivery Full term delivery post term delivery

Spontaneous Induced labour

< 1.5 kg 1.5 – 3 kg > 3 kg

> 7 = 7 < 7

pale overall blue blue at the extremities pink

limb flexion active motion

slow < 100 beats per minute/ > fast >100 bpm

startles or cries in response to loud sound responds with a facial grimace when stroked on the face

weak cry and slow breathing breathing well and crying normally difficulty in breathing

> 7 = 7 < 7

Yes No

Bacterial meningitis Rubella syndrome ( TORCH infection ) Toxoplasmosis/ Cytomegalovirus Herpes Simplex None

Low grade fever High fever skin rashes swelling in the neck cough or cold swollen lymph nodes None

Small Normal Ears Absent

depressed nasal bridge reduced nostrils

Yes No

open mouth closed mouth

Open Mouth smaller jaw White Forelock near forehead

Occupational therapy Physiotherapy Remedial Therapy Speech and language therapy

Yes No

Yes No