MG Nursery

MGN Discharge and Transfer Planner

Staff access for discharge and transfer planning.

Staff member Password

MG Nursery

MGN Discharge and Transfer Planner

Created by Shakti Pillay
Associate Professor and Neonatologist
Groote Schuur Hospital Neonatal Unit
31 May 2026

Discharge or transfer

Is this for discharge or transfer?

Baby details

Name Surname Date of birth Folder number

Gestational age at birth w d Birth weight g

Current weight g Discharge date

Length at birth cm Head circumference at birth cm Head circumference at discharge cm

Corrected Gestational Age at discharge -

Day of life at discharge -

Maternal details

Maternal folder number Maternal RPR status Maternal blood group Maternal medical history Maternal HIV status

Birth history

Place of birth Mode of delivery

Apgar 1 minute Apgar 5 minutes Apgar 10 minutes

Investigations

Investigations

Problem list

Problem list

Problem 1

Select only relevant problems. This list is not exhaustive; if a problem is not present, enter it manually.

Retinopathy of Prematurity

Ever screened for Retinopathy of Prematurity?

Date of last Retinopathy of Prematurity screening Retinopathy of Prematurity findings Follow-up needed?

Date for next Retinopathy of Prematurity screening

Immunisation status

Birth immunisations Yes No Not yet

Discharge Medication

Medication plan

Follow-up dates

High-Risk Follow-Up Criteria

Birth weight < 1000 grams

Necrotising enterocolitis (NEC) managed surgically

Ventilation at any time during admission

Grade 3 or 4 intraventricular haemorrhage

Periventricular leukomalacia

Sub-cortical leukomalacia

Ventriculomegaly on discharge

Seizures

Meningitis

Hypotension managed with inotropes or vasopressors

Jaundice above exchange level

Congenital infection with central nervous system involvement

Moderate or severe neonatal encephalopathy with abnormal aEEG

Symptomatic hypoglycaemia

Abnormal neurological examination on discharge

Surgery for perforation, congenital bowel anomaly, or congenital diaphragmatic hernia

Confirmed inborn errors of metabolism

Medium-Risk Follow-Up Criteria

Necrotising enterocolitis (NEC) managed medically

Severe hypoglycaemia

Congenital infection without central nervous system involvement

Mild neonatal encephalopathy with suspected hypoxic ischaemic encephalopathy (not cooled, normal aEEG)

Bacteraemia

Neonatal abstinence syndrome

Pneumothorax

Confirmed PDA on anti-failure treatment at discharge

Caregiver Education

General danger signs Sudden infant death prevention strategies Referral pathways Follow-up dates explained

Follow-up dates to explain

Feeding

Feeding plan Feeding counselling and plan

Caregiver details

Caregiver name Caregiver cell number Caregiver email

Staff member details

Staff member name Email Cell number

Trial version. Staff access is password protected for workflow testing.

Discharge planning checklist

Discharge checks

Send summary to cell number

Handoff link for phone