What History and examination is necessary for a neonate to be admitted in ward. Write a template based on standard reference to use a standard in ward for every neonate

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Neonatal Ward Admission: History & Examination Template

Based on: Textbook of Family Medicine 9e · Tintinalli's Emergency Medicine · The Harriet Lane Handbook 23rd Ed · Fitzpatrick's Dermatology 9e

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NEONATAL WARD ADMISSION PROFORMA

══════════════════════════════════════════

INSTITUTION: ___________________________   WARD: ___________________
DATE OF ADMISSION: ___________________   TIME: ___________________
MRN / File No.: _______________________   Admitted by: _____________

SECTION 1 — PATIENT IDENTIFICATION

Field	Details
Neonate's Name (if given)
Date / Time of Birth
Gestational Age at Birth	______ weeks ______ days
Actual Age at Admission	______ days / hours
Birth Weight	______ kg
Sex	☐ Male ☐ Female ☐ Ambiguous
Place of Birth	☐ This hospital ☐ Other hospital ☐ Home ☐ Other
Referring facility (if transferred)
Mother's Name
Mother's Age
Mother's MRN
Consultant / Attending

SECTION 2 — PRESENTING COMPLAINT

Chief reason for admission (in caregiver's words):
_________________________________________________________________
Duration: _______________

SECTION 3 — MATERNAL HISTORY

"Gathering a complete maternal history, including a review of the mother's medical problems; past obstetric history; medications, drug, alcohol, or tobacco use during pregnancy; and prenatal serologies is important." — Textbook of Family Medicine 9e, p. 529

3A. Antenatal History

Parameter	Details
Gravida / Para / Abortus	G ___ P ___ A ___
Number of fetuses this pregnancy
Antenatal care	☐ Regular ☐ Irregular ☐ None
No. of ANC visits
Maternal medical conditions	☐ Diabetes (GDM / pre-existing) ☐ Hypertension ☐ Epilepsy ☐ Thyroid disease ☐ Cardiac disease ☐ Renal disease ☐ Other: _______
Infections during pregnancy	☐ TORCH (T. gondii, rubella, CMV, HSV) ☐ Syphilis ☐ HIV ☐ HBsAg ☐ Group B Strep ☐ Malaria ☐ COVID-19 ☐ Zika ☐ UTI
Prenatal serologies result	Blood group: ______ Rh: ______ VDRL: ______ HIV: ______ HBsAg: ______ Rubella immunity: ______
Genetic / anomaly screening	☐ Done — result: ______ ☐ Not done
Ultrasound findings	☐ Normal ☐ Anomaly detected: ______ ☐ Not done
Medications in pregnancy	(List all, include folic acid, iron, antihypertensives, steroids, antiretrovirals)
Substance use	☐ Alcohol ☐ Tobacco ☐ Recreational drugs ☐ None
Radiation / teratogen exposure
Blood transfusion in pregnancy	☐ Yes ☐ No
Significant illness in pregnancy
Antenatal corticosteroids given (if preterm)	☐ Yes (complete/incomplete course) ☐ No

3B. Previous Obstetric History

Parameter	Details
Previous stillbirths / neonatal deaths
Previous infants with congenital anomalies
Previous infant with jaundice requiring exchange transfusion
Previous preterm deliveries
Previous infant with metabolic / genetic disease

SECTION 4 — INTRAPARTUM HISTORY

"Obtain a brief history from the mother, including gestational age, number of fetuses, history of diabetes, hypertension, prolonged rupture of membranes, fever, and meconium-stained amniotic fluid." — Tintinalli's Emergency Medicine, p. 716

Parameter	Details
Mode of delivery	☐ SVD ☐ Assisted vaginal (vacuum/forceps) ☐ Elective LSCS ☐ Emergency LSCS
Indication for operative delivery
Duration of labour (total)	______ hours
Duration of ROM before delivery	______ hours
Prolonged ROM (>18 hours)	☐ Yes ☐ No
Amniotic fluid appearance	☐ Clear ☐ Meconium-stained (thin/thick) ☐ Blood-stained ☐ Foul-smelling
Maternal fever in labour (>38°C)	☐ Yes ☐ No
Maternal antibiotics in labour	☐ Yes — drug: ______ ☐ No
Fetal distress / abnormal CTG	☐ Yes ☐ No
Cord complications	☐ Cord prolapse ☐ Nuchal cord ☐ Short cord ☐ None
Placental complications	☐ Abruption ☐ Previa ☐ Normal
Birth attendant	☐ Physician ☐ Midwife ☐ TBA ☐ Unattended
Place of delivery (if different from admission)

SECTION 5 — NEONATAL BIRTH HISTORY

Parameter	Details
Apgar score	1 min: ___/10 5 min: ___/10 10 min (if applicable): ___/10
Resuscitation required	☐ None (routine care) ☐ Stimulation/drying ☐ Supplemental O₂ ☐ PPV ☐ Chest compressions ☐ Intubation ☐ Epinephrine
Time to first cry	______ min
Birth weight	______ g
Birth weight category	☐ LBW (<2500 g) ☐ VLBW (<1500 g) ☐ ELBW (<1000 g) ☐ Normal ☐ Macrosomic (>4000 g)
Length at birth	______ cm
Head circumference at birth	______ cm
Birth trauma noted	☐ Yes — describe: ______ ☐ No
NICU admission at birth	☐ Yes ☐ No
Time of first feed
Vitamin K given	☐ Yes ☐ No
Eye prophylaxis given	☐ Yes ☐ No
BCG / HBV given	☐ Yes ☐ No
Newborn screening done	☐ Yes ☐ No

SECTION 6 — POSTNATAL HISTORY (for admissions after day 1)

Parameter	Details
Feeding type	☐ Exclusive breastfeed ☐ Formula ☐ Mixed ☐ IV/NG only
Feeding problems	☐ Poor latch ☐ Poor suck ☐ Vomiting ☐ Regurgitation ☐ None
Stool passed	☐ Meconium passed ☐ Transitional ☐ Yellow ☐ Not yet
Time of first meconium	______ hours
Urine passed	☐ Yes ☐ No — Time of first void: ______ hours
Weight change since birth	______ % loss / gain
Jaundice onset	☐ <24 hr ☐ Day 2–3 ☐ Day 4+ ☐ None
Phototherapy previously	☐ Yes ☐ No
Umbilicus status	☐ Clean/drying ☐ Discharge ☐ Erythema
Circumcision (if male)	☐ Yes ☐ No
Any medications/treatments given
Hospital discharge since birth	☐ Yes, discharged on day ______ ☐ Not yet discharged

SECTION 7 — FAMILY & SOCIAL HISTORY

Parameter	Details
Consanguinity of parents	☐ Yes (relationship: ______) ☐ No
Family history of:	☐ Metabolic disease ☐ Haematologic disease (e.g., sickle cell, G6PD, thalassaemia) ☐ Congenital anomalies ☐ Hearing loss ☐ Sudden infant death ☐ Neurologic disease ☐ None known
Siblings' health
Socioeconomic status	☐ Good ☐ Fair ☐ Poor
Primary caregiver	☐ Mother ☐ Father ☐ Other: ______
Mother's education level
Concerns about home environment	☐ Yes — detail: ______ ☐ No

SECTION 8 — PHYSICAL EXAMINATION

"The examination is best performed if the infant is quietly resting and should begin with an assessment of the infant's general appearance followed by auscultation of the heart and lungs. The examination should then proceed from head to toe in a systematic fashion." — Textbook of Family Medicine 9e, p. 529

8A. Anthropometry & Vital Signs

Parameter	Value	Normal Range (Term)
Weight (today)	______ g/kg	Birth weight ± expected change
Length	______ cm	48–52 cm
Head Circumference (OFC)	______ cm	33–37 cm
Heart Rate	______ bpm	100–180 bpm
Respiratory Rate	______ breaths/min	24–60 breaths/min
Temperature	______ °C	36.0–38.0 °C
Systolic BP	______ mmHg	65–90 mmHg
Diastolic BP	______ mmHg	50–70 mmHg
SpO₂ (right hand / preductal)	______ %	≥95% (after 10 min of age)
Blood glucose (POC)	______ mmol/L	≥2.6 mmol/L
Weight-for-GA percentile	______ th	☐ AGA ☐ SGA (<10th) ☐ LGA (>90th)

Normal vital sign values from Harriet Lane Handbook 23rd ed.

8B. General Appearance

☐ Active / vigorous    ☐ Lethargic    ☐ Irritable    ☐ Inconsolable cry
☐ Comfortable at rest  ☐ Respiratory distress

Color:
☐ Pink (normal)   ☐ Pallor   ☐ Jaundice   ☐ Central cyanosis
☐ Acrocyanosis (peripheral — may be normal in first hrs)
☐ Plethoric / ruddy   ☐ Mottled

Tone:
☐ Normal (extremities flexed, symmetric)   ☐ Hypotonic (frog-leg posture)
☐ Hypertonic / rigid   ☐ Asymmetric

Nutritional status:
☐ Well-nourished   ☐ Thin/malnourished   ☐ Oedematous

8C. Head & Skull

Shape: ☐ Normal   ☐ Microcephaly   ☐ Macrocephaly   ☐ Asymmetric
       ☐ Molding (overriding sutures — common, resolves in days)
       ☐ Craniosynostosis (persistent asymmetry — refer)

Anterior fontanel: ☐ Soft/flat (normal)   ☐ Bulging (↑ICP)   ☐ Sunken (dehydration)
  Size: ______ × ______ cm (normal: 4–6 cm diameter)

Posterior fontanel: ☐ Open (<1 cm, normal)   ☐ Closed   ☐ Enlarged

Scalp:
☐ Normal   ☐ Caput succedaneum (crosses sutures, resolves in days)
☐ Cephalohematoma (does NOT cross sutures, resolves in weeks–months)
☐ Subgaleal hematoma (fluctuant, crosses sutures — URGENT)
☐ Scalp lacerations / electrode marks

8D. Eyes

Spacing: ☐ Normal   ☐ Hypertelorism   ☐ Hypotelorism
Symmetry: ☐ Symmetric   ☐ Asymmetric
Pupils: ☐ Equal & reactive   ☐ Unequal (anisocoria)
Red reflex: ☐ Present bilaterally (NORMAL)   ☐ White reflex — REFER (retinoblastoma/cataract/retinal detachment)
Sclera: ☐ White   ☐ Icteric   ☐ Haemorrhage (subconjunctival — birth trauma, benign)
Discharge: ☐ None   ☐ Purulent (ophthalmia neonatorum — URGENT)   ☐ Watery (dacryostenosis)
Eyelids: ☐ Normal   ☐ Ptosis   ☐ Coloboma

8E. Ears, Nose & Throat

Ears:
☐ Normal position and morphology
☐ Low-set ears (Turner, Down, renal anomaly)
☐ Pre-auricular skin tag / pit
☐ Ear canal patent bilaterally

Nose:
☐ Patent both nares (test: occlude one at a time)
☐ Choanal atresia suspected (respiratory distress relieved by crying)
☐ Nasal flaring (respiratory distress)

Mouth:
Palate: ☐ Intact   ☐ Cleft palate   ☐ Cleft lip
        ☐ Submucosal cleft (palpate midline)
Tongue: ☐ Normal   ☐ Macroglossia   ☐ Tongue-tie (ankyloglossia)
Teeth: ☐ None (normal)   ☐ Natal teeth
Gums: ☐ Normal   ☐ Epstein's pearls (benign keratin cysts)
Oral mucosa: ☐ Normal   ☐ Thrush (white plaques)
Throat: ☐ Not examined   ☐ Normal

8F. Neck

☐ No masses   ☐ Webbing (Turner syndrome)
☐ Cystic hygroma   ☐ Goitre   ☐ Sternocleidomastoid mass (torticollis)
☐ Clavicle fracture (birth trauma — crepitus, asymmetric Moro reflex)

8G. Chest & Respiratory

Chest shape: ☐ Normal   ☐ Barrel   ☐ Pectus excavatum/carinatum

Work of breathing:
☐ None   ☐ Nasal flaring   ☐ Subcostal recession   ☐ Intercostal recession
☐ Sternal retraction   ☐ Grunting   ☐ Tracheal tug

Breath sounds: ☐ Equal bilaterally   ☐ Reduced: ______ side
               ☐ Crackles   ☐ Wheeze   ☐ Stridor

Percussion (if applicable): ☐ Resonant   ☐ Dull: ______ ☐ Hyperresonant: ______

Breast tissue: ☐ Normal   ☐ Neonatal breast hypertrophy (physiological)
               ☐ Mastitis (erythema, swelling, tenderness)

8H. Cardiovascular

Precordium: ☐ Normal   ☐ Hyperactive   ☐ Displaced apex
Heart sounds: ☐ S1 S2 normal   ☐ Murmur (describe): ___________________
              Grade: ____/6   Location: ______   Radiation: ______
              ☐ Gallop rhythm

Femoral pulses: ☐ Present & equal bilaterally   ☐ Absent/weak (coarctation)
Brachial pulses: ☐ Normal

Perfusion: ☐ CRT < 3 sec (normal)   ☐ CRT ≥ 3 sec (poor perfusion)
           ☐ Peripheral oedema   ☐ Central oedema

Four-limb BP differential: R arm ______ / L arm ______ / Leg ______ (if coarctation suspected)

8I. Abdomen

Shape: ☐ Soft/rounded (normal)   ☐ Distended   ☐ Scaphoid (diaphragmatic hernia)
Umbilicus: ☐ Normal (2 arteries + 1 vein)   ☐ Single umbilical artery (renal anomaly)
           ☐ Omphalitis (erythema/discharge)   ☐ Granuloma   ☐ Hernia
           ☐ Omphalocele / Gastroschisis
Bowel sounds: ☐ Present   ☐ Absent   ☐ Hyperactive
Liver: ______ cm below RCM   ☐ Normal (<2 cm)   ☐ Enlarged
Spleen: ☐ Not palpable   ☐ Palpable: ______ cm
Kidneys: ☐ Not palpable   ☐ Palpable (bilateral — PKD / hydronephrosis)
Masses: ☐ None   ☐ Present: describe ______
Anus: ☐ Patent and normally positioned   ☐ Imperforate anus   ☐ Anteriorly displaced

8J. Genitalia

Male:
☐ Testes descended bilaterally   ☐ Undescended (R/L/bilateral)   ☐ Retractile
☐ Scrotum normal   ☐ Hydrocele   ☐ Hernia
☐ Phallus normal   ☐ Hypospadias (describe position)   ☐ Epispadias
Foreskin: ☐ Normal (non-retractile, physiological)

Female:
☐ Labia majora cover labia minora (term)   ☐ Prominent labia minora (preterm)
☐ Vaginal tag (normal)   ☐ Vaginal discharge (physiological)   ☐ Hydrocolpos
Clitoris: ☐ Normal   ☐ Enlarged (virilization — CAH screen)

Ambiguous genitalia: ☐ Yes — URGENT workup (electrolytes, karyotype, 17-OHP)   ☐ No

8K. Spine & Back

☐ Intact midline skin   ☐ Sacral dimple (shallow — benign; deep/complex — image)
☐ Spina bifida (myelomeningocele / meningocele)   ☐ Pilonidal sinus
☐ Sacrococcygeal teratoma   ☐ Hairy patch / lipoma (tethered cord)
Spine shape: ☐ Normal   ☐ Scoliosis   ☐ Kyphosis

8L. Extremities & Musculoskeletal

Limbs: ☐ Symmetric   ☐ Asymmetric movement
Digits: ☐ Normal number   ☐ Polydactyly   ☐ Syndactyly   ☐ Clinodactyly
Palmar creases: ☐ Normal   ☐ Single palmar crease (Down syndrome)
Hands/feet: ☐ Normal   ☐ Clubfoot (talipes equinovarus)   ☐ Rocker-bottom feet (Trisomy 18)

Hips (MANDATORY):
Ortolani test: ☐ Negative   ☐ Positive (clunk on abduction — femoral head relocates)
Barlow test: ☐ Negative   ☐ Positive (clunk on adduction — hip subluxes)
Risk factors for DDH: ☐ Female ☐ Breech ☐ Family history
(If positive or equivocal → refer orthopaedics / USS hips at 6 weeks)

Clavicles: ☐ Intact   ☐ Crepitus / fracture (R/L)

8M. Neurological Examination

Alertness: ☐ Alert   ☐ Drowsy   ☐ Lethargic   ☐ Comatose / unresponsive
Cry: ☐ Normal   ☐ High-pitched   ☐ Weak/absent   ☐ Cat-like (Cri-du-chat)

Tone:
☐ Normal (strong flexion, symmetric)
☐ Hypotonic — frog-leg position, limbs extended, poor head control
☐ Hypertonic — spasticity / opisthotonos
☐ Asymmetric (lateralizing sign)

Primitive Reflexes (present at term; asymmetry is abnormal):

| Reflex | Present | Absent | Asymmetric |
|---|---|---|---|
| Moro (startle) | ☐ | ☐ | ☐ |
| Rooting | ☐ | ☐ | ☐ |
| Sucking | ☐ | ☐ | ☐ |
| Palmar grasp | ☐ | ☐ | ☐ |
| Plantar grasp | ☐ | ☐ | ☐ |
| Stepping | ☐ | ☐ | ☐ |
| Tonic neck (asymmetric) | ☐ | ☐ | ☐ |

Cranial nerves (if indicated): Facial symmetry ☐ | Eye movements ☐ | Suck-swallow ☐
Seizure activity: ☐ None   ☐ Subtle (eye deviation, cycling)   ☐ Tonic   ☐ Clonic   ☐ Myoclonic

Brachial plexus:
☐ Normal   ☐ Erb's palsy (C5–C6: adduction/internal rotation, absent Moro on affected side)
☐ Klumpke's palsy (C7–C8, T1: isolated hand paralysis)

8N. Skin

Color: (see General Appearance above)
Jaundice distribution: ☐ None   ☐ Face only   ☐ Trunk   ☐ Below umbilicus   ☐ Palms/soles (severe)

Lesions (common benign — reassure parents):
☐ Erythema toxicum neonatorum (erythematous macules/pustules on trunk, resolves spontaneously)
☐ Milia (tiny white facial papules)   ☐ Mongolian spots (blue-gray sacral pigmentation)
☐ Salmon patch / "stork bite"   ☐ Port wine stain (if facial — Sturge-Weber screen)
☐ Lanugo (fine hair — preterm)   ☐ Vernix caseosa

Concerning lesions:
☐ Vesiculopustular rash (HSV?)   ☐ Petechiae / purpura (sepsis, TORCH)
☐ Bullous lesions   ☐ Congenital melanocytic nevus (large)

Umbilical stump: ☐ Dry/drying   ☐ Moist   ☐ Infected (omphalitis)

SECTION 9 — APGAR SCORE DOCUMENTATION

Component	0	1	2	1-min score	5-min score	10-min score
Heart Rate	Absent	<100 bpm	>100 bpm
Respiratory Effort	Absent	Weak/irregular	Crying
Muscle Tone	Limp	Some flexion	Active/flexed
Reflex Irritability	No response	Grimace	Cry/cough
Color	Blue/pale	Acrocyanosis	Completely pink
TOTAL				/10	/10	/10

If 5-min score <7, continue at 5-min intervals until ≥7. (Harriet Lane Handbook / Tintinalli's EM)

SECTION 10 — GESTATIONAL AGE ASSESSMENT (if uncertain)

Ballard/New Ballard Score: _______ weeks (if performed)
Physical maturity criteria used: ☐ Skin ☐ Lanugo ☐ Plantar surface ☐ Breast ☐ Eye/ear ☐ Genitalia
Neuromuscular criteria used: ☐ Posture ☐ Square window ☐ Arm recoil ☐ Popliteal angle ☐ Scarf sign ☐ Heel to ear

Classification:
☐ Full-term (37–42 weeks)   ☐ Late preterm (34–36⁺⁶ weeks)   ☐ Preterm (<34 weeks)   ☐ Post-term (>42 weeks)

Weight-GA classification:
☐ AGA (10th–90th percentile)   ☐ SGA (<10th percentile)   ☐ LGA (>90th percentile)

SECTION 11 — WORKING DIAGNOSIS / PROBLEM LIST

1. ___________________________________________________________________
2. ___________________________________________________________________
3. ___________________________________________________________________
4. ___________________________________________________________________

SECTION 12 — INVESTIGATIONS ORDERED

Investigation	Ordered	Result
Blood glucose (bedside)	☐
FBC + differential	☐
CRP / Procalcitonin	☐
Blood culture	☐
Serum bilirubin (total/direct)	☐
Serum electrolytes (Na, K, Cl, HCO₃)	☐
Serum calcium	☐
Renal function (creatinine, urea)	☐
Blood gas (venous/arterial)	☐
Chest X-ray	☐
Cranial ultrasound	☐
Newborn metabolic screen	☐
Hearing screen (OAE/AABR)	☐
Congenital heart disease screen (pulse oximetry 4-limb)	☐
Maternal blood group / Coombs (if jaundice)	☐
Other: _________________	☐

SECTION 13 — INITIAL MANAGEMENT PLAN

Feeding:
☐ Breastfeeding — support and encourage
☐ Formula — type: ______  Volume: ______ mL/kg/day  Frequency: ______
☐ IV fluids — type: ______  Rate: ______ mL/kg/day
☐ NGT / OGT — indications: ______

Thermoregulation:
☐ Skin-to-skin / kangaroo care
☐ Incubator (target: 36.5–37.5°C)
☐ Radiant warmer

Monitoring:
☐ Continuous cardiorespiratory monitoring
☐ SpO₂ monitoring   ☐ Hourly glucose monitoring   ☐ 4-hrly vitals

Medications:
☐ Vitamin K given   ☐ Vitamin K to be given — dose: ______
☐ Eye prophylaxis   ☐ HBV vaccine
☐ Other: _____________

Prophylaxis / Infection prevention:
☐ Sepsis screen and empirical antibiotics: ______  (if indicated)
☐ Antifungal prophylaxis (VLBW): ______
☐ Phototherapy (if jaundice): threshold reached ☐ Yes ☐ No

Parental counselling: ☐ Done   ☐ Pending
Consent: ☐ Obtained

SECTION 14 — SIGNATURE

Examining Clinician: _______________________
Designation: ______________________________
Date / Time: ______________________________
Supervisor review: ________________________  Date: ______________

Quick Reference — Normal Neonatal Vital Signs

Parameter	Normal (Term Neonate)
Heart Rate	100–180 bpm
Respiratory Rate	24–60 breaths/min
Systolic BP	65–90 mmHg
Diastolic BP	50–70 mmHg
Temperature	36.0–38.0°C (96.8–100.4°F)
SpO₂ (preductal)	≥95%
Blood glucose	≥2.6 mmol/L (≥47 mg/dL)

Source: Harriet Lane Handbook 23rd ed.; Rudolph's Fundamentals of Pediatrics

Sources

Textbook of Family Medicine, 9th ed. — Sondheimer & Associates, Chapter 21 (Newborn History & Physical Examination, pp. 529–531)
Tintinalli's Emergency Medicine: A Comprehensive Study, 9th ed. — Chapter 108 (Neonatal Resuscitation, p. 716)
The Harriet Lane Handbook, 23rd ed. (Johns Hopkins Hospital) — Normal Vital Signs & Drug Dosing
Fitzpatrick's Dermatology, 9th ed. — Neonatal Skin Diseases (p. 1757)
Creasy & Resnik's Maternal-Fetal Medicine — Neonatal Assessment

Creta a word file for this

Reading File

Running Command

mkdir -p /home/daytona/workspace/neonatal-admission && ls /home/daytona/skills/docx/scripts/office/

Writing File

~/neonatal-admission/generate.js

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  });
}

// ── helper: header row for a table ───────────────────────────────
function headerRow(cols) {
  return new TableRow({
    tableHeader: true,
    children: cols.map(c => new TableCell({
      shading: { type: ShadingType.CLEAR, fill: MID_BLUE },
      borders: thinBorder,
      children: [new Paragraph({
        children: [new TextRun({ text: c, bold: true, size: 20, color: WHITE, font: "Calibri" })],
        spacing: { before: 40, after: 40 }, indent: { left: 80 },
      })],
    })),
  });
}

// ── helper: data row ──────────────────────────────────────────────
function dataRow(cells, shade) {
  return new TableRow({
    children: cells.map(c => new TableCell({
      shading: { type: ShadingType.CLEAR, fill: shade || WHITE },
      borders: thinBorder,
      children: [new Paragraph({
        children: [new TextRun({ text: c, size: 20, font: "Calibri" })],
        spacing: { before: 40, after: 40 }, indent: { left: 80 },
      })],
    })),
  });
}

// ═══════════════════════════════════════════════════════════════════
// BUILD DOCUMENT
// ═══════════════════════════════════════════════════════════════════
const children = [];

// ── TITLE BLOCK ───────────────────────────────────────────────────
children.push(new Paragraph({
  children: [new TextRun({ text: "NEONATAL WARD ADMISSION PROFORMA", bold: true, size: 36, color: WHITE, font: "Calibri" })],
  heading: HeadingLevel.HEADING_1,
  alignment: AlignmentType.CENTER,
  spacing: { before: 0, after: 100 },
  shading: { type: ShadingType.CLEAR, fill: DARK_BLUE },
}));
children.push(new Paragraph({
  children: [new TextRun({ text: "History & Examination Template  |  Based on Harriet Lane Handbook 23rd ed · Tintinalli's EM · Textbook of Family Medicine 9e", italics: true, size: 18, color: WHITE, font: "Calibri" })],
  alignment: AlignmentType.CENTER,
  spacing: { before: 0, after: 200 },
  shading: { type: ShadingType.CLEAR, fill: MID_BLUE },
}));

// ── ADMIN FIELDS ──────────────────────────────────────────────────
children.push(new Table({
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: thinBorder,
  rows: [
    new TableRow({ children: [
      new TableCell({ borders: thinBorder, shading: { type: ShadingType.CLEAR, fill: LIGHT_GRAY }, children: [labelLine("Institution:", "")] }),
      new TableCell({ borders: thinBorder, shading: { type: ShadingType.CLEAR, fill: LIGHT_GRAY }, children: [labelLine("Ward:", "")] }),
    ]}),
    new TableRow({ children: [
      new TableCell({ borders: thinBorder, children: [labelLine("Date of Admission:", "")] }),
      new TableCell({ borders: thinBorder, children: [labelLine("Time:", "")] }),
    ]}),
    new TableRow({ children: [
      new TableCell({ borders: thinBorder, shading: { type: ShadingType.CLEAR, fill: LIGHT_GRAY }, children: [labelLine("MRN / File No.:", "")] }),
      new TableCell({ borders: thinBorder, shading: { type: ShadingType.CLEAR, fill: LIGHT_GRAY }, children: [labelLine("Admitted by:", "")] }),
    ]}),
  ],
}));
children.push(new Paragraph({ children: [], spacing: { before: 120 } }));

// ═══════ SECTION 1: PATIENT IDENTIFICATION ════════════════════════
children.push(sectionHeading("SECTION 1 — PATIENT IDENTIFICATION"));
children.push(kvTable([
  ["Neonate's Name", ""],
  ["Date / Time of Birth", ""],
  ["Gestational Age at Birth", "______ weeks  ______ days"],
  ["Actual Age at Admission", "______ hours / days"],
  ["Birth Weight", "______ kg"],
  ["Sex", "☐ Male   ☐ Female   ☐ Ambiguous"],
  ["Place of Birth", "☐ This hospital   ☐ Other hospital   ☐ Home   ☐ Other"],
  ["Referring Facility (if transferred)", ""],
  ["Mother's Name", ""],
  ["Mother's Age", ""],
  ["Mother's MRN", ""],
  ["Consultant / Attending", ""],
]));

// ═══════ SECTION 2: PRESENTING COMPLAINT ═════════════════════════
children.push(sectionHeading("SECTION 2 — PRESENTING COMPLAINT"));
children.push(labelLine("Chief reason for admission (caregiver's words):", ""));
children.push(para("________________________________________________________________________________", { color: "999999" }));
children.push(para("________________________________________________________________________________", { color: "999999" }));
children.push(labelLine("Duration:", ""));

// ═══════ SECTION 3: MATERNAL HISTORY ═════════════════════════════
children.push(sectionHeading("SECTION 3 — MATERNAL HISTORY"));
children.push(note('Source: Textbook of Family Medicine 9e, p.529 — "Gathering a complete maternal history, including medical problems, past obstetric history, medications, drug/alcohol/tobacco use, and prenatal serologies is important."'));

children.push(subHeading("3A. Antenatal History"));
children.push(kvTable([
  ["Gravida / Para / Abortus", "G ___   P ___   A ___"],
  ["Number of Fetuses", ""],
  ["Antenatal Care", "☐ Regular   ☐ Irregular   ☐ None     No. of visits: ______"],
  ["Maternal Medical Conditions", "☐ GDM   ☐ Pre-existing DM   ☐ Hypertension   ☐ Epilepsy\n☐ Thyroid disease   ☐ Cardiac   ☐ Renal   ☐ Other: ______"],
  ["Infections During Pregnancy", "☐ TORCH   ☐ Syphilis   ☐ HIV   ☐ HBsAg   ☐ GBS\n☐ Malaria   ☐ COVID-19   ☐ Zika   ☐ UTI   ☐ None"],
  ["Prenatal Serologies", "Blood group: ___   Rh: ___   VDRL: ___   HIV: ___\nHBsAg: ___   Rubella: ___"],
  ["Genetic / Anomaly Screening", "☐ Done — result: ______   ☐ Not done"],
  ["Ultrasound Findings", "☐ Normal   ☐ Anomaly: ______   ☐ Not done"],
  ["Medications in Pregnancy", "(List all, including folic acid, iron, antihypertensives, ARVs):"],
  ["Substance Use", "☐ Alcohol   ☐ Tobacco   ☐ Recreational drugs   ☐ None"],
  ["Radiation / Teratogen Exposure", ""],
  ["Antenatal Corticosteroids (preterm)", "☐ Yes — Complete course   ☐ Incomplete course   ☐ No"],
]));

children.push(subHeading("3B. Previous Obstetric History"));
children.push(kvTable([
  ["Previous stillbirths / neonatal deaths", ""],
  ["Previous infant with congenital anomaly", ""],
  ["Previous infant with severe jaundice / exchange transfusion", ""],
  ["Previous preterm deliveries", ""],
  ["Previous infant with metabolic / genetic disease", ""],
]));

// ═══════ SECTION 4: INTRAPARTUM HISTORY ══════════════════════════
children.push(sectionHeading("SECTION 4 — INTRAPARTUM HISTORY"));
children.push(note('Source: Tintinalli\'s Emergency Medicine, p.716 — "Obtain history including prolonged rupture of membranes, fever, and meconium-stained amniotic fluid."'));
children.push(kvTable([
  ["Mode of Delivery", "☐ SVD   ☐ Assisted vaginal (vacuum/forceps)   ☐ Elective LSCS   ☐ Emergency LSCS"],
  ["Indication for Operative Delivery", ""],
  ["Duration of Labour", "______ hours"],
  ["Duration of Ruptured Membranes (ROM)", "______ hours"],
  ["Prolonged ROM (>18 hours)", "☐ Yes   ☐ No"],
  ["Amniotic Fluid Appearance", "☐ Clear   ☐ Meconium-stained (thin/thick)   ☐ Blood-stained   ☐ Foul-smelling"],
  ["Maternal Fever in Labour (>38°C)", "☐ Yes   ☐ No"],
  ["Maternal Antibiotics in Labour", "☐ Yes — drug: ______   ☐ No"],
  ["Fetal Distress / Abnormal CTG", "☐ Yes   ☐ No"],
  ["Cord Complications", "☐ Cord prolapse   ☐ Nuchal cord   ☐ Short cord   ☐ None"],
  ["Placental Complications", "☐ Abruption   ☐ Previa   ☐ Normal"],
  ["Birth Attendant", "☐ Physician   ☐ Midwife   ☐ TBA   ☐ Unattended"],
]));

// ═══════ SECTION 5: NEONATAL BIRTH HISTORY ════════════════════════
children.push(sectionHeading("SECTION 5 — NEONATAL BIRTH HISTORY"));

// Apgar table
children.push(subHeading("Apgar Score"));
children.push(note('If 5-min score <7, continue at 5-min intervals until ≥7.  (Harriet Lane Handbook 23rd ed / Tintinalli\'s EM)'));
children.push(new Table({
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: thinBorder,
  rows: [
    headerRow(["Component", "0", "1", "2", "1-min", "5-min", "10-min"]),
    dataRow(["Heart Rate", "Absent", "<100 bpm", ">100 bpm", "", "", ""], LIGHT_GRAY),
    dataRow(["Respiratory Effort", "Absent", "Weak / Irregular", "Crying", "", "", ""], WHITE),
    dataRow(["Muscle Tone", "Limp", "Some flexion", "Active / Flexed", "", "", ""], LIGHT_GRAY),
    dataRow(["Reflex Irritability", "No response", "Grimace", "Cry / Cough", "", "", ""], WHITE),
    dataRow(["Color", "Blue / Pale", "Acrocyanosis", "Completely pink", "", "", ""], LIGHT_GRAY),
    dataRow(["TOTAL", "", "", "", "   /10", "   /10", "   /10"], LIGHT_BLUE),
  ],
}));

children.push(kvTable([
  ["Resuscitation Required", "☐ None (routine care)   ☐ Stimulation/Drying   ☐ Supplemental O₂\n☐ PPV   ☐ Chest compressions   ☐ Intubation   ☐ Epinephrine"],
  ["Time to First Cry", "______ min"],
  ["Birth Weight Category", "☐ LBW (<2500g)   ☐ VLBW (<1500g)   ☐ ELBW (<1000g)\n☐ Normal   ☐ Macrosomic (>4000g)"],
  ["Length at Birth", "______ cm"],
  ["Head Circumference at Birth", "______ cm"],
  ["Birth Trauma Noted", "☐ Yes — describe: ______   ☐ No"],
  ["NICU Admission at Birth", "☐ Yes   ☐ No"],
  ["Vitamin K Given", "☐ Yes   ☐ No"],
  ["Eye Prophylaxis Given", "☐ Yes   ☐ No"],
  ["BCG / HBV Given", "☐ Yes   ☐ No"],
  ["Newborn Metabolic Screen Done", "☐ Yes   ☐ No"],
]));

// ═══════ SECTION 6: POSTNATAL HISTORY ════════════════════════════
children.push(sectionHeading("SECTION 6 — POSTNATAL HISTORY (Admissions after Day 1)"));
children.push(kvTable([
  ["Feeding Type", "☐ Exclusive breastfeed   ☐ Formula   ☐ Mixed   ☐ IV/NG only"],
  ["Feeding Problems", "☐ Poor latch   ☐ Poor suck   ☐ Vomiting   ☐ Regurgitation   ☐ None"],
  ["Stool Passed", "☐ Meconium   ☐ Transitional   ☐ Yellow   ☐ Not yet\nTime of first meconium: ______ hours"],
  ["Urine Passed", "☐ Yes   ☐ No     Time of first void: ______ hours"],
  ["Weight Change Since Birth", "______ % loss / gain"],
  ["Jaundice Onset", "☐ <24 hr (PATHOLOGICAL — investigate)   ☐ Day 2–3   ☐ Day 4+   ☐ None"],
  ["Phototherapy Previously", "☐ Yes   ☐ No"],
  ["Umbilicus Status", "☐ Clean / Drying   ☐ Discharge   ☐ Erythema (omphalitis)"],
  ["Medications / Treatments Given", ""],
  ["Previous Discharge Since Birth", "☐ Yes — discharged on day: ______   ☐ Not yet discharged"],
]));

// ═══════ SECTION 7: FAMILY & SOCIAL HISTORY ══════════════════════
children.push(sectionHeading("SECTION 7 — FAMILY & SOCIAL HISTORY"));
children.push(kvTable([
  ["Consanguinity of Parents", "☐ Yes (relationship: ______)   ☐ No"],
  ["Family History of:", "☐ Metabolic disease   ☐ Haematologic (sickle cell / G6PD / thalassaemia)\n☐ Congenital anomalies   ☐ Hearing loss   ☐ SIDS   ☐ Neurologic disease   ☐ None"],
  ["Siblings' Health", ""],
  ["Socioeconomic Status", "☐ Good   ☐ Fair   ☐ Poor"],
  ["Primary Caregiver", "☐ Mother   ☐ Father   ☐ Other: ______"],
  ["Concerns About Home Environment", "☐ Yes — detail: ______   ☐ No"],
]));

// ═══════ SECTION 8: PHYSICAL EXAMINATION ══════════════════════════
children.push(sectionHeading("SECTION 8 — PHYSICAL EXAMINATION"));
children.push(note('Source: Textbook of Family Medicine 9e, p.529 — "The examination should begin with general appearance, then auscultation, then proceed head to toe in a systematic fashion."'));

// 8A Anthropometry
children.push(subHeading("8A. Anthropometry & Vital Signs"));
children.push(new Table({
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: thinBorder,
  rows: [
    headerRow(["Parameter", "Value", "Normal Range (Term)"]),
    dataRow(["Weight (today)", "______ g", "Birth weight ± expected change"], LIGHT_GRAY),
    dataRow(["Length", "______ cm", "48–52 cm"], WHITE),
    dataRow(["Head Circumference (OFC)", "______ cm", "33–37 cm"], LIGHT_GRAY),
    dataRow(["Heart Rate", "______ bpm", "100–180 bpm"], WHITE),
    dataRow(["Respiratory Rate", "______ breaths/min", "24–60 breaths/min"], LIGHT_GRAY),
    dataRow(["Temperature", "______ °C", "36.0–38.0 °C"], WHITE),
    dataRow(["Systolic BP", "______ mmHg", "65–90 mmHg"], LIGHT_GRAY),
    dataRow(["Diastolic BP", "______ mmHg", "50–70 mmHg"], WHITE),
    dataRow(["SpO₂ (right hand / preductal)", "______ %", "≥95% (after 10 min of age)"], LIGHT_GRAY),
    dataRow(["Blood Glucose (POC)", "______ mmol/L", "≥2.6 mmol/L"], WHITE),
    dataRow(["Weight-for-GA Percentile", "______ th", "☐ AGA   ☐ SGA (<10th)   ☐ LGA (>90th)"], LIGHT_GRAY),
  ],
}));
children.push(note("Normal vital sign values: Harriet Lane Handbook 23rd ed. & Rudolph's Fundamentals of Pediatrics"));

// 8B General
children.push(subHeading("8B. General Appearance"));
for (const item of [
  "☐ Active / vigorous   ☐ Lethargic   ☐ Irritable   ☐ Inconsolable cry",
  "Color: ☐ Pink (normal)   ☐ Pallor   ☐ Jaundice   ☐ Central cyanosis   ☐ Acrocyanosis (may be normal 1st hrs)   ☐ Plethoric / ruddy   ☐ Mottled",
  "Tone: ☐ Normal (extremities flexed, symmetric)   ☐ Hypotonic (frog-leg)   ☐ Hypertonic / rigid   ☐ Asymmetric",
  "Nutritional status: ☐ Well-nourished   ☐ Thin / malnourished   ☐ Oedematous",
]) { children.push(para(item)); }

// 8C Head
children.push(subHeading("8C. Head & Skull"));
for (const item of [
  "Shape: ☐ Normal   ☐ Microcephaly   ☐ Macrocephaly   ☐ Molding (common, resolves)   ☐ Asymmetric — suspect craniosynostosis",
  "Anterior Fontanel: ☐ Soft/flat (normal)   ☐ Bulging (↑ICP)   ☐ Sunken (dehydration)     Size: ___×___ cm (normal 4–6 cm)",
  "Posterior Fontanel: ☐ Open (<1 cm, normal)   ☐ Closed   ☐ Enlarged",
  "Scalp: ☐ Normal   ☐ Caput succedaneum (crosses sutures)   ☐ Cephalohematoma (does NOT cross sutures)\n         ☐ Subgaleal hematoma (URGENT — fluctuant, crosses sutures)   ☐ Scalp lacerations",
]) { children.push(para(item)); }

// 8D Eyes
children.push(subHeading("8D. Eyes"));
for (const item of [
  "Spacing: ☐ Normal   ☐ Hypertelorism   ☐ Hypotelorism",
  "Pupils: ☐ Equal & reactive   ☐ Anisocoria",
  "Red Reflex: ☐ Present bilaterally (NORMAL)   ☐ WHITE reflex — URGENT referral (retinoblastoma / cataract / retinal detachment)",
  "Sclera: ☐ White   ☐ Icteric   ☐ Subconjunctival haemorrhage (birth trauma — benign)",
  "Discharge: ☐ None   ☐ Purulent (ophthalmia neonatorum — URGENT)   ☐ Watery (dacryostenosis)",
]) { children.push(para(item)); }

// 8E ENT
children.push(subHeading("8E. Ears, Nose & Throat"));
for (const item of [
  "Ears: ☐ Normal position   ☐ Low-set   ☐ Pre-auricular tag/pit   ☐ Canal patent bilaterally",
  "Nose: ☐ Both nares patent   ☐ Choanal atresia suspected (distress relieved by crying)   ☐ Nasal flaring",
  "Palate: ☐ Intact   ☐ Cleft palate   ☐ Cleft lip   ☐ Submucosal cleft (palpate midline)",
  "Tongue: ☐ Normal   ☐ Macroglossia   ☐ Tongue-tie (ankyloglossia)",
  "Gums: ☐ Normal   ☐ Epstein's pearls (benign)   ☐ Natal teeth",
  "Oral mucosa: ☐ Normal   ☐ Thrush (white plaques)",
]) { children.push(para(item)); }

// 8F Neck
children.push(subHeading("8F. Neck"));
children.push(para("☐ No masses   ☐ Webbing (Turner)   ☐ Cystic hygroma   ☐ Goitre   ☐ SCM mass (torticollis)\n☐ Clavicle fracture (crepitus, asymmetric Moro)"));

// 8G Chest
children.push(subHeading("8G. Chest & Respiratory"));
for (const item of [
  "Work of breathing: ☐ None   ☐ Nasal flaring   ☐ Subcostal recession   ☐ Intercostal recession   ☐ Sternal retraction   ☐ Grunting   ☐ Tracheal tug",
  "Breath sounds: ☐ Equal bilaterally   ☐ Reduced ______ side   ☐ Crackles   ☐ Wheeze   ☐ Stridor",
  "Breast tissue: ☐ Normal   ☐ Physiological hypertrophy (benign)   ☐ Mastitis (erythema, tenderness — treat)",
]) { children.push(para(item)); }

// 8H CVS
children.push(subHeading("8H. Cardiovascular"));
for (const item of [
  "Precordium: ☐ Normal   ☐ Hyperactive   ☐ Displaced apex",
  "Heart sounds: ☐ S1 S2 normal   ☐ Murmur — Grade: ___/6   Location: ______   Radiation: ______   ☐ Gallop",
  "Femoral pulses: ☐ Present & equal bilaterally   ☐ Absent / weak (suspect coarctation of aorta)",
  "Perfusion: ☐ CRT <3 sec (normal)   ☐ CRT ≥3 sec (poor perfusion)   ☐ Peripheral oedema",
  "Four-limb BP (if coarctation suspected): R arm: ______   L arm: ______   Leg: ______",
]) { children.push(para(item)); }

// 8I Abdomen
children.push(subHeading("8I. Abdomen"));
for (const item of [
  "Shape: ☐ Soft / rounded (normal)   ☐ Distended   ☐ Scaphoid (suspect diaphragmatic hernia)",
  "Umbilicus: ☐ Normal (2 arteries + 1 vein)   ☐ Single umbilical artery (screen renal)   ☐ Omphalitis\n            ☐ Granuloma   ☐ Hernia   ☐ Omphalocele / Gastroschisis",
  "Bowel sounds: ☐ Present   ☐ Absent   ☐ Hyperactive",
  "Liver: ______ cm below RCM   ☐ Normal (<2 cm)   ☐ Hepatomegaly",
  "Spleen: ☐ Not palpable   ☐ Palpable: ______ cm",
  "Kidneys: ☐ Not palpable   ☐ Palpable (PKD / hydronephrosis)",
  "Anus: ☐ Patent and normally positioned   ☐ Imperforate anus   ☐ Anteriorly displaced",
]) { children.push(para(item)); }

// 8J Genitalia
children.push(subHeading("8J. Genitalia"));
children.push(para("Male: ☐ Testes descended bilaterally   ☐ Undescended (R / L / bilateral)   ☐ Hydrocele   ☐ Hernia\n       ☐ Hypospadias (position: ______)   ☐ Epispadias"));
children.push(para("Female: ☐ Normal labia   ☐ Vaginal tag (normal)   ☐ Physiological discharge   ☐ Hydrocolpos\n          ☐ Clitoromegaly — URGENT: screen for CAH (electrolytes, 17-OHP, karyotype)"));
children.push(para("Ambiguous genitalia: ☐ Yes — URGENT workup   ☐ No"));

// 8K Spine
children.push(subHeading("8K. Spine & Back"));
children.push(para("☐ Intact midline skin   ☐ Shallow sacral dimple (benign)   ☐ Deep/complex dimple (image)\n☐ Myelomeningocele   ☐ Meningocele   ☐ Hairy patch / lipoma (tethered cord)   ☐ Sacrococcygeal teratoma"));

// 8L Extremities
children.push(subHeading("8L. Extremities & Musculoskeletal"));
for (const item of [
  "Limbs: ☐ Symmetric movement   ☐ Asymmetric (birth trauma / plexus injury)",
  "Digits: ☐ Normal number   ☐ Polydactyly   ☐ Syndactyly   ☐ Clinodactyly",
  "Palmar crease: ☐ Normal   ☐ Single palmar crease (Down syndrome)",
  "Feet: ☐ Normal   ☐ Clubfoot (talipes equinovarus)   ☐ Rocker-bottom (Trisomy 18)",
]) { children.push(para(item)); }
children.push(para("Hips (MANDATORY IN EVERY NEONATE):", { bold: true }));
children.push(para("   Ortolani test: ☐ Negative   ☐ Positive (clunk on abduction — femoral head relocates — DDH)"));
children.push(para("   Barlow test:   ☐ Negative   ☐ Positive (clunk on adduction — hip subluxes — DDH)"));
children.push(para("   Risk factors for DDH: ☐ Female   ☐ Breech   ☐ Family history"));
children.push(note("If positive or equivocal → refer orthopaedics. Female + breech / family hx + normal exam → hip USS at 6 weeks."));
children.push(note("Source: Textbook of Family Medicine 9e, p.530 — Ortolani & Barlow maneuvers for DDH"));

// 8M Neurological
children.push(subHeading("8M. Neurological Examination"));
for (const item of [
  "Alertness: ☐ Alert   ☐ Drowsy   ☐ Lethargic   ☐ Comatose / unresponsive",
  "Cry: ☐ Normal   ☐ High-pitched   ☐ Weak/absent   ☐ Cat-like (Cri-du-chat)",
  "Tone: ☐ Normal (strong flexion, symmetric)   ☐ Hypotonic (frog-leg, limbs extended)\n       ☐ Hypertonic / opisthotonos   ☐ Asymmetric",
]) { children.push(para(item)); }

children.push(para("Primitive Reflexes (present at term; asymmetry = ABNORMAL):"));
children.push(new Table({
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: thinBorder,
  rows: [
    headerRow(["Reflex", "Present", "Absent", "Asymmetric", "Notes"]),
    dataRow(["Moro (startle)", "☐", "☐", "☐", "Absent Moro on one side — clavicle fracture / Erb's palsy"], LIGHT_GRAY),
    dataRow(["Rooting", "☐", "☐", "☐", ""], WHITE),
    dataRow(["Sucking", "☐", "☐", "☐", "Weak suck — neurologic / metabolic / preterm"], LIGHT_GRAY),
    dataRow(["Palmar grasp", "☐", "☐", "☐", ""], WHITE),
    dataRow(["Plantar grasp", "☐", "☐", "☐", ""], LIGHT_GRAY),
    dataRow(["Stepping", "☐", "☐", "☐", ""], WHITE),
    dataRow(["Asymmetric tonic neck", "☐", "☐", "☐", ""], LIGHT_GRAY),
  ],
}));
children.push(para("Brachial plexus: ☐ Normal   ☐ Erb's palsy (C5–C6: adduction + internal rotation, absent Moro)\n                  ☐ Klumpke's palsy (C7–C8, T1: isolated hand paralysis)"));
children.push(para("Seizures: ☐ None   ☐ Subtle (eye deviation, cycling)   ☐ Tonic   ☐ Clonic   ☐ Myoclonic"));

// 8N Skin
children.push(subHeading("8N. Skin"));
children.push(para("Jaundice distribution: ☐ None   ☐ Face only   ☐ Trunk   ☐ Below umbilicus   ☐ Palms/soles (SEVERE)"));
children.push(para("Common benign lesions (reassure parents):"));
children.push(para("   ☐ Erythema toxicum neonatorum (erythematous macules/pustules on trunk — resolves spontaneously)\n   ☐ Milia (tiny white facial papules)   ☐ Mongolian spots (blue-gray sacral)   ☐ Salmon patch / stork bite\n   ☐ Lanugo (fine hair — preterm)   ☐ Vernix caseosa"));
children.push(para("Concerning lesions:"));
children.push(para("   ☐ Vesiculopustular rash (HSV?)   ☐ Petechiae / purpura (sepsis / TORCH)\n   ☐ Bullous lesions   ☐ Port wine stain on face (Sturge-Weber screen)   ☐ Large congenital melanocytic naevus"));

// ═══════ SECTION 9: GESTATIONAL AGE ══════════════════════════════
children.push(sectionHeading("SECTION 9 — GESTATIONAL AGE ASSESSMENT (if uncertain)"));
children.push(kvTable([
  ["Ballard / New Ballard Score", "______ weeks"],
  ["Classification", "☐ Full-term (37–42 wks)   ☐ Late preterm (34–36⁺⁶ wks)\n☐ Preterm (<34 wks)   ☐ Post-term (>42 wks)"],
  ["Weight-GA Classification", "☐ AGA (10th–90th percentile)   ☐ SGA (<10th percentile)   ☐ LGA (>90th percentile)"],
]));

// ═══════ SECTION 10: WORKING DIAGNOSIS ═══════════════════════════
children.push(sectionHeading("SECTION 10 — WORKING DIAGNOSIS / PROBLEM LIST"));
for (let i = 1; i <= 4; i++) {
  children.push(labelLine(`${i}.`, "____________________________________________________________"));
}

// ═══════ SECTION 11: INVESTIGATIONS ══════════════════════════════
children.push(sectionHeading("SECTION 11 — INVESTIGATIONS ORDERED"));
children.push(new Table({
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: thinBorder,
  rows: [
    headerRow(["Investigation", "Ordered", "Result / Notes"]),
    ...([
      "Blood glucose (bedside)",
      "FBC + differential",
      "CRP / Procalcitonin",
      "Blood culture",
      "Serum bilirubin (total / direct)",
      "Serum electrolytes (Na, K, Cl, HCO₃)",
      "Serum calcium",
      "Renal function (creatinine, urea)",
      "Blood gas (venous / arterial)",
      "Chest X-ray",
      "Cranial ultrasound",
      "Newborn metabolic screen",
      "Hearing screen (OAE / AABR)",
      "Pulse oximetry 4-limb (CHD screen)",
      "Maternal blood group / Coombs (if jaundice)",
      "Other: ______________________",
    ].map((inv, i) => dataRow([inv, "☐", ""], i % 2 === 0 ? LIGHT_GRAY : WHITE))),
  ],
}));

// ═══════ SECTION 12: MANAGEMENT PLAN ════════════════════════════
children.push(sectionHeading("SECTION 12 — INITIAL MANAGEMENT PLAN"));

children.push(subHeading("Feeding"));
for (const item of [
  "☐ Breastfeeding — support and encourage",
  "☐ Formula — type: ______   Volume: ______ mL/kg/day   Frequency: ______",
  "☐ IV fluids — type: ______   Rate: ______ mL/kg/day",
  "☐ NGT / OGT — indication: ______",
]) { children.push(cb(item.replace("☐  ", ""))); }

children.push(subHeading("Thermoregulation"));
for (const item of [
  "Skin-to-skin / kangaroo care",
  "Incubator (target 36.5–37.5 °C)",
  "Radiant warmer",
]) { children.push(cb(item)); }

children.push(subHeading("Monitoring"));
for (const item of [
  "Continuous cardiorespiratory monitoring",
  "SpO₂ monitoring",
  "Hourly blood glucose monitoring",
  "4-hourly vital signs",
]) { children.push(cb(item)); }

children.push(subHeading("Medications & Prophylaxis"));
for (const item of [
  "Vitamin K — dose: ______",
  "Eye prophylaxis given",
  "HBV vaccine",
  "Sepsis screen + empirical antibiotics: ______  (if indicated)",
  "Antifungal prophylaxis (VLBW): ______",
  "Phototherapy (jaundice threshold reached: ☐ Yes   ☐ No)",
  "Other: ______",
]) { children.push(cb(item)); }

children.push(para("Parental counselling: ☐ Done   ☐ Pending", { spaceBefore: 120 }));
children.push(para("Consent: ☐ Obtained"));

// ═══════ SECTION 13: SIGNATURE ════════════════════════════════════
children.push(sectionHeading("SECTION 13 — CLINICIAN SIGNATURE"));
children.push(new Table({
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: thinBorder,
  rows: [
    new TableRow({ children: [
      new TableCell({ borders: thinBorder, shading: { type: ShadingType.CLEAR, fill: LIGHT_BLUE }, children: [labelLine("Examining Clinician:", "")] }),
      new TableCell({ borders: thinBorder, children: [labelLine("Designation:", "")] }),
    ]}),
    new TableRow({ children: [
      new TableCell({ borders: thinBorder, children: [labelLine("Date / Time:", "")] }),
      new TableCell({ borders: thinBorder, children: [labelLine("Supervisor Review:", "")] }),
    ]}),
  ],
}));

// ═══════ QUICK REFERENCE BOX ══════════════════════════════════════
children.push(new Paragraph({ children: [], spacing: { before: 200 } }));
children.push(new Paragraph({
  children: [new TextRun({ text: "QUICK REFERENCE — NORMAL NEONATAL VITAL SIGNS (TERM)", bold: true, size: 22, color: WHITE, font: "Calibri" })],
  alignment: AlignmentType.CENTER,
  spacing: { before: 100, after: 80 },
  shading: { type: ShadingType.CLEAR, fill: DARK_BLUE },
}));
children.push(new Table({
  width: { size: 100, type: WidthType.PERCENTAGE },
  borders: thinBorder,
  rows: [
    headerRow(["Parameter", "Normal Value", "Source"]),
    dataRow(["Heart Rate", "100–180 bpm", "Harriet Lane Handbook 23rd ed."], LIGHT_GRAY),
    dataRow(["Respiratory Rate", "24–60 breaths/min", "Harriet Lane Handbook 23rd ed."], WHITE),
    dataRow(["Systolic BP", "65–90 mmHg", "Harriet Lane Handbook 23rd ed."], LIGHT_GRAY),
    dataRow(["Diastolic BP", "50–70 mmHg", "Harriet Lane Handbook 23rd ed."], WHITE),
    dataRow(["Temperature", "36.0–38.0 °C", "Harriet Lane Handbook 23rd ed."], LIGHT_GRAY),
    dataRow(["SpO₂ (preductal)", "≥95%", "Tintinalli's EM, Chapter 108"], WHITE),
    dataRow(["Blood Glucose", "≥2.6 mmol/L (≥47 mg/dL)", "Harriet Lane Handbook 23rd ed."], LIGHT_GRAY),
  ],
}));

// ═══════ REFERENCES ═══════════════════════════════════════════════
children.push(new Paragraph({ children: [], spacing: { before: 200 } }));
children.push(sectionHeading("REFERENCES"));
for (const ref of [
  "Textbook of Family Medicine, 9th ed. — Chapter 21: Care of the Newborn, pp. 529–531",
  "Tintinalli's Emergency Medicine: A Comprehensive Study, 9th ed. — Chapter 108: Neonatal Resuscitation, p. 716",
  "The Harriet Lane Handbook, 23rd ed. (Johns Hopkins Hospital) — Normal Vital Signs & Drug Dosing",
  "Fitzpatrick's Dermatology, 9th ed. — Neonatal Skin Diseases, p. 1757",
  "Creasy & Resnik's Maternal-Fetal Medicine: Principles and Practice — Neonatal Assessment",
]) {
  children.push(new Paragraph({
    children: [new TextRun({ text: "• " + ref, size: 18, font: "Calibri", italics: true })],
    spacing: { before: 40, after: 40 }, indent: { left: 180 },
  }));
}

// ═══════ ASSEMBLE & WRITE ═════════════════════════════════════════
const doc = new Document({
  creator: "Orris Medical AI",
  title: "Neonatal Ward Admission Proforma",
  description: "Comprehensive neonatal history & examination template based on standard references",
  styles: {
    default: {
      document: { run: { font: "Calibri", size: 20 } },
    },
  },
  sections: [{
    properties: {
      page: {
        margin: { top: 720, bottom: 720, left: 900, right: 900 },
      },
    },
    headers: {
      default: new Header({
        children: [new Paragraph({
          children: [
            new TextRun({ text: "NEONATAL WARD ADMISSION PROFORMA", bold: true, size: 18, font: "Calibri", color: MID_BLUE }),
            new TextRun({ text: "  |  Confidential Medical Record", size: 16, font: "Calibri", color: "888888" }),
          ],
          alignment: AlignmentType.CENTER,
          border: { bottom: { style: BorderStyle.SINGLE, size: 6, color: MID_BLUE } },
        })],
      }),
    },
    footers: {
      default: new Footer({
        children: [new Paragraph({
          children: [
            new TextRun({ text: "Page ", size: 16, font: "Calibri", color: "888888" }),
            new TextRun({ children: [PageNumber.CURRENT], size: 16, font: "Calibri", color: "888888" }),
            new TextRun({ text: " of ", size: 16, font: "Calibri", color: "888888" }),
            new TextRun({ children: [PageNumber.TOTAL_PAGES], size: 16, font: "Calibri", color: "888888" }),
            new TextRun({ text: "  |  Based on Harriet Lane Handbook 23rd ed · Tintinalli's EM · Textbook of Family Medicine 9e", size: 14, font: "Calibri", color: "AAAAAA", italics: true }),
          ],
          alignment: AlignmentType.CENTER,
        })],
      }),
    },
    children,
  }],
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync("/home/daytona/workspace/neonatal-admission/Neonatal_Admission_Proforma.docx", buffer);
  console.log("SUCCESS: Document written.");
}).catch(err => {
  console.error("ERROR:", err.message);
  process.exit(1);
});

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