Table 1 Summary of SIP Case Report Forms

Form 00 – Screening Log

To document population screened

Research nurse/clinician

Form 01 – Eligibility Form

To confirm eligibility

Research nurse/clinician

Form 02 – Obstetric Form

Maternal history and obstetric status

Nurse/Obstetrician/pediatrician

Form 03A – Healthy Newborn Form

To assess preterm infants discharged without NICU admission

Nurse/pediatrician

Form 03B – NICU Admission/Clinical Form

To assess preterm infants admitted to NICU

Clinician/pediatrician

Form 04 – Study Monitoring Form

To monitor infants in NICU

Research nurse/clinician

Form 05 – Follow-up Form

To monitor kids discharged before day 28

Research nurse/clinician

Form 06 – Final Diagnosis at Day 28 or death

Clinical diagnosis at NICU discharge or death < 28 days

Pediatrician

Form 07 – Verbal Autopsy Form (WHO)

To document deaths which occur at home

Research nurse/opted experts from Public health

Form 08A – Complete Diagnostic autopsy

To document detailed findings of additional investigation

Pathologist

Form 08B – Minimally Invasive Tissue Sampling (MITS)