133 6 (UN)WARRANTED VARIATION IN HOSPITAL PROTOCOLS FOR NEONATAL REFERRAL TO THE PEDIATRICIAN | 5 GOODARZI et al. example, indications for referral were specified for different weight categories, with different recommendations for screening/diagnostic tests, treatment, and discharge (Table 5). A detailed overview can be found in Supplement 3. 3.3 | Intrahospital variation: between obstetric and neonatal departments located in the same hospital From 22 (30%) hospitals, we received 99 protocols from both the obstetric and the neonatal department (Table 2). Of these protocols, 18 (18%) contained noncorrespondent recommendations. Five (28%) of the noncorrespondent recommendations were about the type of neonatal referral to the pediatrician. Eleven (61%) of the noncorrespondent recommendations were about the indication for referral. For example, in one hospital, in the obstetric protocol, neonatal referral was recommended after CB when Apgar scores were ≤9/10, whereas in the neonatal department's protocol, neonatal referral was recommended after every CB. Two (11%) of the noncorrespondent recommendations were about the indication for referral and type of referral. For example, in two hospitals, the obstetric protocol Type of department O N O & N n, % n, % n, % Total 39 (47) 44 (53) 22 (27) Type of hospital Secondary-level 34 (45) 41 (55) 21 (29) Tertiary-level 5 (63) 3 (38) 1 (13) Region North 7 (47) 8 (53) 6 (40) East 3 (50) 3 (50) 1 (17) South 9 (53) 8 (47) 3 (18) Southwest 12 (57) 9 (43) 6 (29) Northwest 8 (33) 16 (67) 6 (25) Abbreviations: N, neonatal department; O, obstetric department; O & N = obstetric and neonatal department part of the same hospital. TABLE 1 Department characteristics (n, %) Protocols Number of different indications for neonatal referrala n, % n, % Total 420 (100) 68 (100)b Protocol LGA 65 (15) 14 (21) SGA 70 (17) 27 (40) MSAF 74 (18) 9 (13) VE 72 (17) 8 (12) FE 62 (15) 7 (10) CB 77 (18) 3 (4) Type of department O 189 (45) N 231 (55) Abbreviations: CB, cesarean birth; FE, forceps extraction; LGA, large for gestational age/macrosomia; MSAF, meconium stained amniotic fluid; N, neonatal department; O & N, obstetric and neonatal department part of the same hospital; O, obstetric department; SGA, small for gestational age/fetal growth restriction; VE, vacuum extraction. aNumbers obtained from the results shown in Supplement 3. Excluding the categories “noncorrespondent”, “referred to a different document”, “unclear”, and “not mentioned”. bNumber of unique indications. TABLE 2 Received protocols and number of different indications for neonatal referral specified for protocol and type of department (n) 1523536x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/birt.12690 by Vrije Universiteit Amsterdam, Wiley Online Library on [14/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
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