151 6 (UN)WARRANTED VARIATION IN HOSPITAL PROTOCOLS FOR NEONATAL REFERRAL TO THE PEDIATRICIAN Supplement 3. Recommendations of test before neonatal referral, test criteria, and time frames of referral by 8 department (n). 9 Supplement 3. Recommendations of test before neonatal referral, test criteria, and time frames of neonatal referral by department (n). Protocol# Department Total (n)^ Test before neonatal referral (n) Test criteria (n) Time frame of neonatal referral (n) LGA Obstetric 25 1. Birth weight: 23 - Non-correspondent: 1 - Not mentioned: 1 1. Birth weight >90th percentile: 10 2. Birth weight >90th percentile or >4500 g: 1 3. Birth weight >95th percentile: 5 4. Birth weight >95th percentile and/or macrosomia appearance: 1 5. Birth weight >97th percentile: 1 6. Birth weight >97.7th percentile: 1 7. Birth weight >97.7th percentile or >4500 g: 2 8. Birth weight >4500 g: 1 - Unclear: 1 - Not mentioned: 2 1. Directly pp: 1 2. Directly pp, the pediatrician: 1 3. Directly pp, the pediatrician and the obstetrician together decide: 1 4. During the pediatricians’ rounds: 1 5. <1 hour pp: 3 6. During office hours: 4 - Unclear: 1 - Not mentioned: 13 Neonatal 38 1. Observation: 1 2. Birth weight: 30 3. Birth weight and observation feeding: 1 4. Birth weight and glucose assessment before the first three feedings: 1 5. Birth weight and glucose assessment 30 minutes after first feeding, first feeding <1 hour pp, otherwise glucose assessment one hour pp en thereafter 3,6,12 en 24 hours pp before feeding: 1 6. Birth weight and glucose assessment 1, 3, 6, 9 and 12 hours pp: 1 7. Birth weight and glucose assessment 2, 3, 6, 9, 12, 18 and 24 hours pp: 1 8. Birth weight and glucose assessment 3, 6, 12 ,18 and 24 hours pp: 1 - Referred to different document: 1 1. Macrosomia appearance: 1 2. Birth weight >90th percentile: 9 3. Birth weight >90th percentile or >4200 g: 1 4. Birth weight >90th percentile or >4500 g: 2 5. Birth weight >90th percentile and glucose <2 mmol/l: 1 6. Birth weight >90th percentile and doubt about sufficient feeding: 1 7. Birth weight >90th percentile and severe symptoms of a (assumed) hypoglycemia, or after a glucose bolus, or glucose <1.1 mmol/l, or 3 glucose values <2.3 mmol/l, or 2 glucose values <1.9 mmol/l: 1 8. Birth weight <90th percentile and hypoglycemia (=glucose <2.2mmol/l <4 hours pp, <2.5mmol/l >4 hours pp, <3.0mmol/l >24 hours pp): 1 9. Birth weight >95th percentile: 6 10. Birth weight >95th percentile and/or macrosomia appearance: 1 11. Birth weight >97th percentile: 4 12. Birth weight >97.7th percentile: 6 13. Birth weight >97th percentile and first glucose assessment <2.6 mmol/l and symptoms, or glucose <1.6 mmol/l without symptoms: 1 14. Birth weight >97th percentile and/or >4500 g and hypoglycemia: 1 - Referred to different document: 1 - Non-correspondent: 1 1. Directly pp: 2 2. Directly pp, the pediatrician and the obstetrician together decide: 1 3. At day time directly, pediatrician decides, at night time the next day during pediatricians’ rounds: 1 4. <1 hour pp: 3 5. <6 hour pp: 1 6. During office hours: 4 7. Between 09:00 and 23:00 o’clock <1 hour pp, between 23:00 and 09:00 o’clock pediatrician notified at 08:55 o’clock, birth after 02:30 o’clock during pediatricians’ rounds at 11:00 o’clock: 1 8. During the pediatricians’ rounds: 3 - Referred to different document: 1 - Unclear: 3 - Not mentioned: 18 SGA Obstetric 47 1. Birth weight: 45 2. Birth weight and glucose assessment 30 minutes after first feeding, first feeding <1 hour pp, 15. Birth weight <2.3th percentile : 1 16. Birth weight <2.3th percentile or <2500 g: 2 17. Birth weight <3th percentile : 2 1. Directly pp: 5 2. Directly, the pediatrician decides: 1 2. Easy VE: 1 3. Difficult VE: 1 4. VE and fetal distress, and/or expulsion stage <1.5 hours: 1 5. VE and abnormal PEWS, or suspected subgaleal hemorrhage: 1 Neonatal 26 1. Conducting VE: 22 2. VE and fetal distress: 1 3. VE and fetal distress during, and/or expulsion stage <1.5 hours: 1 4. VE because of fetal indication, or abnormal observations pp such as pain (comfort scale ≥17) or vomiting: 1 5. VE and (expected) poor neonatal vitals pp: 1 FE Obstetric 21 1. Conducting FE: 18 2. Easy FE: 1 3. Difficult FE: 1 4. FE and fetal distress during and/or expulsion stage <1.5 hours: 1 Neonatal 25 1. Conducting FE: 20 2. FE and fetal distress: 1 3. FE and fetal distress during and/or expulsion stage <1.5 hours: 1 4. FE because of fetal indication, or abnormal observations pp such as pain (comfort scale ≥17) or vomiting: 1 5. FE and (expected) poor neonatal vitals pp: 1 - Unclear: 1 CB Obstetric 32 1. Conducting CB: 29 2. Secondary CB and primary CB unless poor vitals of the baby are not expected: 1 3. CB and AS ≤9/10: 2 Neonatal 38 1. Conducting CB: 35 2. CB and AS ≤9/10: 2 - Unclear: 1 #LGA: large for gestational age/macrosomia, SGA: small for gestational age/fetal growth restriction, MSAF: meconium stained amniotic fluid, VE: vacuum 6 extraction, FE: forceps extraction, CB: caesarean birth 7
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