153 6 (UN)WARRANTED VARIATION IN HOSPITAL PROTOCOLS FOR NEONATAL REFERRAL TO THE PEDIATRICIAN 7. VE, assessment fetal condition and pain (comfort scale): 1 - Unclear: 1 12. VE and signs of fetal distress and/or expulsion stage >1.5 hours: 2 13. VE and (expected) poor neonatal vitals pp: 1 14. VE and expected neonatal problems or difficult VE: 1 15. VE because of fetal indication, or abnormal observations pp such as pain (comfort scale ≥17) or vomiting: 1 - Unclear: 1 o’clock, birth between 23.00 and 2.30 o’clock as soon as possible and if possible at 09.00 o’clock, birth after 02.30 o’clock that the consult should be scheduled for the 11.00 o’clock rounds: 1 7. At 09.00 or 14.00 o’clock: 1 - Unclear: 1 - Not mentioned: 20 FE Obstetric 22 1. Always after FE: 17 2. FE, assessment fetal condition: 2 3. Assessment of the difficulty of the FE: 1 4. FE, assessment fetal condition and duration expulsion stage: 2 1. Conducting FE: 17 2. Easy FE: 1 3. Difficult FE: 1 4. FE and no abnormal observations: 1 5. FE and signs of fetal distress: 1 6. FE and signs of fetal distress and/or expulsion stage >1.5 hours: 1 1. <1 hour pp: 2 2. During office hours: 2 3. During the pediatricians’ rounds: 1 4. During pediatricians’ rounds or <17.00 o ‘clock: 1 5. At 09.00 or 14.00 o’clock: 1 - Non-correspondent: 1 - Unclear: 1 - Not mentioned: 13 Neonatal 29 1. Always after FE: 17 2. FE, assessment fetal condition: 3 3. FE, assessment of condition: 1 4. FE, assessment fetal condition and duration expulsion stage: 3 5. FE, assessment fetal condition and pain (comfort scale): 1 6. Assessment of the difficulty of the FE: 2 7. Assessment of the difficulty of the FE and assessment neonatal condition: 1 - Unclear: 1 1. Conducting FE: 17 2. Easy FE: 1 3. Difficult FE: 1 4. FE and no abnormal observations: 1 5. FE and signs of fetal distress: 2 6. FE and signs of fetal distress and/or expulsion stage >1.5 hours: 2 7. FE and no fetal distress during and/or expulsion stage <1.5 hours: 1 8. FE and expected neonatal problems or difficult FE: 1 9. FE and (expected) poor neonatal vitals pp: 1 10. FE and fetal indication, or abnormal observations pp such as pain (comfort scale ≥17) or vomiting: 1 - Unclear: 1 1. Directly: 1 2. <1 hour pp: 2 3. During office hours: 2 4. During the pediatricians’ rounds: 2 5. Decided by the pediatrician, during the day if birth is between 17.00- 07.00 o’clock: 1 6. Birth between 09.00-23.00 o’clock <1 hour pp, birth between 23.00 and 09.00 o’clock call at 08.55 o’clock, birth between 23.00 and 2.30 o’clock as soon as possible and if possible at 09.00 o’clock, birth after 02.30 o’clock that the consult should be scheduled for the 11.00 o’clock rounds: 1 7. At 09.00 or 14.00 o’clock: 1 - Not mentioned: 19 CB Obstetric 39 1. Always after CB: 33 2. Assessment of indication for primary or secondary CB: 1 3. AS after CB: 4 - Unclear: 1 4. Conducting CB: 26 5. Primary CB: 2 6. Secondary CB: 3 7. Emergency CB: 1 8. CB because of fetal indication: 1 9. CB because of maternal indication: 1 10. CB and AS 9/10: 2 11. CB and AS <9 : 2 - Unclear: 1 1. Directly: 4 2. <6 hours pp: 1 3. Outside office hours: 2 4. After one day/the following day: 1 - Unclear: 3 - Not mentioned: 28 Neonatal 42 1. Always after CB: 37 2. AS after CB: 4 - Unclear: 1 1. CB: 34 2. CB because of fetal indication: 2 3. CB because of maternal indication: 1 4. CB and AS 9/10: 2 5. CB and AS <9: 2 - Unclear: 1 1. Directly: 4 2. <6 hours pp: 1 3. <24 hours pp: 1 4. At a later time (not directly pp): 1 5. In the morning: 1 6. During pediatricians’ rounds: 2 7. After one day/the following day: 1 8. Birth between 09.00-23.00 o’clock <1 hour pp, birth between 23.00 and 09.00 o’clock call at 08.55 o’clock, birth between 23.00 and 2.30 o’clock as soon as possible and if possible at 09.00 o’clock, birth after 02.30 o’clock that the consult should be scheduled for the 11.00 o’clock rounds: 1 - Unclear: 2 - Not mentioned: 28 #LGA: large for gestational age/macrosomia, SGA: small for gestational age/fetal growth restriction, MSAF: meconium stained amniotic fluid, VE: vacuum extraction, FE: forceps extraction, CB: caesarean birth 10 ^Excluding the categories ‘referral not indicated’ and ‘unclear if referral is indicated’. 11 Pp: postpartum. 12 CMV: Cytomegalovirus. 13 VBO: we were unable to decipher the meaning of this abbreviation. 14 SDS: standard deviation score. 15 EFM: electronic fetal monitor . 16 AS: Apgar score. 17 PEWS: pediatric early warning score. 18 19 20 Supplement 3. (Continued) 21 Supplement 3. (Continued) Protocol# Department Total (n) Screening/diagnostic tests (n) Tests’ cut-off values (n) Treatment (n) Discharge (n) LGA Obstetric 25 1. Glucose assessment: 3 2. Glucose assessment during 24 hours pp: 1 3. Glucose assessment <1 hour pp, 2, 4, 12 and 24 hours pp: 1 4. Glucose assessment 30 minutes after first feeding, first feeding <1 hour pp, and glucose assessment 3, 6, 12 and 24 hours pp before feeding: 1 5. Glucose assessment 30 minutes after first feeding, first feeding <1 hour pp, otherwise glucose assessment 1 hour pp and thereafter 3, 6, 12 and 24 hours pp before feeding: 2 6. Glucose assessment 1,3 and 6 hours pp: 1 7. Glucose assessment 1, 3, 6 and 12 hours pp: 1 8. Glucose assessment 1, 3, 6, 9 and 24 hours pp: 1 9. Glucose assessment 1,4 and 7 hours pp: 1 10. Glucose assessment 3, 6, 12, 18 and 24 hours pp: 1 11. Glucose assessment for which referred to a different document, temperature assessment every 3 hours, assessment of heartrate and breathing rate, observation of feeding, defecation tone and umbilical cord and skull circumference two days pp: 1 - Referred to a different document: 6 - Unclear: 1 - Not mentioned: 4 1. Glucose <1.9 mmol/l 0-1 hour pp. <2.2 mmol/l 2-24 hours pp and <2.6 mmol/l >24 hours pp: 1 2. Glucose ≥2 <6 hours pp and ≥2.7 mmol/l ≥6 hours pp: 1 3. Glucose <2 mmol/l 0-4 hours pp, thereafter <2.5 mmol/l: 1 4. Glucose <2.6 mmol/l: 2 5. For glucose cut-off values referred to a different document, and breathing rate 3555/min, and heartrate 155-200/min, and temperature 36.5-37.5 °C:1 - Referred to a different document: 8 - Unclear: 3 - Not mentioned: 8 1. Supplementary feeding: 4 2. Supplementary feeding and upscaling with glucose infusion: 3 3. Supplementary feeding and upscaling with glucose infusion and glucose gel: 1 4. Enteral feeding every 3 hours if possible, if liquid intake becomes too much start with glucose 15%, 20% etc.: 1 - Referred to a different document: 8 - Unclear: 1 - Not mentioned: 7 1. After a least 24 hours pp: 2 2. After several glucose values >2.6 mmol/l at serval and infusion proofs unnecessary and pediatrician’s permission: 1 3. After 3 glucose values >2.6 mmol/l: 1 - Unclear: 3 - Not mentioned: 18 Neonatal 38 1. Glucose assessment: 3 2. Glucose assessment 30 minutes after first feeding, first feeding <1 hour pp, and glucose assessment 3, 6, 12 and 24 hours pp before feeding: 1 3. Glucose assessment 1 hour pp, thereafter 2 more assessments before feeding (about 4 and 7 hours pp): 2 4. Glucose assessment 1 or 2 hours pp after first feeding and 3, 6, 9, hours pp before feeding: 1 5. Glucose assessment 1 and 4 hours pp: 1 6. Glucose assessment 1,3 and 6 hours pp: 1 7. Glucose assessment 1, 3, 6 and 12 hours pp: 1 8. Glucose assessment 1, 3, 12 and 24 hours pp: 1 9. Glucose assessment 1, 3, 6, 9 and 12 hours pp: 2 10. Glucose assessment 1,4 and 7 hours pp: 4 11. Glucose assessment 2, 3, 6, 9, 18 and 24 hours pp: 2 12. Glucose assessment 3, 6, and 9 hours pp: 1 13. Glucose assessment 3, 6, 9, 12, 18 and 24 hours pp: 1 - Not mentioned: 8 - Referred to a different document: 8 1. Severe symptoms of hypoglycemia (such as convulsions) and/or very low glucose (<1.1 mmol/l): 2 2. Glucose <1.8 mmol/l 1 hour pp, <2.3 mmol/l ≥4 hours pp: 1 3. Glucose <1.9 mmol/l 1-3 hours pp or <2.2 mmol/l 3-24 hours pp or <2.6 mmol/l with clinical symptoms: 1 4. First glucose assessment <2 mmol/l <1 hour pp, thereafter <2.6 mmol/l: 1 5. Glucose <2.2 mmol/ l <4 hours pp, <2.5 mmol/l >4 hours pp, <3 mmol/ l >24 hours pp: 2 6. Glucose 2.2-2.5 mmol/l or 1.9-2.1 mmol/l or 1.5-1.8 mmol/l or <1.4 mmol/l: 1 7. Clinical symptoms and glucose ≤2.5 mmol/l or no clinical symptoms and glucose <1.5 mmol/l: 1 8. Glucose <2.6 mmol/l: 4 9. Glucose 2.6 mmol/l, >3 days pp 3 mmol/l: 1 10. Glucose <2.6 mmol/l or >4 days pp <3 mmol/l: 1 11. First glucose assessment <2.6 mm/l and symptoms, or glucose <1.6 without symptoms: 1 1. No routine supplementary feeding: 1 2. If necessary 8 feedings: 1 3. 8 feedings either breast or bottle, consider supplementary feeding: 1 4. Routine supplementary feeding: 4 5. Supplementary feeding and upscaling with glucose infusion: 6 6. Supplementary feeding and upscaling with glucose infusion and glucose gel: 1 7. Feeding every 3 hours, supplementary feeding if necessary or admit sucrose:1 8. Bolus of glucose via infusion: 2 - Referred to a different document: 7 - Unclear: 1 - Not mentioned: 13 1. After at least 24 hours pp: 4 2. After assessment protocol is met and a minimum of 3 consecutive glucose values are normal and glucose infusion proofs unnecessary: 2 3. Normal glucose values: 1 4. The last 2 glucose values >2.3 mmol/l: 1 5. After 3 glucose values >2.6 mmol/l: 1 6. After at least 12 hours pp and normal glucose: 1 7. Glucose ≥2.6, >12 hours and ≥2 stable glucose: 1 8. Normal glucose values >4 hours of screening: 1 9. 12 hours pp only after at least 3 normal glucose values of which 2 consecutive normal (>2 mmol/l 2 hours pp and thereafter 2.6 mmol/l): 1 - Unclear: 2 - Not mentioned: 23
RkJQdWJsaXNoZXIy MjY0ODMw