155 6 (UN)WARRANTED VARIATION IN HOSPITAL PROTOCOLS FOR NEONATAL REFERRAL TO THE PEDIATRICIAN 14. Observation ≥24 hours pp: 1 - Referred to a different document: 2 - Unclear: 1 - Not mentioned: 6 9. After 8-12 hours and reassessment by the pediatrician: 1 10. After 12 hours: 1 11. After 24 hours of observation: 1 12. After at least 24 hours admission: 1 - Referred to a different document: 2 - Not mentioned: 6 Neonatal 37 1. Physical assessment: 1 2. Physical assessment and no minimal duration of observation: 1 3. AS 5 minutes pp, observation respiratory problems and observation clinical symptoms: 1 4. Observation respiratory problems: 1 5. Observation activity, breathing, tone, and assessment heartrate, breathing and saturation every 2 hours: 2 6. Physical assessment and observation breathing, heartrate, and overall condition 1 and 2 hours pp, and thereafter every 2-6 hours: 1 7. Observation ≥8 hours pp: 8 8. Assessment vital parameters at least 3 times ≥8 hours pp: 1 9. Keeping a list of patient reported outcome measures ≥8 hours pp: 1 10. Assessment respiratory problems regularly ≥8 hours pp: 1 11. Physical assessment and assessment breathing and saturation every 3 hours ≥8 hours: 1 12. Assessment temperature, color, grunting, and breathing 1, 3, and 6 hours pp ≥8 hours pp: 1 13. Observation feeding, vomiting, nauseousness and temperature ≥8 hours pp: 1 14. Assessment breathing, temperature and color every 3 hours ≥8 hours pp: 1 15. Assessment breathing, temperature and heartrate every 3 hours ≥8 hours pp: 1 16. Observation breathing, temperature, color, alertness, and psychical examinations ≥8 hours pp: 3 17. Observation breathing, temperature, heartrate, and psychical examinations ≥8 hours pp: 1 18. Observation tachypnoea/dyspnea, grunting, cyanosis, feeding problems and nauseousness ≥8 hours pp: 1 19. Observation ≥24 hours pp: 1 - Referred to a different document: 1 - Not mentioned: 7 1. Signs of dyspnea: 1 2. Temperature >38°C and breathing rate <30 or >60/min: 1 3. AS <7 5 min pp or respiratory problems, or AS 7,8 5 min pp and no abnormal observations: 1 4. Heartrate <80/min, tachypnoea >60/min, grunting, nasal flaring, chest retractions, saturation <92%: 2 - Referred to a different document: 1 - Not mentioned: 31 1. The pediatrician decides about the necessity of long-term observation or admission: 2 2. Admission with monitoring and if necessary additional treatment: 2 - Referred to a different document: 1 - Not mentioned: 32 1. Depending on clinical condition: 1 2. Normal physical assessment, no minimum admission time: 1 3. After 6 hours in absence of respiratory problems: 1 4. After 8 hours observation: 13 5. After 8 hours in absence of respiratory problems: 2 6. After 8 hours if normal assessments, without consultation of the pedestrian: 1 7. After 8 hours in consultation with the pediatrician: 1 8. After 8 hours observation and pediatrician’s assessment: 2 9. After at least 8 hours, pediatrician decides admission time: 1 10. After 8 hours of observation,. Normal breathing, no signs of encephalopathy, no signs of perinatal infection: 1 11. After 24 hours of observation: 1 - Referred to a different document: 2 - Not mentioned: 10 VE Obstetric 26 1. Physical assessment: 2 2. Physical assessment paying extra attention to the head because of complications after caput succedaneum, cephalic hematoma and subgaleal bleeding: 1 3. Observation twice temperature assessment, general condition, color and breathing ≥4 hours pp: 1 4. Observation to timely recognize subgaleal bleeding≥6 hours pp: 1 1. Pain: 1 2. Pain or starting shock or subgaleal bleeding: 1 3. Breathing rate <35/min or >55min/min, heartrate < 100/min or >150/min, temperature <36.5°C or >37.5°C: 1 1. Pain medication: 1 2. Paracetamol if necessary: 2 3. Paracetamol if necessary, extend admission time if necessary to 24 hours pp: 1 4. One-time paracetamol 60 mg: 3 1. After 4 hours: 1 2. After 6 hours: 1 3. After 6 hours and no signs of subgaleal bleeding (assessment head before discharge): 1 4. After 8 hours: 1 5. After 12 hours: 4 5. Observation color, temperature, feeding behavior, drowsiness, and physical assessment ≥6 hours pp: 1 6. Observation pain and skin ≥8 hours pp: 1 7. Observation ≥8 hours pp: 1 8. Observation head skin peeling, subdural hematoma, headache and nauseousness ≥8 hours pp: 1 9. Observation ≥12 hours pp: 1 10. Observation breathing, heartrate, agitation, pain, crying, vomiting, feeding problems, grunting, color, drowsiness, and head every 3 hours ≥12 hours pp: 1 11. Observation color, limb movement, responsiveness to stimuli, breathing, chest retractions, nasal flaring, nauseousness, grunting, pain, head, and feeding problems 12-24 hours pp: 1 12. Observation temperature, heartrate, breathing every 3 hours, and assessment food intake, excretion, tone, belly button, weight and head circumference 12-24 hours pp: 1 13. Observation ≥24 hours pp: 1 - Not mentioned: 12 4. Grunting, quietness, high heartrate, fast breathing rate, and skin discoloration/damage: 1 - Referred to a different document: 1 - Not mentioned: 21 5. Birth weight <4000 g 60 mg paracetamol if necessary 60 mg after 6 hours, birthweight > 4000 g 120 mg paracetamol if necessary 60 mg after 6 hours: 1 6. Paracetamol 60 mg and lowstimulus environment: 1 7. Gastric lavage and paracetamol 60 mg 3 times a day: 1 - Not mentioned: 16 6. After 12-24 hours: 1 7. After 24 hours: 2 8. After 48 hours: 1 - Not mentioned: 14 Neonatal 31 1. Assessment comfort scale: 1 2. Physical assessment paying extra attention to the head because of complications after caput succedaneum, cephalic hematoma and subgaleal bleeding: 1 3. Observation to timely recognize subgaleal bleeding≥6 hours pp: 1 4. Observation ≥6 hours pp, first 3 hours assessment swelling of the head, and every hour breathing, temperature and color: 1 5. Observation ≥8 hours pp: 3 6. Observation and physical assessment ≥8 hours pp: 2 7. Observation ≥12 hours pp: 3 8. Observation paying extra attention to feeding and pain ≥12 hours pp: 1 9. Observation ≥24 hours pp: 2 - Not mentioned: 16 1. Pain: 1 2. Pain, swelling of the head: 1 3. Nauseousness, problem with breastfeeding, and pain: 1 4. Feeding problems or bleedings, nauseousness, vomiting, paleness, grunting, hypoglycemia: 1 - Not mentioned: 27 1. Pain medication: 3 2. Paracetamol if necessary: 2 3. One-time paracetamol 60 mg: 2 4. Paracetamol if necessary, extend admission time if necessary to 24 hours pp: 1 5. Paracetamol 60 mg 3 times a day: 1 6. Paracetamol 60-120 mg: 1 - Not mentioned: 21 1. Good clinical condition: 1 2. After 6 hours: 1 3. After 6 hours and no signs of subgaleal bleeding (assessment head before discharge): 1 4. After 8 hours: 3 5. After 12 hours: 6 6. After 24 hours: 2 - Not mentioned: 17 FE Obstetric 22 1. Physical assessment: 2 2. Assessment swelling and/or bleeding of the skin of the head and signs of pain: 1 3. Physical assessment paying extra attention to the head because of complications after caput succedaneum, cephalic hematoma and subgaleal bleeding: 1 4. Observation twice temperature assessment, general condition, color and breathing ≥4 hours pp: 1 5. Observation pain and skin ≥8 hours pp: 1 6. Observation ≥12 hours pp: 1 7. Observation color, limb movement, responsiveness to stimuli, breathing, chest retractions, nasal flaring, nauseousness, grunting, pain, head, and feeding problems 12-24 hours pp: 1 8. Observation ≥24 hours pp: 1 - Not mentioned: 13 1. Pain: 1 2. Grunting, quietness, high heartrate, fast breathing rate, and skin discoloration/damage: 1 - Referred to a different document: 1 - Not mentioned: 19 1. Pain medication: 1 2. Paracetamol if necessary: 1 3. One-time paracetamol 60 mg: 3 4. Gastric lavage and paracetamol 60 mg 3 times a day: 1 5. Birth weight <4000 g 60 mg paracetamol if necessary 60 mg after hours, birthweight > 4000 g 120 mg paracetamol if necessary 60 mg after 6 hours: 1 6. Paracetamol 60 mg and lowstimulus environment: 1 - Not mentioned: 14 1. After 4 hours: 1 2. After 8 hours: 1 3. After 12 hours: 3 4. After 12-24 hours: 2 5. After 24 hours: 1 - Not mentioned: 14 Neonatal 29 1. Assessment comfort scale: 1 2. Physical assessment paying extra attention to the head because of complications after caput succedaneum, cephalic hematoma and subgaleal bleeding: 1 3. Observation ≥8 hours pp: 3 1. Pain: 1 2. Pain, swelling of the head: 1 3. Nauseousness, problem with breastfeeding, and pain: 1 1. Pain medication: 3 2. Paracetamol if necessary: 1 3. One-time paracetamol 60 mg: 2 1. Good clinical condition: 1 2. After 8 hours: 3 3. After 12 hours: 6 4. After 24 hours: 2 - Not mentioned: 17
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