Hospitals vary widely in when they refer babies to pediatricians

The protocols on which Dutch hospitals decide whether or not to refer a newborn baby to a pediatrician vary widely, obstetrician Bahraeh Goodarzi found in her dissertation on risk selection in maternity care. “Depending on where you live, your newborn may or may not be referred to a pediatrician,” Goodarzi said to NRC. “That’s crazy. You expect the best care everywhere, based on scientific evidence.”

Previous studies revealed significant differences in the number of newborn referrals to pediatricians. Some hospitals refer 5 percent of babies, others as many as 62 percent. The outcomes are no better in the hospitals that refer more babies to pediatricians - no fewer babies die, and babies do not become less ill.

That suggests babies are getting too much care in some hospitals and too little in others, Goodarzi said. Therefore, she and her colleagues at Amsterdam UMC asked the other Dutch hospitals to share their protocols for different indications - babies with very high or low birth weight, babies who defecated in the amniotic fluid, and babies born with forceps delivery, vacuum delivery, or cesarean section. Eighty-eight obstetrics and pediatrics departments submitted a total of 420 protocols.

These showed significant differences in protocols. There were even incidences of a single hospital using different protocols - in one hospital, genygcologists’ C-section protocol said that only children with suboptimal health should be referred, while the pediatricians' protocol said that all babies should be seen by them after a C-section.

Goodarzi didn’t look into where the differences came from. “But it could really be all kinds of things. The lack of scientific research, historical differences in vision, agreements that people have made in the past,” she said. “My main recommendation is to make agreements based on evidence, not consensus. And if nothing is known scientifically about what is best, you have to organize consensus nationally, not regionally.”

Goodarzi will get her doctorate at Amsterdam UMC on February 10.