{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:38:14Z","timestamp":1781192294862,"version":"3.54.1"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T00:00:00Z","timestamp":1668384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Studies indicate unwarranted variation in a wide range of neonatal care practices, contributing to preventable morbidity and mortality. Unwarranted variation is the result of complex interactions and multiple determinants. One of the determinants contributing to unwarranted variation in care may be variation in local hospital protocols. The purpose of this study was to examine variation in the content of obstetric and neonatal protocols for six common indications for neonatal referral to the pediatrician: large for gestational age\/macrosomia, small for gestational age\/fetal growth restriction, meconium\u2010stained amniotic fluid, vacuum extraction, forceps extraction, and cesarean birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a nationwide cross\u2010sectional study examining protocols for neonatal referral to the pediatrician in the obstetric and neonatal departments of all Dutch hospitals. Variation in protocols was analyzed between regions, between neonatal and obstetrics departments located in the same hospital, and within neonatal and obstetrics departments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was considerable variation in protocols between regions, between neonatal and obstetrics departments, and within neonatal and obstetrics departments. The results of this study showed considerable variation in recommendations for type of referral, admission, screening\/diagnostic tests, treatment, and discharge. Furthermore, results generally showed lower referral thresholds in neonatal departments compared with obstetric departments, and higher referral thresholds in the eastern region of the Netherlands. We also found variation in local hospital protocols, which could not be explained by population characteristics but which may be explained by varying recommendations in existing national and international guidelines and\/or lack of adherence to these guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>To reduce unwarranted variation in local protocols, evidence\u2010based, multidisciplinary guidelines should be developed in the Netherlands. Further research addressing knowledge gaps is needed to inform these guidelines. Attention should be paid to the implementation of evidence, and only where evidence is lacking or inconclusive should agreements be based on multidisciplinary consensus. Where protocols deviate from evidence\u2010based guidelines because of specific local circumstances, clearer, more transparent justifications should be made. Uniformity in guidance will offer clear standards for care evaluation and provide opportunities to reduce inappropriate care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12690","type":"journal-article","created":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T12:49:38Z","timestamp":1668430178000},"page":"215-233","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["(Un)warranted variation in local hospital protocols for neonatal referral to the pediatrician: An explorative study in the Netherlands"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9758-1299","authenticated-orcid":false,"given":"Bahareh","family":"Goodarzi","sequence":"first","affiliation":[{"name":"Department of Midwifery Science Vrije Universiteit Amsterdam, Amsterdam UMC  Amsterdam The Netherlands"},{"name":"Midwifery Academy Amsterdam Groningen  Amsterdam The Netherlands"},{"name":"Amsterdam Public Health, Quality of Care  Amsterdam The Netherlands"},{"name":"Department of General Practice and Elderly Care Medicine University of Groningen, University Medical Centre Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5946-2205","authenticated-orcid":false,"given":"Anna","family":"Seijmonsbergen\u2010Schermers","sequence":"additional","affiliation":[{"name":"Department of Midwifery Science Vrije Universiteit Amsterdam, Amsterdam UMC  Amsterdam The Netherlands"},{"name":"Midwifery Academy Amsterdam Groningen  Amsterdam The Netherlands"},{"name":"Amsterdam Public Health, Quality of Care  Amsterdam The Netherlands"},{"name":"Department of General Practice and Elderly Care Medicine University of Groningen, University Medical Centre Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3656-8469","authenticated-orcid":false,"given":"Doug","family":"Cronie","sequence":"additional","affiliation":[{"name":"Rotterdam University of Applied Sciences, Institute of Healthcare  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henri\u00ebtte","family":"van Laerhoven","sequence":"additional","affiliation":[{"name":"Department of Pediatrics OLVG  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-9145","authenticated-orcid":false,"given":"Thomas","family":"van\u00a0den Akker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Leiden University Medical Centre  Leiden The Netherlands"},{"name":"Athena Institute, VU University  Amsterdam The Netherlands"},{"name":"Department of neonatology, Emma Children's Hospital University of Amsterdam, Amsterdam UMC  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton H.","family":"van Kaam","sequence":"additional","affiliation":[{"name":"Department of neonatology, Emma Children's Hospital University of Amsterdam, Amsterdam UMC  Amsterdam The Netherlands"},{"name":"Amsterdam Reproduction and Development  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ank","family":"de Jonge","sequence":"additional","affiliation":[{"name":"Department of Midwifery Science Vrije Universiteit Amsterdam, Amsterdam UMC  Amsterdam The Netherlands"},{"name":"Midwifery Academy Amsterdam Groningen  Amsterdam The Netherlands"},{"name":"Department of General Practice and Elderly Care Medicine University of Groningen, University Medical Centre Groningen  Groningen The Netherlands"},{"name":"Amsterdam Reproduction and Development  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32585-5"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.325.7370.961"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13181"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31472-6"},{"key":"e_1_2_11_6_1","volume-title":"Evidence Check. 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