Observatie van pasgeborenen na vaginale kunstverlossing: dagelijkse praktijk in 98 Nederlandse algemene ziekenhuizen

Objective. To survey current practice regarding management of vacuum or forceps delivered neonates in Dutch general hospitals.

Study design. Interview by phone of pediatricians of all hospital-based pediatric and obstetric practices using a questionnaire. Information regarding pediatric attendance during vaginal instrumental deliveries and current practice regarding physical examination, hospital admission, clinical observation and follow-up of the newborn infants were obtained.

Results. In 2001 all hundred hospital-based pediatric practices in general hospitals in the Netherlands were reached by phone. The majority of pediatricians representing these practices (98%) were willing to answer the questions. In the majority of the hospitals pediatricians attend vaginal instrumental deliveries on indication (92%), instrumentally delivered newborn infants are routinely admitted to the maternity ward (92%), and pediatricians perform physical examination of the newborn infant routinely (70%). Length of routine hospital stay varies from less than 8 hours to more than 48 hours. In all hospitals paracetamol is administered routinely (41%) or on indication (59%) to instrumentally delivered infants. In thirteen hospitals structured pain observation instruments are used whereas in 85 hospitals observation of the vacuum or forceps delivered newborn is not structured. Long term follow-up is not performed in any hospital.

Conclusion. It is unknown how often support of the neonate in the delivery room is needed following vaginal instrumental delivery. Therefore it is questionable to justify that pediatricians do only attend a vaginal instrumental delivery on indication. The high rate of mild and moderate morbidity justifies routine hospital admission and paracetamol treatment of instrumentally delivered infants. However, routine physical examination by pediatricians might become unnecessary and the effect of analgesia might become better evaluated when structured observation (including pain) by trained nurses is performed.