Referral template to paeds - from OBGYN HO prespective

HUSM obgyn paeds referral template:just a note for me to remember when needed to be used. 

This template is also being passed down by seniors, grateful to those who started this. 

It is too common that we are being scolded for not presenting detail enough while referring case to MO paeds. This will be especially useful for those who are like me, went to OBGYN posting first before paeds, and have no idea what to do. 

Good luck guys!

It is part malay and english, so those who dont understand malay it's time to pick up a new language. 

**especially those who graduated oversea. 

Paeds referral

Summary:

Dr, saya HO(houseman) xxx, from LR(labor room)/ward xx nak refer baby of 

(example of problems)

i. M(maternal) GDM on insulin/metformin

ii. M PROM > ? hrs

iii. M GBS positive

iv. Macrosomic baby (> 4.5kg)

v. Low birth weight baby (<2.5kg)

(Example notes to write in record)

This is baby of ___.

Baby boy/girl, currently _ hours of life. 

Born via SVD at _weeks __days POA(period of amenorrhea)/POG(period of gestation) 

with BW(birth weight) _kg & Apgar score __ at 1 min 

Antenatally mother have

1.

2.

3.

4. 

On examination of baby

- Baby pink, active on handling

- Anterior fontanelle normotensive

- Good sucking

- Lungs clear, RR?, no grunting, no nasal flaring

- CVS S1 S2 heard, HR?

- PA soft, 2A1V

- Male/female genitalia normal. Bilateral testes descended (if male), anus patent

- No DDH, good palmar grasp

- Spine Normal

- Moro complete. 

Some details to take note for each case:

1. Low birth weight(LBW) baby

• LBW<2.5kg
• VLBW <1.5 (V: very)
• ELBW <1kg (E: extreme)

*Not all LBW are SGA (Small Gestational Age)

*It can be AGA (Appropriate for Gestational Age)

So plot growth chart if has LBW baby

SGA : wt <10th centile

Symmetrical SGA : all components <10th centile

Asymmetrical SGA : wt (weight) <10th centile, COH (circumference of head) and length almost achieve centile for the gestational age 

2. Infant diabetic mother

Screen for diabetic embryopathy

1. mention types of medication used

- are they on Insulin? 

• type of insulin? actrapid / insulatard
• what is the total dose per day
• when they start?
• is their BSP (blood sugar profile) optimised?

2. Please mention Hba1c: indicates control 

• (if possible mention early pregnancy HbA1c and late pregnancy values)

3. BSL (Blood Sugar Level) of baby at 1 hr

• If refer at 4 hours of life, at least have 2 BSL. If hypoglycemic after feeding refer immediately to MO paeds. 

3. Infant of hyperthyroid mother

• Please know latest TSH, T4 and Medications of mother
• Heart rate of child 

4. Infant risk of sepsis

(PROM, PPROM, UTI(urinary tract infection)) 

UTI

1. If UTI please mention when they got UTI

• inform the UFEME results
• inform urine C+S if available

2.  Any Antibiotic coverage?

• types of antibiotic
• dosage
• given how many times
• since when
• any temperature spike or signs of sepsis in mother

PROM/PPROM

(premature rupture of membrane). preterm premature rupture of membrane

• Please know duration of leaking

• >12hrs? / >24hrs?

• Doses of antibiotics?

            - last dose bila , how many of hour before delivery

            - any chorioamnionitis signs?

            - liquor?

• post delivery baby mcm mana?

• Mother

• FBC: Hb, WBC, PLT

• HVS C+S (high vaginal swap culture and sensitivity)

reference:

1. https://myhow.files.wordpress.com/2013/11/hoguidepeds1.pdf