Table 3

Screening template used to record patient and family characteristics and permission to view clinical records

Baby details
Admission type	Acute/elective
Antenatal diagnosis	Yes/no
Has the baby been cared for within other areas of the neonatal unit or other wards in Leeds?	Yes/no
Has baby been cared for in other neonatal unit?	Yes/no
What was the highest level of care?	Ward area on surgical neonatal unit/High Dependency Unit/NICU
Which surgical specialty?	Upper GI/lower GI/thoracic/general/urology
Gestational age at birth	24–28/29–32 / 33–37/ >38
Gestational age at surgical presentation
Additional co-morbidities
Length of hospital stay in days
Parents/family details
	Mother	Father/partner
Permission to review baby’s medical records?	Yes/no	Yes/no
Has your baby been cared for at any other neonatal unit?	Yes/no	Yes/no
Have any previous children had care at this or another neonatal unit?	Yes/no	Yes/no
Would you consider yourself a single parent?	Yes/no	Yes/no
What is your postcode? How long did it take you to travel to hospital to see your baby? (in minutes)	Minutes	Minutes
In total how many siblings does your baby have?
How many of these siblings live permanently at your home?
Mothers age in years (please circle)	<20/21–25/26–30/31–40/40+ Prefer not to say	<20/21–25/26–30/31–40/40+ Prefer not to say
Marital status	Single Married Cohabiting Separated Divorced Prefer not to say	Single Married Cohabiting Separated Divorced Prefer not to say
Ethnicity
First language (please specify)
Will you require an interpreter?	Yes/no	Yes/no
Do you have access to WiFi at home?	Yes/no/yes but limited	Yes/no/yes but limited
Highest level of education	None Some high school High school College Batchelors degree Masters degree PhD or Higher Prefer not to say	None Some high school High school College Batchelors degree Masters degree PhD or Higher Prefer not to say
Do you have a disability?	Yes/no/prefer not to say	Yes/no/prefer not to say
Was this a multiple pregnancy (ie, twins triplets)?	Yes/no/prefer not to say If yes please specify	1.
Was this pregnancy assisted (ie, In Vitro Fertilisation)	Yes/no/prefer not to say
On completion of this project would you like to receive feedback of our findings?	Yes/no Email	Yes/no Email

NICU, neonatal intensive care unit.