The factors affecting neonatal presentations to the pediatric emergency department

Abstract

Background: A pediatric emergency department (PED) may be utilized by neonates for nonurgent complaints. Various factors, such as primiparity, maternal age, early postnatal discharge, race, income, and maternal and paternal educational levels, have been reported to affect the acuity of neonatal emergency department utilization.

Objective: To determine the characteristics of PED visits by neonates (infants ≤ 28 days of age) and to evaluate the factors affecting the acuity of these visits.

Methods: We prospectively collected the data of neonates who were admitted to the PED of a tertiary university hospital within a 6-month period. Presenting problems were classified as acute if diagnostic tests were requested or the patient was hospitalized, unless the final diagnosis was "normal newborn."

Results: Over this period, 28,389 children (0-18 years of age) visited the PED, of which 531 were newborns (1.9%). The mean age was 14.1 ± 8.3 days, with a slight predominance of males (57.3%). The chief complaints were jaundice (23.4%), irritability (9.5%), and vomiting (7.1%), and the most common diagnoses were normal newborn (33.9%), indirect hyperbilirubinemia (13.2%), and colic (5.8%). Acute visits were 55.7% of the total visits. Premature infants, infants of multiparous mothers, infants of older mothers (≥25 years), and physician-referred infants were more likely to present with acute problems (p values were 0.001, 0.013, 0.006, and <0.001, respectively).

Conclusion: The results suggest that there may be a relationship between nonacute neonatal visits to a PED and insufficient knowledge of the caretaker on newborn care. Thus, more detailed education and early postnatal support programs regarding newborn care may help to decrease nonacute PED visits by neonates.

Keywords: acute visit; emergency department; newborn; prematurity; primiparity.