Neonatal Presentations to the Children’s Emergency Department

Abstract

ABSTRACTBackgroundPaediatric attendances to Emergency Departments (EDs) in the UK are increasing, particularly for younger children. Neonates present a challenge due to their non-specific presentations. Community services are under increasing pressure and parents may preferentially bring their children to the ED, even for non-urgent problems. Neonatal attendances have not been extensively studied, but previous reviews have shown many are well, often not requiring specific medical intervention. This study aimed to characterise the presenting features, management and disposition of neonatal attendances to a tertiary Children’s ED (CED).MethodsRetrospective observational review of medical records identified via the ED Electronic database of neonatal attendances (≤28 days) to Bristol Royal Hospital for Children (BRHC) over 12 months (01/01/2016-31/12/2016). Further information was obtained from investigation results, discharge summaries and historical admissions data.ResultsNeonatal attendances increased from 655 to 1205 from 2008-2016. The most common presenting complaints were breathing difficulty (18.1%), vomiting (8.3%) and poor feeding (8.2%). The most common diagnoses were ‘no significant medical problem’ (41.9%), bronchiolitis (10.5%) and suspected sepsis (10.0%). Just over 1/3 were admitted (23% inpatient, 12% Short Stay Unit). Median length of stay for inpatients was 2 days. Half of neonatal attendances to the ED had no investigations performed and most (77.7%) needed advice or observation only.ConclusionMany neonates presenting to the CED were well and discharged with observation only. This suggests not only that there is potential for improved community management but that increased support for community colleagues and new parents is needed. There are also implications for reviewing training in emergency medicine, especially the ability to assess ‘well’ infants and to manage common neonatal problems. Drivers of health policy should consider developing enhanced models of out of hospital care which are acceptable to clinicians and families