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Published on: April 7, 2023
Retrospective observational study of neonatal attendances to a children's emergency department
Sarah J Blakey1, Mark D Lyttle1,2, Dan Magnus1
1Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.
Insights
Many newborns visiting the children's emergency department (CED) were well and only needed advice or observation. This highlights a need for better community care and support for new parents to reduce unnecessary emergency visits.
Area of Science:
- Pediatrics
- Emergency Medicine
- Neonatal Care
Background:
- Emergency department (ED) attendances are rising in the UK, especially for young children.
- Community services face increasing pressure, potentially leading parents to seek ED care for non-urgent neonatal issues.
Purpose of the Study:
- To characterize the presenting features, management, and disposition of neonatal attendances to a children's emergency department (CED).
Main Methods:
- Retrospective observational review of neonatal attendances (≤28 days) at Bristol Royal Hospital for Children from 01/01/2016 to 31/12/2016.
- Data abstraction included demographics, referral, presenting complaint, diagnosis, investigations, and treatments.
Main Results:
- Neonatal attendances increased significantly between 2008 and 2016.
- Common reasons for attendance were breathing difficulty and vomiting.
- A large proportion (41.9%) were diagnosed with 'no significant medical problem', with most requiring only advice or observation.
Conclusions:
- Many neonates attending the CED were well and discharged without investigations.
- There is potential to improve community management and support for new parents.
- Enhanced out-of-hospital care models are needed to support families and clinicians.
Aim:
Attendances to emergency departments (EDs) in the UK are increasing, particularly for younger children. Community services are under increasing pressure and parents may preferentially bring their babies to the ED, even for non-urgent problems. This study aimed to characterise the presenting features, management and disposition of neonatal attendances to a children's ED (CED).
Methods:
Retrospective observational review of neonatal attendances (≤28 days) to the CED at Bristol Royal Hospital for Children (BRHC) from 01/01/2016 to 31/12/2016. Further information was obtained from investigation results and discharge summaries. Data abstracted included sex, age, referral method, presenting complaint, diagnosis, investigations and treatments.
Results:
Neonatal attendances increased from 655 to 1,205 from 2008 to 2016. The most common presenting complaints were breathing difficulty (18.1%) and vomiting (8.3%). The most common diagnoses were 'no significant medical problem' (41.9%) and bronchiolitis (10.5%). Half of neonatal attendances to the CED had no investigations performed and most (77.7%) needed advice or observation only.
Conclusion:
Many neonates presenting to the CED were well and discharged with observation only. This suggests potential for improving community management and in supporting new parents. Drivers of health policy should consider developing enhanced models of out of hospital care which are acceptable to clinicians and families.
