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Neonatal presentations in the pediatric emergency department: A decade-long retrospective analysis
Boone Rhinehart1, David Sheridan2, SunHee Chung2
1Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.
Insights
Certain neonatal complaints, like temperature instability and feeding issues, significantly increase hospital admission rates in Pediatric Emergency Departments (PEDs). This data can improve caregiver education and triage protocols for newborns.
Area of Science:
- Pediatric Emergency Medicine
- Neonatal Care
- Clinical Triage
Background:
- Rising neonatal visits to Pediatric Emergency Departments (PEDs) necessitate better understanding of contributing factors.
- Vague neonatal symptoms challenge accurate assessment, affecting care decisions and return visit rates.
Purpose of the Study:
- Identify common chief complaints in neonates presenting to the PED.
- Analyze the association between chief complaints, admission rates, and diagnoses.
- Inform educational interventions for caregivers and medical staff.
Main Methods:
- Retrospective review of neonatal (≤30 days) medical records.
- Data collected from a quaternary care medical center from January 2012 to December 2022.
- Analysis of 3175 patient encounters.
Main Results:
- 38% of neonatal encounters resulted in hospital admission.
- Higher admission rates observed for temperature instability (fever 71%, hypothermia 89%), breast concerns (68%), abnormal labs (63%), seizures (53%), and cardiac concerns (54%).
- Neonates presenting on day of life 0 (77%) and day 1 (66%) had elevated admission rates.
Conclusions:
- Specific chief complaints correlate with increased hospital admissions and ED return visits.
- Findings can guide targeted educational programs for caregivers and ED providers.
- Refined triage protocols can ensure optimal and efficient care for neonates.
Background:
The global increase in neonatal visits to Pediatric Emergency Departments (PEDs) underscores the need to better understand the factors driving these visits and their implications. The often vague and nonspecific symptoms of neonates pose significant challenges for clinicians and caregivers in determining the appropriate level of care, impacting the frequency of return visits and overall effectiveness of discharge education.
Objective:
This study aims to compile the most common chief complaints of neonates in the PED and analyze their association with admission rates and final ED diagnoses to inform educational interventions for caregivers and medical personnel.
Methods:
This was a retrospective review of data from medical records from neonatal (≤30 days of life) presentations to the PED at a quaternary care medical center in Portland, Oregon, USA from January 2012 to December 2022.
Results:
3175 patient encounters were identified, of which one-third (38 %) were admitted to the hospital. Certain complaints had higher admission rates than the average: temperature instability (71 % for "fever" and 89 % for "hypothermia"), breast concerns (68 %), abnormal lab results (63 %), "seizures" (53 %), and cardiac concerns (54 %). Notably, neonates presented on DOL 0 and DOL 1 had elevated admission rates of 77 % and 66 %, respectively.
Conclusion:
This study identified specific complaints that were most likely to result in hospital admissions and return visits to the ED. This can guide targeted educational interventions for caregivers and ED providers and refinement of triage protocols to ensure that neonates receive the most appropriate and efficient care.
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