A Prospective Investigation of Factors Influencing Neonatal Visits to a Tertiary Emergency Department

Özet

Objective: Although emergency complaints in newborns are very rare and benign, pediatricemergency department (ED) admissions in Turkey are increasing due to early postpartumdischarge and insufficient prenatal care. We aimed to analyze the factors affecting neonataladmissions to ED and to evaluate progress and outcomes following discharge, and hospitalizationrates.Materials and Methods: All neonates aged 28 days or less admitted to the pediatric ED wereincluded prospectively. Demographics, perinatal–maternal features, and social factors wererecorded. Complaints, clinical findings and diagnoses, hospitalization referral rates, and readmissionfrequencies were analyzed.Results: A total of 2109 neonates were enrolled; the median age was 6 days and 55.7% weremales. More than half the newborns (67.5%) visited the ED out of hours, and 99% were nonreferral.The frequency of multiparity and cesarean delivery were 48.9% and 57.4%, respectively.The most common complaints were jaundice (66.3%), irritability (9.3%), vomiting (3.4%),and fever (2.6%). While the hospitalization rate was 13%, 12.8% had a serious illness (sepsis,pneumonia, bronchiolitis, etc.). Serious diseases and hospitalization rates were higher amongneonates with low birth weight and prematurity (P < .005, P < .001). Mothers who were primiparousand had their pregnancy at a younger age (<21 years) used EDs frequently for nonseriousconditions (P < .05, P < .05, respectively). Early postpartum discharge, admission out ofhours, age ≤ 7 days, residence in proximity to the hospital, and primiparity were significantlyassociated with readmission to the ED within 24 hours (P = .001, P < .001, P < .001, P = .014 andP < .001, respectively).Conclusion: The admission of neonates to family care physicians and sufficient prenatal andpostpartum care will prevent unnecessary referrals to ED and increase the physicians’ qualityof care for serious diseases in neonates.