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

OBJECTIVE: Although emergency complaints in newborns are very rare and benign, pediatric emergency department (ED) admissions in Turkey are increasing due to early postpartum discharge and insufficient prenatal care. We aimed to analyze the factors affecting neonatal admissions to ED and to evaluate progress and outcomes following discharge, and hospitalization rates. MATERIALS AND METHODS: All neonates aged 28 days or less admitted to the pediatric ED were included prospectively. Demographics, perinatal–maternal features, and social factors were recorded. Complaints, clinical findings and diagnoses, hospitalization referral rates, and readmission frequencies were analyzed. RESULTS: A total of 2109 neonates were enrolled; the median age was 6 days and 55.7% were males. More than half the newborns (67.5%) visited the ED out of hours, and 99% were non-referral. 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 among neonates with low birth weight and prematurity (P < .005, P < .001). Mothers who were primiparous and had their pregnancy at a younger age (<21 years) used EDs frequently for non-serious conditions (P < .05, P < .05, respectively). Early postpartum discharge, admission out of hours, age ≤ 7 days, residence in proximity to the hospital, and primiparity were significantly associated with readmission to the ED within 24 hours (P = .001, P < .001, P < .001, P = .014 and P < .001, respectively). CONCLUSION: The admission of neonates to family care physicians and sufficient prenatal and postpartum care will prevent unnecessary referrals to ED and increase the physicians’ quality of care for serious diseases in neonates.