G33(P) “Little patients, big problems”: Neonatal attendances to the Children’s Emergency Department

Aims To analyse the epidemiological characteristics, presenting complaints and outcomes of all neonatal presentations to a Children’s Emergency Department. Methods A retrospective review of neonates (aged ≤28 days) who presented to the Children’s Emergency Department (CED) (25,000 annual attendances) over a 6 month period (1 st November 2012 to 30 th April 2013). Study data was collected from case notes using a standardised proforma and analysed. Results 358 presentations were made by 284 neonates during the 6 month study period, making up 3% of all CED presentations. Only 1 was excluded from the study. 53% were self-presentations, 25% referred by midwives and 10% from the GP. The commonest presenting complaints were jaundice (22%), difficulty in breathing (14%), feeding problems (8%) and weight loss (8%). Of the jaundiced patients, only 45% were admitted, with 18% required phototherapy. Of the patients presenting with feeding problems, 84% were admitted. Most neonates (31%) were given a diagnosis of “normal baby”, and 34% of all presentations were labelled as being primary care problems. The majority of mothers (45%) were primaparous. 42% of all presentations were admitted (25% short stay unit, 65% ward, 7% HDU and 2% NICU). For admitted patients, the main diagnoses were feeding problems (22%), jaundice (17%), infection (17%) and normal (15%). The average duration of stay was 17 hrs in the short stay unit and 74 hrs on the ward. Conclusion Our study shows that there is a large group of neonates who are inappropriately attending the CED and who could be better managed elsewhere in the community. These patients consume a great deal of time and resources and are often medicalised and over investigated. We have identified jaundice, feeding problems and primparous mothers as the most important areas that could be targeted by all the stakeholders involved in neonatal care. We are using this data to work with our clinical commissioning group and stakeholders within the hospital trust to enable redirection of these patients away from the CED.