Archives of Disease in Childhood | 2019
G455(P)\u2005Newborns attending the emergency department – a tsunami of unmet need?
Abstract
Aims To establish what proportion of neonates attending the local A and E department have a diagnosis of ‘well baby’ or ‘feeding problem’. Methods A review of records of newborns attending A and E in a large DGH included a ‘deep dive’ into a 10% sample of attendees under 28 days old. Symphony (local A and E system) was searched for all under 28\u2009day olds attending A and E between 1/1/17 and 31/12/17 and linked where available, with maternity records for maternal characteristics (1085 babies). 106 notes were fully reviewed. This included: presenting complaint, whether feeding was presenting issue, parental perceptions of feeding problem, feed type on review, weight loss, jaundice, admissions, parity, maternal age and diagnosis on leaving A and E. Feeding concerns and weight loss management was then compared to local written guidance on weight loss in the newborn period. Results Of 1085 newborns presenting to A and E, 675 (62%) had matched maternity data. 13% of our hospital births returned before 28 days old. Within the 10% ‘deep dive’ were the following findings: 55% were brought in by parents without referral; 42/106 (40%) came ‘out of hours’; 58/106 (55%)exclusively breast fed; 32/106 (30%) were diagnosed ‘well baby’; 14/106 had jaundice; only 3/106 (2.6%) had sepsis diagnosed; 20% of total were admitted; 39% of which had a weight loss problem, 75% of which the parents had recognised and 56% had sequalae. Conclusion Up to 70% of newborn attendances, and 39% of newborn admissions (those due to weight loss) could potentially be avoided with improved antenatal classes and postnatal feeding support. 29% of attendances were related to feed problems (either weight loss or parental concerns). Another 29% had concerns about well babies, and 12% had a bilirubin level checked, though no further action was needed. This data reinforces using a multi-method approach to help better support families and improve parental confidence, attachment and subsequent feeding choices and behaviour with the aim of reducing the number of such infants attending A and E.