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Neonatal attendance at paediatric accident and emergency department, is it preventable?
  1. C Hateley1,
  2. S Godambe2,
  3. R Salter3,
  4. P Chow2
  1. 1Medicine, Newcastle University, Newcastle, UK
  2. 2Neonatalogy, Imperial College NHS Trust, London, UK
  3. 3Paediatrics, Imperial College NHS Trust, London, UK

Abstract

Most neonatal discharges from postnatal ward occur within 48 h of birth with continuing support from the community. It is unclear how often these neonates would present in paediatric accident and emergency (A&E) department after discharge and the reasons for their attendance.

Aim/Objective To determine the incidence and diagnosis of neonates presenting to an inner city paediatric A&E department. To identify the route of referral of these neonates presenting at the paediatric A&E

Methods Retrospective audit of all neonates attending paediatric A&E between 1 January and 31 May 2008. Main outcome measures: age at presentation (days), sex, ethnicity, presenting complaint, referral route, diagnosis and destination after consultation.

Results Attendance to the paediatric A&E over this period was 8675. Of these, 117 were neonates (1.3%). The mean age at presentation was 13 days (range 0.06–28). Twenty-one (18%) presented with jaundice, 20% with vomiting and 10% with crying. Forty (34%) neonates were deemed to be well requiring reassurance only and 13 (11%) had feeding difficulties. Of the 21 neonates presented with jaundice, five required admission (ranged from 3–10 days at presentation). 59% of neonates presenting to the paediatric A&E had primary care type of problems. 77% neonates were sent home and only 23% was admitted to the paediatric ward. Black/Black British African neonates were more likely to attend than other ethnicities as they were over-represented in the data when comparing to the health authority statistics. 69% of referrals for jaundice were by health visitors, midwives and general practitioners, all of whom were discharged home.

Abstract G74 Figure 1

Diagnosis of neonates attending paediatric

Abstract G74 Figure 2

Outcome of jaundiced neonates.

Conclusions Majority of healthy neonates presenting at paediatric A&E did not require hospital admission. Support of feeding before and after discharge and developing care pathway programme in managing jaundice neonates in the community may reduce unnecessary paediatric A&E attendance in this group of neonates.

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