Retrospective observational study of neonatal attendances to a children's emergency department

Abstract

Aim Attendances to emergency departments (EDs) in the UK are increasing, particularly for younger children. Community services are under increasing pressure and parents may preferentially bring their babies to the ED, even for non‐urgent problems. This study aimed to characterise the presenting features, management and disposition of neonatal attendances to a children's ED (CED). Methods Retrospective observational review of neonatal attendances (≤28 days) to the CED at Bristol Royal Hospital for Children (BRHC) from 01/01/2016 to 31/12/2016. Further information was obtained from investigation results and discharge summaries. Data abstracted included sex, age, referral method, presenting complaint, diagnosis, investigations and treatments. Results Neonatal attendances increased from 655 to 1,205 from 2008 to 2016. The most common presenting complaints were breathing difficulty (18.1%) and vomiting (8.3%). The most common diagnoses were ‘no significant medical problem’ (41.9%) and bronchiolitis (10.5%). Half of neonatal attendances to the CED had no investigations performed and most (77.7%) needed advice or observation only. Conclusion Many neonates presenting to the CED were well and discharged with observation only. This suggests potential for improving community management and in supporting new parents. Drivers of health policy should consider developing enhanced models of out of hospital care which are acceptable to clinicians and families.

Impact of COVID-19 on paediatric emergency department attendances at four English hospitals

“…Our results may not be generalisable as data were taken from only four hospitals, three of whom have similar yearly attendance numbers (table 1). However, historic monthly attendance patterns (figure 1) are broadly comparable between sites which suggests it is likely reflective of other UK hospitals and is further supported by a recent paper 7 from Bristol Royal Hospital for Children on neonatal ED attendances 2016-2020.…”

The Frequency of Infant-Feeding Presentations at English Emergency Departments During the SARS-CoV-2 Pandemic: A Nation-Wide Electronic Health Records Study

“…All quoted studies to date suggest this increase is likely due to the loss of face-to-face support for families in both formal (e.g., health visitors and primary care) and informal (e.g., community and voluntary sector support groups) settings due to pandemic related service disruptions [ 6 , 7 , 23 , 26 , 27 ].…”

“…The duration of hospital stay following childbirth has decreased steadily over the last few decades to improve NHS maternity services efficiency [31,32]. However, studies have shown that shorter hospital stays following childbirth are associated with an increased risk of readmission for feeding problems and jaundice and a recent single center English study noted the number of neonates attending ED for low acuity issues has steadily increased since 2005 [26,[33][34][35]. In addition, and contrary to national policy and WHO guidelines, there were reports that some hospitals separated newborns from mothers soon after birth, in an attempt to reduce SARS-CoV-2 transmission risks [36][37][38].…”