Asistencia a neonatos en el servicio de urgencias de un hospital pediátrico terciario

Evaluation of compliance with early postbirth follow-up and unnecessary visits to the paediatric emergency department: a prospective observational study at the Lenval Children's Hospital in Nice

OBJECTIVE

To evaluate compliance with the French National Authority for Health's (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our paediatric emergency department (PED) and identify risk factors associated with non-compliance and unnecessary emergency department utilisation.

DESIGN

Prospective, single centre.

SETTING

Fourth biggest PED in France in terms of attendance (CHU-Lenval).

PATIENTS

280 patients of whom 249 were included in the statistical analysis.

MAIN OUTCOME MEASURES

The primary outcome of this study was the evaluation of compliance of the care pathway for newborns consulting at the PED with respect to the French postbirth follow-up recommendations. Secondary outcome was the assessment of whether the visit to the PED was justified by means of PED reception software and two postconsultation interviews RESULTS: 77.5% (193) of the newborns had non-compliant care pathways and 43% (107) of PED visits were unnecessary. Risk factors associated with a non-compliance regarding the HAS's postbirth follow-up recommendations were: unnecessary visit to the PED (OR 2.0, 95% CI 1.1 to 3.9), precariousness (OR 2.8, 95% CI 1.4 to 6.2), birth in a public maternity hospital (OR 2.5, 95% CI 1.3 to 4.8) and no information about HAS's postbirth follow-up recommendations on discharge from maternity ward (OR 11.4, 95% CI 5.8 to 23.3). Risk factors for unnecessary PED visits were: non-compliant care pathway (OR 2.0, 95% CI 1.1 to 3.9) and a first medical visit at a PED (OR 1.8, 95% CI 1.1 to 3.1).

CONCLUSION

Postbirth follow-up may lead to decrease unnecessary emergency department visits unnecessary emergency department visits.

TRIAL REGISTRATION NUMBER

The study bears the clinical trial number NCT02863627.

Maternal, Perinatal and Neonatal Outcomes With COVID-19: A Multicenter Study of 242 Pregnancies and Their 248 Infant Newborns During Their First Month of Life

BACKGROUND

Our aim was to describe the clinical features of mothers with coronavirus disease 2019 (COVID-19) infection during gestation or delivery, and the potential vertical transmission. We also wish to evaluate the possible horizontal transmission after hospital discharge, by means of a follow-up of all the newborns included at 1 month of age.

METHODS

This multicenter descriptive study involved 16 Spanish hospitals. We reviewed the medical records of 242 pregnant women diagnosed with COVID-19 from March 13 to May 31, 2020, when they were in their third trimester of pregnancy. They and their 248 newborn infants were monitored until the infant was 1 month old.

RESULTS

Caesarean sections (C-sections) were performed on 63 (26%) women. The initial clinical symptoms were coughing (33%) and fever (29.7%). Mothers hospitalized due to COVID-19 pathology had a higher risk of ending their pregnancy via C-section (P = 0.027). Newborns whose mothers had been admitted due to their COVID-19 infection had a higher risk of premature delivery (P = 0.006). We admitted 115 (46.3%) newborn infants to the neonatal unit, of those, 87 (75.6%) were only admitted due to organizational circumstances. No infants died and no vertical or horizontal transmission was detected. Regarding type of feeding, 41.7% of the newborns received exclusive breast-feeding at discharge and 40.4% at 1 month.

CONCLUSIONS

We did not detect COVID-19 transmission during delivery or throughout the first month of life in the newborns included in our study. Exclusive breast-feeding rates at discharge and at 1 month of age were lower than expected.

[Newborn consultations in paediatric emergency departments]

More and more newborns are being taken to paediatric emergency departments in France. A study was carried out between 2013 and 2015 to identify the reasons for non-emergency consultations, and to analyse the risk factors. The most common diagnoses were: rhinitis, gastro-oesophageal reflux and colic. There were three main predictive factors for consultation: the young age of the mother, primiparity and the short stay in the maternity hospital.

[The Spanish triage system in the evaluation of neonates in paediatric emergency departments]

The triage system in the emergency department classifies patients according to priority levels of care. Neonates are a vulnerable population and require rapid assessment.

OBJECTIVE

To correlate the priority levels in newborns seen in the paediatric emergency department with admissions, resource consumption, and service times.

PATIENTS AND METHOD

Observational study, using the Andorran triage model (MAT-SET) with ePATV4 software database, in paediatric emergencies. Neonates were classified into 3 levels of care established for them as level I resuscitation, level II emergency, and level iii urgent. The correlation between levels of priority and admission and resource consumption were analysed, as well as the time spent on medical care and stay in the emergency department.

RESULTS

The study included 1103 infants. The highest priority level was positively correlated with hospital admission (r = 0.66, P<.005) and resource consumption (r = 0.59, P < .005). The medical care times were 126 ± 203, 119 ± 51, and 33 ± 81 min for levels i, ii, and iii, respectively and the stay in emergency department was 150 ± 203, 131 ± 80, and 55 ± 86 min, respectively for these levels (P < .05).

CONCLUSION

The higher level of priority in the care of neonates in the paediatric emergency department was positively correlated with increased need for hospital admission and resource consumption. They also required a longer time for medical care and stay in the emergency department.

[An epidemiological study of early consultations of newborns in pediatric emergency units]

BACKGROUND

The number of visits to the pediatric emergency services has increased in the past 20 years in France and around the world, especially for neonates (under 28 days of age).

OBJECTIVES

Determine for neonates the reasons requiring medical consultation in the emergency pediatric unit of Saint-Etienne University Hospital (France) and isolate the proportion of "non-urgent" preventable consultations that could be managed outside of emergency units.

METHOD

Epidemiological, retrospective study on computerized data on neonates who were referred to the pediatric emergency unit of the Saint-Étienne University Hospital from 1 January to 31 December 2011. Four composite criteria "child not addressed by a healthcare professional; severity score G1, G2, G3 based on an internal scale; no further review undertaken; and return home" were used to define "non-urgent" consultations.

RESULTS

A total of 419 infants were included in the study. The leading reasons for consultations were crying (14.1%), vomiting (11.9%), chest tightness (10.7%), fever (8.1%), and diarrhea (7%). The main diagnoses were acute nasopharyngitis (11.5%), gastroesophageal reflux (10%), colic (8.1%), and excessive parental anxiety (7.6%). The percentage of "non-urgent" consultations was 52.4%.

CONCLUSIONS

Final diagnoses are quite similar to the reasons for consultation. The baby's unexplained crying and the inexperience of young parents resulted in an irrational anxiety. This study highlights the need for parental support at home after discharge from the maternity ward and the use of large-scale educational initiatives.

What brings newborns to the emergency department?: a 1-year study

AIMS

Characterization of newborn visits to the pediatric emergency department (PED). Analysis of the main illnesses and establishment of association between certain conditions and severity of diseases.

METHODS

Retrospective study information concerning newborns (aged <28 days) who presented to the PED of Hospital Central de Faro during 2005. We studied the clinical and demographic data referring to the PED's episode and to perinatal occurrences.

RESULTS

A total of 540 neonates visited the PED (1.5% of the total PED use), with an average age of 14.0 days and a slight prevalence of males (53.1%). Of the total visits, 17.2% were primary physician referrals. The chief complaints were jaundice, excessive crying, and rash. Diagnostic tests were requested in 27.2% cases. The major diagnoses were nonapparent disease, infant colics, and physiologic jaundice. In 13.0%, hospital admission was necessary. Newborns with referral, those with less than 37 weeks of gestation and those whose delivery weight was less than 2500 g, were more likely to be admitted.

CONCLUSIONS

Most PED visits were because of nonserious diseases, mainly because of insufficient caretaker knowledge and information. This highlights the great need for caretakers' education by health staff. It is also important that physicians are aware of the main illnesses in the newborn period and know how to correctly identify the conditions associated to serious pathology.