Experimental Biology 2010: Newborns In The Emergency Department: What’s The Harm?

Purpose of Study: Newborns comprise over 2500 visits to our Emergency Department (ED) annually. Parents who are unable to identify a medical home early in a child’s life may have poorly developed parenting skills and a lack of psychosocial resources. We hypothesized that an ED visit by an infant in the first thirty days of life (newborn visit) for a non-emergent complaint is associated with a high rate of subsequent ED visits and an increased risk of child abuse and/or placement in foster care.

Methods Used: A retrospective cohort study compared 163 newborns presenting for emergent visits with 163 newborns presenting for non-emergent visits. We compared rates of ED visits over the subsequent 2 years. In the second part of our study, a case-control series compared rate of newborn visits among 703 foster children, 703 children with physical or sexual abuse, and 703 controls.

Summary of Results: In the retrospective cohort study, infants with non-emergent newborn visits had an average of 4.52 (SE0.27) ED visits over the subsequent two years compared to infants with emergent visits had 2.5 (SE0.17) subsequent visits (difference=2.02(95%CI=2.73 to 1.49); P<.001). Our case-control series found that abused children were less likely to have had a newborn ED visit than controls (OR=0.54[0.37-0.77]). There was no association between foster care and newborn ED visits when compared to controls.

Conclusions: Non-emergent ED visits in the first 30 days of life are associated with increased rates of subsequent ED use. Contrary to our hypothesis, abused children are less likely to have presented to the ED in the first 30 days of life. this may indicate that presenting to the ED for a non-emergent reason in the newborn period shows increased parental concern, which may be a factor in decreasing the rates of future child abuse. There was no association between foster care placement and newborn ED visits. Given that many families use the ED in the newborn period for non-emergent care, we envision development of a teachable moment for all newborn discharges to provide guidance for the new parents and to confirm a folow-up appointment with a primary care provider.