Parents Bring Newborns to ED for Many

Non-Urgent Reasons
By Lisa Rapaport
April 30, 2019

One of the hardest things about being a new parent is figuring out
when babies are so sick they need to go to the emergency department
and when worrisome signs or symptoms might actually be perfectly
normal, doctors say.
Anxious parents bring babies to the ED for all kinds of things that
could go either way like conjunctivitis, concerns about how the stump
from the cut umbilical cord looks, vomiting, strange looking stool,
irregular breathing, and jerky or unusual body movements, Dr.
Zachary Drapkin of the University of Utah in Salt Lake City and
colleagues note in a report in the American Journal of Emergency
Medicine, online March 20.
"Differences between potentially dangerous pathology and normal
infant behavior can be subtle," Drapkin said by email. "It can be
helpful if parents are counseled about what to expect over the first few
days of life. Many of these issues could very effectively be addressed
with improved access to primary care."
Even for ED physicians, it can be challenging to distinguish normal
infant signs, symptoms, and behaviors from potentially life-threatening
conditions, Drapkin and colleagues point out.
In their article, they address some common chief complaints of
neonates and young infants presenting to the ED, and contrast
reassuring neonatal and young infant signs and symptoms against
those that need further workup and intervention.
For example, babies with conjunctivitis (what parents may call goopy
eyes) need to be seen in the ED when the cause is an infection, they
note. Infection is more likely the culprit when there's lots of discharge
and gunk.
Normally, the umbilical stump left behind when the cord is cut at birth
will turn black or brown and dry out before it falls off, typically within
about one week. It can also have a foul smell like rotting fruit, the
paper notes. But warmth, swelling, purulent discharge or a fever might
indicate an infection that requires immediate medical attention.
Nearly all babies spit up because their stomachs are so small, and this
isn't necessarily a problem as long babies are urinating, feeding and
growing normally. Unlike spit-up, projectile vomit may be caused by
medical problems that could warrant a trip to the ER, the authors note
infant stool, meanwhile, can be a greenish color for babies who are
fed formula and more of a mustard color for breastfed infants, the
doctors point out. Bloody or black stool after the newborn stage,
however, might mean babies need to be checked for serious health
problems like internal bleeding or bowel obstruction.
Newborns can startle easily and have jittery movements in response
to stimuli, and this is normal, they note. But jitteriness or jerky
movements that continue over time and aren't in response to stimuli
may mean there's a seizure problem or something else that requires
an urgent checkup.
Beyond the challenge of figuring out what infant health issues may be
true emergencies, parents can also struggle to get same-day sick
visits with pediatricians that could help them avoid a trip ED, said Dr.
Rajesh Daftary of the University of California San Francisco and
Zuckerberg San Francisco General Hospital.
"It's hard to estimate what number of emergency department visits by
a newborn or infant could be averted with a same day visit, but it's
certainly the majority," Daftary, who wasn't involved in the paper, said
by email. "The challenge is trying to obtain these same day
appointments."
Nurse advice phone lines may help in some cases, but it can be hard
for a clinician on the phone to make an assessment without directly
examining a baby, Daftary added.
"Urgent care clinics can be especially helpful if they are staffed by a
physician or advanced practitioner (nurse practitioner, physician
assistant) specializing in pediatric care," Daftary added. "Without that
level of experience, an urgent care physician may opt to transfer a
child to an emergency department where a more thorough
assessment can be performed."
SOURCE: http://bit.ly/2DxWQOA
Am J Emerg Med 2019.
 ARTICLE IN EMERGENCY
DEPARTMENT

Submitted by: Carla Dana Q. Gozum

Submitted to: Mrs Criselda Ultado