[Analysis of neonate admissions to the pediatric emergency department]. / Fréquentation des urgences pédiatriques par les nouveau-nés.

ABSTRACT

UNLABELLED Neonate admissions follow the general growing concern of emergency department use. OBJECTIVE: To analyze the epidemiological characteristics of a cohort of neonates admitted to a tertiary-level pediatric emergency department. MATERIAL AND METHODS: Prospective study conducted between August 2008 and April 2009 including all neonates aged 28 days or less admitted to the pediatric emergency department. The data collected for neonates were age, sex, premature or term birth, feeding mode, mode and reason of admission, time of admission, neonatal history, length of stay, and progression. For children admitted between August and October, any later consultations were analyzed during the following 6 months. The data collected for mothers were age, number of live births, living conditions, delivery mode, length of stay in the maternity ward, and occupation. RESULTS: Descriptive analysis: 538 neonates were included, the mean age was 17 days, the malefemale ratio was 1.13. Twenty-nine children were premature (5.4%), 13% had previous conditions (jaundice, maternofetal infection, gastroesophageal reflux). Half the babies were formula-fed. Medical reasons were the most frequent (90%); 8% of children were admitted after a trauma. Almost ½ the neonates were hospitalized (47%). In the group of children followed for possible later consultations, 59 children were readmitted, totalling 103 consultations mainly for the same medical reason. The mothers' average age was 30 years, 53% were primiparae, and the mean length of stay in the maternity ward was 5 days. Comparative analysis: the neonate sex-ratio and prematurity rate were similar to those of the regional area. They differed from other admissions in their higher rate of nighttime consultations (18% versus 8%, P<0.001), physician referrals (23% versus 17%, P<0.001), and a higher rate of hospitalization (relative risk [RR] equal to 3.27 [3.01-3.54], P<0.001). The medical severity responded to the all or nothing principle they were more often admitted for simple consultation (RR=1.31 [1.19-1.45], P<0.001), and for unstable conditions (RR=2.70 [2.36-3.07], P<0.001). A higher risk of emergency department use was noted if the mother was a first-time mother, young, living alone, and in a neighborhood near a hospital, with no occupation and the neonate aged less than 15 days. CONCLUSION: Initially associated with the reduction in the length of stay in the maternity ward, the increase of neonates' admissions to the pediatric emergency department is known to have several origins and is related to neonates' vulnerability or previous medical conditions, their familial environment, and sociological factors.