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Characteristics and Diagnoses of Neonates Who Revisit a Pediatric Emergency Center

Perry, Andrew M. MD*; Caviness, A. Chantal MD, MPH, PhD; Allen, Joseph Y. MD

doi: 10.1097/PEC.0b013e31827b540e
Original Articles

Objective Families with neonates may utilize emergency centers (ECs) for nonurgent complaints. We sought to describe the demographic and clinical characteristics of neonates evaluated in an urban tertiary children’s EC more than once in a 5-day period and to determine the frequency of serious illnesses and admission at the second visit.

Methods We conducted a retrospective case series of neonates (aged <29 days) who visited the EC, were discharged home, and returned within 5 days during a 3-year period.

Results There were 147 study neonates (2.4% of all newborn EC patients) with an average age of 16 days at the first visit and a median 3 days between visits. Sixteen patients (11% of returning patients) returned with fever (≥38°C); 15 patients (10%) returned with respiratory distress or hypoxemia, and 56 (38%) required admission at the second visit. Patients diagnosed with gastroesophageal reflux and/or vomiting at the first visit had a high frequency of admission (55%) and pyloric stenosis (26%) at the second visit.

Conclusions Of neonates discharged from the EC with nonurgent medical issues, more than a third of those revisiting the EC required admission within 5 days. The risk of fever, respiratory distress, and admission was higher in neonates who originally presented with infectious symptoms than neonates who presented with noninfectious process. Of neonates presenting twice with gastroesophageal reflux and/or vomiting, almost a third had pyloric stenosis, indicating that close follow-up of vomiting neonates is needed.

From the *Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, and Emergency Department, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii; †Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, and Emergency Center, Texas Children’s Hospital, Houston, TX.

Disclosure: The authors declare no conflict of interest.

Reprints: Andrew M. Perry, MD, Emergency Department, Kapiolani Medical Center for Women and Children, 1319 Punahou St, Honolulu, HI 96826 (e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.