Parents Bring Newborns to ED for Many Non-Urgent Reasons

By Lisa Rapaport

April 30, 2019

(Reuters Health) - 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."


Am J Emerg Med 2019.