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Anxious parents bring babies to the ER for all kinds of things that
could go either way like goopy eyes, concerns about how the stump
from the cut umbilical cord looks, vomiting, strange looking stool,
irregular breathing, and jerky or unusual body movements, doctors
write in the American Journal of Emergency Medicine.
"Differences between potentially dangerous pathology and normal
infant behavior can be subtle," said lead study author Dr. Zachary
Drapkin of the University of Utah in Salt Lake City.
"It can be helpful if parents are counseled about what to expect
over the first few days of life," Drapkin said by email. "Many of
these issues could very effectively be addressed with improved
access to primary care."
Even for emergency department physicians, it can be challenging to
distinguish normal infant signs, symptoms, and behaviors from
potentially life-threatening conditions, Drapkin and colleagues
write.
For example, babies with conjunctivitis, or goopy eye, need to be
seen in the ER when the cause is an infection, the paper notes.
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 paper notes.
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.
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Newborns can startle easily and have jittery movements in response
to stimuli, and this is normal, the doctors 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 ER, 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 American Journal of Emergency
Medicine, online March 20, 2019.
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