Emergency department use by infants less than 14 days of age.

OBJECTIVE: To determine the factors associated with nonacute presentation to the emergency department (ED) by infants less than 14 days of age. METHODS: A prospective survey was conducted in the pediatric ED of a teaching hospital providing voluntary in-home follow-up for families discharged within 48 hours of delivery. Participants were families of infants less than 14 days of age presenting to the ED over a 1-year period. The main outcome measure was acuteness of presenting problem. Presenting problems were classified as nonacute if the following 4 criteria were met: (i) no physician referral; (ii) nonurgent triage code assigned by a triage nurse; (iii) no investigations performed in the ED; and (iv) discharge home. RESULTS: Of the 142 eligible infants, 70 (49%) infants presented with nonacute problems. Ninety-two (65%) returned questionnaires. There was no significant difference in the proportion of nonacute problems between infants discharged at less than 48 hours of age and those discharged at more than 48 hours (P = 0.7). The proportion of nonacute problems among infants of primiparous mothers was significantly higher (64%) than among infants of multiparous mothers (24%) (P < 0.001). Infants of mothers less than 25 years of age were more likely to present with nonacute problems (P = 0.002). CONCLUSIONS: Primiparity and maternal age less than 25 years were associated with nonacute ED presentation. Acuteness of presentation to the ED was not influenced by timing of neonatal discharge. Therefore, perinatal education might be best targeted at first time mothers and young mothers to reduce the number of nonacute ED visits.

Gemella species endocarditis in a child.

Organisms of the genus Gemella can, on occasion, cause serious systemic illness. The present paper reports a successfully treated case of endocarditis in a 12-year-old girl with congenital heart disease caused by species of Gemella. The child presented with cough, fatigue and decreased appetite without fever. Echocardiogram demonstrated marked mitral insufficiency with flail posterior mitral valve leaflet, mitral valve vegetations, and an enlarged left atrium and ventricle. While being treated with vancomycin, the child initially had persistent bacteremia, which resolved after the addition of gentamycin; the course of therapy was completed with penicillin G and gentamycin once antimicrobial susceptibilities were available. Attempts to identify the species of Gemella were unsuccessful in the local laboratory, and at reference laboratories in Canada and the United States. The isolate is undergoing further evaluation to determine its taxonomic status.

Early neonatal discharge guidelines: Have we dropped the ball?

OBJECTIVES: To determine patterns of follow-up and prenatal education by family physicians and to assess whether practice patterns comply with the 1996 Canadian Paediatric Society/Society of Obstetricians and Gynecologists of Canada (CPS/SOGC) guidelines for early neonatal discharge. DESIGN: Mail survey. SETTING: A community of 300,000 people who were served exclusively for obstetrical care by a tertiary care hospital that performs 5000 deliveries per year and provides an early discharge program (EDP). PARTICIPANTS: Family physicians who provide prenatal and/or newborn care. MAIN OUTCOME MEASURES: The timing of neonatal follow-up and parental teaching by family physicians. RESULTS: Thirty-two per cent of the respondents scheduled their first postnatal visits two or more weeks after early discharge. There was no significant difference (P=0.7) in scheduling of follow-up for babies who were part of an EDP compared with those who were not. Fewer than 20% of physician respondents provided antenatal education in preparation for early discharge. CONCLUSIONS: The 1996 CPS/SOGC guidelines for physician follow-up after early neonatal discharge and for anticipatory parental education are not being followed consistently; however, these guidelines were disseminated without reinforcement. Until further study supports a change in practice guidelines, appropriate implementation strategies must be employed to ensure compliance.