Emergencies in near-term or full-term newborns

Emergencies occurring after maternity discharge in near-term or full-term newborns are infrequent (1%) but life-threatening. A survey has been performed in the Paris area covering: 1) Maternities and Pediatric Emergencies ; 2) SAMU/SMUR (medical emergency system) ; and 3) PMI (medico-social primary centers) in 2001 and 2002. The rate of re-admission after discharge at D3-D4 was 2%. The Emergency Medical Service call incidence was 1%, and a medicalized ambulance was directly sent to the home in one out of ten calls. The call for medical assistance and emergency visits occurred mostly between D13 and D16, for the following reasons: fever, malaise, respiratory or gastrointestinal symptoms. The infants who have required EMS activation had a more severe pathology and poorer prognosis. Given the results of these studies and the ongoing debate in the literature over early maternity discharges, the most frequent etiologies are detailed with their appropriate management. Late-onset neonatal infections and congenital cardiopathies carry the most severe prognosis. Respiratory symptoms primarily due to RSV bronchiolitis requires hospitalization. Child abuse should not be forgotten. Thus, careful evaluation before discharge and appropriate follow-up are essential for a good outcome. [Copyright &y& Elsevier]