Resident physician Medical College of Wisconsin Milwaukee, Wisconsin, United States
Background: Significant changes resulted from the 2021 American Academy of Pediatrics (AAP) updated clinical practice guidelines for febrile neonates including the establishment of new criteria for determining which neonates could safely be discharged home from the emergency department (ED). At our institution, discharged neonates ages 29-60 days were advised to follow-up within 24 hours of discharge the ED. However, there is a lack of data on the implementation of this recommendation. Objective: We aimed to assess adherence to follow-up guidelines among discharged febrile neonates and examine the timing and methods of their post-discharge follow-up. Design/Methods: We conducted a retrospective chart review of infants within the Children’s Wisconsin network discharged from the ED after febrile neonate workup. Data included follow-up occurrence, timing, and method. Results: Among the 107 discharged febrile neonates with pediatricians within the Children’s Wisconsin network who met inclusion criteria, 53.3% (57) followed up within one day. 78.% (79) had documented follow-up, while 26.2% (28) had no follow-up. Of those with follow-up, 72.2% (57) followed up within one day, and 27.8% (22) followed up later. Most patients who followed up within one day visited their primary care physician (PCP) (70.02%), followed by a phone call alone (15.8%).
Conclusion(s): Despite recommendations for follow-up within one day, up to one-fourth of discharged febrile neonates did not follow up or contact their pediatrician at all and a large percentage of patients followed up more than one day after discharge. Our data suggests in-person visits are most common and are feasible, but further research involving unaffiliated pediatricians and family physicians is needed for definitive conclusions.
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