Newborns and the ER

As promised, my friend Jordyn Redwood, ER nurse and writer extraordinaire is going to be posting common medical Q & A’s on my blog twice every month.  I’m superexcited about this and think it will not only be a ton of fun but it will also be really informative. So, a huge thank you to Jordyn!  And, if you want to know more about her, Jordyn is not only a novelist with a book coming out from Kregel in a few months, but she’s also a blogger who writes a superfun blog called “Redwood’s Medical Edge” where she discusses now novelists approach medical issues in their books.  Check it out here.

So, with that said, here’s Jordyn:

First of all, I’d like to thank Erin for hosting me on her blog. My goal is to be of service to you and help educate, offer insight, and support those issues that surround your kids. It’s those issues you talk to your girlfriend about and would definitely ask that girlfriend who is a nurse working in pediatrics. I am a mother of two girls age 7 and 9 so I understand that creeping anxiety that mother’s get when their child is ill.

I’ve worked as a registered nurse in the field of pediatrics for 15 of my 18 years in nursing. Kids are the best population, in my opinion, to work with. I spent five of those years in the pediatric ICU and the last ten working in the urgent care/emergency care arena.

These posts are for educational purposes. I am a proponent of regular visits to the pediatrician and immunizations. These posts should not ever be a substitute for regular doctor’s visits or taking your child to a licensed physician if they are sick, be it your doctor’s office or the emergency department.

I am open to questions. Questions can be sent to Erin at () and she will forward them to me. Not all questions will be answered as I may not be the best one to answer them. If this is the case, I’ll give you some direction as to how to approach the situation.

Now, let’s have some fun!

Question:  Is it really a bad idea to take a newborn out in public? What will really happen if he/she gets sick?

I can remember when my youngest was born and was just a few days old when my in-laws came by to visit. My father-in-law was horribly ill with bronchitis, coughing and hacking at the doorway. I held the baby up for them to see from a distance and kindly asked them to go on their way. They could come back around when he was well.

Here’s the issue: An infant less than two months (some doctors will say three months) that presents with a fever of 100.4 or greater generally gets a septic work-up. The concern is that an infant’s immune system hasn’t quite revved up yet and it can become easily overwhelmed by infection. Therefore, we approach this age infant very cautiously to prevent this from happening.

A septic work-up entails gathering specimens from the most likely places that would become infected. This includes placing an IV to get blood for a blood culture and blood counts, doing a urine cath (placing a small plastic tube into the bladder) for urine and doing a spinal tap (lumbar puncture) to collect cerebrospinal fluid (CSF) which is the fluid that bathes the brain. Infants are generally admitted into the hospital for 24-48 hours at a minimum on IV antibiotics until their cultures are negative. If their cultures are positive, then they would stay longer to get a full course of antibiotics.

This is not always done but is your “worst case scenario” for ER management. There are some situations that may alter the physician’s medical approach. One may be that we can prove the infant has another source for the fever like an ear infection or RSV (in fall and winter). We generally look for these first. If another source cannot be found, then generally, these other tests are performed.

Unfortunately, a small percentage of infants do die from sepsis. This is why we are very cautious.

As you can see, these are very invasive procedures and this is why I personally encourage minimal public contact when the infant is under two months.

If you choose to take your new baby in public, here are a few guidelines:

Use good hand washing. Before anyone touches the baby, they should wash their hands with soap and water. If water is unavailable, then use antiseptic hand gel.

If you develop a cold (runny nose, cough) wear a medical mask around the infant. These can be picked up at stores that have a pharmacy.

Keep sick siblings away from the newborn.

Encourage younger siblings to kiss the baby’s feet or the back of their head.

Well newborns need to stay out of the ER. A common scenario is for the whole family to show up with a sick older sibling and bring the new baby. This should only happen if that’s your only option. Otherwise, keep the newborn at home with a responsible adult. There isn’t a way to fully decontaminate the ER waiting room. It’s likely the baby will pick something up during the ER visit of the other sibling.

What are your thoughts?

Jordyn Redwood has served the pediatric population and their families for many years. She has five years of experience in the pediatric ICU and ten years of pediatric ER nursing which is the area she currently works. Jordyn also teaches CPR and advanced resuscitation courses.

Jordyn is also a suspense author. Her novel, Lilly’s Ashes, will be published by Kregel in the Spring of 2012. She also hosts a medical blog for authors which you can find at www.jordynredwood.com.

Disclaimer: Remember, these posts are for education and discussion. If your child is sick and you think they require medical attention, take them to their pediatrician or local emergency department.

6 Comments

  1. Oops 😛 I took my newborn out to church when he was 8 days old. The following week he went out to a restaurant. We took him almost everywhere–stores, the park, grandparents’ house–within the first month. He’s now almost 3 months and doing well!

    We did make sure everyone washed their hands before touching or holding him. I think I would’ve been much more hesitant to take him out had he been born in the dead of winter.

    • I took all three of mine out early, too. :) Unfortunately, my daughter DID get sick so maybe that was a bad idea!

      • Dara, yes… I think it is good to be especially cautious in the winter. This is when a lot of viruses come out to play. RSV and influenza to name a few.

  2. Your blog is looking great, Erin! I saw it in my newsfeed on FB, so I stopped by for a visit. And wouldn’t you know, there’s a post about the ER! I may be the first guy to ever leave a comment here, but I couldn’t help myself…

    Let me just say to your readers that as an ER physician, I HIGHLY SECOND what Jordyn said here. We did not take our daughter out of the house in her first month except for doctor’s appointments. We got out a little bit during the second month. The septic workup described by Jordyn is exactly what will be done with your baby under 28 days of age if they get a fever over 100.4 – almost no exceptions. The risk of missing a serious bacterial infection in a neonate is just too high – it can be fatal. When our daughter was born, I asked many of my colleagues (other ER physicians) what they did and the answer was the same every time. Stay home under a month of age.

    • Jeremy,

      I appreciate the fellow ER support and also seconding the importance of minimal public contact for those first few precious months.

  3. Great review! This is exactly the type of blog post that needs to be shared around the internet. Shame on the Bing for not ranking this post higher!

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