Variation in management of in-hospital newborn falls: a single-center experience

J Neurosurg Pediatr. 2017 Aug;20(2):176-182. doi: 10.3171/2017.3.PEDS16651. Epub 2017 May 19.

Abstract

OBJECTIVE There are only 3 small case series in the literature that report on the management of in-hospital newborn falls (NFs), and recommendations are unclear. The authors performed a retrospective review to determine outcome and differences in management and to understand why management of NFs varies at their institution. METHODS All NFs occurring within the authors' institution over a 3.5-year period were reviewed. Post-fall management and outcomes of each incident were compared. RESULTS There were 24 NFs out of 40,349 deliveries (5.9 NFs/10,000 deliveries). The mechanism of injury was nearly identical in 22 of 24 falls (the newborn fell to the floor from a parent in a bed or chair), and physical examination findings were normal or benign in all cases. Unexplained management variation based solely on clinician preference was noted, including observation only (in 13 cases), skull radiograph (in 7), head CT scan (in 6), bone survey (in 4), and head ultrasound examination (in 1), with some babies having more than 1 study. Two babies had nondepressed linear parietal fractures diagnosed by skull radiograph, and 2 babies had small subdural hemorrhages diagnosed by head CT scan. All 24 babies had normal findings on examination at discharge. CONCLUSIONS There is a high incidence of nondepressed linear parietal skull fractures associated with NFs. However, since associated intracranial injury is uncommon, imaging studies may not be routinely performed. Neonatal intensive care unit admission, head CT, and neurosurgical evaluation are reserved for the rare baby with abnormal physical examination or neurological findings.

Keywords: AAP = American Academy of Pediatrics; ED = emergency department; EHR = electronic health record; NF = in-hospital newborn fall; NICU = neonatal intensive care unit; SDH = subdural hemorrhage; US = ultrasound; fall; head trauma; infant; newborn; skull fracture; subdural hemorrhage.

MeSH terms

  • Accidental Falls*
  • Conservative Treatment
  • Echoencephalography
  • Hematoma, Subdural / diagnostic imaging
  • Hematoma, Subdural / epidemiology
  • Hematoma, Subdural / etiology
  • Hematoma, Subdural / therapy
  • Hospitalization
  • Humans
  • Incidence
  • Infant, Newborn
  • Inpatients*
  • Parietal Bone / diagnostic imaging
  • Parietal Bone / injuries
  • Retrospective Studies
  • Skull Fractures / diagnostic imaging
  • Skull Fractures / epidemiology
  • Skull Fractures / etiology
  • Skull Fractures / therapy
  • Tomography, X-Ray Computed