Neonates admitted to the neonatal intensive care unit following pediatric emergency department visits in Türkiye: a retrospective single-center study

The neonatal period is characterized by increased vulnerability to disease and often non-specific clinical presentations, leading to frequent visits to pediatric emergency departments (EDs). This study aimed to evaluate the characteristics of neonates presenting to the ED, determine the main causes of neonatal intensive care unit (NICU) admissions, and identify factors associated with prolonged hospitalization. This retrospective single-center study included neonates aged 0–28 days who presented to the pediatric ED and were subsequently admitted to the NICU over a one-year period. Demographic characteristics, clinical diagnoses, laboratory findings, microbiological results, and length of hospital stay were analyzed. Prolonged hospitalization was defined as a length of stay > 7 days. Factors associated with prolonged stay were evaluated using both univariate and multivariable logistic regression analyses. Among 4,573 neonatal ED visits, 378 (8.2%) required NICU admission. The most common causes of admission were jaundice (36.5%) and respiratory distress (27.5%). More than half of admissions occurred within the first postnatal week. In multivariable logistic regression analysis, refugee status remained independently associated with prolonged hospitalization (adjusted OR [aOR] 1.99, 95% CI 1.16–3.43; p = 0.013) after adjustment for sex, low birth weight, postnatal age at admission, and major clinical diagnoses. Low birth weight (aOR 2.56, 95% CI 1.10–5.94; p = 0.028), respiratory distress (aOR 2.90, 95% CI 1.26–6.69; p = 0.012), and jaundice with urinary tract infection (aOR 4.69, 95% CI 1.65–13.37; p = 0.004) were also independently associated with prolonged stay, whereas isolated jaundice was inversely associated with prolonged hospitalization (aOR 0.16, 95% CI 0.07–0.35; p < 0.001). Neonates presenting to the pediatric ED constitute a vulnerable population with a considerable need for NICU admission. Respiratory distress and infection-related conditions are major determinants of prolonged hospitalization, whereas jaundice is generally associated with shorter stays. Early identification of high-risk patients may improve clinical management and resource utilization.