ANMJ Featured Story

Need for improved recognition of in-hospital newborn falls

Wednesday 24th June, 2015

In-hospital newborn falls can be described as an event when a neonate falls to the hospital floor accidentally, either as a result of environmental factors or errors in judgement of the hospital staff or carer (Phalen and Smolenski, 2010; Paul et al. 2011). In-hospital newborn falls occur at a rate of 1.6 to 4.4 per 10,000 live births (Helsley et al. 2010), however this is likely to be an underestimate given that this remains an under-reported entity. The incidence data highlighted is based on studies from the United States but the findings can be reasonably transferred to the United Kingdom (UK) and other developed countries. A local guideline (from two tertiary maternity units in the UK) released in response to in-hospital newborn falls, has revealed an incidence figure of 15 per 10,000 births (Janiszewski and Lee, 2014).

Studies have shown that falls are the most common cause of accidental injury in neonates and children in the community (Agran et al. 2003; Matteson et al. 2013), and many parenting websites provide education and information supporting fall prevention. It is essential that this education be reflected in the hospital environment. The number of studies looking at in-hospital newborn falls is limited possibly due to the perception that the hospital setting is considered to be safe for babies and accidents are highly unlikely to happen. This article aims to increase the awareness of these events and to help prevent and manage these events in the future hospital environment.

In-hospital newborn falls are under recognised

It is becoming increasingly acknowledged that in-hospital newborn falls are an under-recognised entity and this is likely to be due to a number of reasons (Helsley et al. 2010; Paul et al. 2011; Matteson et al. 2013): 

•     parental reluctance to report the fall as they may feel guilty or fear a negative response from health professionals;

•     parental apprehension of being judged about their parenting skills and the fear of social service involvement;

•     lack of education and understanding about the condition and its serious adverse effects (eg. head injury, skull fracture, rarely death) amongst health professionals; 

•     lack of awareness amongst health professionals about environmental and maternal risk factors that increase the risk of in-hospital newborn falls;

•     health professionals addressing the issue at ground level and not highlighting the event as a risk management issue; 

•     the lack of a transparent no-blame culture, which discourages reporting of these events.

The majority of these falls are preventable and associated serious outcomes can be minimised. This article further highlights the high-risk groups, clinical presentation, and management of injured neonates after in-hospital falls and provides useful strategies that can minimise such events.

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